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Extreme hyperbilirubinemia and rescue exchange transfusion in California from 2007 to 2012

Journal of Perinatology volume 36, pages 853–857 (2016)Cite this article

Subjects

Abstract

Objective:

To evaluate the impact of statewide learning collaboratives that used national guidelines to manage jaundice on the serial prevalence of extreme hyperbilirubinemia (EHB, total bilirubin ⩾25 mg dl−1) and exchange transfusions introduced in California Perinatal Quality Care Collaborative (CPQCC) hospitals in 2007.

Study Design:

Adverse outcomes were retrieved from statewide databases on re-admissions for live births ⩾35 weeks’ gestation (2007 to 2012) in diverse CPQCC hospitals. Individual and cumulative select perinatal risk factors and frequencies were the outcomes measures.

Results:

For 3 172 762 babies (2007 to 2012), 92.5% were ⩾35 weeks’ gestation. Statewide EHB and exchange rates decreased from 28.2 to 15.3 and 3.6 to 1.9 per 100 000 live births, respectively. From 2007 to 2012, the trends for TB>25 mg dl−1 rates were −0.92 per 100 000 live births per year (95% CI: −3.71 to 1.87, P=0.41 and R2=0.17).

Conclusion:

National guidelines complemented by statewide learning collaboratives can decrease or modify outcomes among all birth facilities and impact clinical practice behavior.

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Acknowledgements

We are thankful for the thoughtful and deliberate translation of the 2004 AAP Practice Guideline by the California-based authoring taskforce to develop a CPQCC website: ‘Severe Neonatal Hyperbilirubinemia Toolkit’ and conduct statewide initiatives. We are also indebted to the meticulous attention of CPQCC member institutions who have voluntarily retrieved, reviewed, reported and audited their respective institutional data to the CPQCC website. YK was supported in part by the NIH T32 HD007249 and the Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.

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Authors and Affiliations

  1. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA

    V K Bhutani, N F Meng, Y Knauer, R J Wong, D K Stevenson & J B Gould

  2. Health Information Solutions, Rocklin, CA, USA

    B H Danielsen

  3. California Perinatal Quality Care Collaborative, Stanford, CA, USA,

    J B Gould

Authors
  1. V K Bhutani
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  2. N F Meng
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  3. Y Knauer
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  4. B H Danielsen
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  6. D K Stevenson
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  7. J B Gould
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Corresponding author

Correspondence to V K Bhutani.

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Bhutani, V., Meng, N., Knauer, Y. et al. Extreme hyperbilirubinemia and rescue exchange transfusion in California from 2007 to 2012. J Perinatol 36, 853–857 (2016). https://doi.org/10.1038/jp.2016.106

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