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Placing preterm infants for sleep: first prone, then supine

2007; BMJ; Volume: 92; Issue: 5 Linguagem: Inglês

10.1136/adc.2006.113720

1468-2052

Christian F. Poets, Anette von Bodman,

Respiratory Support and Mechanisms

In the UK and Republic of Ireland the responsibility for detecting significant postdischarge jaundice rests with the primary healthcare team of midwives, health visitors, general practitioners and informed parents.This survey throws up concerns that this early warning system is insufficiently robust.It may be necessary to consider the type of predictive testing being adopted in the USA.Bhutani et al 3 recommend a universal predischarge total serum bilirubin measurement plotted on an hour-specific bilirubin nomogram to help customise the appropriate timing of follow-up appointments.It would be interesting to know how many of the 108 babies in this cohort would have been in the high risk .95thpercentile zone on the nomogram, had such testing been done.It is a woeful situation in the UK that there are no nationally agreed guidelines for the assessment and management of hyperbilirubinaemia in the newborn.A recent survey of more than 160 respondent UK neonatal units revealed a ''massive variation in the choice of the threshold levels at which treatment was recommended'' (J M Rennie personal communication, 2006).Equally, there is no agreement about whether treatment thresholds should take into account sickness (however defined), prematurity or the conjugated fraction of bilirubin.Because bilirubin encephalopathy is comparatively rare, a degree of complacency towards treatment has evolved.Manning and colleagues have woken us up to a likely resurgence of kernicterus in our present day practice, and it is to be hoped that lessons will be learned from this important study.One lesson should be to call for a consensus agreement on UK treatment guidelines and to monitor the incidence of kernicterus through surveys such as this and a national registry of cases.Definitive randomised trials of jaundice management are unlikely to be conducted, and future refinement of treatment guidelines may evolve more readily from a well-observed experience base.