Extreme hyperbilirubinaemia in term and near‐term infants in Denmark

Abstract

Aim: To determine the incidence amongst infants born at term or near‐term of extreme hyperbilirubinaemia, i.e., with a serum concentration of unconjugated bilirubin exceeding the limit above which an exchange transfusion was indicated according to the authorized guidelines. Method: The investigation period covered 2 y, 1 January 2000 to 31 December 2001, and included all infants born alive at term or near‐term in Denmark. All infants with extreme hyperbilirubinaemia admitted to paediatric departments were recorded. Results: Thirty‐two infants developed extreme hyperbilirubinaemia, i.e., an incidence of 25 per 100 000. The maximum total serum bilirubin concentration (TSB) was 492 (385–689) μmol/l (median (range)). The median value of the exchange transfusion limits was 450 μmol/l. Twelve infants had signs and symptoms of central nervous system involvement; 11 had acute bilirubin encephalopathy phase‐1 symptoms; and one had phase‐2 symptoms. Nineteen infants developed extreme hyperbilirubinaemia during primary admission to the maternity ward or neonatal department; the others after having been discharged. There was no difference in maximum TSB between those infants not discharged from hospital and those infants admitted to hospital from home. Maximum TSB appeared latest amongst those infants admitted from home (p<0.01), and these more often had signs and symptoms of central nervous system involvement (p<0.05). Ten infants were of non‐Caucasian extraction. Less than half of all Danish mothers receive both verbal and written information after birth on jaundice in the infant. Conclusion: Twenty‐five per 100 000 infants born at term or near‐term developed extreme hyperbilirubinaemia, the majority of them whilst in hospital. Infants admitted from home more often had signs and symptoms of central system involvement.

Extreme Neonatal Hyperbilirubinemia and a Specific Genotype: A Population-Based Case-Control Study

“…2 In Denmark, extreme hyperbilirubinemia and chronic bilirubin encephalopathy (kernicterus) occur in 1 in 2000 live births and 1 in 95 000 live births, respectively. [3][4][5][6] These rates correspond well with reports from other parts of the privileged world, 7 but in the developing world, bilirubin encephalopathy persists as a frequent cause of neonatal morbidity. 8 Severalriskfactorsforhyperbilirubinemia are known, among these are blood type iso-immunization, congenital hemolytic diseases, gender, prematurity, race, starvation, and early discharge from hospital, but in a large number of patients, a causal factor is never established.…”

Neonatal hyperbilirubinemia, acute bilirubin encephalopathy and Kernicterus: The conti-nuum is still valid in the 21st century

“…El riesgo de kernictetrus en neonatos con bilirrubina > 25 mg/dl es de 1 /17,6, en Canadá y de 1 en 16,2 en Dinamarca. En cambio el riesgo en neonatos con (30,31) valores mayores a 30mg /dl, es de 1 en 7 . No obstante, el tratamiento de la hiperbilirrubinemia severa basado solo en el nivel de bilirrubina tiene un valor limitado para prevenir daño neurológico, porque existen otros factores biológicos, que estarían (32) implicados en la patogenia .…”

Systems changes to prevent severe hyperbilirubinemia and promote breastfeeding: pilot approaches

“…Of these, approximately 5% develop hyperbilirubinemia severe enough to require treatment with phototherapy and approximately one in 15 000 develop serum bilirubin concentrations exceeding 30 mg per 100 ml. 1,2 Lack of appropriate treatment places these infants at risk for kernicterus, the devastating, irreversible neurological condition that affects approximately one in 50 000 to 100 000 newborns in developed countries. An important challenge of the health care system is to maintain sufficient vigilance to reduce the incidence of these relatively rare but serious events while minimizing unintended consequences, such as increased parental anxiety, decreased breastfeeding or unnecessary treatment leading to excessive cost.…”