Strides towards less invasive jaundice testing

In July 2004, the American Academy of Pediatrics (AAP) developed the Clinical Practice Guideline on Hyperbilirubinemia framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. Within these guidelines, the AAP requires that clinicians perform a systematic assessment of all infants before discharge for the risk of severe hyperbilirubinemia. All hospital nurseries in the US are now required to establish protocols for assessing this risk.

For certain infants at higher risk, additional follow-up assessments are necessary. Data secured from infants both at risk and at no risk will contribute to identifying the magnitude of the jaundice problem and may help to develop proper interventional treatments for jaundice.

Jaundice screening policy for consistent diagnose and safety Clinicians at St. Mary’s Health Center of Richmond Heights, Missouri (USA) recognized that due to increasingly short hospital stays for newborns and their mothers and the increase in breast feeding, the need for identifying babies at high risk for hyperbilirubinemia/ kernicterus was increasing. With more than 2,600 births at St. Mary’s each year, the hospital staff wanted to develop an approach that adequately screened for “at risk” infants, yet was cost-effective.

In light of the AAP requirements, and the fact that visual inspection was the primary method being used at St. Mary’s for jaundice screening, the hospital determined that a more structured, less subjective system was needed. A jaundice screening policy that ensured consistency in diagnoses and safety throughout the entire perinatal center was implemented.

The AAP guideline poses an increased cost to healthcare facilities as a result of having to assess all infants (as opposed to only those infants with jaundice symptoms) for the risk of developing severe hyperbilirubinemia. The best methods for assessing this risk are to measure either the serum bilirubin or transcutaneous bilirubin. Drawing a serum bilirubin on all infants is not only expensive, but is also a painful procedure for the newborn. The cost of transcutaneous bilirubin screening can vary, as some jaundice meters have disposable parts that cost a great deal more than the initial investment in the meter. With these meters, each test performed requires that a new tip be used for the reading.

Simple screening by gently pressing

Balancing cost considerations with concern for precision and accuracy, SSM St. Mary’s Health Center purchased a Konica Minolta Dräger Medical Air-Shields JM-103 Jaundice Meter® (JM-103). The JM-103 is a non-invasive screening device that assists in the management of neonatal jaundice by using transcutaneous measuring technology to estimate the level of bilirubin in blood. Screening is as simple as placing the measuring probe on the baby’s chest (or forehead) and pressing gently. To take another measurement, the nurse simply cleans the probe with an alcohol swab, and presses the reset button. In a few minutes’ time, nurses can test all babies being discharged on a particular day.

Increase objective risk assessment

Implementation of the jaundice assessment policy with the reusable JM- 103 device as the primary screening tool has enabled St. Mary’s to increase objective risk assessment for hyperbilirubinemia prior to discharge from 20 percent to 100 percent in just four months. About 25 percent of the babies screened with the JM-103 have significant enough levels to warrant a serum bilirubin measurement. Infants requiring hospital phototherapy, home phototherapy, or early follow-up are quickly identified, and unanticipated emergency re-admission for jaundice treatment is avoided.

About Dräger Medical:

Dräger Medical AG & Co. KG is one of the world's leading manufacturers of medical devices, the largest division of Drägerwerk AG (history dates back to 1889) and a 65:35 joint venture company between Drägerwerk AG and Siemens AG. The global Company offers products, services and integrated CareArea™ Solutions throughout the patient care process – Emergency Care, Perioperative Care, Critical Care, Perinatal Care and Home Care. With headquarters in Lübeck, Germany, Dräger Medical employs nearly 6,000 people worldwide.