A Systems Approach for Neonatal Hyperbilirubinemia in Term and Near‐Term Newborns

Abstract

To propose and implement a family-centered systems approach to manage newborn jaundice for safer outcomes. Observational study for known adverse outcomes. Semiprivate urban birthing hospital. 31,059 well babies discharged as healthy from a cohort of 41,961 live births (1990-2000). Incremental implementation of a systems approach that incorporated a hospital policy to (a) authorize nurses to obtain a bilirubin (total serum/transcutaneous) measurement for clinical jaundice, (b) universal predischarge total serum bilirubin (at routine metabolic screening), and (c) targeted follow-up, using the bilirubin nomogram (hour-specific, percentile-based total serum bilirubin/transcutaneous bilirubin). Known adverse outcomes assessed for early- and late-onset severe hyperbilirubinemia before, during, and after systems approach implementation. Adverse outcomes decreased for well babies: exchange transfusion, intensive phototherapy, and readmission. During the study period, there were no "never events" (total serum bilirubin greater than or equal to 30 mg/dl), while "close calls" (total serum bilirubin greater than or equal to 25 mg/dl) were 1 in 15,000 as compared to a reported incidence of 1 in 625. Reduced adverse events, significant reduction in close calls, and no never events met family expectations for safer experiences with this approach.