REPUBLIC of the PHILIPPINES

City of Makati
UNIVERSITY OF MAKATI
COLLEGE OF ALLIED HEALTH STUDIES
CENTER OF NURSING
J.P. Rizal Extension, West Rembo Makati City 1215
Telephone No.: (+632) – 881 – 1571

Journal Critiquing
ARTICLE REVIEWED:
Tzy-Chyi Yu, et al.,
(2019): Prevalence and burden of illness of treated hemolytic neonatal
hyperbilirubinemia in a privately insured population in the United States, Issue 19, Volume
53 pg. 1-15

Submitted to: Prof. Cynthia A. Umila ,RN,MAN

Submitted by: Yvette Claire L. Borres

2-AN
Introduction

 Did the title of the article interest you and give you an immediate idea of what the
research is about? Who are the authors of the article/conductors of the research and
in which journal is the article published? Does the introduction of the article, clearly
describe what problem is that they were addressing in the research?

I chose the article because I found the title interesting and this is an update to what is the
recent diseases fostering in the pediatrics today. Since we are tackling topics about
Hyperbilirubinemia, I find it very relevant to what we are studying about. The authors of this
research are Tzy-Chyi Yu, Chi Nguyen, Nancy Ruiz , Siting Zhou , Xian Zhang , Elaine A.
Böing and Hiangkiat Tan. It was published under BMC pediatrics, February 11,2019.
• Does the introduction clearly describe the purpose of the research?

The introduction clearly describes the purpose of the research. The introduction discussed
about clearly the definitive characteristics of Neonatal Hyperbilirubinemia as common condition
in newborn infants, results from elevated blood bilirubin levels, and the study aims to describe
the commonness, clinical characteristics, and economic burden of hemolytic NHB newborns
receiving treatment in U.S. real-world settings.
• Is the research likely to have an impact on our nursing practice?

The research has an impact on the nursing practice because it implies the issue on the
current children diseases and its effect to their health status and this implies a great mark on the
nursing practice because it evaluates the ways to address the complications pertaining to growth
and development of the children and their health status.

Literature Review

• Is the literature review current (in the last 5 – 10 years?)

The literature review is relevant because most of the research references range from years
2000-2017. Most of the information came from the latest reference from 5-10 years which
retrieved from years, 2004-2018.

• Is the literature review relevant to the research that has been conducted?

The literature review is relevant because it gave information about understanding

neonatal jaundice, hyperbilirubinemia in neonates, its types, causes, clinical examinations,
preventive measures and treatments, approach to the management of hyperbilirubinemia in the
preterm infant less than 35 weeks of gestation perspective on causation which are the most
relevant and needed informations to the study.
Research Question

• What is the research question/hypothesis?

The research question is to evaluate the prevalence, clinical characteristics, and economic
burden of hemolytic NHB newborns receiving treatment in U.S. real-world settings.

Research Methods

• Is the research quantitative/qualitative?

This research is quantitative form of research since it is a cohort study.

• What is the research method?

This cohort study used administrative claims from 01/01/2011 to 08/31/2017. The treated
cohort had hemolytic NHB diagnosis and received phototherapy, intravenous immunoglobulin,
and/or exchange transfusions. They were matched with non-NHB newborns who had neither
NHB nor related treatments on the following: delivery hospital/area, gender, delivery route,
estimated gestational age (GA), health plan eligibility, and closest date of birth within 5 years.
Inferential statistics were reported.

• Do you think it is appropriate/the best way?

Yes, I think it is the most appropriate way because they need to collect information about
the study population, hospitalization and healthcare resource utilization, treated hemolytic NHB
cohort, non-NHB cohort, clinical characteristics and outcomes, costs of care, the annual
prevalence of NHB, and extrapolation to the U.S. newborn population.

• What was the method of sampling participants?

The method of sampling is probability sampling a technique in which sample from a

larger population are chosen using a method based on the theory of probability. The sampling
participants were a total Using U.S. Centers for Disease Control and Prevention (CDC) 2016
birth data by gestational age [18] and the estimated prevalence from our study, they applied a
direct standardization method to extrapolate the 2016 U.S. GA-adjusted treated hemolytic NHB
prevalence.

• Was the sample big enough?

Yes, I think that, the sample was big enough to get information they needed. There were
a total of 1.4 million identified newborns.
Research Methods

• Could there be any bias in the sample? If yes, why?

No, I think it is not bias, because it only uses sample from the population across United
States and it is more accessible for this study.

• How was the data collected?

The data was collected through the use of the HealthCore Integrated Research Database
(HIRDSM), a geographically dispersed managed-care repository with claims data on more than
45 million enrollees residing across all 50 states, to identify infants born from 01/01/2011
through 08/31/2017. The HIRD is one of the largest privately insured population databases in the
U.S [15].

• Where any tools used? Were they reliable and accurate? • Did they need/get ethics
approval to conduct the study?

The study used McNemar or McNemar-Bowker tests and Wilcoxon signed-rank tests.
This non-experimental observational study was exempt from Institutional Review Board (IRB)
informed consent stipulations. The researchers accessed a limited dataset without individual
enrollee identifiers, and only summary statistics were reported. This work complied with all
relevant provisions of the US federal Health Insurance Portability and Accountability Act of
1996 (HIPAA).

,Results and Findings

• How was the data analyzed?

All outcome measures were compared between the treated hemolytic NHB and matched
non-NHB cohorts. Statistical differences between groups were assessed using McNemar or
McNemar-Bowker tests for categorical variables and paired t-tests or Wilcoxon signed-rank tests
for continuous variables, respectively. A conventional alpha of 0.05 with two-tailed level of
significance was used to interpret statistical significance

• What were the findings of the research?

The findings of this study was that, the prevalence of treated hemolytic NHB was 4.6–5.5
patients per 1000 newborns. This high-risk hemolytic NHB imposed substantial burdens of
healthcare resource utilization and incremental costs on newborns, their caregivers, and the
healthcare system.

• Were the results displayed in a clear and understandable way?

 Yes, the results were displayed in a clear and understandable way because it described
the ways to have an effective approach for this kind of case including the interdisciplinary
aspects to benefit the common good.

Results and Findings

• Did the authors discuss the results in relation to the original problem identified?

The authors discussed about this study as the first study estimating the prevalence of
newborns with hemolytic NHB who received intervention in the U.S. which is the original
problem identified. This high-risk population imposes a substantial burden of healthcare resource
utilization and incremental costs on newborns, their caregivers, and the healthcare system.
Effective management protocols and emerging new treatments may help to mitigate the overall
burden of hemolytic NHB.

• What were the main strengths of the study?

The main strengths of this study is that it will be a great impact to the development of
strategies to address this kind of problems and how it is very applicable to all families and
children around the world.

• What do you think were the limitations of the study and were they identified by
the authors?

The limitations of this study are, the results should be interpreted in light of certain
limitations. Known risk factors such as family history, race and ethnicity, and breastfeeding
status are not available in administrative claims data. Cases of mild NHB do not usually require
intervention, and can be underdiagnosed and/or under-coded in administrative data leading to
underestimation of NHB and hemolytic NHB. The use of phototherapy during hospitalization
might not have been observed due to bundled payments and/or under-coding. Duration on
phototherapy was also not captured. This study population was from a U.S. privately insured
population, which may limit the generalizability of these results to other population segments,
such as Medicaid.

Reflections

• Could the study be replicated?

Yes, it is recommended that the study should be replicated and should be elaborated to
find out a better treatment and early detection and prevention on this kind of disease.

• Does the study, or could you, make any suggestions as to how this research could be
taken further?
 This study could be taken further by getting population from other country and not only
in the U.S. privately insured population to discover more about this disease across the globe.

• How can you relate this research and its findings to your nursing practice and patient
care?

Nurses who specialize in pediatrics devote their knowledge and skills to caring for
children from infancy through the late teen years and their families. These specialized nurses
usually complete advanced training in pediatrics and collaborate closely with physicians and
other health care providers who share their dedication to children’s health.

Like other nurses, pediatric nurses can perform physical examinations, measure vital
statistics, take blood and urine samples and order diagnostic tests. Nurses with advanced training
can interpret test results to form diagnoses and develop treatment plans.

• Consider one thing you have learnt from reading this article.

One thing I learned is that, Neonatal jaundice is usually not harmful and a self-limiting
condition; however, very high levels of bilirubin may cause permanent brain damage, a condition
called kernicterus.1 Therefore, it is important to diagnose neonatal jaundice and manage it
appropriately. We need to focus on things like the onset and prevalence of the disease because it
may have great effect on the proliferation of disease and risks of the disease. Looking at within
correlation of the health status and disease process it is possible for us to formulate a proper
intervention and treatment for this kind of disease within the normal process and needs of the
human being. Delivering care also needs collaboration from other health care professional to
bring the patient in a non disease state.