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Pediatría (Asunción)

On-line version ISSN 1683-9803


BENITEZ-LEITE, S; MESQUITA, M  and  MACCHI, ML. Management of neonatal hyperbilirubinemia by pediatricians providing immediate care of the newborn. Pediatr. (Asunción) [online]. 2005, vol.32, n.1, pp.23-31. ISSN 1683-9803.

Introduction: An increase in the number of cases of kernicterus in healthy exclusively breast fed neonates with no known risk factors for hyperbilirubinemia has been reported since 1990. Objective: to evaluate the knowledge of AAP guidelines for the management of hyperbilirubinemia in the full-term and nearly full-term newborn by clinical pediatricians, neonatologists and residents in training providing immediate care of newborn children. Material and methods: a poll was done in Asuncion and the metropolitan area of pediatricians and neonatologists providing immediate care of newborns, as well as residents in training in various centers in the metropolitan area during the month of August 2004, including doctors in hospital and in private practice. Results: 24.4% (31/127) were residents in training; 38.6% (49/127) reported having finished 2 or more years residency in neonatology. Most, 60% (75/127), had graduated 10 or fewer years previously and 41% (52/127) had graduated 10 or more years previously. Some questions were answered correctly by more than 80% of the population studied. These questions concerned the recommendation to continue breast feeding incase of jaundice without dehydration (92.1% 116/127), the age in hours as the best criterion to interpret bilirubinemia (Bna) (98.4% 120/127), and stopping phototherapy in neonates with jaundice but no hemolytic disease when bilirubin levels descend to 30% of the initial value (90.4% 104/127). Other questions were answered correctly by less than 80% of the population. These questions concerned the management of a neonate less than 24 hours old with a bilirubin of 5.5mg/dl (28% 34/123), follow-up of a healthy newborn with jaundice for 48-72 hours after discharge (57.5% 73/127), dosing total bilirubin alone rather than fractions (0.8% 1/126), considering that the first 4 days is the period of greatest risk of encephalopathy or severe hyperbilirubinemia (14.5% 18/124), recommending the use of green or blue fluorescent lights (33% 41/126), the correct meaning of intensive phototherapy (71% 87/122), considering total bilirubinemia alone to indicate phototherapy (19.4% 24/124), controling bilirubinemia 4-8 hours after intensive phototherapy (70% 85/121), interrupting phototherapy during feeding in conventional phototherapy (63% 79/125), knowing treatment options other than exsanguination/ transfusion and phototherapy for the treatment of hyperbilirubinemia (43% 35/124), knowing how to measure the dose of radiation (14% 17/124), knowledge of risk factors (12% 15/125), frequent feeding (8-12 times a day) to prevent hyperbilirubinemia (30% 37/124). Conclusion: AAP guidelines followed infrequently; there were no significant differences between pediatricians, neonatologists and according to the number of post-gradute years.

Keywords : Hyperbilirubinemia; newborn; management.

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