Management of neonatal hyperbilirubinemia: pediatricians' practices and educational needs.
Management of neonatal hyperbilirubinemia: pediatricians' practices and educational needs.
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DOI：
10.1186/1471-2431-6-6
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发表时间：
2006-03-06
期刊：
影响因子：
2.4
通讯作者：
Hegyi, Thomas
中科院分区：
文献类型：
--
作者：
Petrova, Anna;Mehta, Rajeev;Hegyi, Thomas
背景：新生儿高胆红素血症的早期发现和治疗对于预防胆红素脑病非常重要。在这项研究中，我们评估了新泽西州儿科医生对新生儿高胆红素血症管理的实践和信念，以及他们对美国儿科学会（AAP）1994年建议的依从性。调查问卷邮寄给随机抽样的800名儿科医生，他们是从1623名新泽西AAP研究员中选出的，最初是在2003年10月，2004年2月，对未作答复的人进行了调查。除了医生的人口统计学特征，调查问卷解决了新生儿高胆红素血症管理的各个方面，包括诊断，治疗和后续行动，以及儿科医生的信念的重要性的危险因素在发展中的严重hyperglycerubinemia.RESULTS：调整后的反应率为49.1%（n = 356），计算出725个合格的受访者。总的来说，执业儿科医生报告了黄疸头尾向进展的高利用率（77.9%）和经皮胆红素测定的低利用率（16.1%），以量化黄疸的严重程度。大多数（87.4%）的受访者认为黄疸是新生儿出院前血清胆红素（TSB）检测的指标，而出院后，只有57.7%的受访者认为TSB是必要的（P < 0.01）。如果新生儿的年龄在72小时以下，不到三分之一的受访者报告开始光疗的TSB水平低于1994年AAP推荐的治疗参数，而如果婴儿超过72小时，几乎60%的开始光疗的TSB低于1994年AAP指南。大多数受访者不认为出院后和胎龄37-38周的新生儿黄疸在严重高胆红素血症的发展中具有重要意义。然而，大多数人确实认识到在最初24小时内出现黄疸和Rh/ABO血型不合的重要性。儿科医生关于出院后黄疸量化的实验室诊断利用率低和低估导致严重高胆红素血症发展的风险因素的做法与以低于AAP推荐的治疗参数开始光疗相关，认识到新生儿高胆红素血症是重要的公共卫生问题。
BACKGROUND: Early detection and treatment of neonatal hyperbilirubinemia is important in the prevention of bilirubin-induced encephalopathy. In this study, we evaluated the New Jersey pediatricians' practices and beliefs regarding the management of neonatal hyperbilirubinemia and their compliance with the recommendations made by the American Academy of Pediatrics (AAP) in 1994.METHODS: A survey questionnaire was mailed to a random sample of 800 pediatricians selected from a list of 1623 New Jersey Fellows of the AAP initially in October 2003 and then in February 2004 for the non-respondents. In addition to the physicians' demographic characteristics, the questionnaire addressed various aspects of neonatal hyperbilirubinemia management including the diagnosis, treatment, and follow up as well as the pediatricians' beliefs regarding the significance of risk factors in the development of severe hyperbilirubinemia.RESULTS: The adjusted response rate of 49.1% (n = 356) was calculated from the 725 eligible respondents. Overall, the practicing pediatricians reported high utilization (77.9%) of the cephalocaudal progression of jaundice and low utilization (16.1%) of transcutaneous bilirubinometry for the quantification of the severity of jaundice. Most of the respondents (87.4%) identified jaundice as an indicator for serum bilirubin (TSB) testing prior to the neonate's discharge from hospital, whereas post-discharge, only 57.7% felt that a TSB was indicated (P < 0.01). If the neonate's age was under 72 hours, less than one-third of the respondents reported initiation of phototherapy at TSB levels lower than the treatment parameters recommended by the AAP in 1994, whereas if the infant was more than 72 hours old, almost 60% were initiating phototherapy at TSB lower than the 1994 AAP guidelines. Most respondents did not regard neonatal jaundice noted after discharge and gestational ages 37-38 weeks as being significant in the development of severe hyperbilirubinemia. However, the majority did recognize the importance of jaundice presenting within the first 24 hours and Rh/ABO incompatibility.CONCLUSION: The pediatricians' practices regarding the low utilization of laboratory diagnosis for the quantification of jaundice after discharge and underestimation of risk factors that contribute to the development of severe hyperbilirubinemia are associated with initiation of phototherapy at lower than AAP recommended treatment parameters and recognition of neonatal hyperbilirubinemia as an important public health concern.