Bilirubin graph — phototherapy timing and misread thresholds
The prosecution’s claim: Bilirubin trends were used at trial as part of the corroborative clinical picture supporting the prosecution's narrative of unexpected deterioration.
Prosecution claim
Bilirubin trends were used at trial as part of the corroborative clinical picture supporting the prosecution's narrative of unexpected deterioration.
Counter-evidence
Independent paediatric review of the bilirubin graphs in several indicted cases identifies misreading of the phototherapy thresholds applicable to extremely preterm infants. The thresholds are gestation-specific and weight-specific; readings interpreted as 'unexpected' against full-term thresholds fall well within the expected range for the affected gestational ages. Phototherapy initiation timing in the clinical record is consistent with appropriate management in some cases and with delayed initiation in others — both findings carry implications for the deterioration trajectory that were not foregrounded for the jury.
Key point: Bilirubin thresholds are gestation-specific. Readings that look 'unexpected' against full-term thresholds fall within the expected range for extremely preterm infants — and were misread or under-contextualised in the trial picture.
What the jury heard
Bilirubin readings were presented as part of the corroborative clinical picture. The gestation-specific phototherapy threshold framework was not foregrounded.
What the Panel says
The Panel's case-by-case findings emphasise the importance of gestation-specific clinical-management thresholds when assessing whether a deterioration is anomalous or expected.
What independent experts add
- NICE CG98 (neonatal jaundice) sets out the gestation-specific phototherapy thresholds applicable to the affected infants.
- The misreading is one of several documentation-interpretation problems identified by independent paediatric review.