Recent advances in the management of neonatal jaundice

Abstract

Advances in the clinical assessment strategies used to identify neonates at risk for the development of severe hyperbilirubinemia and bilirubin neurotoxicity, as well as the treatment measures to control hyperbilirubinemia in newborns, continue to be made. They include, among others, universal predischarge birth hospitalization bilirubin screening, the confirmation that hemolysis is an important risk factor for bilirubin neurotoxicity, the use of a numeric scoring system to help stage the severity of acute bilirubin encephalopathy, the potential advantages of turquoise-light phototherapy, and the potential role of heme-oxygenase inhibitors in preventing the need for exchange transfusions, all of which are reviewed here.

Predictors of Repeat Exchange Transfusion for Severe Neonatal Hyperbilirubinemia*

“…The correlation between bilirubin levels and kernicterus is still poorly understood, and TSB alone has been shown to be of limited value in predicting neurologic impairment and kernicterus in infants with hyperbilirubinemia (34,38). Our study underscores the utility of effective TSB monitoring, which remains the only biochemical measurement of bilirubin widely available to clinicians, and supports current evidence on the substantial risk of kernicterus among infants with marked elevations in TSB (17,34,39).…”

“…This is based on the evidence from studies demonstrating timely ET/RET to be effective in reversing the neurologic signs of ABE and/or arresting its progression to chronic bilirubin encephalopathy (kernicterus) (24,34). However, although the early phase of ABE is generally considered reversible (24), studies investigating the reversibility of neurologic abnormalities in infants with intermediateto-advanced ABE after ET have shown mixed results (35,36).…”

“…It is, therefore, not surprising that peak TSB is strongly predictive of RET among infants with prior ET in this study. A numeric scoring system, known as "bilirubininduced neurologic dysfunction" (BIND) algorithm, has been demonstrated as a valuable clinical tool for identifying infants with or without various stages of ABE (17,34). A modified version of BIND recently validated in resource-limited settings is currently being piloted in this hospital (37).…”

Revisiting the Criteria for Exchange Transfusion for Severe Neonatal Hyperbilirubinemia in Resource-Limited Settings

“…The limitation of sole reliance on TSB as a predictor of neurotoxicity or as the primary intervention/outcome measure has been highlighted in several reports [3,38]. In particular, TSB has been shown to have a high sensitivity but a low specificity for identifying infants at risk of ABE.…”

“…Use of the bilirubin/albumin ratio as a surrogate for plasma-free bilirubin had been suggested because it contains 2 of the 3 components for deriving free bilirubin (i.e. TSB, albumin, and the binding constant K) [38,39,40]. Despite this, clinical studies, especially in preterm infants, have demonstrated that bilirubin/albumin does not improve the prediction of ABE or residual encephalopathy over TSB alone [40].…”