Hyperbilirubinemia monitoring program in infants ≥ 35 weeks: a Brazilian quality improvement study

OBJECTIVE: To implement a systematic monitoring program for hyperbilirubinemia in the first week of life in newborns ≥ 35 weeks of gestational age. METHODS: A quality assessment study was conducted with an estimated sample size of 385 newborns using a phototherapy utilization rate of 10 %. All newborns with a gestational age of ≥ 35 weeks admitted to a secondary general hospital well-baby nursery were included. Transcutaneous bilirubin (TcB) was systematically measured, and total serum bilirubin (TsB) was measured as needed. Patients with TcB levels above the 75th percentile according to the nomogram by Bhutani et al. (2021) were followed up after discharge from a specific outpatient clinic. The rates of outpatient follow-up clinic utilization, incidence of total bilirubin ≥ 15 mg/dL at discharge, readmission for phototherapy, and exchange transfusion were evaluated. RESULTS: Of the 432 newborns analyzed, 53 (12.3 %) were referred for follow-up, with a return rate of 83 % (44). Twelve newborns (27.2 % of those who attended the return visit and 2.7 % of the total sample) were readmitted for phototherapy for a median duration of 36 (30-48) hours. Three infants had bilirubin values ≥ 15.0 mg/dL at discharge and did not require readmission. None of the patients required an exchange transfusion. CONCLUSIONS: The outpatient follow-up program for jaundice demonstrated high adherence, safety, and effectiveness, and reduced the rate of phototherapy use threefold.