A systems approach for neonatal hyperbilirubinemia in term and near-term newborns

J Obstet Gynecol Neonatal Nurs. Jul-Aug 2006;35(4):444-55. doi: 10.1111/j.1552-6909.2006.00044.x.


Objective: To propose and implement a family-centered systems approach to manage newborn jaundice for safer outcomes.

Design: Observational study for known adverse outcomes.

Setting: Semiprivate urban birthing hospital.

Patients/participants: 31,059 well babies discharged as healthy from a cohort of 41,961 live births (1990-2000).

Interventions: Incremental implementation of a systems approach that incorporated a hospital policy to (a) authorize nurses to obtain a bilirubin (total serum/transcutaneous) measurement for clinical jaundice, (b) universal predischarge total serum bilirubin (at routine metabolic screening), and (c) targeted follow-up, using the bilirubin nomogram (hour-specific, percentile-based total serum bilirubin/transcutaneous bilirubin).

Main outcome measures: Known adverse outcomes assessed for early- and late-onset severe hyperbilirubinemia before, during, and after systems approach implementation.

Results: Adverse outcomes decreased for well babies: exchange transfusion, intensive phototherapy, and readmission. During the study period, there were no "never events" (total serum bilirubin greater than or equal to 30 mg/dl), while "close calls" (total serum bilirubin greater than or equal to 25 mg/dl) were 1 in 15,000 as compared to a reported incidence of 1 in 625.

Conclusions: Reduced adverse events, significant reduction in close calls, and no never events met family expectations for safer experiences with this approach.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aftercare
  • Algorithms
  • Bilirubin / blood
  • Breast Feeding
  • Critical Pathways / organization & administration*
  • Decision Trees
  • Humans
  • Hyperbilirubinemia, Neonatal* / diagnosis
  • Hyperbilirubinemia, Neonatal* / therapy
  • Infant, Newborn
  • Infant, Premature, Diseases* / diagnosis
  • Infant, Premature, Diseases* / therapy
  • Neonatal Nursing / organization & administration*
  • Neonatal Screening
  • Nurse's Role
  • Nursing Assessment
  • Nursing Evaluation Research
  • Outcome Assessment, Health Care
  • Parents / education
  • Parents / psychology
  • Patient Discharge
  • Patient Readmission
  • Patient-Centered Care / organization & administration
  • Practice Guidelines as Topic
  • Professional Autonomy
  • Systems Analysis*


  • Bilirubin