INADEQUATE ATTENTION GIVEN TO JAUNDICE IN HEALTHY TERM INFANTS DURING THE FIRST POSTPARTUM WEEK

Henry Bernstein¹, Cathie Spino², Stacia Finch³, Rebecca Stoltz¹, Ann Stark⁴, Heide Woo⁵ and Richard Wasserman⁶. ¹Medicine/General Pediatrics, Childrens Hospital/Harvard Medical School, Boston, MA; ²Ann Arbor, MI; ³Pediatric Research in Office Settings (PROS), Department of Practice and Research, Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, IL; ⁴Neonatology, Brigham and Womens Hospital/Harvard Medical School, Boston, MA; ⁵Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA and ⁶Pediatric Research in Office Settings (PROS), University of Vermont, Burlington, VT.

 

Background:  Hyperbilirubinemia is common during the neonatal period and may be exacerbated by difficulty with breastfeeding. Short hospital stays may limit timely detection, putting newborns at risk for kernicterus.

 

Objective:  To describe the attention mothers and pediatricians give to jaundice and breastfeeding during the first postpartum week. 

 

Design/Methods:  Pediatric Research in Office Settings (PROS) conducted a national prospective cohort study of mothers and their healthy term infants. Upon nursery discharge (d/c), mothers and pediatricians completed surveys assessing the d/c decision-making process, prenatal and in-hospital education, and follow-up plans. Data about jaundice, breastfeeding, and health care utilization were obtained from mothers daily for 14 days post d/c and from pediatrician at each office visit during the neonatal period.

 

Results:  Healthy term infants (n=4,306) and their mothers (41% primiparas) were enrolled. Of mothers who took prenatal classes, 42% and 80%, respectively, recalled discussions of jaundice and breastfeeding. Mothers reported talking about jaundice and breastfeeding, respectively, with pediatrician (54%, 46%), obstetrician (11%, 37%), or hospital staff (67%, 83%) while in hospital. At time of d/c (median lengths of stay 47 hours for vaginal and 75 hours for cesarean deliveries), most mothers (63%) planned to breastfeed, with the remainder using formula (25%) or both (12%). In the first 14 days post d/c, 35% of mothers reported at least 1 day of concern about jaundice, half within 48 hours of d/c. On day of infants d/c, 98% of physicians recommended, while only 76% of mothers recalled being asked, to schedule baby's first visit at a median of 7 days post d/c. Only 54% of first office visits actually occurred within 7 days post d/c. Pediatricians identified jaundice as a medical issue in 19% of these visits, almost all (96%) resulting in bilirubin being measured. Pediatricians were more likely to diagnose jaundice in breastfed infants (65% vs. 38%, X² p<. 001) and first time mothers (64% vs. 58%, X² p=. 08).

 

Conclusions:  Jaundice and breastfeeding are not optimally addressed with mothers. More education and earlier follow-up should improve detection of hyperbilirubinemia in healthy term infants to ensure safety and reduce the risk for kernicterus.