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Monographs in Clinical Paediatrics: Neonatal Jaundice.
  1. J Tripp
  1. Department of Child Health, University of Exeter, School of Postgraduate Medicine and Health Sciences, Church Lane, Heavitree, Exeter EX2 5SQ, UK

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    This monograph is a useful summary of the problem of significant hyperbilirubinaemia in the neonate with full description of the biochemical and pathophysiological aspects of the condition. Each of the subjects is also dealt with from a historical perspective, which provides considerable interest. I was particularly interested to note that the first ever exchange transfusion performed on a jaundiced child (five previous children had died of bilirubin toxicity) is described as “transfusion and exanguination” via the saphenous vein and sagittal sinus respectively: this was carried out as a continuous exanguination/transfusion. Since that time, many techniques have been used, although the approach to the sagittal sinus via the anterior fontanel is no longer practiced. Interestingly, although other continuous techniques have been developed they are now rarely used; there is a common preference for a “in/out” technique.

    In the chapter on The Clinical Approach to the Jaundiced Newborn, the algorithm of the American Academy of Paediatrics is reproduced. I was particularly interested to look at the approach to persistent jaundiced and was disappointed to find that the only advice given for jaundice persisting more than three weeks was to “perform appropriate physical and laboratory assessment of infant including possibility of cholestatic jaundice” when it had already been established that the infant did not have abnormal physical exam results, dark urine, or light stools. In my view, the demonstration of normal levels of conjugated bilirubin at this age is sufficient to rule out significant liver disease, which requires further management.

    There is an interesting discussion of whether total or unconjugated bilirubin should be measured in assessing risk for kernicterus. The surprising conclusion (supported by anecdotal case reports) is that conjugated bilirubin should not be subtracted from the total unless it exceeds 50% of the total, when there is some evidence that even conjugated hyperbilirubinaemia may contribute towards kernicterus in the presence of a high total bilirubin.

    I conclude that this is a useful reference text and an excellent source of definitive information, but it is unlikely to find its way to the benchbook section of the neonatal library.