Survey of Management of Neonatal Jaundice by Medical Practitioner Type in Ontario: Are We Following Guidelines?

Abstract

Background: Hyperbilirubinemia continues to be the most common cause of neonatal readmission to hospitals in North America and kernicterus has been reported in healthy near-term and term infants with no apparent risk factors. In response to concerns about neonatal hyperbilirubinemia, the Canadian Paediatric Society (CPS) published a statement in June 2007 to promote good practice in the screening and management of hyperbilirubinemia. The guidelines indicate that all neonates need measurement of their serum total bilirubin during the first three days of life. Clearer guidelines for phototherapy and follow up were also outlined. It is important to assess knowledge translation and assess the extent to which the CPS guidelines are known and practiced. Objective: To determine current practices among medical practitioners in Ontario in the screening for and management of neonatal hyperbilirubinemia. Design/Methods: A cross-sectional survey of medical practitioners in Ontario involved in the care of healthy newborns in the immediate neonatal period was completed. Within Ontario there are 4844 general practitioners, 5716 family medicine physicians and 1042 pediatricians. Five hundred participants were randomly selected from each group of family medicine physicians and pediatricians. In Ontario there are 390 midwives, thus all midwives were included. An anonymized questionnaire, developed by our group, was sent out via postal service and electronic mail using Survey Monkey to the selected sample of practitioners. Results: See Table (Table presented) Conclusions: In our sample there was considerable variation in practice among the various practitioner types. Pediatricians were more aware of the guidelines and were more likely to follow them. Increased efforts are required to promote knowledge translation of CPS guidelines across all practitioner types but particularly among the family medicine group.