Opinion EDITORIAL The Slippery Slope James A. Taylor, MD; Pearl W. Chang, MD Perhaps it is human nature that when given a specific cutoff had a level above the phototherapy threshold during their birth hospitalization. Overall, 72.7% of newborns found to have a value for initiating therapy for a specific condition, health care professionals actually begin treatment at ever lower values over TSB level between 0.1 and 3.0 mg/dL below the phototherapy time in anticipation of the patient approaching the treatment threshold during their birth hospitalization and not treated threshold. This can occur even when the threshold values are when their levels were subthreshold never developed a TSB established more to provide a wide range of safety than to de- level above the threshold. lineate the line between sick and well. The authors of the 2004 AAP guideline offer the option of This slippery slope effect is dramatically illustrated in the beginning phototherapy 2.0 to 3.0 mg/dL below the treat- 1 2 1 report by Wickremasinghe et al in this issue of JAMA Pediatrics. ment threshold values. Wickremasinghe et al indicate that These investigators report that in a large health care organi- the clinicians who ordered phototherapy for newborns
JAMA Pediatrics – American Medical Association
Published: Apr 26, 2018
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