A Graphical Decision-Theoretic Model for Neonatal Jaundice

Abstract

Background. Neonatal jaundice is treated daily at all hospitals. However, the routine, urgency, and case load of most doctors stop them from carefully analyzing all the factors that they would like to (and should) take into account. This article develops a complex decision support system for neonatal jaundice management. Methods. The problem is represented by means of an influence diagram, including admission and treatment decisions. The corresponding uncertainty model is built with the aid of both historical data and subjective judgments. Parents and doctors were interviewed to elicit a multiattribute utility function. The decision analysis cycle is completed with sensitivity analyses and explanations of the results. Results. The construction and use of this decision support system for jaundice management have induced a profound change in daily medical practice, avoiding aggressive treatments—there have been no exchange transfusions in the past 3 years—and reducing the lengths of stay at the hospital. More information is now taken into account to decide on treatments. Interestingly, after embarking on this modeling effort, physicians came to view jaundice as a much more difficult problem than they had initially thought. Comparisons between real cases and system proposals revealed that treatments by nonexpert doctors tend to be longer than what expert doctors would administer. Conclusion. The system is especially designed to help neonatologists in situations in which their lack of experience may lead to unnecessary treatments. Different points of view from several expert doctors and, more interestingly, from parents are taken into account. This knowledge gives a broader picture of the medical problem— incorporating new action criteria, new agents to intervene, more uncertainty variables—to get an insight into the suitability of each therapeutic decision for each patient situation. The benefits gained and the usefulness perceived by neonatologists are worth the increased and time-consuming effort of developing this complex system. Although specially designed for a specific hospital and for neonatal jaundice management, it can be easily adapted to other hospitals and problems.