Published online October 1, 2004
PEDIATRICS Vol. 114 No. 4 October 2004, pp. 1086-1088 (doi:10.1542/10.1542/peds.2004-1753)
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COMMENTARY

Management of Hyperbilirubinemia: Quality of Evidence and Cost

Neil A. Holtzman, MD, MPH

Department of Pediatrics and Institute of Genetic Medicine
Johns Hopkins University School of Medicine
Baltimore, MD 21205

Abbreviations: AAP, American Academy of Pediatrics

The first 20% of the full text of this article appears below.

Kernicterus is associated with early hospital discharge, reduced concern about jaundice in otherwise healthy newborns, and breastfeeding.1–3 To compensate for early discharge, the American Academy of Pediatrics (AAP) recommends that newborns be seen by a qualified health professional by 5 days of age (see "Recommendation 6.1.2" in ref 4). Providing this rapid follow-up to the estimated 70% of all infants now discharged before 48 hours of age would probably cost more than $10 million to prevent 1 case of kernicterus, as Suresh et al5 describe in this issue of Pediatrics. Here I address 2 questions: (1) Is the evidence sufficient to justify the recommendation? (2) Is the cost too high?

Of the 30 recommendations on the management of hyperbilirubinemia for which the AAP guidelines indicated "evidence quality," none were in the highest category ("well-designed, randomized, controlled trials or diagnostic studies on relevant populations"4(p308)), 10 were in the lowest category ("expert opinion, case reports, reasoning from first principles"4(p308)), and 15 were . . . [Full Text of this Article]

Address correspondence to Neil A. Holtzman, MD, MPH. E-mail: nholtzma@jhsph.edu


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