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The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy while minimizing the risks of unintended harm such as maternal anxiety, decreased breastfeeding, and unnecessary costs or treatment.
Although kernicterus should almost always be preventable, cases continue to occur.
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Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus.
Nomogram for designation of risk in 2840 well newborns at 36 or more weeks’ gestational age with birth weight of 2000 g or more or 35 or more weeks’ gestational age and birth weight of 2500 g or more based on the hour-specific serum bilirubin values.
The serum bilirubin level was obtained before discharge, and the zone in which the value fell predicted the likelihood of a subsequent bilirubin level exceeding the 95th percentile (high-risk zone) as shown in Appendix 1, Table 4. RECOMMENDATION 4.1: The possible cause of jaundice should be sought in an infant receiving phototherapy or whose TSB level is rising rapidly (ie, crossing percentiles [Fig 2]) and is not explained by the history and physical examination (evidence quality D: benefits versus harms exceptional)RECOMMENDATION 4.1.2: Sick infants and those who are jaundiced at or beyond 3 weeks should have a measurement of total and direct or conjugated bilirubin to identify cholestasis (Table 1) (evidence quality D: benefit versus harms exceptional)phosphate dehydrogenase (G6PD) level is recommended for a jaundiced infant who is receiving phototherapy and whose family history or ethnic or geographic origin suggest the likelihood of G6PD deficiency or for an infant in whom the response to phototherapy is poor (Fig 3) (evidence quality C: benefits exceed harms)Guidelines for phototherapy in hospitalized infants of 35 or more weeks’ gestation.
Note: These guidelines are based on limited evidence and the levels shown are approximations.
The guidelines refer to the use of intensive phototherapy which should be used when the TSB exceeds the line indicated for each category.
The evidence-based approach to guideline development requires that the evidence in support of a policy be identified, appraised, and summarized and that an explicit link between evidence and recommendations be defined.
Evidence-based recommendations are based on the quality of evidence and the balance of benefits and harms that is anticipated when the recommendation is followed.
These recommendations seek to further the aims defined by the Institute of Medicine as appropriate for health care: safety, effectiveness, efficiency, timeliness, patient-centeredness, and equity.Tags: Adult Dating, affair dating, sex dating