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Title Computerized Decision-Making Assistance for Managing Neonatal Hyperbilirubinemia
Author(s) Gil Dollberg, Michael Mimouni, Shaul Dollberg
Source Pediatrics, Vol. 117, No. 1, Pages 262-263
Publication Date Jan. 2006
Abstract In October 2004, the Subcommittee on Hyperbilirubinemia of the American Academy of Pediatrics (AAP) issued a clinical practice guideline on the management of hyperbilirubinemia in the newborn infant of ?35 weeks' gestation.1 On the basis of the best available scientific evidence and expert opinion, these guidelines incorporated specific figures for suggesting follow-up procedures according to hour-specific nomograms, indications to initiate phototherapy in hospitalized infants, and bilirubin concentrations that are indicative of the need for a double-volume exchange transfusion. The application of these figures has become commonplace, and the subsequent requirement of computerized means for implementing them prompted the design of a Web-based program, BiliTool, in which the clinician can input the bilirubin concentration and the age of the infant at the time of the sampling and receive the Bhutani nomogram-based recommendations and guidance on initiation of phototherapy. We found this Web-based system to be helpful, but it also has a number of limitations: (1) the clinician must have access to a computer connected to the Internet at the point of care of the infant, and (2) there are no guidelines for exchange transfusion (ie, the ones incorporated in the AAP clinical practice guidelines).

To overcome these limitations, we developed 3 types of computerized solutions that are used on a stand-alone personal computer running Windows (Microsoft, Seattle, WA), on a handheld computer running the Palm operating system, and on a handheld PocketPC running the Windows Mobile operating system. These programs include a data-entry screen (Fig 1) for recording the age of the infant (in hours) at the time that the laboratory bilirubin test was obtained and the results of the test (in mg/dL). After entering the data, a results screen showing the Bhutani risk zone, the AAP guidelines for phototherapy, and the AAP guidelines for exchange transfusion (the latter 2 based on neurotoxicity factors) are displayed (Fig 2). This easy-to-use program obviates the need to chart the results on paper in addition to reducing the possibility of human error. These programs can be downloaded from www.babydoc.co.il/software/Bili-Aid.html and are free of charge for noncommercial use. We emphasize that these programs should never be used as a substitute for professional medical judgment. In view of the possibility of human error or changes in medical practice, users should confirm the local suitability of the information supplied by these programs through independent sources.

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