Department of Pediatrics, Washington University, St. Louis, MO 63110, USA.
Acad Pediatr. 2012 Jul-Aug;12(4):283-7. doi: 10.1016/j.acap.2012.03.021. Epub 2012 May 26.
To describe primary care management of early and prolonged jaundice in otherwise-healthy term infants to identify opportunities to increase early diagnosis of cholestasis.
Community-based pediatricians in St Louis, Missouri completed a mailed, anonymous, 29-item survey to assess practice demographics, timing of routine newborn office visits, and the management of early and prolonged neonatal jaundice.
A total of 108 of 230 (47%) of eligible physicians responded (mean years in practice, 15.3, SD, 9.4). More respondents were very familiar with national guidelines for management of early (49%) than prolonged (16%) neonatal jaundice. Eighty-six percent reported all newborns were checked with transcutaneous bilirubin before hospital discharge. For transcutaneous bilirubin results at 48 hours of 7, 10, 12 and 15 mg/dL, 1%, 26%, 70%, and 74% of respondents, respectively, would order a fractionated bilirubin. Although the first routine visit usually occurred in the first week after discharge, 25% of physicians reported the 2nd visit was routinely scheduled after 4 weeks of age. Ninety-four percent reported they would obtain a fractionated bilirubin for infants jaundiced beyond 4 weeks of age. If cholestasis was identified at 6 weeks of age, 32% would obtain additional testing without referral to a subspecialist.
Management of early and prolonged neonatal jaundice is variable. Current practices appear to miss opportunities for early diagnosis of cholestasis and referral that are unlikely to be addressed without redesigning systems of care.
描述一般健康足月婴儿早发性和迁延性黄疸的初级保健管理，以确定增加胆汁淤积症早期诊断的机会。
密苏里州圣路易斯的社区儿科医生完成了一项邮寄、匿名、29 项的调查，以评估实践人口统计学、常规新生儿门诊就诊时间以及早发性和迁延性新生儿黄疸的管理。
共有 230 名合格医生中的 108 名（47%）做出了回应（平均从业年限为 15.3 岁，标准差为 9.4 岁）。更多的受访者非常熟悉早期（49%）而非迁延性（16%）新生儿黄疸管理的国家指南。86%的受访者报告所有新生儿在出院前均进行经皮胆红素检查。对于 48 小时的经皮胆红素值为 7、10、12 和 15mg/dL，分别有 1%、26%、70%和 74%的受访者会开胆红素分离医嘱。虽然第一次常规就诊通常发生在出院后的第一周，但 25%的医生报告第二次就诊通常在 4 周后。94%的受访者表示，如果婴儿黄疸持续超过 4 周，他们会进行胆红素分离检查。如果在 6 周龄时发现胆汁淤积，32%的人会在不转诊给专科医生的情况下进行额外检查。
早发性和迁延性新生儿黄疸的管理存在差异。如果不重新设计医疗保健系统，目前的做法似乎错过了早期诊断胆汁淤积症和转介的机会。
