Date of Award

2026

Document Type

Project

College/School

College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Alic Shook

Readers

Teresa van Winkle

Abstract

BACKGROUND: Neonatal hyperbilirubinemia affects approximately 60% of term and 80% of preterm newborns in the first week of life and remains a leading cause of preventable neonatal readmissions. Outpatient detection is inconsistent due to limitations of visual assessment and serum bilirubin testing. Transcutaneous bilirubin (TcB) screening offers a noninvasive point-of-care alternative but remains underutilized in outpatient settings. METHODS: A retrospective cohort study using pre- and post-implementation design was conducted at an urban pediatric clinic in Seattle, Washington. Eligible outpatient newborn visits included 108 encounters before and 98 after TcB implementation. Visits with a prior outpatient visit or documented high-risk conditions were excluded when identifiable; however, retrospective review limited complete identification of all exclusion criteria. TcB use and total serum bilirubin (TSB) ordering rates were compared using chi-square analysis (α = .05). SETTING AND SCREENING PROTOCOL: TcB screening using the Draeger JM-105 was incorporated into routine newborn follow-up visits. Readings were interpreted using the Bhutani nomogram to guide risk stratification and determine the need for confirmatory TSB testing. RESULTS: Following TcB implementation, TSB ordering declined from 37.0% (40/108) to 19.4% (19/98), a 17.6 percentage point decrease (95% CI: 5.6%–29.6%). A chi-square test demonstrated a statistically significant association between TcB implementation and reduced TSB ordering, χ²(1, N = 206) = 7.83, p = .005, Cramér's V = 0.20, indicating a small-to-moderate effect size. Among 98 postimplementation visits, 40 (40.8%) received TcB screening. Of these, 32 (32.7%) had reassuring values requiring no further laboratory workup and 8 (8.2%) exceeded the threshold and prompted confirmatory TSB. Ten visits (10.2%) resulted in direct TSB ordering without prior TcB screening. Monthly TSB ordering rates declined progressively from 32.4% in February 2026 to 9.7% in May 2026. CONCLUSIONS: TcB screening was associated with a significant reduction in TSB ordering and demonstrated feasibility in an outpatient pediatric setting. Findings suggest TcB may reduce unnecessary serum testing, lessen procedural burden, and support timely jaundice assessment. Results should be interpreted in the context of the study’s single-site retrospective design and limited demographic data. Larger prospective studies are needed to further evaluate effectiveness and generalizability.

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