HCA hospitals screening newborns for severe jaundice
NASHVILLE — The nation’s largest for-profit hospital operator, HCA Inc., is administering an inexpensive test which detects severe jaundice in newborns that can lead to kernicterus, a condition that can leave babies brain damaged.
Nashville-based HCA — which delivers about 5 percent of the 4 million babies born each year in the U.S. — initiated the screening in February at its 124 obstetrics units. Until May 31, none of the 72,870 babies born have had kernicterus, which has increased in incidence since the early 1990s, when hospital stays for mothers and babies shortened.
Before the screenings began, from May 1 through Dec. 31, 2004, HCA documented a monthly average of 1.2 cases of babies with jaundice severe enough to put them at hazardous risk for kernicterus.
HCA’s new screening policy follows recommendations issued by the American Academy of Pediatrics last year that hospitals needed to improve monitoring of newborns to prevent severe jaundice and kernicterus, a rare but serious condition that causes permanent brain damage, leading to cerebral palsy and hearing and vision loss.
“The fact that hospitals are doing this we presume is a good thing,” said Dr. Jeffrey Maisels, chairman of a committee that wrote the academy’s recommendations. “We know it’s a good way of predicting risk. But follow-up is crucial. If they (newborns) go home in less than 72 hours, we want them to be seen in two days.”
The academy’s recommendations say blood tests or noninvasive skin tests — both of which are administered by HCA — should be given to newborns who appear jaundiced to measure levels of bilirubin, a naturally occurring byproduct of decomposing red blood cells.
Babies’ livers can have problems processing bilirubin, and when too much builds up it causes jaundice, which affects about 60 percent of newborns and frequently causes a yellowing of the skin and eyes. If not treated, high levels of bilirubin can damage the brain.
Jaundice is not always visually detectable and the tests — which cost HCA about $1 each — can identify infants at risk.
“Most hospitals are not doing this,” said Dr. Vinod Bhutani, professor of pediatrics at the Stanford University School of Medicine, who has a conducted a study using kernicterus data compiled by HCA. The company estimates about a third of hospitals are currently doing similar screening to detect severe jaundice.
“I think this is quite remarkable of them (HCA) to take this step,” Bhutani said. “It’s an option that has been suggested, but hasn’t been mandated by any organization. It’s the most preventable form of brain injury in newborns. The actual incidence should be zero.”
About 174 incidents of kernicterus in the U.S. have been reported during the last 15 years, while in developing countries, the rate is higher, Bhutani said.
Composed of locally managed facilities that include about 190 hospitals and 90 outpatient surgery centers in 23 states, England and Switzerland, HCA delivers more than 225,000 babies each year.
In April, the company saw its first-quarter profit rise 20 percent on increased patient volume and raised its outlook for the year. Results exceeded Wall Street estimates, and its shares edged up.
HCA said its quarterly income grew to $414 million, or 95 cents per share, in the January-March period from $345 million, or 69 cents per share, a year ago. Revenue rose 4 percent to $6.18 billion from $5.94 billion last year.
In the 1970s and ’80s, the average hospital stay for mothers and babies was four days, enough time for jaundice problems to be detected and treated. Today the average stay is 24 hours, and babies may not look jaundiced at that point because the peak level of bilirubin is not usually reached until the four or fifth day.
Dr. Frank Houser, senior vice president of quality and medical director for HCA, said about five years ago, 9 percent of all HCA malpractice claims were obstetrics related. A third of all money for malpractice suits was spent to settle such cases — over half of whose settlements were in excess of $1 million.
Since that time, HCA has improved training for its labor and delivery nurses and seen the number of malpractice claims decrease. From 1995-99 six claims per thousand live births resulted in some kind of malpractice suit. Now the number is about 2.5, Houser said.
“We were averaging about one malpractice claim a year on kernicterus,” Houser said. “It’s (screening) more than paid for itself just in claims. It’s not only the right thing to do, but it makes financial sense.”
———
On the Net:
HCA: http://www.hcahealthcare.com/