Neonatal hyperbilirubinemia management: a model for change

Currently, active public health surveillance of hyperbilirubinemia and kernicterus is lacking. Recently, the Hospital Corporation of America (HCA), a private health care system with an estimated quarter of a million births annually, instituted recommendations to provide universal hyperbilirubinemia screening before discharge for all infants born within their system. Over 98% of the infants born at HCA hospitals were screened within the first year of the recommendations. From May to December 2004, 13 infants were identified with total serum bilirubin (TSB) ⩾30 mg per 100 ml, but that number was reduced in 2006, with only seven infants born in HCA hospitals developing a TSB of ⩾30 mg per 100 ml. This program provides a model for actively monitoring the occurrence of hyperbilirubinemia and for tracking its occurrence, thus improving health care quality for patients while collecting important public health information.