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Over the last 25 years there have been considerable advances in the treatment and technologies used in the care of newborn infants. Most of these advances are related to the care of the premature infants and there have been few changes in the management of conditions commonly seen in term infants.Neonatal jaundice is one of the commonest neonatal disorders and has been recognized since early history. Early neonatal jaundice is usually caused by the physiological destruction of red blood cells in the infant and its importance lies in the ability of the bilirubin pigment so produced to cross the blood brain barrier resulting in neurotoxicity. Prolonged neonatal jaundice (after 14 days of age) may be an indication of an underlying liver disorder. The approach to neonatal jaundice has remained largely unchanged over the last two to three decades. We continue to rely on visual inspection to assess the severity of early neonatal jaundice. We have technology that is effective in reducing the level of bilirubinaemia but in the UK there is no clear consensus as to the level at which jaundice should be treated. We do not have a standardized approach to the management of prolonged jaundice and there is potential for infants with significant liver problems to be diagnosed at a relatively late stage. Some countries (for example the US) have professional bodies who have introduced guidelines to ensure a standardized approach to the jaundice infant. We have little information about neonatal jaundice treatment in other parts of the developing world.

Before routine infant pneumococcal immunisation and improved access to neuroimaging, around 25% of children with pneumococcal meningitis (PM) suffered ischaemic stroke (IS).1 ,2 In a population-based retrospective audit (UHS ZAUD2053), we investigated the postimmunisation prevalence of stroke/cerebrovascular disease (CVD), and compared features of children with and without IS/CVD. We included all cases of PM in children 5 white cells in the CSF and/or signs of meningism and/or focal neurology and/or meningeal enhancement on CT with contrast. Stroke and/or CVD were identified on CT …

We review the findings of prospective randomized controlled clinical trials which have compared the efficacy of extracorporeal membrane oxygenation (ECMO) with conventional ventilator-based therapy (CT) in the treatment of severe persistent pulmonary hypertension of the newborn (PPHN). Initial trials in Michigan and Boston were non-conventional in their design, conduct and analysis; as a result their interpretation proved to be highly controversial. We review the relevant statistical issues and, in their light, discuss the implications of a third trial with a more conventional randomized design which has recently been completed in the UK.

Summary Aim To determine the current management of early neonatal jaundice in the UK and to evaluate whether the current practices are evidence based. Methods A questionnaire survey was carried out among identified lead paediatricians of neonatal intensive care units. Results The survey found markedly differing practices for the recognition, investigation and treatment of neonatal jaundice. This applies particularly to confirmation of the clinical suspicion of jaundice; use of invasive and non-invasive technologies for diagnosis; preferred wavelength and intensity of light used for treatment; and whether birth weight, gestational age and postnatal age should influence treatment. Conclusion The study found a lack of consistency in the management of jaundiced infants in the UK. The evidence-based practice currently available does not appear to have been incorporated into treatment protocols.