ABSTRACT
Background: Neonatal Jaundice is a common disorder worldwide. Early identification and proper management is needed to prevent the serious neurological complications associated with it. Objective: The aim of this study is to assess the predictive ability of a pre-discharge serum bilirubin measurement to screen for subsequent significant hyperbilirubinemia in the term and near-term newborn. Materials and Methods: This is a historic cohort study conducted at Makassed General Hospital during two periods of time: January 2011 till December 2011, versus January 2013 till December 2013. A bilirubin screening program, instituted in February 2012, called for a total serum bilirubin to be performed on every neonate before discharge regardless of whether clinical jaundice was observed. For non-jaundiced neonates, the nursery staff was encouraged to obtain the screening total serum bilirubin at the sametime they obtained the hospital-mandated newborn screen for inborn errors of metabolism. Bilirubin values were plotted on an hour-specific nomogram. This study compared mean total serum bilirubin and hospital readmission data for two different periods before and after implementing the program. Results: The study involved 1200 neonates: 601 in period one and 599 in period two. After initiating the program, the mean peak of total serum bilirubin fell from 14.76 mg/dl to 11.03 mg/dl. Also the rate of hospital readmission with a primary diagnosis of jaundice fell from 10% in period one to 1.8% in period two. Conclusion: A pre-discharge total serum bilirubin applied as a policy in hospitals would facilitate targeted intervention and follow-up for indirect hyperbilirubinemiaina safe, cost-effective manner.
ABSTRACT
OBJECTIVE To strengthen the management for visitors in the newborn nursery,in order to reduce the newborn hospital infection rate and enhance the hospital infection management quality in the newborn nursery.METHODS Taken the air and the object surface sampling in the newborn nursery,and the sampling derived from the hands of staff and visitors to undertake the contrast examination.RESULTS Before and after visits,the air pollution rate was over norm by increase of 58.3%,and after disinfection it declined 75.0%,after visiting,the object surface contamination rate was over norm by 56.3%,after disinfection it fell by 77.1%.Before washing-hands,the bacterial contamination rate of visitors and staff was over norm by respectively 100.0% and 68.3%,after washing,the passing rate of visitors was 92.0%,and no medical staff were over norm.CONCLUSIONS To adopt the effective management for visitors in the newborn nursery is very important to reduce the hospital infection rate in newborn nursery.
ABSTRACT
To assess the adequacy of medical manpower and medical fee for the newborn nursery care, the author visited 20 out of 24 hospitals with the pediatric training program in Youngnam area between July 29 and August 14, 1991. Total number of newborn, both normal and sick, admission and discharge in 1--30 June 1991 was obtained from the logbook of nursery. Head nurse and staff pediatrician of the nursery were interviewed to get the current staffing for the nursery and their subjective opinion on the adequacy of nursery manpower and the difficulties in recruiting manpower. Average medical fee charged for the maternity and normal newborn nursery care was obtained from the division of self-audit of medical insurance claim of each hospital. Average minimum requirement of nursing care time for one normal newborn per day was 179.5 (+/-58.6) minutes; 2023(+/-50.7) minutes for the university hospitals and 164.2(+/-60.5) minutes for the general hospitals. The ratio of minimum requirement of nursing care time and available nursing time was 1.42 on the average. Taking the additional requirement of nursing care for the sick newborns into consideration, the ratio was 2.06. The numbers of R. N. and A. N. in the nurserys of study hospitals were 31%, and 17%, respectively, of the nursing manpower for the nursery recommended by the American Academy of Pediatrics. These findings indicate that the nursing manpower in newborn nursery is in severe shortage. Ninety percent of the head nurses and 85% of the staff pediatrician stated that the newborn nursery is short of R.N. and 75% of them said that the nurse's aide is also short. Major reason for not recruiting R.N. was the financial constraint of hospital. For the recruitment of nurse's aide, short supply was the second most important reason next to the financial constraint. However, limit of quarter in T.O. was the major reason for the national university hospitals. Average total medical fee for the maternity and newborn nursery cares of a normal vaginal delivery who stayed two nights and three days at hospital was 219,430Won. Out of the total medical fee, 20,323Won(9.3%) was for the newborn nursery care. In case of C-section delivery six nights and seven days, who stayed otal medical fee was 732,578Won and out of the total fee 76,937Won (12.0%) was for the newborn care. Cost for a newborn care per day by cost accounting was 16,141Won for the tertiary care hospitals and 14,576Won for the all other hopitals. The ratio of cost and the fee schedule of the medical insurance for a newborn care per day was 5.0 for the tertiary care hospitals and 4.9 for the all other hospitals. Considering the current wage level of the medical personnel, capital investment for the hospital facilities and equipments, and the cost for hospital maintenance, it is hard to expect adequate quality care in the newborn nursery under the current medical insurance fee schedule.