Newborn Bilirubin Screening for Preventing Severe Hyperbilirubinemia and Bilirubin Encephalopathy: A Rapid Review

Bhardwaj, Kalpana; Locke, Tiffany; Biringer, Anne; Booth, Allyson; Darling, Elizabeth; Dougan, Shelley; Harrison, Jane; Hill, Stephen A.; Johnson, Ana; Makin, Susan R.; Potter, Beth K.; Lacaze‐Masmonteil, Thierry; Little, Julian

doi:10.2174/1573396313666170110144345

Cited by 26 publications

(25 citation statements)

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“…TSB has been extensively used as an indicator of timely intervention of hyperbilirubinemia in clinics, but the accurate value of TSB to predict the occurrence and prognosis of ABE is controversial. 25 In this study, we find no correlation between TSB and adverse outcomes. Notably, there was one infant with adverse outcome, and the highest TSB level was 398.3 µmol/L, which may distort our findings, since there were only 25 infants with adverse outcomes in the final analytical.…”

Section: Discussioncontrasting

confidence: 50%

Early prediction of adverse outcomes in infants with acute bilirubin encephalopathy

Kang

Xiao

Zhang

et al. 2020

Ann Clin Transl Neurol

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Objective: Acute bilirubin encephalopathy (ABE) remains one of the important causes of neonatal mortality and child disability, early identification, and intervention which could improve outcomes. The purpose of this study was to evaluate early predictors of adverse outcomes in infants with ABE. Methods: Newborns of gestational age ≥ 35 weeks and diagnosed with ABE were included in the study. Bilirubin-induced neurological dysfunction (BIND) score, total serum bilirubin (TSB) peak value, and serum albumin levels were determined. Adverse outcomes were defined as death or survival with auditory dysfunction and/or cerebral palsy. Results: Eighty-two infants were eligible for recruitment in the study. The outcome data from 76 ABE infants (92%) were used for analysis, of which 25 infants got adverse outcomes and 51 live a normal life. Univariate analysis for BIND score, TSB peak value, bilirubin-albumin ratio (B/A), albumin level, abnormal AABR, and neonatal sepsis was performed to elucidate the association with adverse outcomes. Bivariate logistic regression analysis showed B/A (OR 10.48, 95%CI: 1.55-70.81, P = 0.02) and BIND score (OR 3.68, 95%CI: 1.39-9.72, P = 0.01) were correlated with adverse outcomes. ROC curve analysis showed that B/A (≥8.9 mg/g), BIND score (≥6) could predict adverse outcomes of ABE separately; B/A in conjunction with BIND score could increase prediction sensitivity to 100%. Interpretation: Both B/A and BIND score can be used to predict adverse outcomes of ABE, and the combination of the two parameters can increase prediction sensitivity significantly.

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Section: Discussioncontrasting

confidence: 50%

Early prediction of adverse outcomes in infants with acute bilirubin encephalopathy

Kang

Xiao

Zhang

et al. 2020

Ann Clin Transl Neurol

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“…22 If all forms of neonatal hyperbilirubinemia can be detected, diagnosed, and treated earlier, it will improve treatment results and decrease the occurrence of sequelae. The American Academy of Pediatrics Subcommittee on hyperbilirubinemia and some units recommend that all newborns should be screened with transcutaneous bilirubin measurements, 23 which cannot distinguish hyperbilirubinemia type, or with total serum bilirubin and direct bilirubin measurement, which is the clinical laboratory method not suitable to mass screening. 11,12,21 Recently, we published a method to measure UBIL MS , BMG, BDG from the DBSs using MS/MS.…”

Section: Discussionmentioning

confidence: 99%

Can Free Carnitine or Bilirubin in Blood Be Used in Neonatal Screening for Biliary Atresia?

Zheng

Chen

et al. 2019

Eur J Pediatr Surg

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Objective To investigate the efficiency of free carnitine, unconjugated bilirubin (UBIL), bilirubin monoglucuronide (BMG), and bilirubin diglucuronide (BDG) in dry blood spots (DBSs) measured using tandem mass spectrometry (MS/MS) for screening biliary atresia (BA). Materials and Methods All the patients with BA, residing in Shanghai, were collected from four different children's hospitals in Shanghai from January 1, 2015, to June 30, 2017. UBILMS, BMG, BDG, and free carnitine were measured in the DBS samples of 48 patients with BA, 10,008 pediatric patients, and 52,862 newborns using MS/MS. Conjugated bilirubin was measured by MS/MS (CBMS) = BMG + BDG, and total bilirubin was measured by MS/MS (TBMS) = UBILMS + CBMS. Four hundred pediatric patients' direct bilirubin (DB) and total bilirubin (TB), measured by the clinical laboratory and MS/MS, were used as a control. Results The total number of births at the registered permanent residences in Shanghai was 233,000; among them, the occurrence of BA was in 33 patients in 2 years. Therefore, the incidence of BA in Shanghai was 1:7,060. The ratio of DB/TB and CBMS/TBMS of most patients with BA was elevated gradually in the neonatal period and higher than the normal range after 1 month after birth. The area under the receiver operating characteristic curve of DB, DB/TB, CBMS/TBMS, CBMS, and free carnitine for predicting BA was 0.98, 0.95, 0.73, 0.57, and 0.92, respectively. Using the 95% percentile as a cutoff, the sensitivity of DB and free carnitine to predict BA was 100 and 85%, respectively, and the specificity was 52 and 85%, respectively. Conclusion In free carnitine, DB, and CBMS/TBMS tests, blood concentrations are elevated in all infants with BA. However, they may not be elevated while they are newborns. These tests will result in high false negatives or positives. Thus, they should not be used as newborn screening tests for BA due to their lower sensitivity and specificity.

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“…More recent evidence suggests that while this program may be costly due to the high number of infants to be tested and treated, it was likely to be a better predictor of infants requiring treatment if the screening utilised postnatal age-adjusted TSB/TcB combined with clinical risk factors, especially gestational age. 15,78 The prospects in LMICs remain uncharted as detection of jaundiced infants largely relies on visual assessment by clinicians in many settings.…”

Section: Early Detection and Diagnosismentioning

confidence: 99%

Neonatal hyperbilirubinaemia: a global perspective

Olusanya

Kaplan

Hansen

2018

The Lancet Child & Adolescent Health

203

195

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Hyperbilirubinaemia, presenting as jaundice, is a ubiquitous and frequently benign condition in newborn babies but is a leading cause of hospitalisation in the first week of life. In some infants jaundice can become severe, progressing to acute bilirubin encephalopathy and kernicterus with a substantial risk of neonatal mortality and long-term neurodevelopmental impairments. Severe hyperbilirubinaemia and its sequelae continue to occur in industrialised countries with functioning medical systems and a disproportionately high burden also persists in low-income and middle-income countries due primarily to delays in delivering effective treatments that are routinely available in high-income countries. In this Review we summarise up-to-date evidence on the epidemiology of neonatal jaundice including its global burden based on estimates of its prevalence, and both fatal and non-fatal health outcomes. We also discuss the management of severe hyperbilirubinaemia including the prevention of kernicterus, and highlight future directions for research.

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Newborn Bilirubin Screening for Preventing Severe Hyperbilirubinemia and Bilirubin Encephalopathy: A Rapid Review

Abstract: We found substantial observational evidence that severe hyperbilirubinemia can be accurately predicted and prevented through universal bilirubin screening. So far, there is no evidence of any harm.

Cited by 26 publications

References 0 publications

Early prediction of adverse outcomes in infants with acute bilirubin encephalopathy

Early prediction of adverse outcomes in infants with acute bilirubin encephalopathy

Can Free Carnitine or Bilirubin in Blood Be Used in Neonatal Screening for Biliary Atresia?

Neonatal hyperbilirubinaemia: a global perspective

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