Neonatal hyperbilirubinemia: An evidence-based approach

,; ,; ,

Applied Evidence

Neonatal hyperbilirubinemia: An evidence-based approach

J Fam Pract. 2019 January;68(1):E4-E11

PDF Download

References

1. Schwartz HP, Haberman BE, Ruddy RM. Hyperbilirubinemia: current guidelines and emerging therapies. Pediatr Emerg Care. 2011;27:884-889.

2. Sarici SU, Serdar MA, Korkmaz A, et al. Incidence, course, and prediction of hyperbilirubinemia in near-term and term newborns. Pediatrics. 2004;113:775-780.

3. Maisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. Pediatrics. 1998;101:995-998.

4. Maisels MJ. Neonatal jaundice. Pediatr Rev. 2006;27:443-454.

5. Gholitabar M, McGuire H, Rennie J, et al. Clofibrate in combination with phototherapy for unconjugated neonatal hyperbilirubinaemia. Cochrane Database Syst Rev. 2012;12:CD009017.

6. Maruo Y, Morioka Y, Fujito H, et al. Bilirubin uridine diphosphate-glucuronosyltransferase variation is a genetic basis of breast milk jaundice. J Pediatr. 2014;165:36-41.e1.

7. Brumbaugh D, Mack C. Conjugated hyperbilirubinemia in children. Pediatr Rev. 2012;33:291-302.

8. Lauer BJ, Spector ND. Hyperbilirubinemia in the newborn. Pediatr Rev. 2011;32:341-349.

9. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316.

10. Bertini G, Dani C, Tronchin M, et al. Is breastfeeding really favoring early neonatal jaundice? Pediatrics. 2001;107:E41.

11. Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999;103:6-14.

12. Varvarigou A, Fouzas S, Skylogianni E, et al. Transcutaneous bilirubin nomogram for prediction of significant neonatal hyperbilirubinemia. Pediatrics. 2009;124:1052-1059.

13. Gamaleldin R, Iskander I, Seoud I, et al. Risk factors for neurotoxicity in newborns with severe neonatal hyperbilirubinemia. Pediatrics. 2011;128:e925-e931.

14. Wisnowski JL, Panigrahy A, Painter MJ, et al. Magnetic resonance imaging of bilirubin encephalopathy: current limitations and future promise. Semin Perinatol. 2014;38:422-428.

15. Shapiro SM. Chronic bilirubin encephalopathy: diagnosis and outcome. Semin Fetal Neonatal Med. 2010;15:157-163.

16. Kuzniewicz MW, Wickremasinghe AC, Wu YW, et al. Incidence, etiology, and outcomes of hazardous hyperbilirubinemia in newborns. Pediatrics. 2014;134:504-509.

17. Mahram M, Oveisi S, Jaberi N. Trans-cutaneous bilirubinometery versus serum bilirubin in neonatal jaundice. Acta Med Iran. 2015;53:764-769.

18. Campbell DM, Danayan KC, McGovern V, et al. Transcutaneous bilirubin measurement at the time of hospital discharge in a multiethnic newborn population. Paediatr Child Health. 2011;16:141-145.

19. Bhutani VK, Gourley GR, Adler S, et al. Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics. 2000;106:E17.

20. Holland L, Blick K. Implementing and validating transcutaneous bilirubinometry for neonates. Am J Clin Pathol. 2009;132:555-561.

21. Kolman KB, Mathieson KM, Frias C. A comparison of transcutaneous and total serum bilirubin in newborn Hispanic infants at 35 or more weeks of gestation. J Am Board Fam Med. 2007;20:266-271.

22. Slusher TM, Angyo IA, Bode-Thomas F, et al. Transcutaneous bilirubin measurements and serum total bilirubin levels in indigenous African infants. Pediatrics. 2004;113:1636-1641.

23. Riskin A, Tamir A, Kugelman A, et al. Is visual assessment of jaundice reliable as a screening tool to detect significant neonatal hyperbilirubinemia? J Pediatr. 2008;152:782-787.

24. Bhutani VK, Vilms RJ, Hamerman-Johnson L. Universal bilirubin screening for severe neonatal hyperbilirubinemia. J Perinatol. 2010;30 Suppl:S6-S15.

25. Nagar G, Vandermeer B, Campbell S, et al. Reliability of transcutaneous bilirubin devices in preterm infants: a systematic review. Pediatrics. 2013;132:871-881.

26. Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks’ gestation) - summary. Paediatr Child Health. 2007;12:401-418.

27. US Preventive Services Task Force. Screening of infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy: US Preventive Services Task Force recommendation statement. Pediatrics. 2009;124:1172-1177.

28. National Institute for Health and Care Excellence. Jaundice in newborn babies under 28 days. Clinical guideline [CG98].https://www.nice.org.uk/guidance/cg98. Updated October 2016. Accessed October 17, 2018.

29. Mah MP, Clark SL, Akhigbe E, et al. Reduction of severe hyperbilirubinemia after institution of predischarge bilirubin screening. Pediatrics. 2010;125:e1143-e1148.

30. Darling EK, Ramsay T, Sprague AE, et al. Universal bilirubin screening and health care utilization. Pediatrics. 2014;134:e1017-e1024.

31. Suresh GK, Clark RE. Cost-effectiveness of strategies that are intended to prevent kernicterus in newborn infants. Pediatrics. 2004;114:917-924.

32. Kumar P, Chawla D, Deorari A. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. Cochrane Database Syst Rev. 2011;7:CD007969.

33. Besser I, Perry ZH, Mesner O, et al. Yield of recommended blood tests for neonates requiring phototherapy for hyperbilirubinemia. Isr Med Assoc J. 2010;12:220-224.

34. Iskander I, Gamaleldin R, El Houchi S, et al. Serum bilirubin and bilirubin/albumin ratio as predictors of bilirubin encephalopathy. Pediatrics. 2014;134:e1330-e1339.

35. Aspberg S, Dahlquist G, Kahan T, Källén B. Confirmed association between neonatal phototherapy or neonatal icterus and risk of childhood asthma. Pediatr Allergy Immunol. 2010;21(4 Pt 2):e733-e739.

36. Muchowski KE. Evaluation and treatment of neonatal hyperbilirubinemia. Am Fam Physician. 2014;89:873-878.

37. Kemper K, Forsyth B, McCarthy P. Jaundice, terminating breast-feeding, and the vulnerable child. Pediatrics. 1989;84:773-778.

38. Willis SK, Hannon PR, Scrimshaw SC. The impact of the maternal experience with a jaundiced newborn on the breastfeeding relationship. J Fam Pract. 2002;51:465.

39. The Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #22: guidelines for management of jaundice in the breastfeeding infant equal to or greater than 35 weeks’ gestation. Breastfeed Med. 2010;5:87-93.

40. Honar N, Ghashghaei Saadi E, Saki F, et al. Effect of ursodeoxycholic acid on indirect hyperbilirubinemia in neonates treated with phototherapy. J Pediatr Gastroenterol Nutr. 2016;62:97-100.

41. Suresh GK, Martin CL, Soll RF. Metalloporphyrins for treatment of unconjugated hyperbilirubinemia in neonates. Cochrane Database Syst Rev. 2003;2:CD004207.

42. Muchowski KE. Evaluation and treatment of neonatal hyperbilirubinemia. Am Fam Physician. 2014;89:873-878.

The US Preventative Services Task Force, however, found insufficient evidence to recommend universal screening for infants ≥35 weeks’ gestation.²⁷ The main rationale for their “I” recommendation was that although screening can identify infants at risk of developing severe hyperbilirubinemia, there is no clear evidence that identifying and treating elevated bilirubin levels results in the prevention of kernicterus.

The United Kingdom’s National Institute for Health and Care Excellence (NICE) guidelines do not support universal screening either.²⁸NICE recommends risk factor assessment and visual inspection for jaundice in all newborns and also additional physical examination for newborns with risk factors. NICE recommends against routine monitoring of bilirubin levels in infants who do not appear jaundiced.

Several recent cohort studies suggest that breastfeeding may not be a significant risk factor for hyperbilirubinemia.

All infants who appear jaundiced should be evaluated with either risk factor assessment or bilirubin measurement (TSB or TcB). Infants born to mothers who are Rh-negative or have type O blood should have cord blood tested for blood type, Rh status, and other antibodies with a direct Coombs test, as ABO and Rh incompatibility are major risk factors for development of hyperbilirubinemia because of hemolysis.^8,9

A question of cost-efficacy? Data from a multicenter prospective clinical trial suggest a number needed to screen of 128,600 to prevent 1 case of kernicterus,²⁹ making cost another important factor in the discussion about screening for neonatal hyperbilirubinemia. Universal screening is associated not only with the cost of TSB and TcB measurements, but also with the cost of phototherapy, rates of which are increased with universal screening.^24,29,30 The cost of caring for 1 patient with kernicterus over a lifetime is estimated at $900,000, while the estimated cost to prevent 1 case of kernicterus with universal TSB/TcB screening is between $5.7 and $9.2 million.³¹

In Canada, universal screening was found to decrease emergency department visits for jaundice, but did not affect rates of readmission for hyperbilirubinemia, length of hospital stay, or rates of phototherapy after discharge.³⁰

Continue to: Phototherapy: What kind of light, when to initiate