Assessment of adherence level for neonatal hyperbilirubinemia management by various physicians in ‎Iraq: a multi-clinic study

Background: Neonatal jaundice is a physiological process that occurs normally ‎for every infant to a varying degree. In some cases, this process becomes pathological ‎and imposes an increased risk of morbidity and mortality for the infant. The aim of this study was to assess the adherence level of various physicians to different guidelines ‎of management of neonatal hyperbilirubinemia in Iraq. Methods: An observational cross-sectional study was conducted in ‎multiple outpatient clinics in various Iraqi provinces, from February ‎‎2018 to ‎February 2019. ‎The study involved 130 physicians, who were divided into emergency physicians (EPs), general practitioners (GPs), and pediatricians (PDs), and assessed their compliance to guidelines for management of neonatal hyperbilirubinemia using a questionnaire, which included providing the correct management for a test case scenario. Results: PDs had significantly longer discharge times compared to EPs and GPs. In total, ‎91.7‎% of PDs always tested the neonate for bilirubin levels ‎before discharge, while 5.5‎% of GPs and 0% of EP did so. Regarding follow-up visits, 16.7‎%, 4.8% and 45.2% of PDs, EPs and GPs, respectively, scheduled a follow-up between 49-72 hours; ‎47.6‎% and 38.1% of EPs scheduled a follow-up at ≤24 hours and 25-48 hours, respectively‎‏. In addition, 91.7% of PDs gave the correct answer for the management of the test ‎case scenario, followed by 58.9% of GPs, and 38.1% of ‎EPs‎‏.‏ About half of ‎PDs extended neonates length of stay beyond 48 ‎hours. Conclusion: GPs and EPs show lower adherence levels for the management of neonatal jaundice than PDs, which indicates that these physicians adhere well to current management guidelines from the WHO, ‎AAP, and NICE.

Knowledge of Neonatal Hyperbilirubinemia Among Primary Health Care Physicians: A Single-Center Experience

Background and objectives:

To evaluate the knowledge of the primary health care physicians (PHCP) in Kalubia governorate, Egypt, about the causes, diagnosis, complications, and treatment of neonatal hyperbilirubinemia (NHB).

Methods:

Cross-sectional survey distributed by interview to 500 physicians working in the primary health care (PHC) sector in Kalubia.

Results:

Out of 500 distributed surveys, 419 (84%) PHCP completed the questionnaire. They represent 174 (90%) out of 193 PHC units and centers. About 18% were males and 82% females with mean age of 28.5 ± 5.2 years, and mean duration of work was 3.3 ± 4.4 years. All of the respondents have patients with NHB in their daily practice. The knowledge of the PHCP was good in some aspects about NHB; however, it was poor and may be even hazardous in other aspects.

Conclusions:

Many areas of defects are detected in PHCP knowledge about NHB. Pre-service and continuous training of the PHCP about the diagnosis and management of NHB are essential.

Severe Neonatal Hyperbilirubinemia Decreased after the 2007 Canadian Guidelines

OBJECTIVES

To estimate the incidence of severe neonatal hyperbilirubinemia in Canada from 2011-2013 following the implementation of the Canadian Pediatric Society's published guidelines on the management of hyperbilirubinemia in 2007. Our previously reported incidence of hyperbilirubinemia in Canada was 1 in 2480.

STUDY DESIGN

Term infants ≤ 60 days of age, with a peak serum total bilirubin level > 425 μmol/L or who had an exchange transfusion were followed prospectively through the Canadian Pediatric Surveillance Program from 2011-2013. Infants with rhesus isoimmunization or born < 35 weeks gestation were excluded.

RESULTS

Ninety-one cases of severe neonatal hyperbilirubinemia were confirmed. Sixty-nine infants (76%) were readmitted to hospital, 47 (52%) of them within 6 days of age. The remaining 22 infants (24%) were identified with severe neonatal hyperbilirubinemia before they were discharged from the hospital. The mean reported peak bilirubin level was 484 μmol/L (range 181-788; SD ± 92). An etiology was identified in 57 (63%) cases, with ABO incompatibility (n = 35) and glucose-6-phosphate dehydrogenase deficiency (n = 11) being the most common. An infant was 3.5 times more likely to be diagnosed with severe neonatal hyperbilirubinemia from 2002-2004 compared with 2011-2013 (95% CI 2.72-4.47).

CONCLUSIONS

The minimum estimated incidence of severe neonatal hyperbilirubinemia in Canada is 1 in 8352 live births. Introduction of the Canadian Pediatric Society guidelines and improved physician awareness of severe neonatal hyperbilirubinemia in the last 10 years likely made positive contributions to this trend.

Incidence, risk factors and causes of severe neonatal hyperbilirubinemia in the South of iran (fars province)

BACKGROUND

Today, Severe hyperbilirubinemia is the most common cause of neonatal readmissions. Identification of the cause of neonatal hyperbilirubinemia is useful in determining whether therapeutic interventions can prevent severe hyperbilirubinemia.

OBJECTIVES

We conducted this study to estimate the incidence of severe hyperbilirubinemia in Fars province and to determine the underlying causes and risk factors, which would be of value in identifying and implementing strategies to prevent morbidity from this condition.

PATIENTS AND METHODS

All infants less than 28 days referred due to severe indirect hyperbilirubinemia were included. Complete history, physical examination and lab work up were performed. This is a longitudinal prospective study in 2009-2010.

RESULTS

More common causes of severe indirect hyperbilirubinemia were blood group incompatibility, G6PD deficiency, sepsis and unknown. Risk factors of severe hyperbilirubinemia were Male sex, previous siblings with severe hyperbilirubinemia, early discharge, NVD, Breast feeding and cultural background of mothers.

CONCLUSIONS

Our study showed severe neonate indirect hyperbilirubinemia is still prevalence in Fars province and ethnic and cultural background of the mothers was more effective than school education in preventing hyperbilirubinemia complication.

Acute neurological findings in a national cohort of neonates with severe neonatal hyperbilirubinemia

OBJECTIVE

To describe and compare infants with severe hyperbilirubinemia, who presented with and without abnormal neurological findings and to identify associated risk factors.

STUDY DESIGN

Data on infants with severe hyperbilirubinemia (>425 μmol l(-1) and/or received exchange transfusion) were collected prospectively through the Canadian Paediatric Surveillance Program (CPSP) from 2002 to 2004. Cases were categorized into two groups on the basis of information provided by the reporting physician: neurologically normal or abnormal. Demographic characteristics were compared and univariate logistic regression was performed to identify factors associated with acute neurological abnormalities in infants.

RESULT

Of the initial cohort of 258 infants, 32 (12.4%) were identified to have neurological abnormalities. Infants in the highest peak bilirubin level group (>550 μmol l(-1)) had the greatest risk of acute neurological abnormalities. The mid range (451 to 550 μmol l(-1)) and lowest level (450 μmol l(-1)) groups were less likely to have abnormalities (odds ratio (OR)=0.174; P=0.0013 and 0.402; P=0.0613, respectively). Exchange transfusion and presentation within the first 2 days of age were positively associated with abnormal neurological findings in infants (OR=3.332, P=0.003 and OR=2.572, P<0.0001, respectively).

CONCLUSION

In this national cohort of infants with severe hyperbilirubinemia, a significant percentage of infants developed acute bilirubin encephalopathy. Long-term neurodevelopmental follow-up is necessary to determine the incidence of permanent neurological sequelae.