Alexander Rakow
24th November 2006, 16:50
Leading article - December 2006
This Leading article about neonatal hyperbilirubinemia, is published in collaboration with Bloodgas.org (http://www.bloodgas.org).
The article is written by Lois Johnson and Vinod Bhutani, affiliated to University of Pennsylvania and Stanford University in the US,.
The introduction is published below. The article could be read and downloaded here (http://99nicu.org/articles/Hyperbili.pdf).
Permission to publish the article has been given by the Editor of Bloodgas.org.
* * * * * * * * * * * * * * * * * * *
Management of neonatal hyperbilirubinemia:
A need for vigilance
Lois Johnson and Vinod Bhutani
Introduction
In the late 1980s, the question whether bilirubin damaged the brain of healthy infants was unanswered. The absence of documented evidence influenced the formulation of the 1994 consensus-based guidelines for the management of jaundice. Though there has been no formal outcome evaluation of the impact of these guidelines, evidence of bilirubin-related brain damage has been reported in infants with kernicterus discharged as healthy from well baby nurseries through voluntary reports to the informal Pilot Kernicterus Registry.
Do these and other cases indicate a re-emergence of kernicterus in the US? Do we know the risk of clinically monitored jaundice and the current prevalence of kernicterus and can we define the risk for occurrence of kernicterus? As these questions were addressed, lapses in care were identified and attributed as root causes of kernicterus in an era when there should be no barriers to safe and effective bilirubin reduction strategies. Of these barriers, lack of continuity of medical supervision during the first week after birth emerges as an underlying concern.
Are there sequelae of severe or prolonged moderate hyperbilirubinemia in the absence of recognized acute bilirubin encephalopathy? More importantly, can we define a bilirubin level that is safe? The updated 2004 AAP guidelines attempt to address these questions and recommend, by consensus, a systems approach which, if implemented by all birthing institutions, should prevent virtually all cases of kernicterus in term and near-term infants. Pending formal evidentiary basis for this preventive strategy, these clinical cases of kernicterus remind us of a need to be vigilant.
* * * * * * * * * * * * * * * * * * *
You may comment the article directly below or discuss etiologies and treatment of hyperbilirubinemia in the forums Hematology or Gastroenterology.
This Leading article about neonatal hyperbilirubinemia, is published in collaboration with Bloodgas.org (http://www.bloodgas.org).
The article is written by Lois Johnson and Vinod Bhutani, affiliated to University of Pennsylvania and Stanford University in the US,.
The introduction is published below. The article could be read and downloaded here (http://99nicu.org/articles/Hyperbili.pdf).
Permission to publish the article has been given by the Editor of Bloodgas.org.
* * * * * * * * * * * * * * * * * * *
Management of neonatal hyperbilirubinemia:
A need for vigilance
Lois Johnson and Vinod Bhutani
Introduction
In the late 1980s, the question whether bilirubin damaged the brain of healthy infants was unanswered. The absence of documented evidence influenced the formulation of the 1994 consensus-based guidelines for the management of jaundice. Though there has been no formal outcome evaluation of the impact of these guidelines, evidence of bilirubin-related brain damage has been reported in infants with kernicterus discharged as healthy from well baby nurseries through voluntary reports to the informal Pilot Kernicterus Registry.
Do these and other cases indicate a re-emergence of kernicterus in the US? Do we know the risk of clinically monitored jaundice and the current prevalence of kernicterus and can we define the risk for occurrence of kernicterus? As these questions were addressed, lapses in care were identified and attributed as root causes of kernicterus in an era when there should be no barriers to safe and effective bilirubin reduction strategies. Of these barriers, lack of continuity of medical supervision during the first week after birth emerges as an underlying concern.
Are there sequelae of severe or prolonged moderate hyperbilirubinemia in the absence of recognized acute bilirubin encephalopathy? More importantly, can we define a bilirubin level that is safe? The updated 2004 AAP guidelines attempt to address these questions and recommend, by consensus, a systems approach which, if implemented by all birthing institutions, should prevent virtually all cases of kernicterus in term and near-term infants. Pending formal evidentiary basis for this preventive strategy, these clinical cases of kernicterus remind us of a need to be vigilant.
* * * * * * * * * * * * * * * * * * *
You may comment the article directly below or discuss etiologies and treatment of hyperbilirubinemia in the forums Hematology or Gastroenterology.