The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #61388

Petra Liljestrand, PhD¹, Thomas B. Newman, MD², and Gabriel J. Escobar, MD¹. (1) Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, 510-891-3476, petral@itsa.ucsf.edu, (2) Dept of Epidemiology and Biostatistics, University of California, San Francisco, Box 0560, San Francisco, CA 94143

Jaundice is one of the most common and potentially serious conditions affecting newborns in the first two weeks of life. Fifty years ago, severe brain damage from jaundice occurred frequently, but decreased over time as the problem became more recognized. Three decades ago when post-partum stays averaged four days, recognition of jaundice was primarily the responsibility of nursery staff. With shorter hospital stays responsibility has shifted to parents and outpatient providers, possibly resulting in more severe jaundice before identification and treatment (e.g., phototherapy, exchange transfusions). The American Academy of Pediatrics, as a result of increasing concerns, is currently updating clinical guidelines for treatment and prevention. Our paper will review the etiology and epidemiology of jaundice, and the clinical guidelines, in order to strengthen and broaden the knowledge base among public health professionals. We will also present data from our research on jaundice, in particular on an index based on history (e.g., gestational age, race, sex, maternal age) and physical examination that predicts the risk of neonatal jaundice. The risk index is the result of a retrospective cohort study of jaundiced newborns in the Northern California Kaiser Permanente Medical Care Program. Using c, the area under the ROC curve, the risk index showed a strong correlation between risk group and subsequent jaundice levels (c=.834, P<0.001). We believe the clinical guidelines and risk index, along with visual assessment, are useful tools for public health practitioners or policy makers involved in the outpatient care of newborns.

Learning Objectives:

At the conclusion of this session,participants will:
• Be familiar with existing clinical guidelines for treating and preventing neonatal jaundice.
• Have learned to identify the risks for neonatal jaundice.
• Developed knowledge about the etiology and epidemiology of neonatal jaundice.

Keywords: Infant Health, Public Health Nursing

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.