Screening for Severe Neonatal Hyperbilirubinemia

Vinod K. Bhutani

Disclosures

Pediatr Health. 2009;3(4):369-379. 

In This Article

Detection & Treatment

There is adequate evidence that screening using hour-specific bilirubin measurement and/or clinical risk factors can identify infants who are likely to develop severe neonatal hyperbilirubinemia.[1,11] However, there is no known screening test that will identify infants at risk of developing chronic bilirubin encephalopathy.[26] Screening tests for hyperbilirubinemia consist of clinical risk assessment, measuring bilirubin level (either in plasma or by transcutaneous estimation) or a combination of methods.[1]

Phototherapy is commonly used to treat severe neonatal hyperbilirubinemia.[1] A recent systematic review[27] reported that one needs to treat six to ten otherwise healthy jaundiced neonates with TB greater than or equal to 15 mg/dl (≥257 μmol/l) with phototherapy in order to prevent the TB in one additional infant from rising above 20 mg/dl (342 μmol/l). Exchange transfusion is used to treat acute bilirubin encephalopathy or extreme hyperbilirubinemia that is unresponsive to effective phototherapy.[1] With early detection and early intervention, the number of infants with severe hyperbilirubinemia are likely to decrease.[28,29] However, the ability of phototherapy to prevent chronic bilirubin encephalopathy is not proven. Phototherapy has been safe and effective, it is associated with a declining need for exchange transfusions.[30] On the other hand, the harms of detection and early treatment of hyperbilirubinemia could include potential unknown side effects of phototherapy and possible adverse events related to exchange transfusion. Owing to the extreme rarity of chronic bilirubin encephalopathy, it is nearly impossible to design and conduct a study that could directly evaluate the effectiveness of an intervention to reduce the incidence of this condition. As a result, intermediate outcomes, such as bilirubin levels, severe neonatal hyperbilirubinemia (adjusted for postnatal age in hours, gestational age and hemolysis) are used.[1]

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