Universal bilirubin screening for severe neonatal hyperbilirubinemia.
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 μmol l(-1) 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.
Bhutani
V K
VK
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94304, USA. bhutani@stanford.edu
Vilms
R J
RJ
Hamerman-Johnson
L
L
D001663:Bilirubin / Q000378:metabolism; D019091:Critical Pathways / Q000458:organization & administration; D003661:Decision Support Techniques; D042241:Early Diagnosis; D055317:Evidence-Based Practice / Q000379:methods / Q000458:organization & administration; D005865:Gestational Age; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D015994:Incidence; D007231:Infant, Newborn; D007647:Kernicterus / Q000209:etiology / Q000517:prevention & control*; D015997:Neonatal Screening / Q000379:methods / Q000451:nursing / Q000458:organization & administration; D010290:Parents; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000379:methods / Q000458:organization & administration; D018570:Risk Assessment; D018571:Sentinel Surveillance; D014481:United States / Q000453:epidemiology
D001663:Bilirubin