Journal of Perinatology (2014) 34, 81–83 & 2014 Nature America, Inc. All rights reserved 0743-8346/14 www.nature.com/jp

LETTERS TO THE EDITOR

Multidisciplinary guidelines for the care of late preterm infants Journal of Perinatology (2014) 34, 81; doi:10.1038/jp.2013.126

CONFLICT OF INTEREST The authors declare no conflict of interest.

The recent Multidisciplinary guidelines for the care of the late preterm infants facilitated by The National Perinatal Association are succinct and draw upon a variety of literature resources.1 I was particularly drawn to the panels on ‘reducing risks of hyperbilirubinemia’. Phillips et al.1 state that ‘if rate of bilirubin rise is 40.5 mg dl  1 h  1 consider initiating phototherapy’. Neither is there a citation for this statement nor is there any evidence to support this opinion. Implementation of such a practice would actually increase the risks of hyperbilirubinemia and this recommendation should be retracted immediately. The bilirubin rate of rise of 40.5 mg dl  1 h  1 was used as a guide to initiate exchange transfusion for infants with Rh disease in an era prior to advent of intensive phototherapy. The hour-specific bilirubin nomogram, which is essentially a predictive percentile-based depiction rate of bilirubin rise, illustrates a rise of 0.2 mg dl  1 h  1 at 95th percentile, 0.15 mg dl  1 h  1 at the 75th percentile and 0.1 mg dl  1 h  1 at the 40th percentile tracks during the first 72 h of age.2 The authors also need to refer to Maisels et al.3 and more recent articles that have focused applying guidelines to late preterm infants.4,5 In summary, indications for the use of phototherapy in late preterm infants are based on hour-specific bilirubin thresholds presented in the 2004 and 2009 AAP guidelines. The rate of bilirubin rise is generally 40.15 mg dl  1 h  1.

VK Bhutani1 Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA E-mail: [email protected] 1

REFERENCES 1 Phillips RM, Goldstein M, Hougland K, Nandyal R, Pizzica A, Santa-Donato A et al. Multidisciplinary guidelines for the care of late preterm infants. J Perinatol 2013; 33(Suppl 2): S5–S22. 2 Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 1999; 103(1): 6–14. 3 Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant 435 weeks’ gestation: an update with clarifications. Pediatrics 2009; 124(4): 1193–1198. 4 Keren R, Luan X, Friedman S, Saddlemire S, Cnaan A, Bhutani VK. A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics 2008; 121: e170–e179. 5 Bhutani VK, Stark AR, Lazzeroni LC, Poland R, Gourley GR, Kazmierczak S et al. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr. 2013; 162(3): 477–482.

Reply to Bhutani et al. Journal of Perinatology (2014) 34, 81; doi:10.1038/jp.2013.131

CONFLICT OF INTEREST The authors declare no conflict of interest.

R Phillips1 Multidisciplinary Guidelines for the Care of Late Preterm Infants Steering Committee, Loma Linda University Children’s Hospital, Loma Linda, CA, USA E-mail: [email protected]

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We agree with Dr Bhutani et al., that waiting to consider initiating phototherapy until the rate of rise of bilirubin is 40.5 mg dl  1 h  1 would, indeed, increase the risks of hyperbilirubinemia. This value, listed in the ‘Multidisciplinary Guidelines for the Care of Late Preterm Infants,’ p S8,1 was an unfortunate typographical error and was meant to read 40.2 mg dl  1 h  1. Dr. Bhutani and co-authors use this value as an indicator of babies ‘who are likely to cross into higher-risk zones with accelerated rates of bilirubin rise (40.2 mg per 100 ml per h)’.2 We appreciate Dr Bhutani’s keen eye and have great respect for the contributions he has made to the appropriate management of hyperbilirubinemia, including his latest publication,3 which we would have included in our references had it been available at the time the guidelines went into print (and will certainly be included in future updates). We regret not catching this error ourselves and appreciate the opportunity to make the correction.

REFERENCES 1 Phillips RM, Goldstein M, Hougland K, Nandyal R, Pizzica A, Santa-Donato A et al. Multidisciplinary guidelines for the care of late preterm infants. J Perinatol 2013; 33(Suppl 2): S5–S22. 2 Bhutani VK, Vilms RJ, Hamerman-Johnson L. Universal bilirubin screening for severe neonatal hyperbilirubinemia. J Perinatol 2010; 30(Suppl): S6–15. 3 Bhutani VK, Stark AR, Lazzeroni LC, Poland R, Gourley GR, Kazmierczak S et al. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatrics 2013; 162(3): 477–482.

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