Uniforme bilirubinegrenzen voor de behandeling van icterische premature neonaten

OBJECTIVE: To compare the guidelines of the 10 Dutch neonatal intensive care units (NICUs) for the treatment of preterm infants with hyperbilirubinemia, in order to develop uniform threshold levels for the total serum concentration of bilirubin (TSB) above which treatment with phototherapy or exchange transfusion is indicated.

DESIGN: Survey.

METHODS: Guidelines for hyperbilirubinemia in preterm infants (gestational age < 32 weeks) from all 10 Dutch NICUs were obtained and compared with each other and with international guidelines.

RESULTS: All 10 NICUs used intervention criteria based on TSB. 9 NICUs used TSB thresholds based on birth weight (1 used gestational age) with 2, 3 or 5 categories. 6 NICUs used age-specific TSB thresholds and 4 NICUs used a constant TSB threshold. The maximum range in TSB thresholds was 170 micromol/l for phototherapy and 125 micromol/l for exchange transfusion. Acidosis, sepsis, asphyxia, active haemolysis and intraventricular haemorrhage were the risk factors most frequently used. During a consensus meeting with representatives of the 10 NICUs, a guideline was agreed upon that will now be used for all neonates with a gestational age < 35 weeks.

CONCLUSION: There was considerable variation in the TSB thresholds used to date by the 10 NICUs. Now in the Netherlands, in addition to guideline 'Hyperbilirubinemia' for children with a gestational age >or= 35 weeks, 'uniform yellow thresholds' shall be used for jaundiced preterm infants with a gestational age < 35 weeks.