Range of UK practice regarding thresholds for phototherapy and exchange transfusion in neonatal hyperbilirubinaemia
- 1Neonatal Unit, Elizabeth Garrett Anderson & Obstetric Hospitals, London, UK
- 2NICU, Monash Medical Centre, Melbourne, Australia
- 3Centre 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;
- Accepted 6 October 2008
- Published Online First 10 November 2008
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.
Funding This work was undertaken at UCLH/UCL, which received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme.
Competing interests JR has provided advice to lawyers advising both claimants and defendants in litigation regarding kernicterus. She was appointed as Chair of the NICE Guideline Development group on neonatal jaundice in 2007, after the work for this article was carried out.
▸ An additional appendix is published online only at http://adc.bmj.com/content/vol94/issue5