title: Uniform treatment thresholds for hyperbilirubinemia in preterm infants: background and synopsis of a national guideline.
abstract: BACKGROUND
  To prevent severe hyperbilirubinemia and bilirubin neurotoxicity, the American Academy of Pediatrics' management guideline for hyperbilirubinemia in near term infants is used worldwide. A leading guideline for jaundiced preterm infants is lacking whereas the risk on severe hyperbilirubinemia is high in these infants. Our aim was to define uniform treatment thresholds for jaundiced preterm infants. In this article we present the history and a synopsis of this novel national guideline.
  
  
  METHODS
  A survey on guidelines for hyperbilirubinemia in preterm infants was sent to all Dutch Neonatal Intensive Care Units (NICUs). After comparison with international guidelines, a new consensus-based guideline was developed.
  
  
  RESULTS
  Treatment thresholds of all 10 NICUs were based on Total Serum Bilirubin (TSB) and related to birth weight (n = 9) and gestational age (n = 1). NICUs used age-specific (n = 6) or fixed (n = 4) TSB-thresholds resulting in a large range of thresholds (maximal 170 μmol/L for phototherapy and 125 μmol/L for exchange transfusion). Acidosis, asphyxia, sepsis, active hemolysis and intraventricular hemorrhage were the most frequently used risk factors. Consensus was agreed upon TSB-based treatment thresholds, categorized in 5 birth weight groups and divided in high and low risk infants.
  
  
  CONCLUSIONS
  There was no standardized care for jaundiced preterm infants in the Netherlands. In addition to the internationally used guideline for (near) term infants, a novel "consensus based" guideline for preterm infants with a gestational age of less than 35 weeks has been developed and implemented in the Netherlands. This guideline is approved and recommended by the Dutch Society of Pediatrics.
authors.affiliation: Dept. of Pediatrics, Div. of Neonatology, University Medical Center Groningen, Hanzeplein 1, 9700 RB, the Netherlands. d.e.van.imhoff@bkk.umcg.nl
authors.forename: Deirdre Elisabeth
authors.initials: DE
authors.lastname: van Imhoff
authors.forename: Peter Hendrik
authors.initials: PH
authors.lastname: Dijk
authors.forename: Christian Victor
authors.initials: CV
authors.lastname: Hulzebos
mesh_terms: D001724:Birth Weight; D005078:Exchange Transfusion, Whole Blood; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000628:therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D007363:Intensive Care Units, Neonatal; D009426:Netherlands; D010789:Phototherapy; D017410:Practice Guidelines as Topic; D012307:Risk Factors