Clinical decision support tool for phototherapy initiation in preterm infants

J Perinatol. 2020 Oct;40(10):1518-1523. doi: 10.1038/s41372-020-00782-0. Epub 2020 Aug 13.

Abstract

Objective: Adherence to guidelines for phototherapy initiation in preterm infants was 39% in our academic NICU (61% of phototherapy was initiated at total bilirubin (TB) levels below recommended thresholds). We hypothesized that adoption of an electronic health record integrated clinical decision support (CDS) tool would improve adherence to phototherapy guidelines.

Study design: We developed and implemented Premie BiliRecs (PBR), a novel CDS tool for phototherapy initiation in preterm infants from 27 through 34 weeks postmenstrual age. The primary outcome measure was the proportion of phototherapy initiation events consistent with recommended TB thresholds.

Result: Following the implementation of PBR, adherence to guidelines for phototherapy initiation in preterm infants increased to 69.8% (p < 0.001), an improvement of 77%. There was no increase in the incidence of severe hyperbilirubinemia nor exchange transfusions.

Conclusion: The adoption of PBR was associated with improved adherence to phototherapy guidelines in preterm infants without increased adverse events.