Fibreoptic versus conventional phototherapy for treatment of neonatal jaundice

Family-centered, evidence-based phototherapy delivery

Jaundice develops in most newborn infants and is one of the most common reasons infants are rehospitalized after birth. American Academy of Pediatrics clinical practice guidelines strongly support the recommendation that clinicians promote and support breastfeeding. Recognizing that the disruptions associated with phototherapy interfere with breastfeeding, the challenge often faced by clinicians is how to provide effective phototherapy while supporting evidence-based practices, such as rooming-in, skin-to-skin contact, and breastfeeding. We report here on a case that reflects a common clinical scenario in newborn medicine in order to describe a technique for providing phototherapy while maintaining evidence-based practices. This approach will assist clinicians in providing best-practices and family-centered care.

Understanding neonatal jaundice: UK practice and international profile

Over the last 25 years there have been considerable advances in the treatment and technologies used in the care of newborn infants. Most of these advances are related to the care of the premature infants and there have been few changes in the management of conditions commonly seen in term infants.

Neonatal jaundice is one of the commonest neonatal disorders and has been recognized since early history. Early neonatal jaundice is usually caused by the physiological destruction of red blood cells in the infant and its importance lies in the ability of the bilirubin pigment so produced to cross the blood brain barrier resulting in neurotoxicity. Prolonged neonatal jaundice (after 14 days of age) may be an indication of an underlying liver disorder. The approach to neonatal jaundice has remained largely unchanged over the last two to three decades. We continue to rely on visual inspection to assess the severity of early neonatal jaundice. We have technology that is effective in reducing the level of bilirubinaemia but in the UK there is no clear consensus as to the level at which jaundice should be treated. We do not have a standardized approach to the management of prolonged jaundice and there is potential for infants with significant liver problems to be diagnosed at a relatively late stage. Some countries (for example the US) have professional bodies who have introduced guidelines to ensure a standardized approach to the jaundice infant. We have little information about neonatal jaundice treatment in other parts of the developing world.

Critical overview of the management of neonatal jaundice in the UK

AIM

To determine the current management of early neonatal jaundice in the UK and to evaluate whether the current practices are evidence based.

METHODS

A questionnaire survey was carried out among identified lead paediatricians of neonatal intensive care units.

RESULTS

The survey found markedly differing practices for the recognition, investigation and treatment of neonatal jaundice. This applies particularly to confirmation of the clinical suspicion of jaundice; use of invasive and non-invasive technologies for diagnosis; preferred wavelength and intensity of light used for treatment; and whether birth weight, gestational age and postnatal age should influence treatment.

CONCLUSION

The study found a lack of consistency in the management of jaundiced infants in the UK. The evidence-based practice currently available does not appear to have been incorporated into treatment protocols.