Hyperbilirubinaemia in healthy full-term neonates:Guidelines for diagnosis and treatment

In healthy full-term neonates without haemolytic disease, hyperbilirubinaemia is not associated with neurological, auditory or cognitive disorders later in life. Therefore, the new threshold levels of hyperbilirubinaemia at which further diagnosis and treatment are indicated, are higher than the former ones.</p

Hyperbilirubinaemia in healthy full-term newborns:Effects on later development not too bad

Objective. Critical evaluation of guidelines for treatment of hyperbilirubinaemia in healthy full-term newborns, based on literature data concerning effects of hyperbilirubinaemia on later development. Design. Structured literature survey. Setting. Groningen, the Netherlands. Methods. By electronic and hand searching of literature according to published guidelines data were collected on the relation between the peak total serum bilirubin concentration (TSB) in the first week of life and later development. Results. One large study, the Collaborative Perinatal Project (CPP), showed statistically significant negative associations of TSB in the first week of life with Bayley development score at age 8 months, intelligence quotient (IQ) at age 4 years, and unspecified neurological abnormalities at age 7-8 years. In other studies, with considerable less power than the CPP, no such findings were made. In the original analyses of the CPP no correction was made for confounders and effect modifiers; after correction for such variables, a relation between TSB in the first week of life and later development was no longer found. At the age of 6 years, no statisfically significant differences in IQ, hearing, and neurological abnormalities were found between children who, as newborns, had or had not been treated with phototherapy because of hyperbilirubinaemia. Conclusion. Treatment for jaundice in healthy full-term newborns is only indicated at considerably higher serum bilirubin levels than those recommended previously.</p

Hyperbilirubinaemia in healthy full-term neonates:Guidelines for diagnosis and treatment

In healthy full-term neonates without haemolytic disease, hyperbilirubinaemia is not associated with neurological, auditory or cognitive disorders later in life. Therefore, the new threshold levels of hyperbilirubinaemia at which further diagnosis and treatment are indicated, are higher than the former ones.</p

Vroeggeboorte, intra-uteriene groeiachterstand en lichamelijke ziehten op de volwassen leeftijd; resultaten van 19 jaar POPS-follow-up

Infants born very prematurely are at greater risk of neurosensory handicaps and developmental problems than are term born children. Premature birth, intrauterine growth retardation, and the combination of both, may also be risk factors for physical disease in adulthood. As this aspect has been little studied so far, we looked into its first signs in the pops-cohort (Project On Preterm and Small for gestational age infants). Prematurity seems to be a risk factor for the development of insulin resistance. The risk is extra high for individuals showing disposition to obesity at later age. Having experienced intrauterine growth retardation even increases the risk. Former premature infants on average show higher mean systolic blood pressure, yet unrelated to degree of intrauterine growth retardation. Renal function (clearance and protein excretion) in young adulthood is less favorable for prematurely born individuals who also experienced intrauterine growth retardation. Prematurely born children show more airway symptoms and poorer lung function in young adulthood. We conclude that neonatal follow up is not only indicated for very premature infants but also for children who experienced severe intrauterine or neonatal growth retardation. Pediatricians ought to inform parents and children as well as the family doctor that prematurity or intrauterine growth retardation may be risk factors for chronic disease at adult age. Active prevention of obesity from an early age onwards is indicated for prematurely born children who experienced intrauterine growth retardation. Family doctors should be extra alert to the development of particularly hypertension and microalbuminuria when these children reach young adult age; a regular check-up for example every two years is recommended. Awareness of their medical history may stimulate the children themselves to prevent obesity, take up sports, and never start smoking