A narrative review of electronic clinical decision support tools for hyperbilirubinemia management

Abstract

is to provide an overview of common electronic clinical decision support (CDS) tools available to help clinicians manage neonatal hyperbilirubinemia. We focus on the guidelines behind their recommendations, their differences, manner of implementation, and future potential. Background: Hyperbilirubinemia assessment is recommended in all preterm and term infants. Various guidelines for the management of hyperbilirubinemia exist, and many guidelines have corresponding electronic CDS tools. The increasingly widespread adoption of electronic health records provides an opportunity for both enhanced integration of CDS tools into daily workflow and automated data collection. Methods: Based on our collective experience in pediatrics, neonatology, and clinical informatics, we identified commonly used CDS tools for neonatal hyperbilirubinemia management. We performed manual searches on the Apple App Store and Google Play Store to identify mobile applications that follow published guidelines for neonatal hyperbilirubinemia management. Conclusions: CDS tools have the potential to improve patient care through increased adherence to guidelines, and to improve the provider experience through workflow integration. In addition, the electronic health record integration of hyperbilirubinemia management tools allows for the collection of data that can be used to refine recommendations over time and inform the development of future guidelines. increasing thresholds for most infants depending on GA and the presence of neurotoxicity risk factors. Treatment thresholds were not changed for infants 35 weeks GA with neurotoxicity risk factors. A web-based tool that automates the NCNC guidelines is available at www.phototherapyguidelines.com. The data entry page requires inputs of gestational age at birth, TB value, and age in hours at the time the TB level was obtained. The results display provides treatment thresholds for initiating phototherapy, and shows the 2004 AAP treatment thresholds for comparison purposes. An API exists for EHR integration. Recently, an abstract reported decreased phototherapy exposure with adoption of the NCNC guidelines, including the avoidance of phototherapy for 34% of TB values above AAP thresholds with no increase in hazardous hyperbilirubinemia (20).