Quality Metrics for the Management of Hyperbilirubinemia

The following are examples of non-validated quality metrics that could be used by individual providers, health care systems or multi-center quality improvement collaboratives to monitor adherence to the American Academy of Pediatrics guideline for the management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. These metrics reflect several key aspects of care for common clinical issues related to the management of hyperbilirubinemia. A subset of these metrics or entirely different metrics could also be selected.

David G. Bundy, MPH, MD served as the Implementation Scientist for the guideline and developed these metrics with support from the guideline subcommittee. Questions/comments should be directed here.

• Routine bilirubin testing for newborns discharged before 24 hours
  • Numerator: At least one total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) measure before discharge
  • Denominator: Newborns discharged at or before 24h after birth
• Routine bilirubin testing for newborns discharged after 24 hours
  • Numerator: At least one TSB or TcB measure between 24h and 48h after birth
  • Denominator: Newborns discharged after 24h after birth
• Appropriate TSB testing after TcB measure
  • Numerator: TSB measured
  • Denominator: Newborns with TcB within 3 mg/dL of the phototherapy treatment threshold or above
• TSB monitoring after inpatient intensive phototherapy initiation
  • Numerator: TSB within 12 hours of the start of phototherapy
  • Denominator: Hospitalized newborns receiving intensive phototherapy for a TSB concentration above the treatment threshold
• Providing phototherapy for elevated TSB
  • Numerator: Newborns treated with phototherapy
  • Denominator: Newborns exceeding the phototherapy threshold based on age in hours, gestational age, and neurotoxicity risk factors
• Avoiding unnecessary phototherapy
  • Numerator: Newborns not treated with phototherapy
  • Denominator: Newborns who never had a TSB higher than 3 mg/dL below the threshold based on age in hours, gestational age, and risk factors
• Escalation of care
  • Numerator: Receipt of IV hydration, emergent intensive phototherapy, and neonatologist consultation
  • Denominator: Newborns requiring escalation of care
• Evaluation for anemia for those requiring phototherapy
  • Numerator: Newborns in whom a hematocrit, hemoglobin concentration, or CBC was done
  • Denominator: Newborns receiving phototherapy for a TSB above the phototherapy threshold
• Family education
  • Numerator: Prior to discharge, family given information about jaundice, place and time of follow-up and birth hospital information (last TcB or TSB, age at which it was done, any DAT results)
  • Denominator: All newborns discharged at <7 days of age