Neonatal bilirubin triage with transcutaneous meters: when is a blood draw necessary?

OBJECTIVE: To find the optimal transcutaneous bilirubin (TcB) screening level in term neonates that minimizes the discomfort of phlebotomy, while protecting the child from harm and controlling costs. METHODS: All available TcB and total serum bilirubin (TSB) measurements taken between 27 and 51 hours of life from a cohort of term newborns were analyzed in a retrospective chart review. TcB cutoffs between 6 and 12 mg/dL were evaluated for their negative predictive values (NPVs) for high risk (HR) and for the combination of high-intermediate risk and HR on the Bhutani TSB risk nomogram. RESULTS: One thousand seventy-one full-term newborns were entered into the study. Of 601 newborns with TcB < 7 mg/dL, none were HR by TSB. Of newborns with a TcB of < 8 mg/dL, 1 in 759 was HR. The NPVs for screening levels of 7 and 8 mg/dL were of 100% and 99.9%, respectively, for HR and 99% and 97.60%, respectively, for high-intermediate/HR. A cutoff at 12 mg/dL had NPVs of 99.3% for HR, with 7 neonates, and 92.7% for high-intermediate/HR, with 76 infants of 1041. CONCLUSIONS: In our center, term infants with a TcB of < 8 mg/dL may be safely discharged without a follow-up TSB, with the understanding that -1/1000 infants may be at HR for developing severe hyperbilirubinemia. Practices with universal follow-up may safely choose cutoffs up to 12 mg/dL. An institution's degree of comfort and confidence in follow-up of the newborn cohort will guide the choice of an appropriate TcB cutoff requiring a TSB.

Office immunization.

Nothing has improved disease control as thoroughly as immunizations. In well-immunized populations, there is no flaccid paralysis (polio), almost no epiglottitis or postmeningitis deafness (Haemophilus influenzae), and little postviral male sterility (mumps). Immunizations are not perfect; they may cause side effects, some of which have led to the discontinuation of the vaccine when side effects have outweighed the vaccine's protective effects. However, immunization works best not by the protection it provides the individual but by the protection provided to the population at risk. This article discusses the currently available vaccines along with recommendations for their use.

Primary ambulatory care of overweight children.

Pediatric practitioners are getting closer to an evidence-based consensus on the diagnosis of obesity and on its sequelae through a structured best-practices approach, as outlined above, but much more research into actual treatment is needed. The long-term solution to overweight in childhood probably lies in a society-wide intervention, but what will be successful is not yet known. Currently, we are restricted to evidence-based treatment of the comorbidities, but we do not yet know how to treat weight successfully.