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- W2184793209 abstract "The evaluation and management of the jaundiced term newborn has changed significantly over the past several years and continues to present a challenge for practitioners, who must balance the risk of bilirubin toxicity leading to kernicterus, with the risk of over-investigating and treating healthy infants. Recent reports of increasing kernicterus have led to further discussion regarding the level of bilirubin considered detrimental to the otherwise healthy term neonate, whose jaundice is not attributable to hemolysis. Sixty percent of term infants will become clinically jaundiced in the first week of life, with a higher incidence occurring in breastfed infants. Most neonatal jaundice is physiologic, occurring as the result of accelerated red blood cell breakdown, transient immaturity of the hepatic enzyme systems and increased enterohepatic circulation. Following extensive reviews, Newman & Maisels (1992) concluded that healthy term newborns with physiologic jaundice have a low risk of bilirubin toxicity. Based on these findings they recommended a less aggressive approach in managing these infants. Guidelines from the Fetus and Newborn Committee of the Canadian Paediatric Society (1999) and the American Academy of Pediatrics (1994) for the initiation of phototherapy in the healthy, term infant support this approach. Traditional guidelines for the evaluation and management of the jaundiced newborn were based on a population of infants who spent 3–5 days in hospital and were predominantly formula fed. Significant jaundice was almost always recognized and treated before discharge. Today, with shortened hospital stays of 24–48 hours and the increased rate of breastfeeding, bilirubin levels peak after discharge. Several reviews of early hospital discharge programs have found an increase in readmission of infants to hospital primarily for dehydration and jaundice requiring phototherapy. Of great concern are reports that cases of kernicterus are increasing. It is therefore important to consider identification of infants at risk, appropriate treatment and adequate follow-up." @default.
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- W2184793209 date "2002-01-01" @default.
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- W2184793209 title "Kernicterus and the healthy term newborn" @default.
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