Background Neonatal hyperbilirubinemia is a common cause for neonatal admission in term and preterm infants. These infants are primarily managed on postnatal wards; however, they require admission to neonatal unit due to jaundice above the exchange level, rapidly increasing bilirubin levels, pathological jaundice or sepsis.
Failure to initiate and establish adequate breastfeeding can play an important role in development of severe jaundice. Face-to-face professional support has been shown to increase breastfeeding success.
Objectives The objectives of this project included evaluation of the management of infants admitted to neonatal unit with jaundice including the feeding practices; and identifying the areas of improvement to reduce admissions.
Methods This was a retrospective observational project including infants born at ≥ 35 weeks admitted to neonatal unit at District Hospital with a diagnosis of jaundice from January 1, 2017 to December 2018. Data was collected using proforma, medical records and blood results on computer system.
Results A total of 519 infants ≥ 35 weeks were admitted to the neonatal unit of which 12%(60) infants were admitted due to jaundice. 42%(25) were preterm and 58%(35) were term infants.
The risk factors for jaundice were identified as male infant (66%), first born (49%), gestation, prematurity, and breast fed babies.
The mean birth weight was 2892.5 grams and 20%(12) were low birth weight. 35%(21) infants were admitted from home (average 3.9 days) and 65%(39) from postnatal wards.
27%(16) infants had jaundice <24 hours. 6 infants had > 10% weight loss on admission. DAT was positive in 23%(14) infants of which 8 infants presented <24 hours.
Sepsis was suspected in 72% (43) infants but was proven in none.
Only 20%(12) received lactation support on the postnatal ward prior to admission whereas 43%(26) did not receive any support. 36 infants were exclusively breastfed, 13 were formula fed and 11 were mixed-fed. After admission, formula feeds were added to 32 infants while 4 infants exclusively breast fed. 10 infants were given intravenous fluids.
The causes of jaundice included prematurity(25), ABO incompatibility(11), Rh incompatibility(3), poor feeding or exaggerated jaundice(25).
33 infants had bilirubin above exchange line, and required a mean of 24 hours (range 6- 144 hours) of phototherapy. None of them required immunoglobulins or exchange transfusion.
The mean length of stay was 3 days (range 1–14 days) and there was a remarkable decrease in breast feeding as only 7(11.6%) infants were breast fed on discharge.
Conclusions There is a scope to decrease the admissions due to jaundice by optimising the postnatal support on the postnatal wards and community in the presence of risk factors.
Transitional care for late preterm infants is important to reduce admission to the neonatal unit thereby reducing the separation of mother and baby.
The opportunities to support breast feeding on postnatal ward and neonatal unit are often missed.
Effective measures should be taken to promote lactation support at all levels.
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