Page 289 - 16Neonatal Jaundice_compressed

Appendix H: Evidence tables

Bibliographic details Study type & Patient characteristics Test, Reference Standard, Results Reviewers Comments
Evidence level Threshold for a positive test
Black = 39.1% own discretion (1993–95) Phase 4: 1:3198
Asian = 6.9% Phase 3: Phase 5: 1:11995
Hispanic = 4.5% universal TSB screening along with
post-discharge follow-up based on Number of readmissions
the hour-specific nomogram 14 per 1000 well-baby infants discharged in
Exclusion: (1996–98) 1994 to 5.5 per 1000 in 2001–2003.
low BW preterm babies admitted to Phase 4:
the well-baby nursery organised institutional systems- Results in babies (6 – 72 hours of age) with
babies admitted to and treated in the based management of newborn ABO incompatibility (n = 553)
intensive care nursery for any jaundice (1999–2000)
th
neonatal illness Phase 5: High risk zone or TSB > 95 centile (n = 55
impact of the complete approach or 9.9%)
assessed in 2001–2003.
Phototherapy: 54.5%
Under the systems-based approach Exchange Transfusion: 5.4%
all babies had pre-discharge Length of stay: 3.3 days
bilirubin estimation (TSB or TcB)
and follow-up care for jaundice th th
was given either at the hospital Intermediate risk zone or TSB 40 -74
(more than 85% cases) or at home centile (n = 233 or 42.1%)
within 24–48 hours of discharge.
Other components of the approach Phototherapy: 22.7%,
included lactation support services, Exchange Transfusion: 0%
counselling and information to Length of stay 2.6 days
parents on the clinical course and
th
rare risk of neurotoxicity, and close Low risk zone or TSB < 40 centile
follow-up of jaundiced babies (n = 265 or 48.0%)
based on their hour-specific
bilirubin levels. Phototherapy: 2.6%
A clinical evaluation for jaundice Exchange Transfusion: 0%
severity was mandatory for all length of stay: 2.36 days
babies at about the age of 4 days,
along with subsequent follow-up of
at-risk infants at age 7 days and
2 weeks.

Eggert LD; Study Type: Retrospective cohort study to Pre-discharge bilirubin screening Incidence of severe hyperbilirubinaemia Retrospective cohort study with
Retrospective cohort determine the effectiveness of a pre- programme started in December exclusion criteria not defined
Year: 2006 study discharge bilirubin screening 2002 to measure bilirubin levels in TSB levels ≥ 342 micromol/litre Baseline characteristics of the
programme instituted in December every baby either at the recognition Group 1 - 1:77 two groups not compared
Country: USA Evidence Level: II 2002. of jaundice or before discharge Group 2 - 1:142 Confounding variables not
from hospital. P < 0.0001 adjusted
48 Two hospitals used TcB (BiliChek)
All babies delivered at = 35 weeks of levels while others used TSB. TSB levels ≥ 428 micromol/litre
gestation within a private healthcare Bilirubin levels plotted on the hour- Group 1 - 1:1522
organisation involving 18 hospitals specific nomogram and Group 2 - 1:4037
during two time periods: levels = 40 centile notified to the P < 0.005
th
relevant healthcare provider and

217