Intervention Recommendations for Neonatal Hyperbilirubinemia

To the Editor. —

In their recent article describing a benchmarking model for the management of hyperbilirubinemia, Chou et al¹ are to be commended for creating within their health care organization a systematic approach to the prevention of hyperbilirubinemia. At the same time, the prominent inclusion of a full-color nomogram in the article is a potential disservice for the reader.

To their credit, the authors indicate that their model for a laminated pocket card was developed prior to the 1994 publication of the American Academy of Pediatrics (AAP) practice guidelines,² but readers are encouraged to examine carefully the very significant differences. Unlike the AAP guidelines, the pocket card has no adjustment for consideration of lower birth weights, nor does it reflect the recommendation for more aggressive management when hemolysis is present. The area shaded in blue suggests that an infant with a bilirubin level as high as 20 mg/dL at 3 days of age need not start phototherapy if repeat measurement is performed and implies that phototherapy is optional for a level as high as 24 mg/dL at 4 days of age, …