Phototherapy to prevent severe neonatal hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. 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. Aetna's policy on treatment of hyperbilirubinemia in infants is adapted from guidelines from the American Academy of Pediatrics. It not only decreased the total serum bilirubin level after 3 days [MD: -18.05, 95 % CI: -25.51 to -10.58), p < 0.00001], 5 days [MD: -23.49, 95 % CI: -32.80 to -14.18), p < 0.00001], 7 days [MD: -33.01, 95 % CI: -37.31 to -28.70), p < 0.00001] treatment, but also decreased time of jaundice fading [MD: -1.91, 95 % CI: -2.06 to -1.75), p < 0.00001], as well as the duration of phototherapy [MD: -0.64, 95 % CI: -0.84 to -0.44), p < 0.00001] and hospitalization [MD: -2.68, 95 % CI: -3.18 to -2.17), p < 0.00001], when compared with the control group. Depending on the study, 2 to 10 percent of newborns have inconclusive results at discharge (e.g., there may be fluid in the middle ear; the newborn may be fussy; one ear might pass, but the other does not). 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. One study evaluated the role of zinc in very low birth-weight (VLBW) infants and remaining enrolled neonates greater than or equal to 35 weeks of gestation. Although an undescended testicle usually is described as palpable or impalpable, also get the location, if you can. J Matern Fetal Neonatal Med. In search of a 'gold standard' for bilirubin toxicity. Use a cupped hand or percussor cup. 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. Infants had been treated with DXM (0.25 mg/kg twice-daily at postnatal day 1 and 2) or with placebo (normal saline). 1990;10(4):435-438. The pediatrician will spend time evaluating the condition, and at some point, a code in the Q53 Undescended and ectopic testicle range will be used. Ip S, Glicken S, Kulig J, et al. The infant is otherwise ready to be discharged from the hospital; The infant is feeding well, is active, appears well; TSBis less than 20 to 22 mg/dL in term infants, or less than 18 mg/dL in preterm infants; Arrangements have been made to evaluate the infant within 48 hours after discharge by an early office/clinic visit to the pediatrician, or by a home visit by a well-trained home health care nurse who should be able to: Be available for follow-up clinical assessments and blood drawing as determined to be necessary by the responsible physician based on changes in bilirubin levels, Clinically assess the initial level of jaundice, Explain all aspects of the phototherapy system to the parents, Oversee set-up of the phototherapy system. Immaturity is not congenital absence, agenesis, stenosis, stricture, or malformation. The literature search was done for various randomized control trial (RCT) by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Web of Science, Scopus, Index Copernicus, African Index Medicus (AIM), Thomson Reuters (ESCI), Chemical Abstracts Service (CAS) and other data base. These investigators reviewed the current literature to examine if home-based phototherapy is more effective than hospital-based phototherapy for the treatment of neonatal hyperbilirubinemia. Jaundice, Coombs, and Phototherapy AAP Clinical Practice Guideline - Summary Bhutani Nomogram Guidelines for Phototherapy FAQs About Phototherapy Metalloporphyrins in the management of neonatal hyperbilirubinemia. Suresh GK, Martin CL, Soll RF. Evaluation and management (E/M) services provided to normal newborns in the first days of life prior to hospital discharge are reported with Newborn Care Services codes. Valaes T. Problems with prediction of neonatal hyperbilirubinemia. J Pediatr (Rio J). registered for member area and forum access. TcB measurements obtained on the forehead, sternum, abdomen and covered lower abdomen were statistically compared with the corresponding TSB. 1986;25(6):291-294. Moreover, they stated that routine use of probiotics to prevent or treat neonatal jaundice cannot be recommended; large well-designed trials are needed to confirm these findings. 2019;32(1):154-163. Usually, the time spent teaching parents how to care for the newborns eyes until the lacrimal ducts mature is not significant. Clicking hips may develop into dysplasia of the hip. 1995;96(4 Pt 1):727-729. The authors concluded that the role of massage therapy in the management of NNH was supported by the current evidence. 1992;89:821-822. The order of use of the instruments was randomized. Do not confuse light treatment with ultraviolet light therapy, which is usually used for skin conditions such as psoriasis. Home phototherapy. In general, serum bilirubin levels . 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)". Thayyil S, Milligan DW. The presumed mechanism of effect is photo-excitation of bilirubin extravascularly in the skin with the formation of bilirubin isomers which can be e 1993;32:264-267. Medline, Embase, Cochrane Library, CINAHL and Scopus databases (from inception to May 8, 2014) were searched. foam closure strips for metal roofing | keokuk, iowa arrests newington high school football coach 0 De Luca D, Zecca E, Corsello M, et al. These investigatorscalculated the sensitivity and specificity of early TSB, TcB measurements, or risk scores in detecting hyperbilirubinemia. The studies were included if they compared TcB results with TSB in term and near-term infants during phototherapy or after discontinuation of phototherapy. Murki S, Dutta S, Narang A, et al. Pediatrics. 96.4. I have a provider that ordered phototherapy for a newborn in the hospital with jaundice and he is wanting to bill 96900. Chawla D, Parmar V. Phenobarbitone for prevention and treatment of unconjugated hyperbilirubinemia in preterm neonates: A systematic review and meta-analysis. Policy Home phototherapy is considered reasonable and necessary for a full-term Exchange transfusion should be performed in a neonatal intensive care unit (NICU) due to significant risks. Trikalinos TA, Chung M, Lau J, Ip S. Systematic review of screening for bilirubin encephalopathy in neonates. Aetna considers management of physiologic hyperbilirubinemia medically necessary in preterm infants (defined as an infant born prior to 37 weeks gestation) according to guidelines published by the AAP. Incidence of hyperbilirubinaemia, defined as serum total bilirubin (STB) greater than or equal to 15 mg/dL, was similar between groups (n = 286; risk ratio (RR) 0.94, 95 % CI: 0.58 to 1.52). The authors concluded that zinc sulfate could not reduce the TSB on 3 days and 7 days, the incidence of hyperbilirubinemia and phototherapy requirement, but resulted in significantly decreased duration of phototherapy. Most of the included studies only mentioned the use of random allocation, but they did not describe the specific random allocation method. Philadelphia, PA: W.B. If approved, tin-mesoporphyrin could find immediate application in preventing the need for exchange transfusion in infants who are not responding to phototherapy." J Matern Fetal Neonatal Med. Prediction of hyperbilirubinemia in near-term and term infants. Approximately 2 ml of peripheral venous blood was taken from all subjects. J Adv Nurs. San Carlos, CA: Natus Medical Inc.; 2002. These researchers used the standard methods of the Cochrane Collaboration and its Neonatal Review Group for data collection and analysis. A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. 2011;100(2):170-174. Second, according to Cochrane risk of bias estimation, randomized allocation of participants was mentioned in 9 trials. Weisiger RA. Incidences of side effects like vomiting (n = 286; RR 0.65, 95 % CI: 0.19 to 2.25), diarrhea (n = 286; RR 2.92, 95 % CI: 0.31 to 27.71), and rash (n = 286; RR 2.92, 95 % CI: 0.12 to 71.03) were found to be rare and statistically comparable between groups. Wong RJ, Bhutani VK. Reference No. Attempt to improve transcutaneous bilirubinometry: A double-blind study of Medick BiliMed versus Respironics BiliCheck. There was no evidence of a significant difference in duration of phototherapy between the prebiotic and control groups, which was only reported by 1 study (MD 0.10 days, 95 % CI: -2.00 to 2.20; 1 study, 50 infants; low-quality evidence). According to available guidelines, no further measurement of bilirubin is necessary in most cases. Although the duration of phototherapy in the zinc group was significantly shorter compared to the placebo group (n = 286; MD -12.80, 95 % CI: -16.93 to -8.67), the incidence of need for phototherapy was comparable across both the groups (n = 286; RR 1.20; 95 % CI: 0.66 to 2.18). Travan et al (2014) examined if UGT1A1 promoter polymorphisms associated with Gilbert Syndrome (GS) occur with a greater frequency in neonates with severe hyperbilirubinemia. 2019;8:CD012731. An UpToDate review on "Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants" (Wong and Bhutani, 2015) does not mention genotyping of SLCO1B1 and UGT1A1 as management tools. Some watchful waiting conditions include: Some conditions happen more frequently in premature newborns such as cryptorchidism and umbilical hernias. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for reporting methods and results of synthesis with meta-analysis. 2010;15(3):169-175. Randomized controlled trials were identified by searching MEDLINE (1950 to April 2012) before being translated for use in The Cochrane Library, EMBASE 1980 to April 2012 and CINAHL databases. These investigators conducted a systematic review and meta-analysis to examine the safety and efficacy of zinc sulfate on hyperbilirubinemia among neonates. @media print { This is not the same as for professional services coding, where the first-listed diagnosis is the reason for the encounter. 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 USPSTF and the Agency for Healthcare Research and Quality (2009) reported on the effectiveness of various screening strategies for preventing the development of CBE. All the studies used zinc sulfate, only 1 study used zinc gluconate. When the depression is too shallow, the femoral head may move around in the depression and sometimes move out of the acetabulum. There are 4 chief Current Procedural Terminology (CPT) codes for reporting phototherapy services: (1) 96900: actinotherapy (UV light treatment); (2) 96910: photochemotherapy, tar, and UVB (Goeckerman treatment) or petrolatum and UVB; (3) 96912: photochemotherapy and PUVA; and (4) 96913: photochemotherapy (Goeckerman and/or PUVA) for severe Chu and colleagues (2020) stated that phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. Extreme neonatal hyperbilirubinemia and a specific genotype: A population-based case-control study. Malpresentations are almost always noted on the inpatient record. Pediatrics. Resources 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. So, it was hard for these investigators to determine whether the allocation scheme was appropriate and whether blinding of participants and personnel was implemented. 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. 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. Available at: http://www.emedicine.com/med/topic1065.htm. 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. Pace EJ, Brown CM, DeGeorge KC. Front Pharmacol. .newText { Menu penelope loyalty quotes. 16th ed. 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). Mothers typically are counseled on newborn jaundice signs and when to bring the newborn in. 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis. The AAP Guidelines suggest that an infant readmitted for hyperbilirubinemia, with a level of 18 mg/dL or more, should have a level of 13 - 14 mg/dL in order to discontinue phototherapy. For these hydroceles, the swelling will become greater and decrease. Secondary outcomes included incidence of jaundice, TSB level at 24, 48, 72, 96hours, and day 7, duration of hospital stay, and adverse effects (e.g., probiotic sepsis). The beroptic system consists of a pad of For most newborns, the transition from fetal to newborn blood simply involves watchful waiting. Pediatrics. As a family physician, you may also address needs of the mother during a newborn's encounter (e.g., lactation problems). UpToDate [online serial]. Home-based phototherapy versus hospital-based phototherapy for treatment of neonatal hyperbilirubinemia: A systematic review and meta-analysis. Severe neonatal hyperbilirubinemia and UGT1A1 promoter polymorphism. 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. NY State J Med. Phototherapy in the home setting. J Pediatr. Ludwig MA. 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. They stated that TSB assessment remains necessary, if treatment of hyperbilirubinemia is being considered. Code 99477 represents initial hospital care of the neonate (28 days or younger) who is not critically ill but requires intensive observation, frequent interventions, and other intensive care services. The efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia: A meta-analysis of randomized controlled studies. ol.numberedList LI { Do I Use 25 or 59 for Same-day Assessment and E/M? This review included total of 10 RCTs (2 in preterm neonates and 8in term neonates) that fulfilled inclusion criteria. list-style-type: upper-roman; In a Cochrane review, Gholitabar et al (2012) examined the safety and effectiveness of clofibrate in combination with phototherapy versus phototherapy alone in unconjugated neonatal hyperbilirubinemia. If done right, you will hear a popping sound. www.hkjpaed.org/pdf/2007%3B12%3B93-95.pdf sacral dimple J Matern Fetal Neonatal Med. .strikeThrough { Management of neonatal hyperbilirubinemia. Two hundred years ago, newborns would have been placed on blankets in the sun for newborn jaundice. Lacrimal ducts are the drainage system for fluid that lubricates the eye. Maisels MJ, McDonagh AF. Place the thermometer in your newborn's armpit while the phototherapy lights are on. Effects of Gly71Arg mutation in UGT1A1 gene on neonatal hyperbilirubinemia: A systematic review and meta-analysis. The nurses role in caring for newborns and their caregivers. 7. The receiver operating characteristic analysis (for serum bilirubin levels greater than 205.2 micromol/L or greater than 239.4 micromol/L) showed significantly higher areas under the curve for BiliCheck than those for BiliMed (p < 0.001).