Evaluation of Professional Practices Prior to and Subsequent to Training in the use of Phototherapy for Preterm Infants in an Intensive Care Unit

Background: Newborn jaundice is one of the most common conditions for preterm infants. Phototherapy is the treatment of choice to reduce bilirubin levels. Untreated severe jaundice can cause permanent brain damage but phototherapy has to be carefully used because of its side effects such as melanocytic nevus development.

There are international guidelines regarding the use of phototherapy for preterm infants in order to reduce long-term adverse effects and to improve its efficacy.

Objective: The purpose of this audit was to determine whether the training of staff could improve the compliance with phototherapy good clinical practice guidelines for infants < 35 weeks of gestation in incubators in a level III hospital unit.

Methods: The first part of this evaluation was a six-month retrospective study before training, the second part was a two-month prospective study after staff training. Data regarding prescription and indication were gathered and qualified (i.e. compliance with or variation from guidelines), and the two periods were compared.

Results: The study included 70 infants born at 28,6 weeks of gestation on average. 276 prescriptions were analysed. Prior to staff training only 75% of indications to phototherapy onset complied with guidelines versus 90% after training (p<0,05). No side effect monitoring was prescribed prior to training (i.e 0%) versus 78% after training (p<0,0001). Treatment efficacy monitoring with Transcutaneous Bilirubin Measurements was prescribed in 44,6% of cases prior to training versus 81% after training (p=0,059). The prescribing doctor’s signature was found in 84% of cases prior to training versus 92% after training (p<0,0001).

Conclusion: Regarding its side effects, phototherapy must be used only when indicated and with careful monitoring for complications. This clinical audit showed a better compliance with international standards after training with regard to indications and prescription. Training must be considered as an asset to improve clinical practice in the NICU.