Abstract Ref Number = APCP1051
VARIATION OF PHOTOTHERAPY THRESHOLDS BY CLINICIANS IN COMPARISON WITH HYPERBILIRUBINEMIA GUIDELINE IN INDONESIA
Dorothea Martini,Mahendra TA Sampurna,Kartika DHandayani,Dina Angelika,Risa Etika,Martono TUtomo,Agus Harianto
Departement of child Health Faculty of Medicine Universitas Airlangga Dr Soetomo Hospital Surabaya Indonesia Departement of Child Health, Faculty of Medicine, Universitas Airlangga Dr Soetomo Hospital Surabaya, Indonesia
Background : The Indonesian hyperbilirubinemia guideline was developed based on the AAP guideline. Current practice of local clinicians using this implementation is still unknown. The aim of this study is to determine variation of phototherapy thresholds by clinicians in comparison with the Indonesian hyperbilirubinemia guideline.
Material : Medical records based study was conducted at Dr. Soetomo Hospital Surabaya, between January-December 2017. Neonates were classified into two groups, infant 35 or more weeks of gestation and < 35 weeks, total serum bilirubin (TSB) levels were plotted based on Clinical Practice Guideline 2nd edition by Indonesian Pediatric Society. Variation of phototherapy (PT) thresholds were determined by mean and (SD) (mg/dL). Clinicians' decision were defined as prompt-treatment (as suggested by the guideline), over-treatment (given PT meanwhile not yet recommended by the guideline) and under-treatment (not given PT meanwhile exceed PT threshold).
Results : A total 169 samples were observed. There were 107(63%) infant 35 or more weeks of gestation, 50(46%) who received prompt-treatment, 57(54%) over-treatment, with mean variation 2.74(SD 1.65)mg/dL. There were 62(37%) neonates <35 weeks, 48(77%) who received prompt-treatment, 2(4%) over-treatment and 12(19%) under-treatment. Under-treatment neonates with birth weight <1500g were 5(31%), 1501-2000g were 7(20%) with mean variation 4.12(SD 2.03)mg/dL, 1.35(SD 1.16)mg/dL respectively. TSBs were measured during 24, 48, 72 and >96 hours postnatal-age, consist of 0, 4(4%), 30(28%), and 73(68%) neonates 35 or more weeks of gestation and 0, 7(11%), 16(25%), 39(64%) neonates respectively among<35weeks.
Conclusions : Clinicians prefer to use lower PT threshold than the recommended guideline in neonates 35 or more weeks of gestation. On the other hand, there seemed to be a lack of awareness in PT threshold for neonates < 35 weeks. Personal preferences may lead to inappropriate use of PT. Easy-access guideline aimed to improve clinicians' adherence is needed.
Keywords: hyperbilirubinemia adherence phototherapy guideline