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Hyperbilirubinemia guideline adherence in Russia illustrates universal challenges

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Abstract

Guidelines for management of newborn hyperbilirubinemia have existed in Russia for many years. We sought to determine the degree to which management of hyperbilirubinemia in Russia meets three existing clinical protocols. We performed a cross-sectional chart review in a government-run, academic hospital in an urban setting in Moscow, Russia. Subjects were admitted to Level II nursery at Hospital No.13, were not transferred to a Level III nursery, did not die during hospitalization, and had at least one pairing of total serum bilirubin (TSB) and clinical evaluation of jaundice. We measured physician adherence to three available guidelines based upon TSB levels at which phototherapy and exchange transfusions were performed. We identified 594 infants and 1,924 pairings. Despite availability of TSB to inform decision-making, physicians did not follow the protocols. Under Russian and U.S. guidelines, physicians often failed to start phototherapy, started phototherapy unnecessarily, and missed recommended exchange transfusions. Despite a resource-poor setting, guideline adherence in Russia was remarkably similar to that of U.S. physicians. The data illustrate the challenge of overcoming physician behavior to standardize practice, and raise questions about the presumed higher quality of care in a more developed medical system. A new framework for guideline implementation is needed, and many of the necessary tools already exist.

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Authors and Affiliations

  1. Department of Pediatrics, Stanford University, 770 Welch Road, Suite 100, Palo Alto, CA, 94304-5781, USA

    Anthony E. Burgos

  2. Department of Pediatrics, Division of General Pediatrics, Stanford University, Stanford, CA, USA

    Asya Agulnik & Anthony E. Burgos

  3. Moscow Research Institute for Pediatrics and Children’s Surgery, Moscow, Russia

    Irina I. Ryumina

Authors
  1. Asya Agulnik
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  2. Irina I. Ryumina
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  3. Anthony E. Burgos
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Corresponding author

Correspondence to Anthony E. Burgos.

Additional information

Note

The Volodin guideline is currently under consideration by Russia’s public health department as a universal, national guideline. This study provided supporting data for this proposed policy change.

“What is already known on this topic”

Neonatal jaundice is a universal problem that affects large numbers of newborns all over the world. Several countries have developed clinical guidelines, but data on physician adherence is scarce. Russian physicians have long had two local guidelines and, since 2004, the most recent AAP guideline.

“What this study adds”

This study is the first to show data of guideline adherence in Russia and to compare it to US data. Poor guideline adherence regardless of the level of resources available questions the quality of care delivered in every setting. More importantly, this study shows that implementation of hyperbilirubinemia guidelines is lacking, and that the current approach may be misdirected.

Competing interests

The authors have no competing interests to disclose.

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The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive license (or non-exclusive for government employees) on a worldwide basis to the publisher.

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Agulnik, A., Ryumina, I.I. & Burgos, A.E. Hyperbilirubinemia guideline adherence in Russia illustrates universal challenges. Eur J Pediatr 168, 1175–1180 (2009). https://doi.org/10.1007/s00431-008-0900-1

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  • DOI: https://doi.org/10.1007/s00431-008-0900-1

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