tions for the management of hyperbilirubinemia in the infant at 35 or more weeks of gestation. Recommenda-tions in the guideline were based on a review of the avail-able evidence, including a comprehensive literature re-view by the United States Department of Health and Hu-man Services' Agency for Health Care Research and Quality, New England Medical Center Evidence-based Practice Center  . Under the auspices of the European Society for Pediatric Research, an expert multinational (European and US) panel was convened in Siena, Italy, in September 2005, to develop an approach to the preven-tion of kernicterus in nations with diverse healthcare sys-tems and birthing practices. This expert panel met again in Barcelona, Spain (October 2006) to define the key practices intended for use by hospitals and by pediatri-cians/neonatologists and other healthcare providers who treat newborn infants in the hospital and ambulatory set-tings. The resulting recommendations are consistent with the AAP guideline and promote an approach di-rected at reducing the frequency of severe neonatal hy-perbilirubinemia and bilirubin encephalopathy, while minimizing the risk of unintended harms such as in-creased anxiety, decreased breastfeeding, or unnecessary treatment for the general population that would contrib-ute to excessive cost and waste. Abstract Kernicterus is still occurring but should be largely prevent-able if health care personnel follow the recommendations listed in this guideline. These recommendations emphasize the importance of universal, systematic assessment of the risk of severe hyperbilirubinemia, lactation support, close follow-up, and prompt intervention when necessary. A sys-tems-based approach to prevent severe neonatal hyperbili-rubinemia should be implemented at all birthing facilities and coordinated with continuing ambulatory care. Transla-tional research is needed to better understand the mecha-nisms of bilirubin neurotoxicity and potential therapeutic interventions.
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