Hyperbilirubinemia in the Newborn Infant ≥35 Weeks’ Gestation: An Update With Clarifications

Maisels, M. Jeffrey; Bhutani, Vinod K.; Bogen, Debra L.; Newman, Thomas B.; Stark, Ann R.; Watchko, Jon F.

doi:10.1542/peds.2009-0329

Cited by 429 publications

(386 citation statements)

References 23 publications

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“…It is in this context that universal predischarge screening, combined with assessment of gestational age, is most predictive of the risk of subsequent severe hyperbilirubinemia at age >72 h during the first week to 10 days after birth when timely intervention should be implemented efficiently because of a narrow safety margin. 1,11 Biological risk factors Jaundice is the most common clinical diagnosis in neonatal medicine and is due to elevated unconjugated (indirect) and/or conjugated (direct) bilirubin levels. Confirmation is by a total serum (plasma) blood test for bilirubin (TSB) or transcutaneous bilirubin (TcB).…”

Section: Background Reviewmentioning

confidence: 99%

“…1,11 The nomogram provides a more appropriate understanding of the magnitude of hyperbilirubinemia in the contexts of postnatal age in hours and the percentile level as defined for healthy infants. 35 It is important to note that infants with early-onset extreme hyperbilirubinemia that required intervention before age <48 h were not included in the predictive nomogram because treatment with phototherapy and/ or exchange transfusion had already been instituted.…”

Section: Screening Testsmentioning

confidence: 99%

“…The predictive ability of TSB has now been validated by several other prospective studies. 11,21 Recent data indicate that at least one major clinical analyzer provided inaccurate bilirubin values for Neonatal Bilirubin Survey specimens administered by the College of American Pathologists. Use of human serum-based survey specimens to calibrate bilirubin testing is likely to reduce system error and yield a substantial improvement in bilirubin measurements.…”

Section: Screening Testsmentioning

confidence: 99%

“…Table 4 charts a bilirubin care map for designating follow-up for a repeat test based on the predischarge bilirubin risk zone. 11,41 What does an abnormal test result mean? The hour-specific bilirubin nomogram serves as a useful clinical guide for management because the patterns of severity in mg per 100 ml are at or above the 75th percentile for age in hours.…”

Section: Use Of Hour-specific Bilirubin Nomogram To Guide Follow-upmentioning

confidence: 99%

“…In addition to risk assessment, the measurement of the TSB or TcB when interpreted using the hour-specific nomogram provides the caregiver with one immediate and quantitative mechanism for assessing the degree of hyperbilirubinemia and the need for additional surveillance and testing. 11,35 An online tool for riskassessment through http://www.bilitool.org allows for immediate clinician access and promotes a clinician-parent partnership for seamless continuity of care from the birthing hospital to home care. Through effective implementation and surveillance, universal bilirubin screening could prevent ABE and kernicterus.…”

Section: Need For Effective Implementationmentioning

confidence: 99%

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Universal bilirubin screening for severe neonatal hyperbilirubinemia

2010

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To reduce the incidence of severe neonatal hyperbilirubinemia affecting newborns with jaundice in the United States and to prevent kernicterus, there is a need to implement proven prevention strategies for severe neonatal hyperbilirubinemia as recommended in the 2004 American Academy of Pediatrics Guidelines for newborns >35 weeks gestational age. The purpose of universal predischarge bilirubin screening is to identify infants with bilirubin levels >75th percentile for age in hours and track those with rapid rates of bilirubin rise (>0.2 mg per 100 ml per h). Early identification has been reported to predict severe hyperbilirubinemia and allow for evidence-based targeted interventions. A systems approach is likely to reduce the preventable causes of acute bilirubin encephalopathy. To do so, highest priority should be given to (i) designating extreme hyperbilirubinemia (total serum bilirubin >427 mmol l À1 or >25 mg per 100 ml) as a reportable condition by laboratories and health-care providers through public health mandates; (ii) implementation of Joint Commission's Sentinel Report for kernicterus; (iii) nursing outreach to communities for education of prospective parents; (iv) development of clinical pathways to monitor, evaluate and track infants with extreme hyperbilirubinemia; and (v) societal awareness. These efforts should be monitored by a state and national surveillance system in order to critically improve the timeliness and completeness of notifications and to allow evaluation and interventions at the policy and individual family level.

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Section: Background Reviewmentioning

confidence: 99%

Section: Screening Testsmentioning

confidence: 99%

Section: Screening Testsmentioning

confidence: 99%

Section: Use Of Hour-specific Bilirubin Nomogram To Guide Follow-upmentioning

confidence: 99%

Section: Need For Effective Implementationmentioning

confidence: 99%

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