Outcome Analysis of Jaundice Fast-Track System Implementation in Thammasat University Hospital

Pattara Tanticharoenwiwat MD*, Wilaiporn Techasatid MD*

Affiliation : * Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand

Background : Infants who were readmitted with high level of bilirubin (more than 20 mg/dL) should be treated as an acute medical emergency to prevent acute and chronic bilirubin encephalopathy.
Objective : To determine causes of severe neonatal hyperbilirubinemia, risk factors for exchange transfusion and outcomes of neonate after implementation of the Jaundice Fast-track System in Thammasat Hospital. Material and Method: The medical records of neonates presenting with clinically significant hyperbilirubinemia to the outpatient department or emergency department after implementation of the Jaundice Fast-track System at Thammasat University from October 1, 2010 through September 30, 2012, were retrospectively reviewed.
Results : There were 76 infants included in the study. One infant had neurological abnormalities consistent with acute bilirubin encephalopathy at presentation. All infants received intensive phototherapy. Eight infants (10.5%) underwent an exchange transfusion. A cause of hyperbilirubinemia was identified in 66 cases (86%). Breastfeeding jaundice was the most common cause (47%). The mean peak MB level was higher in the exchange transfusion group than the phototherapy group (25.02.9 mg/dL vs. 21.21.8 mg/dL, p<0.001). Three infants in the exchange transfusion group had sepsis on admission compared to none in the phototherapy group, (p<0.001). No infant diagnosed as cephalhematoma underwent an exchange transfusion. The median (range) length of stay was significantly longer in the exchange transfusion group than the phototherapy group (9 (2-15) days vs. 2 (1-12) days, p<0.001). There were no statistical differences between the two groups in age at readmission and time to phototherapy. All infants in this study were discharged as no neurological abnormalities. Infants presented with peak MB ≥24 mg/dL had the greatest risk of exchange transfusion (OR = 26.6; 95% CI = 4.6, 153.7).
Conclusion : Initiating phototherapy within an hour of admission in infants who were readmitted with high levels of bilirubin is effective to prevent bilirubin encephalopathy. Physicians’ early recognition of the risk factors to exchange transfusion is, therefore, crucial.

Keywords : Exchange transfusion, Hyperbilirubinemia, Jaundice fast track, Kernicterus, Neonate, Phototherapy

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