Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California.
Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
Hosp Pediatr. 2023 Sep 1;13(9):857-864. doi: 10.1542/hpeds.2022-007098.
To determine the impact of higher bilirubin thresholds on testing and treatment of healthy infants during the neonatal period.
This quality improvement study included infants born at ≥35 weeks gestation and admitted to the well-baby nursery between July 2018 and December 2020. We assessed the transition from infants treated according to the 2004 AAP guidelines (pregroup) with those following the Northern California Neonatal Consortium guidelines (postgroup). We examined the proportion of infants receiving phototherapy and total serum bilirubin (TSB) assessments as outcome measures. We examined critical hyperbilirubinemia (TSB above 25 mg/dL or TSB within 2 mg/dL of threshold for exchange transfusion), exchange transfusion, and readmission for jaundice as balancing measures. We compared the differences in outcomes over time using Statistical Process Control p charts. Balancing measures between the pre and postgroups were compared using χ square tests and t-tests.
In our population of 6173 babies, there was a significant shift in the proportion receiving phototherapy from 6.4% to 4%. There were no significant changes in incidences of bilirubin >25 mg/dL (0 of 1472 vs 7 of 4709, P = .37), bilirubin within 2 mg/dL of exchange transfusion thresholds (4 of 1472 vs 5 of 4709, P = .15), exchange transfusion (0 of 1472 vs 1 of 4709, P = .70) or readmission for phototherapy (2.9% versus 2.4%, P = .30), between the 2 groups.
Higher thresholds for phototherapy treatment of neonatal hyperbilirubinemia can decrease the need for phototherapy without increasing critical hyperbilirubinemia or readmission rate.
确定较高胆红素阈值对新生儿期健康婴儿的检测和治疗的影响。
这是一项质量改进研究，纳入了 2018 年 7 月至 2020 年 12 月期间在足月（≥35 周）出生并入住婴儿室的婴儿。我们评估了根据 2004 年 AAP 指南（前组）治疗的婴儿与遵循北加州新生儿联合会指南（后组）治疗的婴儿之间的过渡情况。我们以光疗和总血清胆红素（TSB）评估的比例作为结果测量指标。我们检查了临界高胆红素血症（TSB 高于 25mg/dL 或 TSB 接近换血阈值的 2mg/dL）、换血和因黄疸再次入院的比例作为平衡措施。我们使用统计过程控制 p 图比较了不同时间的结果差异。使用卡方检验和 t 检验比较了前组和后组之间的平衡措施差异。
在我们的 6173 名婴儿人群中，接受光疗的比例从 6.4%显著下降至 4%。胆红素＞25mg/dL 的发生率（0/1472 例比 7/4709 例，P=0.37）、胆红素接近换血阈值的 2mg/dL 的发生率（4/1472 例比 5/4709 例，P=0.15）、换血的发生率（0/1472 例比 1/4709 例，P=0.70）或因光疗再次入院的发生率（2.9%比 2.4%，P=0.30）在两组之间均无显著变化。
新生儿高胆红素血症光疗治疗的较高阈值可减少光疗的需求，而不会增加临界高胆红素血症或再次入院率。
