title: Prospective Surveillance of Extreme Neonatal Hyperbilirubinemia in Australia.
abstract: OBJECTIVE
  To determine the incidence, causes, associated factors, and short-term outcomes of extreme neonatal hyperbilirubinemia in Australia in order to identify opportunities for prevention.
  
  
  METHODS
  This was a prospective population-based surveillance study in collaboration with the Australian Pediatric Surveillance Unit between April 1, 2010, and March 31, 2013. Case definition was: infants >34 weeks gestation with a peak total serum bilirubin ≥450 μmol/L and or clinical evidence of bilirubin encephalopathy. Clinicians completed questionnaires detailing demographic and clinical data including: peak serum bilirubin, signs of bilirubin encephalopathy, etiology, associated pathology, management, and short-term outcomes.
  
  
  RESULTS
  The questionnaire return rate was 95%, and 87 infants met the case definition. The Australian incidence of extreme neonatal hyperbilirubinemia is estimated to be 9.4/100,000 live births. Main etiologies were: idiopathic ABO blood group incompatibility, glucose-6-phosphate dehydrogenase deficiency, and Rhesus isoimmunization. There were no significant differences in short-term outcomes between inpatient and outpatient cases. Cases with a hemolytic etiology were significantly more likely to have extremely high levels of hyperbilirubinemia (P < .002).
  
  
  CONCLUSIONS
  The incidence of extreme neonatal hyperbilirubinemia in Australia is comparable with previous studies. Robust pre- and post-discharge assessment and management strategies of neonatal hyperbilirubinemia are essential to prevent neurodisability. Universal glucose-6-phosphate dehydrogenase screening and serial bilirubin monitoring may optimize preventative strategies.
authors.affiliation: Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia. Electronic address: angela.mcgillivray@sswahs.nsw.gov.au.
authors.forename: Angela
authors.initials: A
authors.lastname: McGillivray
authors.affiliation: Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jan
authors.initials: J
authors.lastname: Polverino
authors.affiliation: The University of Sydney, Sydney, New South Wales, Australia; The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Notre Dame, Darlinghurst, New South Wales, Australia.
authors.forename: Nadia
authors.initials: N
authors.lastname: Badawi
authors.affiliation: Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Evans
mesh_terms: D001315:Australia / Q000453:epidemiology; D001663:Bilirubin / Q000097:blood*; D005260:Female; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000150:complications / Q000453:epidemiology*; D015994:Incidence; D007231:Infant, Newborn; D007647:Kernicterus / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D001663:Bilirubin