Reduction in Hospital Readmission Rates for Hyperbilirubinemia Is Associated with Use of Transcutaneous Bilirubin Measurements

Abstract

The use of transcutaneous bilirubin (TcB) measurements would seem to represent an opportunity to decrease the use of laboratory total serum bilirubin (TSB) testing because the former would serve as a surrogate for the latter. Many authors of previous studies have concluded that TcB measurements are useful and can serve as a reliable index for estimating TSB concentrations (1)(2)(3)(4), even in darkly pigmented neonates (5). Although the use of TcB measurements might represent, correspondingly, an opportunity to decrease expenses by decreasing laboratory TSB measurements, such a consequence would be dependent on several factors, including the cost of personnel and reagents for performing the TcB measurements and the number of TcB measurements performed. In addition, the TcB results might impact other caretaker practice behaviors, such as the ordering of TSB measurements and compliance with guidelines for the application of phototherapy, whether used in or outside the hospital, as governed by local practice routines. The newly revised American Academy of Pediatrics (AAP) Clinical Practice Guideline on management of hyperbilirubinemia in the newborn (6) would not necessarily affect or predict the interaction of these factors. In this issue of Clinical Chemistry , Petersen et al. (7) demonstrate that the introduction of TcB measurements for the identification of infants with hyperbilirubinemia was followed by a decrease in the number of hospital readmissions of infants with hyperbilirubinemia per 1000 births/month. However, they found that the interaction of various factors did not contribute to changes in the length of stay for normal newborns and that new costs, in addition to those for TcB measurements, arose from an increased use of laboratory TSB testing and increases in the number …