Read this Janybird, maybe you can send a copy to Dr. Maisels also. There is NO MARKET FOR THIS DEVICE WHICH IS WHY OVER THE PAST YEAR NOT ONE SINGLE HOSPITAL HAS SIGNED ON TO USE IT.
csmc.edu
Here are some important points:
1. Outpatient Management of Non-pathologic Jaundice
Most healthy infants over 24 hours of age with non-pathologic jaundice will be safely managed as outpatients. No other labwork beyond the type and Coombs' is needed if the medical assessment is negative.
Healthy full term infants who meet guidelines to receive phototherapy can be easily managed at home, especially with the fiber optic phototherapy blankets that are now available. The AAP guidelines present several treatment options for jaundiced breast-fed infants. Breast feeding may be continued while providing phototherapy.
2. Measurement of Bilirubin Levels
Both total serum bilirubin (TSB) and direct bilirubin (fraction conjugated with glucuronic acid) are commonly measured. In-office instruments are available for TSB measurements, but may not be sufficiently accurate in the most important range (over 18 mg/dl).
There are several instruments on the market that give transcutaneous bilirubin measurements. These may provide a strategy, in the future, for reliable office and home bilirubin assessments. However, the systems that are now available seem limited in their usefulness, because they must be calibrated to a given laboratory, as well as calibrated for different skin types and colors.
3. Assessment of Jaundice: Physiologic vs. Pathologic
The new quidelines adopted by the AAP (Pediatrics: 94:558-565, Oct. 1994 and 95:458-461, March, 1995) provide reasonable criteria for when and how to start "work-ups", for when phototherapy should be started, and for when exchange transfusions should be performed.
When jaundice is initially noticed, the first step in the decision making process is to determine whether it is pathologic or not (Hence Janybird, you must determine DIRECT and INDIRECT levels). Most jaundice in infants is not pathologic, but one must carefully consider and exclude pathologic conditions before relaxing vigilance.
Jaundice visible in the first 24 hours of life is generally considered "pathologic," (HENCE YOU NEED TO CHECK DIRECT AND INDIRECT) and will be discussed in the last section of this document. |
