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.
Department of Pediatrics, University of Pennsylvania School of Medicine, 800 Spruce Street, Philadelphia, PA 19107, USA. vkbdev@aol.com
Vinod K
VK
Bhutani
Lois H
LH
Johnson
Ron
R
Keren
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