Resident SSM Cardinal Glennon Children's Medical Center High Ridge, Missouri, United States
Background: Informed guidelines for hyperbilirubinemia are important in preventing severe hyperbilirubinemia, which can cause kernicterus. In 2022, new clinical practice guidelines were published on the prevention and treatment of hyperbilirubinemia in infants >35 weeks of age. One of the changes includes increased thresholds to initiate phototherapy, with the new thresholds based on gestational age without neurotoxicity risk factors separate from threshold for gestational age with neurotoxicity risk factors. To improve implementation of these new guidelines in our hospital, we provided physician education through academic conferences, local clinical practice guideline revisions and publishing an article in our monthly hospital newsletter. Objective: To assess the impact of physician education on implementation of new 2022 Clinical Practice Guidelines of Management of Hyperbilirubinemia from AAP towards reducing sub-threshold phototherapy use. Design/Methods: A retrospective chart review was performed of all infants >35 weeks of age admitted to the nursery, general medicine inpatient service, and Neonatal Intensive Care Unit (NICU) from February 2022 to January 2023 (pre-implementation). Data extracted from the electronic medical record included demographics (sex, ethnicity); birth history (gestational age, delivery method, birth weight); serum total bilirubin levels prior to phototherapy, prior to discontinuation of phototherapy and ‘rebound’ levels. Physician education efforts began in April 2023 which included implementation of new clinical practice guidelines which was published on institution websites and physician workrooms, academic conferences, and publishing a hospital newsletter article. Review of preliminary data will include analysis of outcomes including mean percentage of sub-threshold therapy use before (pre-implementation) and after (post-implementation) completing education and implementation of new guidelines and strategies for continuous education. Due to the nature of this project, a full IRB review was submitted and approved prior to data review and analysis.
