Assessment of adherence level for neonatal hyperbilirubinemia management by various physicians in ‎Iraq: a multi-clinic study

Background: Neonatal jaundice is a physiological process that occurs normally ‎for every infant to a varying degree. In some cases, this process becomes pathological ‎and imposes an increased risk of morbidity and mortality for the infant. The aim of this study was to assess the adherence level of various physicians to different guidelines ‎of management of neonatal hyperbilirubinemia in Iraq. Methods: An observational cross-sectional study was conducted in ‎multiple outpatient clinics in various Iraqi provinces, from February ‎‎2018 to ‎February 2019. ‎The study involved 130 physicians, who were divided into emergency physicians (EPs), general practitioners (GPs), and pediatricians (PDs), and assessed their compliance to guidelines for management of neonatal hyperbilirubinemia using a questionnaire, which included providing the correct management for a test case scenario. Results: PDs had significantly longer discharge times compared to EPs and GPs. In total, ‎91.7‎% of PDs always tested the neonate for bilirubin levels ‎before discharge, while 5.5‎% of GPs and 0% of EP did so. Regarding follow-up visits, 16.7‎%, 4.8% and 45.2% of PDs, EPs and GPs, respectively, scheduled a follow-up between 49-72 hours; ‎47.6‎% and 38.1% of EPs scheduled a follow-up at ≤24 hours and 25-48 hours, respectively‎‏. In addition, 91.7% of PDs gave the correct answer for the management of the test ‎case scenario, followed by 58.9% of GPs, and 38.1% of ‎EPs‎‏.‏ About half of ‎PDs extended neonates length of stay beyond 48 ‎hours. Conclusion: GPs and EPs show lower adherence levels for the management of neonatal jaundice than PDs, which indicates that these physicians adhere well to current management guidelines from the WHO, ‎AAP, and NICE.