'Halving the heel pricks': evaluation of a neonatal jaundice protocol incorporating the use of a transcutaneous bilirubinometer.
OBJECTIVE
This study aimed to assess the impact of implementing a new jaundice protocol incorporating the use of the Konica Minolta/Air Shields JM 103 Jaundice Meter (JM103) (Konica Minolta Sensing Inc., Osaka, Japan) in the setting of an Australian post-natal ward.


METHODS
A before-and-after study was completed following the introduction of a protocol integrating the use of the JM103 monitor on to the post-natal ward. Eligible infants were ≥ 36 weeks gestation, > 24 h and < 8 days of age. The number of Total Serum Bilirubin tests (TSBRs) were compared for the 12 months prior (T1) with a 6-month period and 6 months after protocol introduction (T2). Transcutaneous bilirubin (TcBR) results were also collected in T2. Rates of phototherapy and peak TSBRs at commencement were also compared as measures of safety.


RESULTS
Four hundred and twenty-six of the 2197 live births in T1 required one or more TSBRs compared with 119 of the 1169 live births in T2. This represents an odds ratio of 0.47 (95% confidence interval 0.38-0.58) for infants in T2 having ≥ 1 TSBR compared with T1. There was no difference between the groups for rates of phototherapy (3.8% vs. 3.0%; P= 0.2) nor any difference between the groups for peak SBR during phototherapy (301.9 µmol/L (standard deviation, SD 58) for T1 vs. 303.2 µmol/L (SD 54) for T2; P= 0.45). The estimated cost saving per year is $6966.00.


CONCLUSIONS
TcBR measurement in conjunction with our protocol significantly reduces painful procedures and costs without increasing the risk of delaying treatment with phototherapy.
Hartshorn
David
D
Department of Paediatrics, Gosford District Hospital, Northern Sydney Central Coast Area Health Service, Gosford, Australia.
Buckmaster
Adam
A
D001663:Bilirubin / Q000097:blood*; D019937:Diagnostic Techniques and Procedures / Q000191:economics / Q000295:instrumentation* / Q000706:statistics & numerical data*; D005260:Female; D006365:Heel; D006801:Humans; D007223:Infant; D007565:Jaundice / Q000175:diagnosis*; D008297:Male; D009517:New South Wales; D010789:Phototherapy / Q000706:statistics & numerical data
D001663:Bilirubin