- Thomas B Newman, professor of epidemiology and biostatistics and paediatrics1 (Anewman@itsa.ucsf.edu)1
- 1University of California, San Francisco, UCSF Box 0560, San Francisco, CA 94143-0560, USA
Neonatal jaundice and infant safety on aeroplanes provide two lessons on the power of narrative, rather than statistical evidence, in determining practice
I've always been more comfortable with numbers than with narrative, demanding data rather than accepting anecdotes. Recently, however, as a result of research in two unrelated areas—neonatal jaundice and infant safety on aeroplanes—I've been increasingly impressed with the power of stories over statistics. So I've decided to branch out from my usual publication format and tell a few stories of my own.
Treating jaundice in newborns
The jaundice story is one of me trying to treat jaundice in newborns according to the best evidence. Ironically, the more of an expert on the evidence I have become, the more difficulty I have practising according to that evidence. This is because becoming a “jaundice expert” means becoming familiar with rare but tragic stories of children with kernicterus. These stories are so powerful that it is hard to keep them from trumping other evidence in determining practice.
My neonatal jaundice story starts in the early 1980s, when I was a resident in paediatrics at the University of California, San Francisco. At that time, we treated babies with phototherapy when they had bilirubin concentrations above 14 mg/dl (239 μmol/l), and did exchange transfusions for concentrations above 20 mg/dl (342 μmol/l). Unfortunately, the early 1980s was not a good time to be transfusing blood in San Francisco. Although we did not know it then, the blood supply was contaminated with HIV. We also did not know that most of these exchange transfusions were unnecessary.
In 1983, in an article entitled “Bilirubin 20mg/dL = vigintiphobia,” Watchko and Oski questioned the “fear of twenty” that led to exchange transfusions for jaundice in healthy …