Reduction of severe hyperbilirubinemia after institution of predischarge bilirubin screening.

OBJECTIVE: The objective of this study was to demonstrate efficacy of universal predischarge neonatal bilirubin screening in reducing potentially dangerous hyperbilirubinemia in a large, diverse national population. METHODS: This was a 5-year prospective study directed at neonates who were aged < or =28 days and evaluated at facilities of the Hospital Corporation of America with a serum bilirubin level of > or =20.0 mg/dL. This time frame includes periods before, during, and after the initiation of systemwide institution of a program of universal predischarge neonatal bilirubin screening. The primary outcome measures were serum bilirubin 25.0 to 29.9 and > or =30.0 mg/dL. Neonatal phototherapy use during these years was also analyzed. RESULTS: Of the 1,028,817 infants who were born in 116 hospitals between May 1, 2004, and December 31, 2008, 129,345 were delivered before implementation and 899,472 infants were delivered after implementation of this screening program in their individual hospitals. With a program of universal screening, the incidence of infants with total bilirubin 25.0 to 29.9 mg/dL declined from 43 per 100,000 to 27 per 100,000, and the incidence of infants with total bilirubin of > or =30.0 mg/dL dropped from 9 per 100,000 to 3 per 100,000 (P = .0019 and P = .0051, respectively). This change was associated with a small but statistically significant increase in phototherapy use. CONCLUSIONS: A comprehensive program of prevention, including universal predischarge neonatal bilirubin screening, significantly reduces the subsequent development of bilirubin levels that are known to place newborns at risk for bilirubin encephalopathy.

Pancreatic pseudocystwith stent placement in the background of narcotic use: a case report.

A 49 year old gentleman presents with recurrent abdominal pain. The patient has a known history of chronic pancreatitis, alcoholism and narcotic addiction. Work-up, including computed tomography (CT) of the abdomen, demonstrated a 5.6 x 5.8 cm fluid collection contiguous with the pancreas. This was not seen on CT 18 months earlier. The patient's pain did not improve with bowel rest and pain control. He was transferred to another institution for endoscopic placement of a transgastric pancreatic stent. The procedure decreased the size the cyst and the patient's pain became more manageable.