Evaluating the Phototherapy Practice and Adherence to Guideline in Managing Neonatal Hyperbilirubinemia in an Indonesian Tertiary Referral Hospital
Phototherapy Practice & Adherence to Guideline
Abstract
A guideline for the management of hyperbilirubinemia in infants has recently been established in Indonesia, but physician acceptance and adherence to these standards are unknown. The objective of this study was to assess the current state of phototherapy practice and to determine if this was in-line with the Indonesian Hyperbilirubinemia Guideline. The study was done in the neonatal care units of Dr. Soetomo Hospital in Surabaya, Indonesia. We evaluated all babies on phototherapy between September 2019 and September 2020. The conformity to core elements in the national guideline was assessed on hyperbilirubinemia management for 89 infants, two-third of these being preterm and low birth weight. One-third of infants were commenced on phototherapy just based on transcutaneous bilirubin measurement. A significant proportion of infants had phototherapy ceased without bilirubin level assessment or confirmation that jaundice had significantly resolved. Almost all (95.9%) of the phototherapy sessions did not conform to guidelines, with the most common being inadequate exposure of the body surface area to light. In spite of a guideline adapted to be pragmatic and applicable to the local setting, healthcare practitioners were not sufficiently aligned, thus an urgent reassessment of the implementation and adoption of the current hyperbilirubinemia guideline is required.
Keywords :
Indonesia,
intensive phototherapy,
hyperbilirubinemia guideline,
LMIC,
neonatal mortality,
non-conformity,
Abstrak
Panduan untuk pengurusan hiperbilirubinemia dalam bayi baru lahir telah ditetapkan baru-baru ini di Indonesia, tetapi penerimaan dan pematuhan oleh para doktor terhadap tahap piawai ini tidak diketahui. Objektif kajian ini adalah untuk menilai keadaan semasa ini bagi amalan fototerapi dan menentukan sama ada ini sejajar dengan Panduan Hiperbilirubinemia Indonesia. Kajian ini dilakukan di unit penjagaan neonatal Hospital Dr. Soetomo di Surabaya, Indonesia. Kami menilai semua bayi yang menjalani fototerapi antara September 2019 dan September 2020. Kesesuaian dengan elemen teras dalam panduan kebangsaan dinilai dalam pengurusan hiperbilirubinemia untuk 89 bayi, dua pertiga daripadanya ialah bayi pramatang dan mempunyai berat lahir yang rendah. Sepertiga daripada bayi memulakan fototerapi hanya berdasarkan dengan pengukuran bilirubin melalui kulit. Sebahagian besar daripada bayi menghentikan fototerapi tanpa penilaian tahap bilirubin atau pengesahan bahawa penyakit kuning telah berkurang dengan ketara. Hampir semua (95.9%) sesi fototerapi tidak mematuhi panduan, di mana yang paling kerap ialah kekurangan pendedahan permukaan badan kepada cahaya. Walaupun panduan disesuaikan untuk menjadi pragmatik dan dapat digunakan dalam konteks tempatan, para pengamal kesihatan tidak mematuhi dengan sepenuhnya, menyebabkan penilaian semula yang segera terhadap pelaksanaan dan penerimaan panduan hiperbilirubinemia semasa adalah diperlukan.
Kata Kunci :
Fototerapi intensif,
garis panduan hiperbilirubinemia,
Indonesia,
kematian neonatal,
ketidapatuhan,
LMIC,
Correspondance Address
Mahendra Tri Arif Sampurna. Department of Pediatrics, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia. Tel: +62812-3090-4621 Email: mahendra.tri@fk.unair.ac.id
![FIGURE 1: Plotting of pre-PT TcB level of infants with gestational age ≥35 weeks based on Maisels & Kring (2006) TcB nomogram [63x39 mm (300 x 300 DPI)]](/sites/default/files/manuscript/siti_noorain/Figure_%21_plotting.png)
