Fantoms
Neonatal jaundice
Three articles on neonatal jaundice this month are essential reading. Rennie et al have summarised all the clinical guidelines for the treatment of jaundice that they found to be in use in a survey of UK neonatal units. They highlight the diversity of practice that has evolved in the face of a weak evidence base. The reappearance of kernicterus justifies a new focus on quality of practice in this area. As they point out, the rarity of this adverse outcome is such that new high quality evidence is going to be hard to come by and the way forward may be national consensus guidelines that evolve in relation to outcomes audit. Interim guidelines are proposed pending the forthcoming National Institute for Health and Clinical Excellence guidelines. Keren et al studied the ability of clinical staff to estimate the severity of jaundice in newborn infants prior to hospital discharge. The relationship between clinically assessed jaundice severity and measured bilirubin was weak. Infants assessed as not at all jaundiced did not develop …
