Fantoms
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The report by Manning et al of a prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland and the provocative Perspective by Ives should be read by all. Whether you call it severe, extreme or hazardous (probably all three), bilirubin levels exceeding 510 µmol/l were observed in at least 7.1/100 000 infants. Bilirubin encephalopathy and kernicterus should therefore be a renewed concern for all who care for newborn infants in the UK and Ireland. The majority of cases were identified after discharge from hospital. This highlights the need for appropriate post-discharge review and requires difficulties with measurement of bilirubin after discharge to be overcome. Although many affected infants had characteristics that identified them as at greater risk, such as haemolytic disease, the absence of risk factors in many cases and the common association of severe hyperbilirubinaemia with exclusive breast feeding and dehydration have led some
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