Range of UK practice regarding thresholds for phototherapy and exchange transfusion in neonatal hyperbilirubinaemia

Abstract

Objective: To establish the range of opinion regarding thresholds at which phototherapy and exchange transfusion are used to treat neonatal hyperbilirubinaemia in the United Kingdom.

Design: A survey of existing charts and guidelines collected from around the UK. Threshold levels were extracted from the charts and entered into an Excel spreadsheet. Filters were applied to analyse subsets of guidelines, and calculations were done to analyse the rate of rise of bilirubin (in micromol/l/h) between the origin and the plateau, where this was possible.

Results: Of 263 hospitals contacted 163 submitted guidelines, of which most were in the form of individual charts. There was wide variation in the choice of the threshold levels at which treatment was recommended, particularly in preterm babies. At 28 weeks, for example, the range at which phototherapy was recommended extended from 100 micromol/l to 250 micromol/l, and the upper limit was even higher if data from units who used a single guideline for preterm babies of all gestations were included. There was variation in the choice of the origin of the graph and the time at which the plateau commenced (and hence the slope), whether or not “sickness” criteria should be adopted, and what those criteria should be. Many charts were confusing, poorly presented, sketchily drawn and lacked proper gridlines or axis labels.

Conclusions: This survey has shown that there is a wide variation in practice in the management of neonatal jaundice, an extremely common clinical entity.