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Neonatal jaundice in infants born at 37 weeks: is NICE treating too many?
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  • Published on:
    The "kinder, gentler" approach revisited
    • Janet Rennie, Honorary Consultant Neonatologist UCLH London
    • Other Contributors:
      • Kevin Ives, Consultant Neonatologist


    We read the letter from Noureldein and colleagues with interest. As former members of the NICE guideline committee on neonatal jaundice and individuals who have advised on many medico-legal claims involving kernicterus, we retain our interest in the topic. Thirty years after discussions about a “kinder, gentler” approach (1), the choice of threshold values for phototherapy remains contentious. The Birmingham group question whether the decision to treat babies born at 37 weeks gestation differently from those born at 38-42 weeks was justified. It took many years to appreciate that there was a significant difference regarding the risk of transient tachypnoea of the newborn between babies born at 37 weeks compared with more mature babies (2). Similar information about the risk of kernicterus is never likely to be forthcoming.

    The rationale for treating 37 week gestation babies differently from those born at >38 weeks was based in part on the observation that the less mature group were over-represented in the US kernicterus registry of 1992-2004 (3). Denominator numbers are not available but there were 24 cases at 37 weeks, and a total of 71 at >37 weeks. The new AAP guideline notes that the risk of neurotoxicity from hyperbilirubinaemia is higher at <38 weeks, and with an albumin <3 g/dL (4). The evidence examined for the NICE 2010 guideline consistently showed that a gestational age <38 weeks was associated with an increased risk of hyperbi...

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    Conflict of Interest:
    None declared.