Early postpartum visits with pediatricians may help prevent a dangerous complication associated with jaundice

Early postpartum visits with pediatricians may help prevent a dangerous complication associated with jaundice, according to the presentation, “Inadequate Attention Given to Jaundice in Healthy Term Infants during the First Postpartum Week.”

The presentation, which is scheduled for the May 2004 Pediatric Academic Societies’ meeting in San Francisco, is based on the results of a study of more than 4,300 healthy newborns and their mothers nationwide.

The neonatal period is a critical time for mothers and families to be aware of common health concerns, including jaundice (a build-up of bilirubin in the blood), that often arise in their newborns. A majority of babies have some degree of jaundice during their first week of life as their bodies are just learning to remove bilirubin for themselves. This jaundice can also be made worse by difficulty with breastfeeding.

Gaps exist in the education of postpartum mothers regarding jaundice and the recommendations for timely follow-up, in order to monitor and identify those newborns that may develop elevated levels of bilirubin. Although virtually all pediatricians reported discussing follow-up plans with mothers in the hospital, only about 75 percent of mothers recalled being asked to schedule any follow-up visit.

Pediatricians suggested the baby’s first visit be around one week after hospital discharge. But only about half of these visits actually occurred within this recommended timeframe, which is after the expected peak of jaundice in newborns that usually occurs at three to five days of age. Moreover, among the visits that did take place, the pediatrician had concerns of jaundice in 1 of 5 newborns. These pediatricians were more likely to diagnose jaundice in newborns who were being breastfed and whose mothers were first-time parents.

“Earlier follow-up visits after postpartum discharge and enhanced parental education have the potential to improve detection of jaundice,” says presenter and lead author Henry H. Bernstein, D.O. “This is important because kernicterus – a rare but more acute form of jaundice in which too much bilirubin is in the bloodstream – can lead to permanent brain damage.” Dr. Bernstein is Associate Chief, Division of General Pediatrics at Children’s Hospital Boston.

The results are part of a larger study, “Life Around Newborn Discharge,” (LAND). LAND was conducted in Pediatric Research in Office Settings (PROS), the practice-based research network of the American Academy of Pediatrics. The study explores mothers’, pediatricians’ and obstetricians’ perceptions of whether or not both the mother and infant are ready for postpartum discharge at the time of discharge, and how readiness affects the health of both mother and baby, their health behaviors, and their use of the healthcare system during the four weeks post discharge.

The American Academy of Pediatrics is an organization of 57,000 primary care pediatricians, pediatric medical subspecialists and pediatric specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.