title: Impact of a transcutaneous bilirubinometry program on resource utilization and severe hyperbilirubinemia.
abstract: OBJECTIVE
  Our goal was to assess the impact of programmatic and coordinated use of transcutaneous bilirubinometry (TcB) on the incidence of severe neonatal hyperbilirubinemia and measures of laboratory, hospital, and nursing resource utilization.
  
  
  METHODS
  We compared the neonatal hyperbilirubinemia-related outcomes of 14 796 prospectively enrolled healthy infants ≥35 weeks gestation offered routine TcB measurements in both hospital and community settings by using locally validated nomograms relative to a historical cohort of 14 112 infants assessed by visual inspection alone.
  
  
  RESULTS
  There was a 54.9% reduction (odds ratio [OR]: 2.219 [95% confidence interval (CI): 1.543-3.193]; P < .0001) in the incidence of severe total serum bilirubin values (≥342 µmol/L; ≥20 mg/dL) after implementation of routine TcB measurements. TcB implementation was associated with reductions in the overall incidence of total serum bilirubin draws (134.4 vs 103.6 draws per 1000 live births, OR: 1.332 [95% CI: 1.226-1.446]; P < .0001) and overall phototherapy rate (5.27% vs 4.30%, OR: 1.241 [95% CI: 1.122-1.374]; P < .0001), a reduced age at readmission for phototherapy (104.3 ± 52.1 vs 88.9 ± 70.5 hours, P < .005), and duration of phototherapy readmission (24.8 ± 13.6 vs 23.2 ± 9.8 hours, P < .05). There were earlier (P < .01) and more frequent contacts with public health nurses (1.33 vs 1.66, P < .01) after introduction of the TcB program.
  
  
  CONCLUSIONS
  Integration of routine hospital and community TcB screening within a comprehensive public health nurse newborn follow-up program is associated with significant improvements in resource utilization and patient safety.
authors.affiliation: Department of Pediatrics, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada. wainer@ucalgary.ca
authors.forename: Stephen
authors.initials: S
authors.lastname: Wainer
authors.forename: Seema M
authors.initials: SM
authors.lastname: Parmar
authors.forename: Donna
authors.initials: D
authors.lastname: Allegro
authors.forename: Yacov
authors.initials: Y
authors.lastname: Rabi
authors.forename: Martha E
authors.initials: ME
authors.lastname: Lyon
mesh_terms: D001663:Bilirubin / Q000097:blood*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000175:diagnosis* / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D015997:Neonatal Screening; D010359:Patient Readmission; D010789:Phototherapy / Q000706:statistics & numerical data
chemical_list: D001663:Bilirubin