Prevention of bilirubin encephalopathy

Prevention of bilirubin encephalopathy is based on the detection of infants at risk of developing a significant hyperbilirubinemia. This task can be a ccomplished by performing a simple umbilical cord blood test, such as blood group, Ph, Coombs' test and glucose-6-phosphate dehydrogenase, in order to detect hemolytic diseases. In preterm infants, the prevention of hyperbili rubinemia with phototherapy is a relatively simple task, since these infant s are cared for in hospital. Early hospital discharge of full-term neonates represents a major concern. The management of neonatal jaundice requires t hat therapy begins when total serum bilirubin levels are significantly belo w the levels at which kernicterus is considered an immediate threat. Unfort unately, determination of serum bilirubin is a painful procedure, and is no t very accurate since there is a high variability in laboratory measurement s. The accuracy and precision of a new transcutaneous bilirubin measurement , comparable to the standard of ca re laboratory test, makes the dal ly eva luation of transcutaneous bilirubin measurement a useful tool in distinguis hing physiological from nonphysiological hyperbilirubinemia, and determinin g the bill; rubin increment in the first days of life. Full-term neonates w ho lose a significant amount of weight are especially at risk of significan t hyperbilirubinemia and must be treated with ad libitum feeding and intens ive phototherapy. Copyright (C) 2001 S. Karger AG. Basel.