When babies are born, they are at risk of developing jaundice, which causes a yellow hue of the skin and can lead to serious issues. This is because their livers aren’t developed enough to break down bilirubin — a waste product from red blood cells — out of the body.
Historically, providers have treated many cases of neonatal jaundice pre-emptively because very high levels of bilirubin can be harmful to the brain. But not all babies need to undergo treatment, which can disrupt family bonding and breastfeeding, said Dr. Suzanne Mendez, St. Charles’ Medical Director of Pediatrics.
“There's a movement in medicine and pediatrics toward what we call ‘safely doing less’ or ‘choosing wisely,’ so that all the interventions and tests that we do on patients are warranted,” she said. “We don't want to unnecessarily burden patients with extra tests or treatments that they don't need, but we also want to be safe and make sure they are still getting the care they need.”
In 2022, the American Academy of Pediatrics sought to shift jaundice treatment practices and sponsored a new quality improvement project called Learning and Implementing Guidelines for Hyperbilirubinemia, or LIGHT for short. (Hyperbilirubinemia is a big word for jaundice.) The goal of the LIGHT project is to limit treatment to newborns who are truly at risk of complications.
The typical treatment for jaundice is blue-light therapy (phototherapy), where newborns are placed in a crib flooded with blue light that can break down bilirubin in the skin, allowing the body to flush it out. In addition to phototherapy, providers may administer IVs and will run tests with blood draws. While the treatment itself is relatively painless and benign, it means newborns spend more time in cribs and less time being held by family.
The American Academy of Pediatrics has acknowledged how disruptive that can be to babies and families alike and it put together updated guidelines and criteria for providers to gauge when babies need treatment and when it’s safe to let the condition clear on its own. More than 100 health care sites nationally, including St. Charles, were tapped to receive training on the new guidelines.
“We were excited to be selected to participate,” Mendez said.
After learning about the new guidelines, providers spent the next year implementing them, then compared data on jaundice treatments from a year before and a year after the LIGHT project’s changes. St. Charles was recognized for its excellent work with two “HighLIGHT” awards: One for limiting necessary treatment to babies above a certain risk threshold, and another for not using unnecessary blood tests post-treatment for babies who received phototherapy.
Another way St. Charles excelled in jaundice treatment was by using a non-invasive screening tool, a skin meter that measures bilirubin. By using the tool, providers reduced the number of babies receiving jaundice-related blood work by 70%, Mendez said.
The Pediatrics Department will continue to integrate the new guidelines and is reviewing data through July 2024 to see how the project has been sustained.
“It's always a balance,” Mendez said. “We want to make sure we keep babies safe, but we don't want to subject every baby to phototherapy, if we can help it.”
