Delayed pediatric office follow-up of newborns after birth hospitalization.
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.
Profit
Jochen
J
Section of Neonatology, Department of Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA. profit@bcm.edu
Cambric-Hargrove
Alva J
AJ
Tittle
Kay O
KO
Pietz
Kenneth
K
Stark
Ann R
AR
D001663:Bilirubin / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000453:epidemiology* / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening; D009819:Office Visits / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000706:statistics & numerical data*; D010789:Phototherapy; D012307:Risk Factors; D055502:Secondary Prevention; D013781:Texas
D001663:Bilirubin