[Trends in the diagnosis and management of neonatal hyperbilirubinaemia].
BACKGROUND
The guidelines for diagnosis and treatment of neonatal hyperbilirubinaemia were changed at Vestfold Hospital, Norway in 1994 and 2007. Universal screening for ABO-immunization was implemented in 2006. This article describes effects of these changes.


METHODS
Blood-type immunization, phototherapy and exchange transfusions were prospectively recorded in the 21-year period 1988-2008. Three cohorts comprised the basis for the analyses: infants born in the time-periods 1988-93, 1994-2006 or 2007-2008.


RESULTS
6.2 % of the infants born 1988-93 and 6.7 % born 1994-2006 received phototherapy. Physiological hyperbilirubinaemia in term infants was the main reason for phototherapy in the first cohort, while it was hyperbilirubinemia in preterm infants in the second cohort. 4.8 % of the infants born 2007-8 received phototherapy. Exchange transfusion was performed in 0.02 % born 1994-2008 and 0.2 % born 1988-93. Such transfusions were undertaken more frequently in cases with RhD-immunization (7.8 %) than in those with ABO-immunization (2.0 %). Universal screening for ABO-immunization increased the percentage of diagnosed cases in the population from 2.1 % to 3.6 %. No case of kernicterus was diagnosed.


CONCLUSIONS
Fewer term infants were treated with phototherapy for hyperbilirubinaemia after the changes of therapeutic guidelines in 1994, while more preterm infants were treated after this change. Far less exchange transfusions are performed nowadays than before 1994. ABO-immunization has been diagnosed more often after implementation of universal screening.
Tønne
Andreas
A
Barnesenteret, Sykehuset i Vestfold, 3103 Tønsberg, Norway. andreastonne@gmail.com
Meberg
Alf
A
Hager
Helle Borgstrøm
HB
D000017:ABO Blood-Group System / Q000276:immunology; D015331:Cohort Studies; D005078:Exchange Transfusion, Whole Blood; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D007114:Immunization; D007231:Infant, Newborn; D008403:Mass Screening; D009664:Norway; D010789:Phototherapy; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
D000017:ABO Blood-Group System