Risk Of Serious Jaundice In Newborns Accurately Predicted By Simple Test

[Guest guest]

11 Jan 2008 A simple test can accurately identify which newborn babies are at risk for developing dangerous levels of jaundice, according to researchers at The Children's Hospital of Philadelphia. While neonatal jaundice, a yellowing of the skin caused by a buildup of a blood product called bilirubin, is common in newborns and usually disappears on its own, it can progress to brain damage in a small fraction of cases. The American Academy of Pediatrics currently recommends two options, used alone or in combination, to assess an infant's risk of developing severe hyperbilirubinemia: a predischarge measurement of the bilirubin level and a screening checklist of risk factors such as intended method of feeding, siblings with history of jaundice, and race. The Children's Hospital researchers say that the predischarge bilirubin measurement, combined with the baby's gestational age, is the most accurate method for predicting whether the newborn is at risk. Their findings are published in the January 2008 issue of the journal Pediatrics. Children's Hospital physicians studied outcomes for 823 newborns admitted to the Hospital of the University of Pennsylvania in Philadelphia between September 2004 and October 2005. "The challenge facing every pediatrician who takes care of newborn babies is to identify those infants they send home that will develop a bilirubin level that could cause injury," said Ron Keren, M.D., M.P.H., a pediatrician at Children's Hospital and the lead author of the study. "We found that by measuring the bilirubin in every baby, and combining that information with the baby's gestational age, you could accurately predict which infants are at very high risk and which ones are at very low risk." This screening method should allow pediatricians to determine which newborns should stay in the hospital for monitoring, which may go home and return the next day for another test and which don't need any additional follow-up for jaundice. About 70 percent of babies fell into the low-risk category, while 13 percent were designated high risk and 17 percent were in the middle, said Keren. "It did a nice job of pulling out a very large group of babies you don't have to worry about and a small group of babies that need to be closely followed," Keren said. About four million babies are born in the U.S. each year. Of those, about 60 percent will develop jaundice in the first few days of life, but only about 1 in 100,000 will develop bilirubin levels that cause brain damage, known as kernicterus. The authors caution that the study has a few limitations, including a small sample size. Some infants in the study were treated with phototherapy, high levels of colored light used to break down the bilirubin, before meeting the criteria. Finally, about half of the study participants were born to black mothers and the researchers' data indicates black infants are less prone to develop significant hyperbilirubinemia. "More research on risk-assessment strategies is needed to weigh the cost of implementing a universal program and its effectiveness for preventing severe hyperbilirubinemia against false test results, unnecessary testing and treatment, and delay in hospital discharge," said Keren. ----------------------------Article adapted by Medical News Today from original press release.---------------------------- Keren's research was supported by a grant from the National Institute of Child Health and Human Development. Respironics, of Murrysville, Pa., loaned the researchers the device used for bilirubin measurements during home visits. Keren's co-authors from The Children's Hospital are Xianqun Luan, M.S.; Friedman, M.D.; Saddlemire, M.S.P.H.; Avital Cnaan, Ph.D.; and Vinod K. Bhutani, M.D at Lucile Packard Children's Hospital at Stanford University in Palo Alto, Calif. About The Children's Hospital of Philadelphia: The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of p pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking third in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu/. Source: nn Walsh Children's Hospital of Philadelphia

Article URL: http://www.medicalnewstoday.com/articles/93633.php

Main News Category: Pediatrics / Children's Health

Also Appears In: Neurology / Neuroscience, Start the year off right. Easy ways to stay in shape in the new year.

[Guest guest]

This is a good article. The last hospital I worked at

we did a t/d bili with the newborn screen. Where I

work now, we use a jaundice meter that screens bili

levels through the skin. If the meter reads 15 or

above, we draw a t/d bili. We also see all babies at

about one week of age (or sooner if indicated) either

as outpatient visit at our hospital (for breastfed,

premies, or other ordered visits. The LC's do this

visit. Then , we have a home visit nurse who sees the

other half). This is a great program and we pick up

all kinds of problems early before they become

serious!

What does everyone else do?

Cheryl

East Al. Medical Center

Auburn, AL

--- gin11153@... wrote:

> 11 Jan 2008

>

> A simple test can accurately identify which newborn

> babies are at risk for

> developing dangerous levels of jaundice, according

> to researchers at The

> Children's Hospital of Philadelphia.

>

> While neonatal jaundice, a yellowing of the skin

> caused by a buildup of a

> blood product called bilirubin, is common in

> newborns and usually disappears on

> its own, it can progress to brain damage in a small

> fraction of cases.

>

> The American Academy of Pediatrics currently

> recommends two options, used

> alone or in combination, to assess an infant's risk

> of developing severe

> hyperbilirubinemia: a predischarge measurement of

> the bilirubin level and a

> screening checklist of risk factors such as

> intended method of feeding, siblings

> with history of jaundice, and race.

>

> The Children's Hospital researchers say that the

> predischarge bilirubin

> measurement, combined with the baby's gestational

> age, is the most accurate

> method for predicting whether the newborn is at

> risk.

>

> Their findings are published in the January 2008

> issue of the journal

> Pediatrics. Children's Hospital physicians studied

> outcomes for 823 newborns

> admitted to the Hospital of the University of

> Pennsylvania in Philadelphia between

> September 2004 and October 2005.

>

> " The challenge facing every pediatrician who takes

> care of newborn babies is

> to identify those infants they send home that will

> develop a bilirubin level

> that could cause injury, " said Ron Keren, M.D.,

> M.P.H., a pediatrician at

> Children's Hospital and the lead author of the

> study. " We found that by

> measuring the bilirubin in every baby, and

> combining that information with the

> baby's gestational age, you could accurately

> predict which infants are at very

> high risk and which ones are at very low risk. "

>

> This screening method should allow pediatricians to

> determine which newborns

> should stay in the hospital for monitoring, which

> may go home and return the

> next day for another test and which don't need any

> additional follow-up for

> jaundice. About 70 percent of babies fell into the

> low-risk category, while

> 13 percent were designated high risk and 17 percent

> were in the middle, said

> Keren.

>

> " It did a nice job of pulling out a very large

> group of babies you don't

> have to worry about and a small group of babies

> that need to be closely

> followed, " Keren said.

>

> About four million babies are born in the U.S. each

> year. Of those, about 60

> percent will develop jaundice in the first few days

> of life, but only about

> 1 in 100,000 will develop bilirubin levels that

> cause brain damage, known as

> kernicterus.

>

> The authors caution that the study has a few

> limitations, including a small

> sample size. Some infants in the study were treated

> with phototherapy, high

> levels of colored light used to break down the

> bilirubin, before meeting the

> criteria. Finally, about half of the study

> participants were born to black

> mothers and the researchers' data indicates black

> infants are less prone to

> develop significant hyperbilirubinemia.

>

> " More research on risk-assessment strategies is

> needed to weigh the cost of

> implementing a universal program and its

> effectiveness for preventing severe

> hyperbilirubinemia against false test results,

> unnecessary testing and

> treatment, and delay in hospital discharge, " said

> Keren.

>

> ----------------------------

> Article adapted by Medical News Today from original

> press release.

> ----------------------------

>

> Keren's research was supported by a grant from the

> National Institute of

> Child Health and Human Development. Respironics, of

> Murrysville, Pa., loaned the

> researchers the device used for bilirubin

> measurements during home visits.

>

> Keren's co-authors from The Children's Hospital are

> Xianqun Luan, M.S.;

> Friedman, M.D.; Saddlemire,

> M.S.P.H.; Avital Cnaan, Ph.D.; and

> Vinod K. Bhutani, M.D at Lucile Packard Children's

> Hospital at Stanford

> University in Palo Alto, Calif.

>

> About The Children's Hospital of Philadelphia: The

> Children's Hospital of

> Philadelphia was founded in 1855 as the nation's

> first pediatric hospital.

> Through its long-standing commitment to providing

> exceptional patient care,

> training new generations of p pediatric healthcare

> professionals and pioneering

> major research initiatives, Children's Hospital has

> fostered many discoveries

> that have benefited children worldwide. Its

> pediatric research program is

> among the largest in the country, ranking third in

> National Institutes of Health

> funding. In addition, its unique family-centered

> care and public service

> programs have brought the 430-bed hospital

> recognition as a leading advocate for

> children and adolescents. For more information,

> visit _http://www.chop.edu/_

> (http://www.chop.edu/) .

>

> Source: nn Walsh

> _Children's Hospital of Philadelphia _

> (http://www.chop.edu/)

> ____________________________________

>

> Article URL:

> http://www.medicalnewstoday.com/articles/93633.php

> Main News Category: Pediatrics / Children's Health

> Also Appears In: Neurology / Neuroscience,

>

>

>

> **************Start the year off right. Easy ways

> to stay in shape.

>

http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489

>

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[Guest guest]

If the cord blood comes back as coombs + then we do a stat t bili. Otherwise we have a standing order for a bili if we think the infant appears jaundice & every infant gets a bili with the newborn screening the day of discharge (or sooner for NICU babies of course). Depending on the dr they may have them come back in a couple days to retest or just see them in the office in a week. I think the home visit idea is great, it's not unlikely for us to have infant's on peds due to problems that may have been resolved if we did home visits.

Re: [OBnurses] Risk Of Serious Jaundice In Newborns Accurately Predicted By Simple Test

This is a good article. The last hospital I worked atwe did a t/d bili with the newborn screen. Where Iwork now, we use a jaundice meter that screens bililevels through the skin. If the meter reads 15 orabove, we draw a t/d bili. We also see all babies atabout one week of age (or sooner if indicated) eitheras outpatient visit at our hospital (for breastfed,premies, or other ordered visits. The LC's do thisvisit. Then , we have a home visit nurse who sees theother half). This is a great program and we pick upall kinds of problems early before they becomeserious!What does everyone else do?Cheryl East Al. Medical CenterAuburn, AL--- gin11153aol (DOT) com wrote:> 11 Jan 2008 > > A simple test can accurately identify which newborn> babies are at risk for

> developing dangerous levels of jaundice, according> to researchers at The > Children's Hospital of Philadelphia. > > While neonatal jaundice, a yellowing of the skin> caused by a buildup of a > blood product called bilirubin, is common in> newborns and usually disappears on > its own, it can progress to brain damage in a small> fraction of cases. > > The American Academy of Pediatrics currently> recommends two options, used > alone or in combination, to assess an infant's risk> of developing severe > hyperbilirubinemia: a predischarge measurement of> the bilirubin level and a > screening checklist of risk factors such as> intended method of feeding, siblings > with history of jaundice, and race. > > The Children's Hospital researchers say that the > predischarge bilirubin > measurement,

combined with the baby's gestational> age, is the most accurate > method for predicting whether the newborn is at> risk. > > Their findings are published in the January 2008> issue of the journal > Pediatrics. Children's Hospital physicians studied> outcomes for 823 newborns > admitted to the Hospital of the University of> Pennsylvania in Philadelphia between > September 2004 and October 2005. > > "The challenge facing every pediatrician who takes> care of newborn babies is > to identify those infants they send home that will> develop a bilirubin level > that could cause injury," said Ron Keren, M.D.,> M.P.H., a pediatrician at > Children's Hospital and the lead author of the> study. "We found that by > measuring the bilirubin in every baby, and> combining that information with the > baby's

gestational age, you could accurately> predict which infants are at very > high risk and which ones are at very low risk." > > This screening method should allow pediatricians to > determine which newborns > should stay in the hospital for monitoring, which> may go home and return the > next day for another test and which don't need any > additional follow-up for > jaundice. About 70 percent of babies fell into the > low-risk category, while > 13 percent were designated high risk and 17 percent > were in the middle, said > Keren. > > "It did a nice job of pulling out a very large> group of babies you don't > have to worry about and a small group of babies > that need to be closely > followed," Keren said. > > About four million babies are born in the U.S. each> year. Of those, about 60 >

percent will develop jaundice in the first few days> of life, but only about > 1 in 100,000 will develop bilirubin levels that> cause brain damage, known as > kernicterus. > > The authors caution that the study has a few> limitations, including a small > sample size. Some infants in the study were treated> with phototherapy, high > levels of colored light used to break down the> bilirubin, before meeting the > criteria. Finally, about half of the study> participants were born to black > mothers and the researchers' data indicates black> infants are less prone to > develop significant hyperbilirubinemia. > > "More research on risk-assessment strategies is > needed to weigh the cost of > implementing a universal program and its > effectiveness for preventing severe > hyperbilirubinemia against false test

results,> unnecessary testing and > treatment, and delay in hospital discharge," said> Keren. > > ------------ --------- -------> Article adapted by Medical News Today from original> press release.> ------------ --------- ------- > > Keren's research was supported by a grant from the> National Institute of > Child Health and Human Development. Respironics, of> Murrysville, Pa., loaned the > researchers the device used for bilirubin> measurements during home visits. > > Keren's co-authors from The Children's Hospital are> Xianqun Luan, M.S.; > Friedman, M.D.; Saddlemire,> M.S.P.H.; Avital Cnaan, Ph.D.; and > Vinod K. Bhutani, M.D at Lucile Packard Children's> Hospital at Stanford > University in Palo Alto, Calif. > > About The Children's Hospital of Philadelphia:

The> Children's Hospital of > Philadelphia was founded in 1855 as the nation's> first pediatric hospital. > Through its long-standing commitment to providing> exceptional patient care, > training new generations of p pediatric healthcare> professionals and pioneering > major research initiatives, Children's Hospital has> fostered many discoveries > that have benefited children worldwide. Its> pediatric research program is > among the largest in the country, ranking third in> National Institutes of Health > funding. In addition, its unique family-centered> care and public service > programs have brought the 430-bed hospital> recognition as a leading advocate for > children and adolescents. For more information,> visit _http://www.chop. edu/_ > (http://www.chop. edu/) . > > Source: nn Walsh > _Children's Hospital of Philadelphia _> (http://www.chop. edu/) > ____________ _________ _________ ______> > Article URL:> http://www.medicaln ewstoday. com/articles/ 93633.php > Main News Category: Pediatrics / Children's Health > Also Appears In: Neurology / Neuroscience, > > > > ************ **Start the year off right. Easy ways> to stay in shape. >http://body. aol.com/fitness/ winter-exercise? NCID=aolcmp00300 000002489> ____________ _________

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