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  • Title: Nursery practices and detection of jaundice after newborn discharge.
    Author: Wiley CC, Lai N, Hill C, Burke G.
    Journal: Arch Pediatr Adolesc Med; 1998 Oct; 152(10):972-5. PubMed ID: 9790606.
    Abstract:
    OBJECTIVE: To investigate nursery practices regarding outpatient recognition of neonatal jaundice. DESIGN: Descriptive survey. PARTICIPANTS: Random sample of nursery head nurses and pediatricians from national lists. SETTING: Nurseries with more than 100 births per year and pediatricians responsible for newborn discharges. RESULTS: Head nurses from 204 nurseries and 200 pediatricians were surveyed, with 62% of head nurses and 55% of pediatricians responding. Almost half of the head nurses (45%) reported lack of a written neonatal jaundice protocol. Twenty-seven percent of head nurses and pediatricians reported that no system is in place to track jaundiced newborns after discharge. Forty percent of head nurses and 26% of pediatricians reported from higher-risk nurseries, defined as nurseries where more than 25% of mothers did not have a high school diploma or more than 50% of infants were born to single-parent families. These nurseries were no more likely to have a protocol for jaundice management or to use a system to track newborns after discharge. Discharge of most newborns before 36 hours of age was common (70% of head nurses, 62% of pediatricians) and some respondents discharged most newborns before 24 hours of age (16% of head nurses, 12% of pediatricians). For newborns discharged before 24 hours of age, more than half of the nurseries surveyed scheduled follow-up within 2 to 3 days (53% of head nurses, 62% of pediatricians). The likelihood of such follow-up did not differ by type of health care insurance, level of maternal education, percentage of single-parent families, predominance of minority patients, or higher risk as defined above. CONCLUSIONS: In our sample, many nurseries lack parent education, neonatal jaundice protocols, and neonatal jaundice tracking systems. Newborns discharged before 48 hours of age are often not scheduled to be seen by a health care provider within 2 to 3 days, despite American Academy of Pediatrics guidelines recommending such follow-up.
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