Adherence with American Academy of Pediatrics guidelines when managing neonatal jaundice in Jordan

Mohammad Khassawneh,1 Ziad Rubaie,2 Issa Khashashneh,3 Fakhri Makhlouf,4 Ahmed Alkafajei2 1Department of Pediatrics, 2Department of Public Health, Jordan University of Science and Technology; 3Department of Pediatrics, Prince Rashid Hospital; 4Department of Pediatrics, Princess Rahma Children's Hospital, Irbid, Jordan Background: Bilirubin encephalopathy is a significant health problem in developing countries. Understanding regional practices in comparison with international standards is needed to assess the safety and efficacy of our local management practice. Methods: This retrospective study included all neonates (≥35 weeks gestation) with hyperbilirubinemia who were admitted to the three main neonatal units in northern Jordan between January 2007 and January 2009. Demographic variables and risk factors were collected. Management of hyperbilirubinemia in the absence of national guidelines was compared with that recommended by the American Academy of Pediatrics. Results: Four hundred and sixteen infants were admitted with hyperbilirubinemia and received phototherapy. The phototherapy threshold was met in only 210 (50%) of infants. Seventy infants (17%) received exchange transfusion, and the threshold was met in 60 (86%) infants. Only 50% of infants who needed exchange transfusion received the procedure. Conclusion: Despite the high rate of unnecessary phototherapy, exchange transfusion was performed in one of every two infants who met the international criteria for the procedure. Studies are needed in our country to evaluate the impact of this practice on infants with hyperbilirubinemia. Keywords: neonatal jaundice, hyperbilirubinemia, exchange transfusion, guidelines