A new study may reassure some mothers of nursing infants who look a little orange (the infants, that is; orange mothers should still be concerned). We’ve always known that breastfed infants tend to keep high levels of indirect bilirubin in their bloodstreams long after the first week in life, but no one yet had bothered to establish the typical range and time course. Dr. M. Jeffrey Maisels and a team from Oakland University William Beaumont School of Medicine changed all that with the use of transcutaneous bilirubin (TCB) monitors and 1,044 predominately breastfeeding infants.
Not only did they determine that at age 3-4 weeks between 34% and 43% of these infants still had TCB measurements over 5 mg/dL, they also reaffirmed that we doctors are really bad at guessing bilirubin levels from looking at babies. They asked trained clinicians to guess the “jaundice zone scores” of the infants, which sound like a customer loyalty program at a sporting goods store but are really just an estimate of how far down the infant’s body it looks yellow. The scores were so far off that a baby with a score of 0 could have a bilirubin level as high as 12.8 mg/dL. I can only hope that with his expertise in ferreting out bad human judgment, Dr. Maisels’s next study will investigate candidates for Congress.
Inattention
A complex society cannot function without some degree of trust; there’s all sorts of scary stuff I’d like to know, and I’m happy to pay a few dollars in taxes to make sure someone more qualified than I am is checking. Does this bridge I’m crossing have severe erosion? Is there another plane in our airspace? What was my 14-year-old daughter texting to her “boyfriend” last night? (Thanks, National Security Agency!)
Drug safety is one of those things, especially when many of my patients and one of my own children are taking said drug. A new study from researchers at Boston Children’s Hospital suggests that perhaps when it comes to the long-term safety of attention-deficit/hyperactivity disorder (ADHD) medications, the U.S. Food and Drug Administration has not looked as hard as it might. Paging Dr. Edward Snowden!