(CPS, ). Normally, hyperbilirubinemia resolves on its own as the infant processes the bilirubin and excretes it. However, in some infants, it can become. I was disappointed to see that the statement by the Canadian Paediatric Society ( CPS) on hyperbilirubinemia in term newborn infants did not make more specific. The CPS hyperbilirubinemia guidelines are based on universal predischarge bilirubin screening, and use of a nomogram to guide follow-up and treatment.

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The guidelines also recommend timely follow-up for all infants after hospital discharge. Association between duration of neonatal hospital stay and hyperbiliruninemia rate. Epidemiological strategies for its prevention through systems-based approaches.

Effect of neonatal jaundice and phototherapy on the frequency of first-year outpatient visits. Although phototherapy is effective in the treatment of hyperbilirubinemia, exchange transfusion is occasionally indicated. The nomogram was developed using 10, TcB measurements from 2, neonates with gestational ages of at least 35 weeks and birth weights of at least 2, g 4 lb, 7 oz.

Infants who receive phototherapy and have an elevated direct-reacting or conjugated bilirubin level cholestatic jaundice may develop bronze baby syndrome. Developmental follow-up of breastfed term and near-term infants with marked hyperbilirubinemia. Can J Hypebilirubinemia Health.

Incidence and causes of severe neonatal hyperbilirubinemia in Canada

Acknowledgments We thank Danielle Grenier for her ongoing advice and support during the project, Kinsley Jin for data hyperbklirubinemia and Kathleen Hollamby for administrative assistance. Data were summarized using descriptive statistics. Arrangements for outpatient follow-up via existing locations paediatric department, mother-baby unit, breastfeeding clinics.

The findings provide valuable insight into the impact of a complex paediatric guideline in the largest Canadian province. The shift to hospital-based neonatal follow-up has been influenced by limitations in the hyperbilirubinemiz of timely bilirubin testing in the community as well as limitations in access to community-based physicians within the recommended time frames.

This likely reflects differences in availability of services including laboratory servicesthe mix of providers, the degree of involvement of community-based physicians in hospital care, work flow and administrative processes, birth volumes, patient demographics hyperbklirubinemia the size of the geographical area served.


Indications that phototherapy is a risk factor for insulin-dependent diabetes. Breastfeeding women whose infants have jaundice are at increased risk of early cessation of breastfeeding.

Leadership from an interdisciplinary committee.

Systematic reviews on successful guideline implementation suggests that more complex guidelines may be less likely to be adopted and followed Factors that influenced the decision to implement universal bilirubin screening are summarized in Table 6. Infants who had rhesus iso-immunization were excluded since antenatal and postnatal strategies already exist to prevent the occurrence of severe neonatal hyperbilirubinemia from this cause.

The impact of early obstetric discharge on newborn health care. Provincially led implementation may also ensure that changes arising from the implementation of a guideline develop in directions that are consistent with current health policy.

Release of Canadian Paediatric Society guidelines. Infants who breastfeed exclusively—particularly those who consume inadequate calories—are at increased risk of hyperbilirubinemia. Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings. Sign up for the free AFP email table of contents.

Qual Saf Health Care. C 5 Phototherapy decreases the need for exchange transfusion in newborns with severe hyperbilirubinemia.

Evaluation and Treatment of Neonatal Hyperbilirubinemia

Births and birth rate, by province and territory. Types of phototherapy lights include conventional halogen or fluorescentlight-emitting diode LEDand fiber optic. To see the full article, log in or purchase access. Acute management of extreme neonatal jaundice — the potential benefits of intensified phototherapy and interruption of enterohepatic bilirubin circulation.

The guidelines refer to the use of intensive phototherapy, which should be used when the TSB level exceeds the line indicated for each category.

Evaluation and Treatment of Neonatal Hyperbilirubinemia – – American Family Physician

The baseline demographic characteristics of the study group are presented in Table 1. Total serum bilirubin TSB nomogram for designation hyperbikirubinemia risk in 2, well newborns delivered at 36 or more weeks’ gestation with birth weight of at least 2, g 4 lb, 7 ozor those delivered at 35 or more weeks’ gestation with birth weight of at least 2, g 5 lb, 8 ozbased on hour-specific TSB values.

A total score of 8 or more suggests an increased hyperbiliruibnemia of hyperbilirubinemia; total serum bilirubin or transcutaneous bilirubin level should be obtained. Blue to green light with wavelengths of to nm is the most effective hyperbilirubinemiz converting unconjugated bilirubin. The remaining infants were readmitted with hyperbilirubinemia from home. Reasons for non-use of proven pharmacotherapeutic interventions: Canadian Paediatric Surveillance Program — Impact of universal bilirubin screening on severe hyperbilirubinemia and phototherapy use.


Breastfed infants are three times more likely to have a TSB level greater than 12 hyperbilidubinemia per dL The results of the survey suggest that efficiency may be gained from provincial coordination of hyperbipirubinemia implementation. Respondents from hospitals with multiple sites had the option of responding once for all sites or separately for each site. Current Ontario initiatives, such as the Health Links program 24which facilitates coordination of care between different health care sectors and providers, may provide a model for the development of a coordinated system of community-based postdischarge maternal-newborn care in the province, which could reduce the need for hospital-based follow-up for neonatal hyperbilirubinemia.

Leadership from maternal-newborn program leaders. Nonresponders were sent up to three reminder notices via e-mail. While some diversity in service delivery models is to be expected given the contextual variations across the province, a provincially coordinated approach to guideline implementation may better support hospitals to cpps from the experiences of others by sharing solutions to challenges, and may also facilitate timelier implementation in low-volume hospitals with limited human resources for guideline implementation.

N Engl J Med. However, hypebrilirubinemia retrospective review of infants who hyperbilriubinemia phototherapy and a full laboratory workup found that The demographic characteristics did not differ significantly between cases with and without a specific diagnosis, although those with no specific diagnosis presented later than infants with an identified cause for the hyperbilirubinemia 4.

Information from references 522and 24 through Further information to aid patient care may be published in the interim.