Personal reflections on the AAP practice parameter on management of hyperbilirubinemia in the healthy term newborn.

Abstract

1. Lawrence F. Nazarian, MD* 2. William O. Robertson, MD† 1. 2. *Associate Editor 3. 4. †Professor of Pediatrics Children’s Hospital and Medical Center University of Washington Seattle, WA In the July 1997 issue of Pediatrics in Review, we presented a synopsis of the American Academy of Pediatrics’ (AAP’s) practice parameter on gastroenteritis. Our intent has been to publish similar summaries of all of the published parameters, attempting to bring these guidelines to the attention of readers who are not familiar with them . The second practice parameter to be published dealt with the management of hyperbilirubinemia in normal newborns .1(1) This parameter has stimulated more discussion than any of the others published to date, primarily because the body of data available on this subject is difficult to interpret, making consensus an important element in the formation of any conclusions. Consensus is not the same as unanimity . One of the authors of that document is Dr William Robertson, who also served as the first chair of what has evolved into the Committee on Quality Improvement. Rather than providing a synopsis of the parameter, we have chosen to present some of Robertson’s personal reflections, which include many of the elements of the parameter, as well as a table that summarizes the recommendations for therapy. Not only do Robertson’s remarks provide food for thought on the subject of neonatal jaundice, but they lead the reader into a consideration of the entire quality assurance initiative. The words of a down-to-earth, articulate spokesman who has been part of the history of this movement are worth heeding. These thoughts are those of one individual, but they remind us that all recommendations ultimately come from real people who struggle with the problem of guiding clinicians while using data that could be more complete . Now in print for more than 3 years, the parameter on jaundice is being re-evaluated. All of the guidelines will undergo similar review over time. Until a revised version …