Diagnosis and management of hyperbilirubinemia in the term neonate: for a safer first week.
New data support restructuring the approach toward diagnosis and management of hyperbilirubenia in the term neonate to make it more physician-friendly and gain wider implementation. The authors advocate clear criteria for patient safety, preventive approaches, and timely interventions. Structural changes to facilitate a system-based approach should include predischarge bilirubin management; follow-up bilirubin management; and lactational support and nutritional management. The authors advocate total serum bilirubin screening and a scoring system based on clinical risk factors as predischarge screening strategies; we should screen all babies for hyperbilirubinemia and for targeted follow-up based on an hour-specific total serum bilirubin measured for risk assessment. We should also provide focused universal education emphasizing adequate lactational nutrition, to decrease severe hyperbilirubinemia and thus prevent kernicterus.
Bhutani
Vinod K
VK
Department of Pediatrics, University of Pennsylvania School of Medicine, 800 Spruce Street, Philadelphia, PA 19107, USA. vkbdev@aol.com
Johnson
Lois H
LH
Keren
Ron
R
D005078:Exchange Transfusion, Whole Blood / Q000009:adverse effects; D006801:Humans; D006932:Hyperbilirubinemia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D007231:Infant, Newborn; D007647:Kernicterus / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology