ORIGINAL ARTICLES

Range of UK practice regarding thresholds for phototherapy and exchange transfusion in neonatal hyperbilirubinaemia

J M Rennie¹, A Sehgal², A De¹, G S Kendall¹, T J Cole³

¹ Neonatal Unit, Elizabeth Garrett Anderson & Obstetric Hospitals, London, UK
² NICU, Monash Medical Centre, Melbourne, Australia
³ Centre for Paediatric Epidemiology and Biostatistics, University College London, London, UK

^{Correspondence to} Janet M Rennie, Neonatal Unit, Elizabeth Garrett Anderson & Obstetric Hospitals, University College London Hospitals, Euston Road, London NW1 2PQ, UK; janet.rennie{at}uclh.org

Objective: To establish the range of opinion regarding thresholds at which phototherapy and exchange transfusion are used to treat neonatal hyperbilirubinaemia in the UK.

Design: A survey of existing charts and guidelines collected from around the UK. Threshold levels were extracted from the charts and entered into an Excel spreadsheet. Filters were applied to analyse subsets of guidelines, and calculations were carried out to analyse the rate of rise of bilirubin (in µmol/l/h) between the origin and the plateau, where this was possible.

Results: Of 263 hospitals contacted, 163 submitted guidelines, of which most were in the form of individual charts. There was wide variation in the choice of the threshold levels at which treatment was recommended, particularly in preterm babies. At 28 weeks, for example, the range at which phototherapy was recommended extended from 100 µmol/l to 250 µmol/l, and the upper limit was even higher if data from units which used a single guideline for preterm babies of all gestations were included. There was variation in the choice of the origin of the graph and the time at which the plateau commenced (and hence the slope), whether "sickness" criteria should be adopted, and what those criteria should be. Many charts were confusing, poorly presented, sketchily drawn and lacked proper gridlines or axis labels.

Conclusions: For such a vitally important topic it is disappointing that there is little existing consensus and no national guidance in the UK. Guidelines for England, Wales and Northern Ireland will be available from 2010, when the National Institute for Health and Clinical Excellence completes its review.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Fantoms

Ben Stenson
Arch. Dis. Child. Fetal Neonatal Ed. 2009 94: F313. [Extract] [Full Text] [PDF]

Neonatal jaundice: in the eye of the beholder?

Donal Manning
Arch. Dis. Child. Fetal Neonatal Ed. 2009 94: F314-F316. [Extract] [Full Text] [PDF]