Hyperbiliruibinaemia in the newborn infant (part one):: Guidance on how to undertake a critical review of current research papers using the topic as a focus for enquiry

BackgroundPhysiological jaundice is a common problem faced by neonates affecting approximately 60% full term and 80% preterm infants. If left untreated bilirubin levels continue to rise and can lead to bilirubin encephalopathy and kernicterus. There are many controversies within the literature around the management and treatment of hyperbilirubinaemia creating uncertainty around when to commence phototherapy treatment. This paper will discuss what clinical indicators should be considered when deciding to initiate phototherapy.MethodsA critical review of five research papers was performed in an attempt to explore the clinical uncertainties and reach a conclusion. Each paper was analysed in relation to methodological content to establish the quality of the paper before comparing findings to consider implications for practice.ResultsThe strongest study was Sarici et al. (2004) who clearly showed that near term newborns was a significant clinical risk for hyperbilirubinaemia. Bhutani et al. (1999) and Sarici et al. (2004) showed the usefulness of predictive nomograms to identify infants at risk of significant hyperbilirubinaemia. Gartner et al. (1998) and Petrova et al. (2006) highlighted uncertainties among practitioners in relation to the management and treatment of hyperbilirubinaemia. The weakest study was the RCT by Leite and Facchini (2004) these results were both inconsistent with previous studies and indicated flaws in the methods.Implications for PracticeNew guidelines are required and should incorporate individual guidance for near term newborns as they have been shown to be at increased risk of developing significant hyperbilirubinaemia. Further research into when phototherapy treatment should be initiated is required to provide evidence-based practice for neonates of all gestations.