ผล ของ การ ใช้ แนว ทาง ปฏิบัติ ใน การดูแลรักษาทารกที่มีภาวะตัวเหลืองต่ออัตราการกลับเข้ามารักษาในโรงพยาบาล ภาวะตัวเหลืองอย่างรุนแรงและค่าใช้จ่ายของโรงพยาบาล

Abstract

Neonatal hyperbilirubinemia is one of the most common causes of readmission within the first month of  age. Clinical Practice Guideline (CPG) for neonatal hyperbilirubinemia will help physicians to treat and to followup the infants with hyperbilirubinemia properly. Objective: To evaluate the effect of using the CPG for neonatalhyperbilirubinemia on the rate of readmission rate of severe hyperbilirubinemia and hospital charges per 1,000 livebirths. Methodology: A historical cohort study was conducted in the newborn infants born at Phramongkutklao Hospital  between June 11st and December 11st 2007. We enrolled the infants who had gestational age and birth weight more than 35 weeks and 2,000 grams respectively. Serum bilirubin levels were measured in infants who developed jaundice. The decision to start treatment and follow-up the infants were based on the CPG. We compared the rate of  readmission severe hyperbilirubinemia and hospital charges between after and before using the CPG (January-December, 2006). Statistical analysis: We compared the continuous and categorical data between before and afterusing  the CPG by using unpaired t-test and Z-test (proportion test) respectively. Results: There were 1,067 newborninfants  enrolled into the group of using the CPG. The mean gestational age and birth weight were 38.41 ± 1.30 weeksand 3,083.27 ± 391.54 grams respectively. Eight hundred thirty-seven (78.44%) infants were followed-up after hospitaldischarge. Sixty- six (6.19%) of infants were readmitted to the hospital due to neonatal jaundice. Breast feeding jaundice was the most common  cause of readmission. When we compared the data between before and after using the CPG the rate of severey perbilirubinemia and hospital charges per 1,000 live births significantly increased. Conclusions: The  use of  the CPG improved the rate of follow-up after discharge and increased the chance to detectsevere hyperbilirubinemia. The consequence is increasing the hospital charges per 1,000 live births. We suggestthat the CPG should be  used together with providing good support for mothers who have problems of breast feeding. With these strategies we can prevent neonatal hyperbilirubinemia from inadequate breast feeding and there fore reduce the rate of  severe  hyperbilirubinemia and hospital charges.