Document Detail

Neonatal cholestasis: opportunities to increase early detection.
MedLine Citation:
PMID:  22634076     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To describe primary care management of early and prolonged jaundice in otherwise-healthy term infants to identify opportunities to increase early diagnosis of cholestasis.
METHODS: Community-based pediatricians in St Louis, Missouri completed a mailed, anonymous, 29-item survey to assess practice demographics, timing of routine newborn office visits, and the management of early and prolonged neonatal jaundice.
RESULTS: A total of 108 of 230 (47%) of eligible physicians responded (mean years in practice, 15.3, SD, 9.4). More respondents were very familiar with national guidelines for management of early (49%) than prolonged (16%) neonatal jaundice. Eighty-six percent reported all newborns were checked with transcutaneous bilirubin before hospital discharge. For transcutaneous bilirubin results at 48 hours of 7, 10, 12 and 15 mg/dL, 1%, 26%, 70%, and 74% of respondents, respectively, would order a fractionated bilirubin. Although the first routine visit usually occurred in the first week after discharge, 25% of physicians reported the 2nd visit was routinely scheduled after 4 weeks of age. Ninety-four percent reported they would obtain a fractionated bilirubin for infants jaundiced beyond 4 weeks of age. If cholestasis was identified at 6 weeks of age, 32% would obtain additional testing without referral to a subspecialist.
CONCLUSIONS: Management of early and prolonged neonatal jaundice is variable. Current practices appear to miss opportunities for early diagnosis of cholestasis and referral that are unlikely to be addressed without redesigning systems of care.
Joseph J Palermo; Shannon Joerger; Yumirle Turmelle; Peter Putnam; Jane Garbutt
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-05-26
Journal Detail:
Title:  Academic pediatrics     Volume:  12     ISSN:  1876-2867     ISO Abbreviation:  Acad Pediatr     Publication Date:    2012 Jul-Aug
Date Detail:
Created Date:  2012-07-16     Completed Date:  2012-12-21     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  101499145     Medline TA:  Acad Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  283-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Biliary Atresia / diagnosis
Cholestasis / diagnosis*
Disease Management
Early Diagnosis
Guideline Adherence / statistics & numerical data
Hyperbilirubinemia, Neonatal / therapy*
Infant, Newborn
Jaundice, Neonatal / therapy*
Kernicterus / prevention & control
Middle Aged
Pediatrics / methods
Physician's Practice Patterns / statistics & numerical data*
Physicians / statistics & numerical data
Grant Support
2 U01 DK062452-0809/DK/NIDDK NIH HHS; U01 DK062452-10/DK/NIDDK NIH HHS; UL1 RR024992/RR/NCRR NIH HHS; UL1 RR024992/RR/NCRR NIH HHS; UL1 RR024992-04/RR/NCRR NIH HHS

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