title: Infants with bilirubin levels of 30 mg/dL or more in a large managed care organization.
abstract: OBJECTIVE
  To describe the incidence, etiology, treatment, and outcome of newborns with total serum bilirubin (TSB) levels >or=30 mg/dL (513 micro mol/L).
  
  
  METHODS
  Population-based case series.
  
  
  METHODS
  Eleven Northern California Kaiser Permanente Medical Care Program hospitals and 1 affiliated hospital.
  
  
  METHODS
  Eleven infants with TSB levels of >or=30 mg/dL in the first 30 days after birth, identified using computer databases from a cohort of 111,009 infants born 1995-1998.
  
  
  METHODS
  Clinical data from the birth hospitalization, rehospitalization, and outpatient visits in all infants; psychometric testing at age 5 (N = 3), neurologic examinations by child neurologists at age 5 (N = 3), or primary care providers (N = 7; mean age: 2.2 years); Parent Evaluation of Developmental Status (N = 8; mean age: 4.2 years).
  
  
  RESULTS
  Maximum TSB levels of the 11 infants ranged from 30.7 to 45.5 mg/dL (525 micro mol/L to 778 micro mol/L; mean: 34.9 mg/dL [597 micro mol/L]). Four were born at 35 to 36 weeks gestation, and 7 were exclusively breastfed. Two had apparent isoimmunization; the etiology for the other 9 remained obscure, although only 4 were tested for glucose-6-phosphate dehydrogenase deficiency and 1 was bacteremic. None had acute neurologic symptoms. All received phototherapy and 5 received exchange transfusions. One infant died of sudden infant death syndrome; there was no kernicterus at autopsy. Two were lost to follow-up but were neurologically normal when last seen for checkups at 18 and 43 months. One child was receiving speech therapy at age 3. There were no significant parental concerns or abnormalities in the other children.
  
  
  CONCLUSIONS
  In this setting, TSB levels >or=30 mg/dL were rare and generally unaccompanied by acute symptoms. Although we did not observe serious neurodevelopmental sequelae in this small sample, additional studies are required to quantify the known, significant risk of kernicterus in infants with very high TSB levels.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco 94143, USA. newman@itsa.ucsf.edu
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Newman
authors.forename: Petra
authors.initials: P
authors.lastname: Liljestrand
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Escobar
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood*; D002675:Child, Preschool; D015331:Cohort Studies; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration / Q000639:trends*; D009035:Mothers / Q000706:statistics & numerical data; D010789:Phototherapy; D011159:Population Surveillance; D012203:Rh Isoimmunization / Q000175:diagnosis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin