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Evidence-based Laboratory Medicine and Test Utilization |
Departments of1 Pathology and2 Pediatrics, University of Texas Medical Branch, Galveston, TX.
aAddress correspondence to this author at: Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0551. Fax 409-772-9231; e-mail jrpeters{at}utmb.edu.
Background: Newborns are being discharged from hospitals within 1–2 days of birth, before hyperbilirubinemia usually becomes clinically evident. We investigated the use of transcutaneous bilirubin (TcB) before discharge to determine whether it affects the use of laboratory bilirubin testing or decreases the number of neonates readmitted for hyperbilirubinemia within 7 days of initial discharge.
Methods: We retrospectively searched a clinical laboratory and hospital database to determine the number of births, newborn readmission rates for hyperbilirubinemia, length of stay, and the number of bilirubin measurements in the clinical laboratory ordered for all babies in the newborn unit at the University of Texas Medical Branch from August 2002 to March 2003 (before TcB testing) and from May 2003 to December 2003 (after TcB).
Results: Between August 2002 and December 2003, 8974 newborns (both vaginal and cesarean births) were admitted to the newborn nursery. Babies who did not fit the diagnosis-related group criteria of "normal newborn" were removed, leaving 6933 babies who were included in the study. April was considered a transition month and was not included in the study, leaving 6603 newborns to be included. Of these, 446 (6.8%) required phototherapy for treatment of hyperbilirubinemia before initial discharge. For the 8 months before and 8 months after initiation of TcB testing, the number of laboratory bilirubin measurements ordered per newborn did not change, nor did the mean (SD) length of stay for normal newborns [2.15 (1.1) days vs 2.12 (1.1) days; P = 0.53], nor days of treatment with phototherapy before discharge [2.9 (1.3) days vs 2.9 (1.3) days; P = 0.67]. By contrast, the number of readmissions per 1000 newborns per month for clinically significant hyperbilirubinemia decreased significantly (Wilcoxon rank-sums two-sample test, P = 0.044), from 4.5 (2.4) to 1.8 (1.7) after TcB testing was initiated.
Conclusion: Access to TcB testing is associated with a reduction in the hospital readmission rate for hyperbilirubinemia within 7 days of the initial discharge.
The following articles in journals at HighWire Press have cited this article:
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  M. W. Kuzniewicz, G. J. Escobar, and T. B. Newman Impact of Universal Bilirubin Screening on Severe Hyperbilirubinemia and Phototherapy Use Pediatrics, October 1, 2009; 124(4): 1031 - 1039. [Abstract] [Full Text] [PDF]
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T. A. Trikalinos, M. Chung, J. Lau, and S. Ip Systematic Review of Screening for Bilirubin Encephalopathy in Neonates Pediatrics, October 1, 2009; 124(4): 1162 - 1171. [Abstract] [Full Text] [PDF]
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 S. N. El-Beshbishi, K. E. Shattuck, A. A. Mohammad, and J. R. Petersen Hyperbilirubinemia and Transcutaneous Bilirubinometry Clin. Chem., July 1, 2009; 55(7): 1280 - 1287. [Abstract] [Full Text] [PDF]
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 J. M Kirk Neonatal jaundice: a critical review of the role and practice of bilirubin analysis Ann Clin Biochem, September 1, 2008; 45(5): 452 - 462. [Abstract] [Full Text] [PDF]
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 H T Ho, T K Ng, K C Tsui, and Y C Lo Evaluation of a new transcutaneous bilirubinometer in Chinese newborns Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2006; 91(6): F434 - F438. [Abstract] [Full Text] [PDF]
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D. K. Stevenson, R. J. Wong, and H. J. Vreman Reduction in Hospital Readmission Rates for Hyperbilirubinemia Is Associated with Use of Transcutaneous Bilirubin Measurements Clin. Chem., March 1, 2005; 51(3): 481 - 482. [Full Text] [PDF]
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