Screening for Neonatal Jaundice Prior to Discharge

Abstract for Screening Infants for Jaundice Prior to Discharge

Statement of the Project

Jaundice occurs as a result of breakdown of red blood cells after birth. It is a sign that the blood contains an excess amount of bilirubin. Jaundice affects 60 to 70% of newborns and is the leading cause of hospital readmission in the first two weeks of life. If unidentified or left untreated, these neonates could develop kernicterus which often results in permanent brain damage. Kernicterus is a toxic accumulation of bilirubin in the central nervous system tissues. The purpose of this project was to develop a plan for screening term newborns for jaundice prior to discharge from the hospital to prevent possible development of kernicterus. Description of the Innovation and Resulting Change

 An extensive review of literature concluded that screening was the essential element in reducing or eliminating the chance of developing kernicterus.  However, there were a variety of options available for screening tools. The two most accepted tools were transcutaneous skin testing or blood sampling. Due to the subjectivity of transcutaneous skin testing, the hospital facility opted for developing a plan to implement drawing a blood sample (bilirubin) prior to discharge. There is no true test for hemolysis in the newborn, so bilirubin testing would be the best indicator for determining impending risk in the newborn.

 A policy and procedure and educational plan were developed to implement this new screening tool.  Training and educational inservices of the nurses and pediatricians was conducted. This included a poster board for review, multiple inservices and a post test to measure effectiveness of the training. This plan was well received and the new screening protocol was begun in May 2006. This protocol includes identifying risk factors and charting the laboratory results on a nomogram recommended by the American Academy of Pediatrics (AAP). When the results are plotted and risk factors determined, the nomogram will identify the newborn is either low risk, intermediate risk, or high risk. The pediatrician is notified of the results.

Implications and Significance of the Innovation for Practice and Education

As a result of the new screening protocol, infants were being identified and treated earlier. Additionally, newborns that were being identified as being at moderate or high risk in the hospital were being followed up more aggressively in the pediatricians’ office. Outcomes

The screening protocol has been highly successful. During 2004, 2005, and half of 2006; approximately 300 newborns were readmitted for increased bilirubin levels.  Chart reviews are currently underway to determine results of this new protocol. The nursing staff and pediatricians have realized the benefit of early detection in predicting newborns at higher risk for jaundice.

Recommendation for Future Action

Future actions would include continuing to perform monthly chart audits to ensure the newborns were being properly screened and treated. Data will be collected and disseminated. The results will be shared with the staff and pediatricians. Additionally, current education is consistently offered to new hires and updates to current staff as needed.