Evaluation and management of newborn jaundice by midwest family physicians

BACKGROUND. Recognition and management of newborn jaundice is controversial and even more challenging with the early discharge of newborns. The purpos e of this study was to describe the jaundice management patterns of family physicians in Minnesota and Wisconsin and compare them with American Academ y of Pediatrics recommendations. METHODS. Forty-two members of the Practice-Based Research Group of the Wisc onsin Research Network and of the Minnesota Academy of Family Physicians Re search Network recorded information on study cards about the care they prov ided to healthy full-term newborns for 6 months. RESULTS. Data was collected on 335 infants, 30% of whom were jaundiced. Phy sicians ordered limited laboratory testing on selected jaundiced infants. I nfants with jaundice were more frequently breast-fed, and had longer hospit al stays. Jaundice was commonly managed by phototherapy (17%), home sunligh t (28%), and increased breast-feeding (44%). Twenty-six percent of the phys icians used a formal phototherapy guideline. The timing of the first follow up visit did not differ for infants discharged before or after 48 hours of age. CONCLUSIONS. Family physicians identified and managed newborn jaundice rela tively infrequently in our study. Their practice patterns were consistent w ith most aspects of the American Academy of Pediatrics jaundice guideline, although few of them used it to guide phototherapy use. The study physician s did not generally follow recommendations for follow-up of infants dischar ged early. Until a large-scale clinical trial of newborn jaundice managemen t is performed, a variety of practices should continue to be acceptable.