Evaluation of a simple intervention to reduce exchange transfusion rates among inborn and outborn neonates with jaundice in Myanmar, comparing pre- and post-intervention rates

1) Provision of high intensity phototherapy and a photo radiometer; 2) Promulgation of standard guidelines for phototherapy and exchange transfusion, as used by the lead Myanmar hospital responsible for neonatal care policy. American Academy of Pediatrics 2004 guidelines for infants born at 35 weeks gestation and above specify Total Serum Bilirubin thresholds for commencement of intensive (>=30
W/cm2 per nm at 430-490 nm) and standard (<30 W/cm2 per nm at 430-490 nm) phototherapy and Exchange transfusion, by infant age in hours and risk factors (including gestational age-group). The UK National Institute of Clinical Excellence 2010 guidelines (used for infants born <35 weeks gestation by the Myanmar lead hospital for neonatal care) provide thresholds for phototherapy and Exchange Transfusion by gestational week at birth, and age in hours. Hospitals were given coloured graphs reproduced from the American Academy of Pediatrics guideline to affix to nursery walls, and MS Excel spreadsheets containing the NICE thresholds. Adherence to the guidelines was not externally monitored during the intervention period. 3) Half day training in use of the equipment and guidelines by an Italian Neonatologist. Training was provided in two cities, Yangon and Mandalay, on separate dates, each catering to key staff from two hospitals; 19 staff attended at one location and 21 at the other. Training was by lecture format, with discussion of the guidelines and exercises to demonstrate use of the guidelines, followed by hands-on practice in use of the equipment.

1) Provision of high intensity phototherapy and a photo radiometer; 2) Promulgation of standard guidelines for phototherapy and exchange transfusion, as used by the lead Myanmar hospital responsible for neonatal care policy. American Academy of Pediatrics 2004 guidelines for infants born at 35 weeks gestation and above specify Total Serum Bilirubin thresholds for commencement of intensive (>=30 _x0001_W/cm2 per nm at 430-490 nm) and standard (<30 W/cm2 per nm at 430-490 nm) phototherapy and Exchange transfusion, by infant age in hours and risk factors (including gestational age-group). The UK National Institute of Clinical Excellence 2010 guidelines (used for infants born <35 weeks gestation by the Myanmar lead hospital for neonatal care) provide thresholds for phototherapy and Exchange Transfusion by gestational week at birth, and age in hours. Hospitals were given coloured graphs reproduced from the American Academy of Pediatrics guideline to affix to nursery walls, and MS Excel spreadsheets containing the NICE thresholds. Adherence to the guidelines was not externally monitored during the intervention period. 3) Half day training in use of the equipment and guidelines by an Italian Neonatologist. Training was provided in two cities, Yangon and Mandalay, on separate dates, each catering to key staff from two hospitals; 19 staff attended at one location and 21 at the other. Training was by lecture format, with discussion of the guidelines and exercises to demonstrate use of the guidelines, followed by hands-on practice in use of the equipment.