Evaluation of Discharge Management in the Prediction of Hyperbilirubinemia: The Jerusalem Experience

Objective: We evaluated our program for prediction and follow-up of hyperbilirubinemia in preventing plasma total bilirubin (PTB) ≥25 mg/dL and in limiting readmission for hyperbilirubinemia. Study design: Term and near-term neonates were screened before discharge for risk factors for hyperbilirubinemia. A PTB test was performed when visible jaundice was apparent. Formal postdischarge follow-up was integrated with a possibly unique religious/cultural support system complemented by ritual circumciser (mohel) home visits and a high rate of jaundice awareness in the community. Results: During 2001-2002, 18,079 term and near-term healthy neonates were cared for in our well baby nurseries. Three hundred forty-two (1.9%) were treated with phototherapy, and 4 with exchange transfusion. Seventy-four (21.6%) of these (0.41% of total) were readmitted for hyperbilirubinemia. Forty-two percent of those readmitted had not been regarded as sufficiently jaundiced to warrant a predischarge bilirubin determination. In only 1 neonate did the PTB exceed ≥25.0 mg/dL (0.006%). No infant had signs of bilirubin encephalopathy. Conclusions: Our practice was successful in keeping the number of readmitted neonates low and limiting those with extreme hyperbilirubinemia to the minimum. Local customs, rituals, and practices may be successfully adapted as adjuncts in the detection and prevention of hyperbilirubinemia.