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Children's Health

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First-week followup of newborns after hospital discharge is critical to prevent severe jaundice and other problems

Severe jaundice (hyperbilirubinemia) among newborns is becoming more prevalent, which some attribute to earlier discharge of newborns and lack of early discharge followup by a physician or home health nurse. The July 2004 American Academy of Pediatrics guideline on managing newborn jaundice recommends that all infants be examined in the first few days after discharge (when bilirubin levels peak and jaundice can be diagnosed). Unfortunately, many barriers prevent timely newborn followup, notes R. Heather Palmer, M.B., B.Ch., S.M., of the Harvard School of Public Health.

In a study that was supported by the Agency for Healthcare Research and Quality (HS09782), Dr. Palmer and her colleagues identified three major barriers to early newborn followup and strategies for overcoming them from focus group discussions among physicians and nurses and among parents in 2001. All groups noted barriers in communication and information, systems and processes of care, and parental knowledge and education. For instance, conflicting information was often given to the mother by pediatricians and obstetricians about infant readiness for discharge, communication gaps occurred during "hand-offs" between hospital and community-based providers, and outpatient bilirubin testing and reporting were often delayed.

Home care nurses often had trouble reaching the responsible clinician, and community-based providers often didn't have key information needed to evaluate newborns after discharge, such as exact time of birth, gestational age, and hospital test results. Doctors and nurses recommended using E-mail to notify community-based providers that the baby was born and to provide them with quick access to lab results. They also suggested encouraging parents to choose a pediatrician prior to discharge, giving parents a list of "early warning signs" to report, providing a call-in number for questions, and initiating followup calls from the nursery to the mother.

See "Barriers to first-week follow-up of newborns: Findings from parent and clinician focus groups," by Susanne Salem-Schatz, Sc.D., Laura E. Peterson, B.S.N., S.M., Dr. Palmer, and others, in the November 2004 Joint Commission Journal on Quality and Safety 30(11), pp. 593-601.

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