Neonatal jaundice--are we over-treating?

Hyperbilirubinaemia is the most common condition requiring evaluation and treatment in newborns. A study in the NEJM 2006 suggested that current guidelines for the treatment of hyperbilirubinaemia in otherwise healthy infants should be relaxed. Prompted by this we performed a retrospective review of review of all term infants who received phototherapy between 1998 and 2006 (total number births = 56,894) in the National Maternity Hospital, Holles Street. 1441 infants received phototherapy during this time period (2.5%). Of those that were of term gestation (n=539), only 9% of those infants receiving phototherapy had peak total serum bilirubin (TSB) exceeding 400 umol. Twenty six percent of infants who received phototherapy had a peak TSB that never exceeded 250 umol/l. There were no cases of kernicterus. Review of the Coombs status revealed that 27% of those undergoing phototherapy in the lowest TSB range were Coombs positive. Seven Coombs positive infants had peak TSB >400 umol/l (14%). Four Coombs positive infants received exchange transfusions. Following this study we would concur with the opinion of Newman et al that current guidelines for the treatment of hyperbilirubinaemia in otherwise healthy infants could be relaxed.