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Neonatal jaundice--are we over-treating?

S A Walsh, J F A Murphy

    Irish Medical Journal
    |March 13, 2010
    PubMed

    Insights

    Newborn hyperbilirubinaemia treatment guidelines may be too strict. A review of phototherapy in term infants found many received treatment with low bilirubin levels, suggesting current guidelines could be relaxed for healthier newborns.

    Area of Science:

    • Neonatal Medicine
    • Pediatrics
    • Clinical Practice Guidelines

    Background:

    • Hyperbilirubinaemia is a common neonatal condition requiring intervention.
    • A 2006 NEJM study suggested relaxing treatment guidelines for healthy newborns.
    • This study retrospectively reviewed phototherapy use in term infants from 1998-2006.

    Discussion:

    • Phototherapy was administered to 2.5% of 56,894 births.
    • Of 539 term infants receiving phototherapy, 9% had peak total serum bilirubin (TSB) >400 umol/l.
    • 26% of infants receiving phototherapy had peak TSB ≤250 umol/l, with no kernicterus cases.

    Key Insights:

    • 27% of infants in the lowest TSB phototherapy range were Coombs positive.
    • Among Coombs-positive infants, 14% had peak TSB >400 umol/l.
    • Four Coombs-positive infants required exchange transfusions.

    Outlook:

    • Findings support reconsidering current hyperbilirubinaemia treatment thresholds.
    • Evidence suggests guidelines could be relaxed for otherwise healthy term infants.
    • Further research may refine treatment protocols for neonatal jaundice.

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