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. 2009 Aug;124(2):548-54.
doi: 10.1542/peds.2008-2926. Epub 2009 Jul 27.

Delayed pediatric office follow-up of newborns after birth hospitalization

Jochen Profit  1 , Alva J Cambric-Hargrove, Kay O Tittle, Kenneth Pietz, Ann R Stark
Affiliations

Delayed pediatric office follow-up of newborns after birth hospitalization

Jochen Profit et al. Pediatrics. 2009 Aug.

Abstract

Background: Key recommendations of the American Academy of Pediatrics guideline on management of severe hyperbilirubinemia in healthy infants of >or=35 weeks' gestation include predischarge screening for risk of subsequent hyperbilirubinemia, follow-up at 3 to 5 days of age, and lactation support. Little information is available on contemporary compliance with follow-up recommendations.

Objective: To assess timing and content of the first newborn office visit after birth hospitalization in urban and suburban pediatric practices in Houston, Texas.

Methods: We reviewed office records for the first visit within 4 weeks of birth during January through July 2006 for apparently healthy newborns with a gestational age of >or=35 weeks or birth weight of >or=2500 g seen within a pediatric provider network. For each pediatrician, we selected every fifth patient up to a total of 6.

Results: Of 845 records abstracted, 698 (83%) were eligible for analysis. Infants were seen by 136 pediatricians in 39 practices. They had vaginal (64%) or cesarean (36%) deliveries at 20 local hospitals, of which 17 had routine predischarge bilirubin screening policies. Only 37% of all infants, 44% of vaginally delivered infants, and 41% of exclusively breastfed infants were seen before 6 days of age. Thirty-five percent of the infants were seen after 10 days of age. Among 636 infants seen at <or=15 days, jaundice was noted on examination in 33%; of these, 44% had bilirubin measured. Nine infants had phototherapy documented after birth hospitalization.

Conclusions: Among a large group of urban and suburban pediatricians, implementation of the American Academy of Pediatrics recommendation for follow-up was inconsistent, and delayed follow-up was common. Understanding reasons for delayed follow-up and providing guidance for jaundice management may promote a safer first week of life.

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Figures

FIGURE 1
FIGURE 1
Study-sample flow chart.
FIGURE 2
FIGURE 2
Timing of first office visits. Note the bimodal distribution with a broad peak around 4 and a narrow peak around 14 days of life. The broad peak is a reflection of a combination of guideline-recommended visits by 5 days of life and the customary 1-week follow-up. The narrow peak reflects the “customary” 2-week follow-up.
FIGURE 3
FIGURE 3
Many vaginally delivered and breastfed infants experience delayed follow-up.
See this image and copyright information in PMC

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