Management of the icteric neonate. Presentation of a model by complexity levels of care according to risk factors

Abstract

A model of care for the icteric newborn is presented by levels of complexity based on the calculation of associated risk factors. The program involves Cali, Colombia; the Hospital Universitario del Valle as level III of care; the Hospital San Juan de Dios as level II; and six peripheral centers represent level I. The results of operating the model for six months (November 1990 to May 1991) are also shown. There were 373 patients treated for jaundice in the entire program (18%). The sample analyzed consisted of 224 children: 89 in level III, 77 in level II, and 58 in level I. Phototherapy was administered in all three levels, and exchange transfusion was performed only at levels III and II. Direct mortality due to jaundice was 0%; there were no early complications attributable to this condition nor to exchange transfusion. Unjustified hospitalization was 15% in level III, 32% in level II, and 41% in level I and patients could be managed at less complex levels of care or by ambulatory control. By relocating them according to risk criteria, it was found that it would have been possible to reduce hospitalization costs by 7% for this entity without affecting the quality of care. This is the first article published on a regionalization system in managing icteric newborns.