Authors (including presenting author) :
Lee SY, Lee KP
Affiliation :
Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital
Introduction :
In early 2020, at the beginning of covid-19 pandemic, it was once the policy of the Hospital Authority to reduce outpatient follow-up. Neonates newly born in our hospital on discharge normally had either jaundice reviewed by either transcutaneous bilirubinometer or serum bilirubin. If the bilirubin levels were below phototherapy (PT) threshold as defined by international guideline but within 80 micromol/L below the PT level, follow-up was arranged in our day clinic in the fear of surge of serum bilirubin levels necessitating PT subsequently.
Objectives :
To reduce the number of day clinic follow-up for neonatal jaundice, which was in line with the policy of the Hospital Authority in early 2020.
Methodology :
We lowered the PT threshold by 40 micromol/L. We stopped PT at serum bililrubin level 40 micromol/L lower than we usually did.
Two birth cohorts were retrospectively reviewed and compared: April 2019 and April 2020. The PT threshold in April 2020 was lower than that in April 2019 by 40 micromol/L.
Result & Outcome :
Under the new PT threshold, neonates in April, 2020 were more likely to receive PT than in April 2019 (58 of 111 versus 57 of 175 neonates, p = 0.00118) and on average had longer time on PT (1.27 versus 0.8 calendar days, p = 0.00241). Neonates were less likely to be followed up in our day clinic for neonatal jaundice in April 2020 than in April 2019 (43 of 111 versus 97 of 175 neonates, p = 0.00739) Among those neonates who had ever attended our day clinic, the number of visits were fewer (1.78 versus 3.19, p < 0.0001). Hours spent on PT per neonate were increased from 12 to 19 (p = 0.00476) but hours spent in day clinic were reduced from 5.16 to 2.08 (p < 0.0001). The sum of inpatient hours for PT and outpatient hours in day clinic was not significantly different (17.1 in April 2020 versus 21 hours in April 2019, p = 0.167). Lowering PT threshold increased inpatient provision of PT but reduced outpatient follow-up for neonatal jaundice. This was desirable amidst an epidemic with a ‘lockdown’ policy in place.
