Outcomes following the use of rational guidelines in the management of jaundiced newborn infants.

In 1975, rational guidelines for management of the jaundiced newborn infant were introduced to the Mercy Maternity Hospital, Melbourne. The guidelines were produced as four charts, each chart covering a particular birthweight range. The charts have been used widely. The effect of introduction of the charts has been examined by comparing the years 1971-74 with 1975-77. An overall decrease occurred in the use of phototherapy, without an increase in the use of exchange transfusion or in those with a serum bilirubin level above 339 mumol/L. The difference was not explained by an alteration in the spectrum of causes of jaundice. Long-term follow-up of jaundiced infants managed according to these guidelines revealed a satisfactory outcome despite a significant reduction in active treatment. The associated avoidance of potential side effects of treatment of the jaundiced newborn infant warrants consideration of the use of these charts by other neonatal units.