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Gu J, Zhu Y, Zhao J. Arch Dis Child Fetal Neonatal Ed. JavaScript is disabled. Pediatrics. Code 99391 may be reported with diagnosis code Z00.129 (encounter for routine child health examination without abnormal findings) for this service. Two studies also provided results as Bland-Altman difference plots (mean TcB-TSB differences -29.2 and 30 mol/L, respectively). The total number of neonates enrolled in these different RCT were 749. Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: A systematic review of randomized controlled trials. 2014;134(3):510-515. The genotype of Gilbert syndrome, the UGT1A1*28 allele, causes markedly reduced activity of this enzyme, but its association with neonatal hyperbilirubinemia is uncertain and its relationship with extreme hyperbilirubinemia has not been studied. The meta-analyses of 2 studies demonstrated a significant reduction in the length of hospital stay (MD -10.57 days, 95 % CI: -17.81 to -3.33; 2 studies, 78 infants; I = 0 %, p = 0.004; low-quality evidence). Most newborns have ointment administered at birth, or soon after the initial bonding with the mother. Additional citations were identified from the bibliography of selected articles and from the abstracts of conference proceedings. Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Correlation between neonatal hyperbilirubinemia and vitamin D levels: A meta-analysis. Stigma (plural stigmata) is a finding that may indicate an abnormal condition, such as a sacral dimple without a visible floor being stigma for occult spina bifida. Pediatrics. These investigators evaluated the effects of antenatal phenobarbital in red cell isoimmunized pregnancies in reducing the incidence of phototherapy and exchange transfusion for the neonate. Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: A systematic review of randomized controlled trials. Codes for circumcision procedures include: When providing E/M services to other than normal newborns, choose the level of care based on the intensity of the service and status of the newborn. Approximately 10 to 20 percent of newborns have an umbilical hernia. A total of 416 records were identified through database searching; 4 studies (3 randomized studies and 1 retrospective study) meet the final inclusion criteria. Most of the included studies only mentioned the use of random allocation, but they did not describe the specific random allocation method. Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia. Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 . The authors found a moderate correlation between TcB and TSB during phototherapy with a marginal improvement in the post-phototherapy phase. Reporting of codes for the services requires careful attention to CPT instructions and when more than one physician is caring for the infant, attention to which physician reports which codes. newborn, known as hyperbilirubenemia. Garg BD, Kabra NS, Balasubramanian H. Role of massage therapy on reduction of neonatal hyperbilirubinemia in term and preterm neonates: A review of clinical trials. Metalloporphyrins for treatment of unconjugated hyperbilirubinemia in neonates. 2019;8:CD012731. If this is your first visit, be sure to check out the. However, that is not always the case. Polymerase chain reaction analysis on blood spot was performed to determine the frequency of UGTA1A1 promoter polymorphisms in cases and controls. 2016;109(3):203-212. Data were extracted and analyzed independently by 2 review authors (MG and HM). . Clinical Policy: Phototherapy for Neonatal Hyperbilirubinemia Reference Number: CP.MP.150 Coding Implications . 04/29/2022 2014;165(1):42-45. Petersen JP, Henriksen TB, Hollegaard MV, et al. Zhang M , Tang J, He Y, et al. These researchers performed a systematic review with meta-analysis including genetic studies, which assessed the association between neonatal hyperbilirubinemia and 388 G>A, 521 T>C, and 463 C>A variants of SLCO1B1 between January of 1980 and December of 2012. There is insufficient evidence to support the use of metalloporphyrins (e.g., stannsoporfin (tin mesoporphyrin), Stanate, WellSpring Pharmaceutical Corporation, Neptune, NJ) for the treatment of neonatal jaundice. At the well-baby check, report K42.9 Umbilical hernia without obstruction or gangrene if the condition is addressed (not merely noted in the documentation). Only 1 study met the criteria of inclusion in the review. Both case and control subjects were full term newborns. J Perinatol. A total of 5 RCTs involving 645 patients were included in the meta-analysis. Assign codes for conditions that have been specified by the provider as having implications for future healthcare needs. It may not display this or other websites correctly. Pediatrics. color: red!important; The authors concluded that phototherapy significantly interfered with the accuracy of transcutaneous bilirubinometry; TcB measurements performed 2 hours after stopping phototherapy were not reliable, even if they were performed on the unexposed body area. Mean TSB (120 +/-19 mol/L versus 123 +/- 28 mol/L, DXM versus placebo, respectively) and maximum TSB (178 +/- 23 mol/L versus 176 +/- 48, DXM versus placebo, respectively) concentrations were similar. } Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. A total of 10 articles were included in the study. The authors concluded that the findings of this study demonstrated that the 388 G>A mutation of the SLCO1B1 gene is a risk factor for developing neonatal hyperbilirubinemia in Chinese neonates, but not in white, Thai, Brazilian, or Malaysian populations; the SLCO1B1 521 T>C mutation provides protection for neonatal hyperbilirubinemia in Chinese neonates, but not in white, Thai, Brazilian, or Malaysian populations. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling, and context of counseling. For instance, abnormal findings on screenings for example, newborn hearing screening or lab screenings are not coded in the inpatient record, unless: Here are several watchful waiting findings to consider. Inpatient coders dont collect watchful waiting conditions. Databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database (Wan Fang), Chinese Biomedical Literature Database (CBM), VIP Database for Chinese Technical Periodicals (VIP) were searched and the deadline was December 2016; RCTs of probiotics supplementation for pathological neonatal jaundice in publications were extracted by 2 reviewers. Watchko JF, Lin Z. } Clayton,VIC: Centre for Clinical Effectiveness (CCE); 2003. Zinc sulfate showed no influence on phototherapy requirement (OR=0.90; 95 % CI:0.41 to 1.98; p=0.79), but resulted in significantly decreased duration of phototherapy (MD=-16.69hours; 95 % CI:-25.09 to -8.3hours; p<0.0001). For most newborns, hematomas from the birth process resolve spontaneously. Two hundred years ago, newborns would have been placed on blankets in the sun for newborn jaundice. Results were summarized as per GRADE guidelines. 2020;59(6):588-595. 16th ed. Understanding why a pediatrician documents a finding enables you to determine if it should be coded. The primary outcomes were TSB on 3 days and 7 days, the incidence of hyperbilirubinemia. Take your newborn's temperature every 3 to 4 hours. Pediatrics. Available at: http://www.emedicine.com/med/topic1065.htm. foam closure strips for metal roofing | keokuk, iowa arrests newington high school football coach 0 www.stanfordchildrens.org/en/topic/default?id=developmental-dysplasia-of-the-hip-ddh-90-P02755 hip dysplasia Curr Opin Pediatr. 7. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. These usually heal and resolve on their own. 1998;94(1):39-40. Cochrane Database Syst Rev. 1990;4(6):304-308. Aggressive vs. conservative phototherapy for infants with extremely low birth weight. London, UK: BMJ Publishing Group;November 2006. 2001;108:31-39. If no feeding or other health problem has been previously noted, this visit may be the first well-child visit when provided by a physician, nurse practitioner, or physician assistant. 1992;89:821-822. 1992;89:822-823. list-style-type : square !important; A total of 10 publications (11 studies) were eligible. It suggested that these researchers should use the same guideline to detect the time of jaundice fading in future study. Extreme neonatal hyperbilirubinemia and a specific genotype: A population-based case-control study. They included English-language publications evaluating the effects of screening for bilirubin encephalopathy using early TSB, TcB measurements, or risk scores. When the visit is in follow-up to an identified problem such as jaundice, infrequent stools, or infrequent feedings, and the physician, nurse practitioner, or physician assistant provides the service, an office visit (e.g., 99212-99215) and problem specific diagnosis codes should be reported. Although generally seen as safe, there is rising concern regarding phototherapy and its potentially damaging effects on DNA and increased side effects particularly for pre-term infants. They used a fixed-effect method in combining the effects of studies that were sufficiently similar; and then used the GRADE approach to assess the quality of the evidence. N Engl J Med. 2007;44(3):354-358. A total of 716 neonates were included in the meta-analysis. Effects of Gly71Arg mutation in UGT1A1 gene on neonatal hyperbilirubinemia: A systematic review and meta-analysis. Gholitabar M, McGuire H, Rennie J, et al. @media print { Approximately 60% of term babies and 85% preterm babies will develop clinically apparent jaundice, which classically becomes visible on day 3, peaks days 5-7 and resolves by 14 days of age in a term infant and by 21 days in the preterm infant. Sharma D, Farahbakhsh N, Sharma P, Shastri S. Role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia: A systematic review of current evidence. Aetna's policy on treatment of hyperbilirubinemia in infants is adapted from guidelines from the American Academy of Pediatrics. Newborn Care 1. 1986;25(6):291-294. Pediatrics. These researchers examined whether the UGT1A1*28 allele is associated with extreme hyperbilirubinemia. In pre-planned subgroup analyses, the rates of death were 13 % with aggressive phototherapy and 14 % with conservative phototherapy for infants with a birth weight of 751 to 1,000 g and 39 % and 34 %, respectively (relative risk, 1.13; 95 % CI: 0.96 to 1.34), for infants with a birth weight of 501 to 750 g. The authors concluded that aggressive phototherapy did not significantly reduce the rate of death or neurodevelopmental impairment. #closethis { Treatment effects on the following outcomes were determined: mean change in bilirubin levels, mean duration of treatment with phototherapy, number of exchange transfusions needed, adverse effects of clofibrate, bilirubin encephalopathy and neonatal mortality. J Adv Nurs. Clin Pediatr. Screening had good ability to detect hyperbilirubinemia: reported area-under-the-curve values ranged between 0.69 and 0.84, and reported sensitivities and specificities suggested similar diagnostic ability. These researchers stated that additional large, well-designed RCTs are needed in neonates that compare effects of enteral supplementation with prebiotics on neonatal hyperbilirubinemia with supplementation of milk with any other placebo (particularly distilled water) or no supplementation. (Codes may be selected based on time spent in counseling and coordination of care when documentation indicates more than 50% of face-to-face time was spent in these activities.) Neonatology. Meta-analysis was performed using random- or fixed-effect models. This is not the same as for professional services coding, where the first-listed diagnosis is the reason for the encounter. The following are general age-in-hours specificTSBthreshold values forexchange transfusionbased upon gestational age and the presence or absence of risk factors (isoimmune hemolytic disease, glucose-6-phosphate dehydrogenase [G6PD] deficiency, asphyxia, significant lethargy, temperature instability, sepsis, acidosis, or albumin ofless than 3.0 g/dL [if measured]): Footnotes* Low Risk: 38 weeks gestation and without risk factors; Medium Risk: 38 weeks gestation with risk factors or 35 to 37 6/7 weeks gestation without risk factors; High Risk: 35 to 37 6/7 weeks gestation with risk factors. The USPSTF and the Agency for Healthcare Research and Quality (2009) reported on the effectiveness of various screening strategies for preventing the development of CBE. Resources The need for PT as well as the duration of PT were similar in both groups. Mt Sinai J Med. Newman TB, Maisels MJ. Wong RJ, Bhutani VK. Kumar P, Chawla D, Deorari A. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. Hospital readmission due to neonatal hyperbilirubinemia. Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24-months of age or less, are reported based on the time of face-to-face care beginning when the physician assumes primary responsibility at the referring hospital/facility and ending when the receiving hospital/facility accepts responsibility for the patient's care. However, the methodological quality of the studies determining long-term outcomes is limited in some cases; the surviving children have been assessed predominantly before school age, and no study has been sufficiently powered to detect important adverse long-term neurosensory outcomes. Severe hyperbilirubinemia was used as a surrogate for possible chronic bilirubin encephalopathy (CBE), because no studies directly evaluated the latter as an outcome. Prophylactic probiotics did not reduce the incidence of jaundice significantly [n=1,582, RR: 0.56 (0.25 to 1.27); p=0.16; LOE: low]. FN07-02. 2004;114(1):297-316. The correlation coefficient improved marginally in the post-phototherapy phase (r = 0.72, 95 % CI: 0.64 to 0.78, 4 studies). 4th ed. Wennberg RP. In an evidence-based review on "Neonatal hyperbilirubinemia", Pace and colleagues (2019) stated that clofibrate, metalloporphyrins, and ursodiol have been examined in the management of unconjugated hyperbilirubinemia as augmentation to phototherapy. Hayes Directory. Aggressive phototherapy, as compared with conservative phototherapy, significantly reduced the mean peak serum bilirubin level (7.0 versus 9.8 mg/dL [120 versus 168 micromol/L], p < 0.01) but not the rate of the primary outcome (52 % versus 55 %; relative risk, 0.94; 95 % confidence interval [CI]: 0.87 to 1.02; p = 0.15). First, because the value of jaundice fading in each guideline was different, the heterogeneity was high in time of jaundice fading. Inpatient treatment is not generally medically necessary for preterm infants who present with a TSB less than 18 mg/dL, as these infants can usually be treated with expectant observation or home phototherapy. Pediatrics. Weisiger RA. RM Kliegman, BF Stanton, JW St. Geme, et al., eds. The presumed mechanism of effect is photo-excitation of bilirubin extravascularly in the skin with the formation of bilirubin isomers which can be e For additional language assistance: SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (eg, adverse drug reaction), gene analysis, common variant(s) (eg, *5), UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, irinotecan metabolism), gene analysis, common variants (eg, *28, *36, *37), Molecular pathology procedure, Level 1(eg, identification of single germline variant [eg, SNP] by techniques such as restriction enzyme digestion or melt curve analysis) [for assessing risk of neonatal hyperbilirubinemia], Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion), G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis, Phototherapy (bilirubin) light with photometer, Home visit, phototherapy services (e.g., Bili-lite), including equipment rental, nursing services, blood draw, supplies, and other services, per diem, Injection, phenobarbital sodium, up to 120 mg, Neonatal jaundice due to other excessive hemolysis, Neonatal jaundice from other and unspecified causes, Maternal care for other isoimmunization [not covered for the use of antenatal phenobarbital in red cell isoimmunized pregnant women], Glucose-6-phosphate dehydrogenase (G6PD); quantitative, Glucose-6-phosphate dehydrogenase (G6PD); screen, Genetic susceptibility to other disease [G6PD deficiency], Family history of other endocrine, nutritional and metabolic diseases [G6PD deficiency], Family history of carrier of genetic disease [G6PD deficiency]. As with the initial critical care, only one physician may report code 99469 on a given date. Subsequent days of critical care to the critically ill neonate are reported per day with code 99469. US Preventive Services Task Force; Agency for Healthcare Research and Quality. Per the ICD-10-PCS Official Guidelines for Coding and Reporting, only clinically significant conditions are reported. Thomas JT, Muller P, Wilkinson C. Antenatal phenobarbital for reducing neonatal jaundice after red cell isoimmunization. Accessed January 30, 2019 . Data were statistically extracted and evaluated using RevMan 5.3 software. Evidence Centre Evidence Report. Johnson LH. Home Phototherapy They stated that there is a need for larger trials to determine how effective clofibrate is in reducing the need for, and duration of, phototherapy in term and preterm infants with hyperbilirubinemia. 2011;128(4):e1046-e1052. The linear regression analysis showed a better correlation between BiliCheck and serum bilirubin (r = 0.75) than between BiliMed and serum bilirubin (r = 0.45). Bhutani VK; Committee on Fetus and Newborn; American Academy of Pediatrics. The authors concluded that limited low-quality evidence indicated that probiotic supplementation may reduce the duration of phototherapy in neonates with jaundice. Maisels MJ, Watchko JF. Support teaching, research, and patient care. UGT1A1 is the rate-limiting enzyme in bilirubin's metabolism. Clicking hips may develop into dysplasia of the hip. Pediatrics. Normal Newborn visit, day 2 3. 2003;(1):CD004207. Trikalinos TA, Chung M, Lau J, Ip S. Systematic review of screening for bilirubin encephalopathy in neonates. These investigators assessed the safety and efficacy of probiotics in reducing the need for phototherapy and its duration in NNH. The literature search was done for various RCTs by searching the Cochrane Library, PubMed, and Embase. But unless the breech presentation or other malpresentation caused a significant finding for the newborn, do not code it on the inpatient hospital record. Merenstein GB. A condition does not need to be coded on the inpatient hospital encounter to be coded on the pediatricians hospital encounter. J Perinatol. Guidelines from the American Academy of Pediatrics (AAP, 2004)on management of hyperbilirubinemia in thenewborn infantstate that "Measurement of the glucose-6-phosphate dehydrogenase (G6PD) level is recommended for a jaundiced infant who is receiving phototherapy and whose family history or ethnic or geographic origin suggest the likelihood of G6PD deficiency or for an infant in whom the response to phototherapy is poor(evidence quality C: benefits exceed harms)". J Pediatr Health Care. The beroptic system consists of a pad of Clofibrate in combination with phototherapy for neonatal hyperbilirubinemia is considered experimental and investigational. NY State J Med. OL OL OL OL OL LI { Clin Pediatr (Phila). One study reported a significant reduction in the risk of hyperbilirubinemia and rate of treatment with phototherapy associated with enteral supplementation with prebiotics (RR 0.75, 95 % CI: 0.58 to 0.97; 1 study, 50 infants; low-quality evidence). The authors concluded that despite the potential practical advantages of BiliMed, its reduced diagnostic accuracy in comparison with BiliCheck does not justify its use in clinical practice. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. J Pediatr. This service includes time spent addressing routine feeding issues. However, the accuracy of TcB devices in infants exposed to phototherapy is unclear. OL LI { A total of 447 Chinese neonates with hyperbilirubinemia were selected as the study group and 544 healthy subjects were recruited as the control group matched by baseline sex, age, feeding pattern and delivery mode. These investigators conducted a systematic review and meta-analysis to examine the safety and efficacy of zinc sulfate on hyperbilirubinemia among neonates. If the lining closes and the fluid has nowhere to go, its a noncommunicating hydrocele. 92586 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system, limited When the newborn is critically ill or injured, codes exist for reporting of services provided during interfacility transport, initial critical care, and subsequent critical services. They stated that a Cochrane review of clofibrate (2012) and metalloporphyrins (2003) found that when added to phototherapy, these medications significantly decreased serum bilirubin levels and duration of phototherapy. There is no CPT code because these hospital screenings are usually done by hospital staff who are trained by an audiologist. Huang J, Zhao Q, Li J, et al. Am Fam Physician. There was a significantly lower duration of phototherapy in the clofibrate group compared to the control group for both preterm and term neonates with a weighted mean difference of -23.82 hours (95 % CI: -30.46 hours to -17.18 hours) and -25.40 hours (95 % CI: -28.94 hours to -21.86 hours), respectively. Front Pharmacol. registered for member area and forum access. Procedures included in the services represented by code 99477 include those listed for the Critical Care Services subsection of CPT (codes 99291 and 99292), as well as additional procedures listed in the Inpatient Neonatal and Pediatric Critical Care subsection (codes 99468-99476, 99466-99467). These researchers stated that healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinemia. 2010;15(3):164-168. Coding Guidelines 18, 19 The third trimester is the time of rapid weight gain, development of muscle mass and fat stores for the newborn. Meta-analysis (random-effects model) showed probiotic supplementation reduced duration of phototherapy [n=415, MD: -11.80 (-17.47 to -6.13); p<0.0001; level of evidence (LOE): low]; TSB was significantly reduced at 96hours [MD: -1.74 (-2.92 to -0.57); p=0.004] and 7 days [MD: -1.71 (-2.25 to -1.17); p<0.00001; LOE: low] after probiotic treatment. Otherwise, at 3 to 4 years of age, the hernia will be surgically repaired. The authors concluded that effects of screening on the rates of bilirubin encephalopathy are unknown. Aetna considers prebiotics / probiotics experimental and investigational for the treatment ofneonatal hyperbilirubinemia becausetheir effectiveness for this indication has not been established. Practice patterns in neonatal hyperbilirubinemia. 66940 Removal of lens material; extracapsular (other than 66840, 66850, 66852) Learn more about pediatric cataract billing in Ophthalmic Coding: Learn to Code . Cryptorchidism text-decoration: line-through; Saunders Co.; 2000:513-519. [glucose-6-phosphate dehydrogenase (G6PD), uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1), and. Codes 99478-99480 each are described as, "Subsequent intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant" with the code selected based. 1998;101(6):995-998. When the pediatrician spends additional time explaining the skin condition, and the findings affect the episode of care, it should be coded on professional encounters. For the G6PD 1388 G>A SNP, individuals carrying the A-allele were associated with a significantly increased risk of neonatal hyperbilirubinemia (adjusted OR=1.49, p< 0.001, 95 % CI: 1.31 to 1.67). When the depression is too shallow, the femoral head may move around in the depression and sometimes move out of the acetabulum. Analysis was performed on an intention-to-treat basis. 99462 3. This code may be reported only once per day and by only one physician. A total of 15 studies (2 including preterm neonates and 13 including term neonates) were included in this review. They stated that TSB assessment remains necessary, if treatment of hyperbilirubinemia is being considered. Digestive System Disorders. Bilirubin recommendations present problems: New guidelines simplistic and untested. 96.4. When newborns are discharged with the Pavlik harness, code for the placement of an immobilization device, external, limiting the movement of the upper right leg with 2W3NXYZ Immobilization of right upper leg using other device and upper left leg with 2W3PXYZ Immobilization of left upper leg using other device. These investigators randomly assigned 1,974 infants with extremely low birth weight at 12 to 36 hours of age to undergo either aggressive or conservative phototherapy. Only one physician may report this code. Consistent with available guidelines, continued phototherapy is not medically necessary for healthy term infants when the following criteria for discontinuation of phototherapy are met: A delay in discharge from the hospital in order to observe the infant for rebound once the bilirubin has decreased is not considered medically necessary. For the same reason, subcutaneous vaccine administration (3E0134Z Introduction of serum, toxoid and vaccine into subcutaneous tissue, percutaneous approach) usually is not coded. 2. Trikalinos et al (2009) reviewed the effectiveness of specific screening modalities to prevent neonatal bilirubin encephalopathy. In: Nelson Textbook of Pediatrics. Once the skin is clear or alm BiliCheck variability (+/- 2 SD of the mean bias from serum bilirubin) was within -87.2 to 63.3 micromol/L, while BiliMed variability was within -97.5 to 121.4 micromol/L. J Perinatol. Although an undescended testicle usually is described as palpable or impalpable, also get the location, if you can. Codes 99478-99480 each are described as, "Subsequent intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant" with the code selected based upon the present body weight of the infant as below. Morris and colleagues (2008) compared aggressive versus conservative phototherapy for infants with extremely low birth weight. 1992;31(6):345-352. Primary outcome was the duration of phototherapy. In those (uncommon) circumstances, report P83.5 Congenital hydrocele. Overall, compared with placebo, zinc sulfate supplementation failed to significantly reduce TSB on 3 days (MD=0.09mg/dL; 95 % CI:-0.49 to 0.67; p=0.77), TSB on 7 days (MD=-0.37mg/dL; 95 % CI:-98 to 0.25; p=0.25) as well as the incidence of hyperbilirubinemia (OR=1.14; 95 % CI:0.74 to 1.76; p=0.56). In a Cochrane review, these investigators examined if administration of prebiotics reduces the incidence of hyperbilirubinemia among term and pre-term infants compared with enteral supplementation of milk with distilled water/placebo or no supplementation. display: block; It is an option to provide conventional phototherapy in hospital or at home at TSB levels 2 - 3 mg/dL below those shown, but home phototherapy should not be used in any infant with risk factors. Two reviewers independently assessed studies for inclusion, and discrepancies were resolved with consensus. Fractured clavicles are usually noted by the pediatrician on the newborn evaluation, but do not meet the definition of clinical significance. 66920 Removal of lens material; intracapsular. OL OL LI { These investigatorscalculated the sensitivity and specificity of early TSB, TcB measurements, or risk scores in detecting hyperbilirubinemia. Evaluation and treatment of jaundice in the term infant: A kinder, gentler approach. The provider should document whether the testis is ectopic (e.g., in the superficial inguinal pouch) or abdominal. The authors concluded that the use of antenatal phenobarbital to reduce neonatal jaundice in red cell isoimmunized pregnant women has not been evaluated in randomized controlled trials. Comp arative Effectiveness of Fiberoptic Phototherapy for Hyperbilirubinemia in Term Infants. Study authors were contacted for additional information.