{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T21:42:05Z","timestamp":1788298925402,"version":"build-2803163510"},"reference-count":40,"publisher":"BMJ","issue":"4","funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003061","name":"Erasmus Medisch Centrum","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003061","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,2,18]]},"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Jaundice caused by hyperbilirubinaemia is a physiological phenomenon in the neonatal period. However, severe hyperbilirubinaemia, when left untreated, may cause kernicterus, a severe condition resulting in lifelong neurological disabilities. Although commonly applied, visual inspection is ineffective in identifying severe hyperbilirubinaemia. We aim to investigate whether among babies cared for in primary care: (1) transcutaneous bilirubin (TcB) screening can help reduce severe hyperbilirubinaemia and (2) primary care-based (versus hospital-based) phototherapy can help reduce hospital admissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A factorial stepped-wedge cluster randomised controlled trial will be conducted in seven Dutch primary care birth centres (PCBC). Neonates born after 35 weeks of gestation and cared for at a participating PCBC for at least 2\u2009days within the first week of life are eligible, provided they have not received phototherapy before. According to the stepped-wedge design, following a phase of \u2018usual care\u2019 (visual assessment and selective total serum bilirubin (TSB) quantification), either daily TcB measurement or, if indicated, phototherapy in the PCBC will be implemented (phase II). In phase III, both interventions will be evaluated in each PCBC. We aim to include 5500 neonates over 3 years.<\/jats:p>\n                    <jats:p>Primary outcomes are assessed at 14 days of life: (1) the proportion of neonates having experienced severe hyperbilirubinaemia (for the TcB screening intervention), defined as a TSB above the mean of the phototherapy and the exchange transfusion threshold and (2) the proportion of neonates having required hospital admission for hyperbilirubinaemia treatment (for the phototherapy intervention in primary care).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has been approved by the Medical Research Ethics Committee of the Erasmus MC Rotterdam, the Netherlands (MEC-2017-473). Written parental informed consent will be obtained. Results from this study will be published in peer-reviewed journals and presented at (inter)national meetings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>NTR7187.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-028270","type":"journal-article","created":{"date-parts":[[2019,4,20]],"date-time":"2019-04-20T12:15:39Z","timestamp":1555762539000},"page":"e028270","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Screening and treatment to reduce severe hyperbilirubinaemia in infants in primary care (STARSHIP): a factorial stepped-wedge cluster randomised controlled trial protocol"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9406-793X","authenticated-orcid":false,"given":"Berthe A M","family":"van der Geest","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children\u2019s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands"},{"name":"Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children\u2019s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna P","family":"de Graaf","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children\u2019s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loes C M","family":"Bertens","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children\u2019s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marten J","family":"Poley","sequence":"additional","affiliation":[{"name":"Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, Netherlands"},{"name":"Paediatric Intensive Care Unit, Department of Paediatrics, Erasmus MC - Sophia Childen\u2019s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands"},{"name":"Paediatric Surgery, Erasmus MC - Sophia Children\u2019s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erwin","family":"Ista","sequence":"additional","affiliation":[{"name":"Paediatric Intensive Care Unit, Department of Paediatrics, Erasmus MC - Sophia Childen\u2019s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands"},{"name":"Nursing Science, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9 F","family":"Kornelisse","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children\u2019s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irwin K M","family":"Reiss","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children\u2019s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A P","family":"Steegers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children\u2019s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasper V","family":"Been","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children\u2019s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands"},{"name":"Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children\u2019s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands"},{"name":"Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,20]]},"reference":[{"key":"2025121223041310000_9.4.e028270.1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211157"},{"key":"2025121223041310000_9.4.e028270.2","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/S2352-4642(18)30139-1","article-title":"Neonatal hyperbilirubinaemia: a global perspective","volume":"2","author":"Olusanya","year":"2018","journal-title":"Lancet Child Adolesc Health"},{"key":"2025121223041310000_9.4.e028270.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2014.12.008."},{"key":"2025121223041310000_9.4.e028270.4","doi-asserted-by":"crossref","first-page":"199","DOI":"10.2174\/1573396313666170815100214","article-title":"The Neurological Sequelae of Neonatal Hyperbilirubinemia: definitions, diagnosis and treatment of the Kernicterus Spectrum Disorders (KSDs)","volume":"13","author":"Le Pichon","year":"2017","journal-title":"Curr Pediatr Rev"},{"key":"2025121223041310000_9.4.e028270.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjpo-2017-000105","article-title":"Burden of severe neonatal jaundice: a systematic review and meta-analysis","volume":"1","author":"Slusher","year":"2017","journal-title":"BMJ Paediatr Open"},{"key":"2025121223041310000_9.4.e028270.6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-0253"},{"key":"2025121223041310000_9.4.e028270.7","first-page":"A8518","article-title":"[Kernicterus is preventable but still occurs] Kernicterus is vermijdbaar, maar komt nog steeds voor","volume":"159","author":"Bousema","year":"2015","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2025121223041310000_9.4.e028270.8","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.060328"},{"key":"2025121223041310000_9.4.e028270.9","unstructured":"Nederlandse Vereniging voor Kindergeneeskunde, Kwaliteitsinstituut voor de Gezondheidszorg CBO. [Guideline prevention, diagnosis and treatment of hyperbilirubinaemia among newborns born at a gestational age of more than 35 weeks] Richtlijn preventie, diagnostiek en behandeling van hyperbilirubinemie bij de pasgeborene, geboren na een zwangerschapsduur van meer dan 35 weken. 2008 https:\/\/www.nvk.nl\/Portals\/0\/richtlijnen\/hyperbili\/richtlijnhyperbili.pdf."},{"key":"2025121223041310000_9.4.e028270.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.1976.tb02826.x"},{"key":"2025121223041310000_9.4.e028270.11","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-4299"},{"key":"2025121223041310000_9.4.e028270.12","doi-asserted-by":"publisher","DOI":"10.1097\/MOP.0b013e328339603f"},{"key":"2025121223041310000_9.4.e028270.13","doi-asserted-by":"publisher","DOI":"10.1542\/peds.114.1.297"},{"key":"2025121223041310000_9.4.e028270.14","doi-asserted-by":"crossref","first-page":"67","DOI":"10.2174\/1573396313666170110144345","article-title":"Newborn Bilirubin screening for preventing severe hyperbilirubinemia and bilirubin encephalopathy: a rapid review","volume":"13","author":"Bhardwaj","year":"2017","journal-title":"Curr Pediatr Rev"},{"key":"2025121223041310000_9.4.e028270.15","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2014.08.007"},{"key":"2025121223041310000_9.4.e028270.16","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-0599"},{"key":"2025121223041310000_9.4.e028270.17","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-1338"},{"key":"2025121223041310000_9.4.e028270.18","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211152"},{"key":"2025121223041310000_9.4.e028270.19","first-page":"CD007969","article-title":"Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates","volume":"12","author":"Kumar","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121223041310000_9.4.e028270.20","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/fmu076"},{"key":"2025121223041310000_9.4.e028270.21","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2003.034868"},{"key":"2025121223041310000_9.4.e028270.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-016050","article-title":"Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study","volume":"7","author":"Battersby","year":"2017","journal-title":"BMJ Open"},{"key":"2025121223041310000_9.4.e028270.23","doi-asserted-by":"crossref","first-page":"E285","DOI":"10.9778\/cmajo.20170158","article-title":"Cost savings with transcutaneous screening versus total serum bilirubin measurement for newborn jaundice in hospital and community settings: a cost-minimization analysis","volume":"6","author":"McClean","year":"2018","journal-title":"CMAJ Open"},{"key":"2025121223041310000_9.4.e028270.24","unstructured":"Perined. [Perinatal Care in the Netherlands 2016] Perinatale Zorg in Nederland 2016. Utrecht: Perined, 2018."},{"key":"2025121223041310000_9.4.e028270.25","unstructured":"de Boer J , Zondag L . Multidisciplinary guideline postnatal care] Multidisciplinaire richtlijn Postnatale Zorg - Verloskundige basiszorg voor moeder en kind: Koninklijke Nederlandse Organisatie van Verloskundigen, 2018."},{"key":"2025121223041310000_9.4.e028270.26","doi-asserted-by":"publisher","DOI":"10.1159\/000351274"},{"key":"2025121223041310000_9.4.e028270.27","first-page":"A93","article-title":"Guideline \u2019Prevention, diagnosis and treatment of hyperbilirubinemia in the neonate with a gestational age of 35 or more weeks'] Richtlijn \u2019Preventie, diagnostiek en behandeling bij de pasgeborene, geboren na een zwangerschapsduur van meer dan 35 weken","volume":"153","author":"Dijk","year":"2009","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2025121223041310000_9.4.e028270.28","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-12-70"},{"key":"2025121223041310000_9.4.e028270.29","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-1713"},{"key":"2025121223041310000_9.4.e028270.30","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1177\/0009922817701170","article-title":"A prospective comparison of transcutaneous and serum bilirubin within brief time intervals","volume":"56","author":"Jones","year":"2017","journal-title":"Clin Pediatr"},{"key":"2025121223041310000_9.4.e028270.31","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.clinbiochem.2012.03.014","article-title":"Transcutaneous bilirubin measurement: comparison of Respironics BiliCheck and JM-103 in a normal newborn population","volume":"45","author":"Romagnoli","year":"2012","journal-title":"Clin Biochem"},{"key":"2025121223041310000_9.4.e028270.32","doi-asserted-by":"publisher","DOI":"10.1542\/neo.7-5-e217"},{"key":"2025121223041310000_9.4.e028270.33","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-1494"},{"key":"2025121223041310000_9.4.e028270.34","unstructured":"Hakkaart-van Roijen L , van der Linden N , Bouwmans C , et al . Costing manual: methodology of costing research and reference prices for economic evaluation in health care. Kostenhandleiding: Methodologie van kostenonderzoek en referentieprijzen voor economische evaluaties in de gezondheidszorg, 2015."},{"key":"2025121223041310000_9.4.e028270.35","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-015-0090-2"},{"key":"2025121223041310000_9.4.e028270.36","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h391"},{"key":"2025121223041310000_9.4.e028270.37","unstructured":"International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH). Guideline for Good Clinical Practice ICH 2016."},{"key":"2025121223041310000_9.4.e028270.38","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k1614"},{"key":"2025121223041310000_9.4.e028270.39","unstructured":"International Committee of Medical Journal Editors. Defining the Role of Authors and Contributors. 2017 http:\/\/www.icmje.org\/recommendations\/browse\/roles-and-responsibilities\/defining-the-role-of-authors-and-contributors.html (Cited 22 Nov 2018)."},{"key":"2025121223041310000_9.4.e028270.40","unstructured":"National Collaborating Centre for Women\u2019s and Children\u2019s Health. Neonatal jaundice. National Institute for Health and Clinical Excellence. 2010 https:\/\/www.ncbi.nlm.nih.gov\/pubmedhealth\/PMH0016565\/pdf\/PubMedHealth_PMH0016565.pdf."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-028270","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T07:04:26Z","timestamp":1765609466000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-028270"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,20]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,4,20]]},"published-print":{"date-parts":[[2019,6]]}},"alternative-id":["10.1136\/bmjopen-2018-028270"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-028270","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,20]]}}}