Is current management of neonatal jaundice evidence based?

Jaundice is the most common medical problem affecting babies in the first week of life. Phototherapy was introduced as a treatment for jaundice in 1958, and its widespread use has reduced the need for exchange transfusion. Bilirubin charts or mathematical formulae based on gestation may be used to guide treatment decisions for hyperbilirubinaemia. We were interested in current practices and recently surveyed the management of jaundice in our region. The North of England has 64 medical neonatal intensive and special care units. In October 2003, we posted a questionnaire to a lead paediatrician at each unit to enquire about local guidelines and evidence for their management of jaundice. We sent a further questionnaire by electronic mail to 36 units that did not initially respond. A total of 40 responses (65%) were received. Table 1 summarises the results. Of units that responded, we found that 90% (36/40) used bilirubin charts to guide management. Only four (11%) were able to offer evidence to support the use of their charts, and 20 (55%) did not know the origin of their charts. Thirty eight units (95%) had specific treatment considerations for preterm or low birthweight infants using formulae or special charts. Fifteen different bilirubin charts were submitted to the survey. Of these, only three have been published. The remaining 12 were self derived or of unknown origin. Our survey shows considerable variation in local protocols and a lack of consensus in the current management of jaundice. Apart from the epidemiological decline in the incidence of kernicterus, there is little evidence to support current treatment regimens. It is conceivable that many infants are being overtreated. With the current drive towards evidence based practice, we recommend further analysis of the optimal management of neonatal jaundice and a move towards standardised guidelines.