A University of California, Riverside pediatrician helped evaluate how hospitals across North America adopted updated clinical guidelines for treating newborn jaundice, a common condition that affects most infants during their first days of life.
The findings add to a growing body of evidence showing that integrating updated clinical guidelines into hospital workflows — particularly through electronic health records — can improve consistency in care while avoiding unnecessary interventions for newborns.
Dr. Nancy Chung, a health sciences clinical associate professor of pediatrics in the UCR School of Medicine, participated in a national quality improvement project sponsored by the American Academy of Pediatrics (AAP) that focused on implementing updated practice guidelines for the management of hyperbilirubinemia in infants born at 35 weeks or more gestational age.
The collaborative initiative brought together hospitals, including Eisenhower Medical Center in Rancho Mirage, California, to implement the revised guidelines and identify strategies for providing evidence-based care while reducing unnecessary treatment. Chung is chair of the Department of Pediatrics at Eisenhower Medical Center.
Hyperbilirubinemia, commonly known as newborn jaundice, occurs when bilirubin, a yellowish waste product made when the body breaks down old red blood cells, accumulates in a baby’s bloodstream. Chung explained that most newborns experience some degree of jaundice because they are transitioning from fetal to adult hemoglobin and their immature livers are not yet able to process bilirubin as efficiently as older children and adults.
“The vast majority of babies tend to have bilirubin levels that are higher than adult standards,” Chung said. “It's mainly because of the transition from being inside the womb to outside the womb.”
Most cases resolve with monitoring and frequent feeding. When bilirubin levels rise too high, however, phototherapy is the standard treatment. The therapy uses specific wavelengths of light to convert bilirubin into forms the body can eliminate more easily, preventing potentially serious complications.
Although phototherapy is safe and highly effective, avoiding unnecessary treatment is also important, Chung said.
“When babies need phototherapy, they have to spend as much time as possible under the lights,” she said. “That separates them from their mom, interrupts skin-to-skin contact and breastfeeding, and sometimes means a longer hospital stay or even readmission.”
The study, published in the journal Pediatrics, examined how participating hospitals incorporated the AAP's updated recommendations into clinical practice. At Eisenhower Medical Center, one of the most significant changes was integrating the guidelines into the electronic medical record, giving clinicians immediate access to treatment thresholds and automated decision-support tools.
“The biggest thing was being able to incorporate the recommendations into the electronic medical record so clinicians could immediately compare a baby's bilirubin level with the treatment guidelines,” Chung said. “Once the system could perform those calculations automatically, it made decision-making much easier.”
The experience underscored how electronic clinical decision support can help hospitals adopt evidence-based practices more consistently.
“It made quite clear that incorporating changes into the electronic medical record, when possible, is incredibly helpful,” Chung said. “The graphics also make it much easier to explain what's happening to families.”
Chung emphasized that reducing unnecessary phototherapy does not mean compromising safety. Physicians continue to make treatment decisions based on each infant’s clinical condition, risk factors and access to appropriate follow-up care after discharge.
She said the project illustrates the value of ongoing quality improvement efforts that help healthcare systems keep pace with evolving medical evidence.
“We're pursuing quality,” Chung said. "We’re trying to provide the best care possible for our patients and make sure our management remains up to date. With so much new medical information available, it’s important to have systems that help us consistently provide the best available care.”
The title of the paper is “A National Quality Improvement Collaborative to Reduce Subthreshold Phototherapy for Jaundice.”
Header photo by Christian Bowen on Unsplash.
