338 When to Treat Neonatal Jaundice: Is there any Evidence?

Abstract

Objectives: To analyse if the currently used jaundice action charts are evidence based.

Methods: We contacted 72 neonatal units in the Great Britain and enquired about the unit guidelines for management of neonatal jaundice. The jaundice action charts were analysed to explore the variation between different charts. The time at which the threshold value for treatment reached a plateau was recorded.

Results: Of the 72 units contacted 46 responded with charts. Four neonatal units were using formulas and one hospital was using separate chart for each gestation. The data displayed wide variation in treatment levels (phototherapy and exchange transfusion) at 12 to 168 hours in the three gestational groups studied (28, 32 weeks and term). There was no reference of evidence quoted in the jaundice action charts.

Figure

Figure

The median plateau time was also analysed and for phototherapy this corresponds to 72 hours for all three gestations. For exchange transfusion the median time of plateau was highest for the term babies and lowest for 32 weeks gestation.

Conclusion: Jaundice action charts reviewed in our study showed significant variation in the threshold for treatment of neonatal jaundice. Both the studied parameters (variation in threshold and the median time to plateau) point towards the fact that the charts being used in the neonatal unit are not evidence based and need modification.

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