Implementing Higher Phototherapy Thresholds for Jaundice in Healthy Infants 35 Plus Weeks.

OBJECTIVES: To determine the impact of higher bilirubin thresholds on testing and treatment of healthy infants during the neonatal period. METHODS: This quality improvement study included infants born at ≥35 weeks gestation and admitted to the well-baby nursery between July 2018 and December 2020. We assessed the transition from infants treated according to the 2004 AAP guidelines (pregroup) with those following the Northern California Neonatal Consortium guidelines (postgroup). We examined the proportion of infants receiving phototherapy and total serum bilirubin (TSB) assessments as outcome measures. We examined critical hyperbilirubinemia (TSB above 25 mg/dL or TSB within 2 mg/dL of threshold for exchange transfusion), exchange transfusion, and readmission for jaundice as balancing measures. We compared the differences in outcomes over time using Statistical Process Control p charts. Balancing measures between the pre and postgroups were compared using χ square tests and t-tests. RESULTS: In our population of 6173 babies, there was a significant shift in the proportion receiving phototherapy from 6.4% to 4%. There were no significant changes in incidences of bilirubin >25 mg/dL (0 of 1472 vs 7 of 4709, P = .37), bilirubin within 2 mg/dL of exchange transfusion thresholds (4 of 1472 vs 5 of 4709, P = .15), exchange transfusion (0 of 1472 vs 1 of 4709, P = .70) or readmission for phototherapy (2.9% versus 2.4%, P = .30), between the 2 groups. CONCLUSIONS: Higher thresholds for phototherapy treatment of neonatal hyperbilirubinemia can decrease the need for phototherapy without increasing critical hyperbilirubinemia or readmission rate.

Head lice are not found on floors in primary school classrooms.

BACKGROUND: The control of head lice is frequently based on perceptions rather than evidence, as illustrated by the belief that vacuuming carpets is an essential component of treating head lice, and the less common practice of application of insecticides to floors as an adjunct to head lice treatment. OBJECTIVE: To 1) evaluate the importance of floors as a source of infection for head lice in primary schools to provide evidence on which to base decisions about the need to treat floors; 2) determine the prevalence of active pediculosis and average intensity of infection in primary school children in Townsville, north Queensland. METHODS: In Townsville, north Queensland, we examined preschool and primary classroom floors for lice by using a filter on a vacuum cleaner when the children were absent from the rooms. Active pediculosis was treated, head lice were collected and counted. RESULTS: Of the 2,230 children examined from 118 classrooms, 466 had head lice, a prevalence of 20.9%. A total of 14,033 lice were collected from these children to give an average intensity of infection of 30.1 (95% CI 21.9-38.3) lice per infected child and 129.9 (95% CI 90.7-169.2) lice per infected class. Of the 118 classrooms, 108 (91.5%) had at least one child with active pediculosis. No lice were recovered from the classroom floors. CONCLUSION: Classroom floors are not a risk in the transmission of head lice and no special anti-louse measures are required.