A whole systems team approach to combat jaundice and encourage breastfeeding

Perspectives in jaundice management

If statistics hold true, more than half of all new parents will find themselves staring jaundice in the face of their own newborn babies. But thanks to developments in digital health technology and maternal and infant health promotion programs, the impact of jaundice is being curtailed.

One such program, the Jaundice Early Treatment Study in Term Newborns (JETSET), was created by Dr. Jideofor Menakaya, a neonatal pediatrician practicing at Hillingdon Hospital in London, United Kingdom. JETSET's integrated hospital and community-based care program was developed around a team approach that’s helping new parents and newborns at risk for jaundice make positive strides to fight the condition.

Preventative Medicine at its Best
With other risk factors accounted for, term babies that are exclusively breastfed fall into a high-risk category for jaundice, widening the scope for potential health issues in otherwise healthy infants. A key goal of both the American Academy of Pediatrics and the JETSET program is to promote and support breastfeeding among new mothers. Dr. Menakaya’s program addresses both objectives; increasing breastfeeding success while simultaneously reducing jaundice – with particular attention placed on parental and professionals’ anxieties associated with hyperbilirubinemia and breastfeeding. For Hillingdon Hospital, these fundamentals proved to be a successful pairing. “We found if a baby were jaundiced, we redoubled our efforts to support and encourage breastfeeding,” says Dr. Menakaya. Supporting adequate hydration of the newborn through successful breastfeeding contributes to elimination of bilirubin in the baby’s urine and feces, he says.

The ability to participate in prevention programs such as these opens unprecedented opportunities for new parents to avert health issues in their newborns before issues arise. The benefits certainly don’t stop there; these programs are making a significant impact on the bottom line for hospitals by addressing the main issues for readmission: jaundice and feeding problems.

TcB devices, when used appropriately, provide professional support that can
actually encourage breastfeeding. In fact, even when babies require treatment for
jaundice, we are still encouraging new mothers to continue breastfeeding.”

— Dr. Jideofor Menakaya, neonatal pediatrician practicing at Hillingdon Hospital, London, UK

A Triangulation of Care
A vital component of the JETSET program is the Philips BiliChek noninvasive transcutaneous bilirubin (TcB) measuring device. “Using the BiliChek device gives all healthcare professionals that work with newborn babies the ability to objectively monitor bilirubin levels. That knowledge can give breastfeeding mothers the confidence to persist with their feeding choice — if they know what the level is, they know it's fine to keep breastfeeding,” Dr. Menakaya says.

Midwives who can measure TcB levels in a home environment are better able to identify newborns in need for further testing and treatment and refer them for hospital care promptly. However, in the majority of cases, they are able to instill breastfeeding confidence in the parents and this helps to reduce jaundice-related hospital readmissions for their newborns.

The JETSET program serves as an excellent example of triangulated, carefully choreographed care from the hospital to home, drawing on resources from the physician, patient and midwife.

Paybacks for Health Systems
At Hillingdon Hospital, many of the hospital's fundamental goals are being met through the JETSET program objectives including: breastfeeding promotion, the introduction of new resources e.g., first feed sticker, breastfeeding assessment tool (BFAT), engaging increased numbers of breastfeeding support workers, and adoptin

clear integrated care pathways on how to treat healthy jaundiced babies.

The JETSET program recognizes that every newborn has the potential to develop jaundice, but according to Dr. Menakaya, using the BiliChek device as part of a comprehensive management program “empowers professionals to make rational decisions with parents about a jaundiced baby.” With the program in place, the JETSET team reports significant changes in three critical areas: a reduction in hospital readmissions due to jaundice, reductions in treatment for jaundice and an increase in the number of breastfeeding mothers. “We introduce a very specific plan with pregnant mothers right through to their delivery – identifying jaundice promptly, managing it efficiently and promoting breastfeeding – a very comprehensive approach because we use the BiliChek machine,” says Dr. Menakaya. “While breastfed newborns are at higher risk of developing jaundice, this program actually led to improved breastfeeding rates,” says Dr. Menakaya.

JETSET data points to statistical improvements in multiple patient care areas. Over the course of a calendar year, Dr. Menakaya reports reduced readmission rates from 28 to 19 visits, decreased lengths of stay for admitted babies from 87.2 to 45.5 hours, a successful breastfeeding rate of 81 percent. The program also ensured prompt treatment of babies with an average time of 77 minutes from door to treatment for readmitted babies with severe hyperbilirubinemia.

The ability to participate in prevention programs such as these opens unprecedented opportunities for new parents to avert health issues in their newborns before issues arise.

Breastfeeding Supported
Breastfeeding often tops the list of concerns and challenges faced by new mothers. Without the ability to physically see how much a breastfed baby is consuming, support from external sources becomes an invaluable resource for new mothers – especially for those challenged by jaundice during their baby's first week of life.

Breast pumps allow breastfeeding mothers to measure how much milk they’re producing, while reaping the benefits of a steady milk supply. Philips Avent research has guided product design with a mother’s comfort in mind, as studies suggest there may be a link between relaxation and an increase in breast milk production.

Frequent feedings serve to promote hydration, increase bowel movements and ultimately contribute to the elimination of bilirubin.

And according to Dr. Menakaya, “TcB devices, when used appropriately, provide professional support that can actually encourage breastfeeding. In fact, even when babies require.

treatment for jaundice, we are still encouraging new mothers to continue breastfeeding.”

Breastfeeding issues are commonplace – and they can certainly result in newborn jaundice. When the jaundice isn’t recognized, devastating effects can develop such as kernicterus, a neurological condition caused by jaundice that can lead to brain damage. While some new mothers will eschew breastfeeding to avoid the potential for conditions like kernicterus, Dr. Menakaya and his team believe the JETSET program can both eliminate worries about jaundice while promoting breastfeeding.

Phototherapy with a BiliTx is another method to effectively speed the resolution of jaundice, and Dr. Menakaya hopes to add this to the JETSET program for at-home use in the next twelve months. Delivering real-time information and needed care while treating an infant at home, when possible, is in everyone’s best interest.

Mother & Child Care

Unbound bilirubin – a predictor of kernicterus

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A whole systems team approach to combat jaundice and encourage breastfeeding

Perspectives in jaundice management

The ability to participate in prevention programs such as these opens unprecedented opportunities for new parents to avert health issues in their newborns before issues arise.

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