title: Reduction of severe hyperbilirubinemia after institution of predischarge bilirubin screening.
abstract: OBJECTIVE
  The objective of this study was to demonstrate efficacy of universal predischarge neonatal bilirubin screening in reducing potentially dangerous hyperbilirubinemia in a large, diverse national population.
  
  
  METHODS
  This was a 5-year prospective study directed at neonates who were aged < or =28 days and evaluated at facilities of the Hospital Corporation of America with a serum bilirubin level of > or =20.0 mg/dL. This time frame includes periods before, during, and after the initiation of systemwide institution of a program of universal predischarge neonatal bilirubin screening. The primary outcome measures were serum bilirubin 25.0 to 29.9 and > or =30.0 mg/dL. Neonatal phototherapy use during these years was also analyzed.
  
  
  RESULTS
  Of the 1,028,817 infants who were born in 116 hospitals between May 1, 2004, and December 31, 2008, 129,345 were delivered before implementation and 899,472 infants were delivered after implementation of this screening program in their individual hospitals. With a program of universal screening, the incidence of infants with total bilirubin 25.0 to 29.9 mg/dL declined from 43 per 100,000 to 27 per 100,000, and the incidence of infants with total bilirubin of > or =30.0 mg/dL dropped from 9 per 100,000 to 3 per 100,000 (P = .0019 and P = .0051, respectively). This change was associated with a small but statistically significant increase in phototherapy use.
  
  
  CONCLUSIONS
  A comprehensive program of prevention, including universal predischarge neonatal bilirubin screening, significantly reduces the subsequent development of bilirubin levels that are known to place newborns at risk for bilirubin encephalopathy.
authors.affiliation: Hospital Corporation of America, Nashville, Tennessee, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Mah
authors.forename: Steven L
authors.initials: SL
authors.lastname: Clark
authors.forename: Efe
authors.initials: E
authors.lastname: Akhigbe
authors.forename: Jane
authors.initials: J
authors.lastname: Englebright
authors.forename: Donna K
authors.initials: DK
authors.lastname: Frye
authors.forename: Janet A
authors.initials: JA
authors.lastname: Meyers
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Perlin
authors.forename: Mitch
authors.initials: M
authors.lastname: Rodriguez
authors.forename: Arthur
authors.initials: A
authors.lastname: Shepard
mesh_terms: D001663:Bilirubin / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D008297:Male; D015997:Neonatal Screening; D010351:Patient Discharge; D010789:Phototherapy; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D014481:United States
chemical_list: D001663:Bilirubin