title: Severe Neonatal Hyperbilirubinemia Decreased after the 2007 Canadian Guidelines.
abstract: OBJECTIVE
  To estimate the incidence of severe neonatal hyperbilirubinemia in Canada from 2011-2013 following the implementation of the Canadian Pediatric Society's published guidelines on the management of hyperbilirubinemia in 2007. Our previously reported incidence of hyperbilirubinemia in Canada was 1 in 2480.
  
  
  METHODS
  Term infants ≤ 60 days of age, with a peak serum total bilirubin level > 425 μmol/L or who had an exchange transfusion were followed prospectively through the Canadian Pediatric Surveillance Program from 2011-2013. Infants with rhesus isoimmunization or born < 35 weeks gestation were excluded.
  
  
  RESULTS
  Ninety-one cases of severe neonatal hyperbilirubinemia were confirmed. Sixty-nine infants (76%) were readmitted to hospital, 47 (52%) of them within 6 days of age. The remaining 22 infants (24%) were identified with severe neonatal hyperbilirubinemia before they were discharged from the hospital. The mean reported peak bilirubin level was 484 μmol/L (range 181-788; SD ± 92). An etiology was identified in 57 (63%) cases, with ABO incompatibility (n = 35) and glucose-6-phosphate dehydrogenase deficiency (n = 11) being the most common. An infant was 3.5 times more likely to be diagnosed with severe neonatal hyperbilirubinemia from 2002-2004 compared with 2011-2013 (95% CI 2.72-4.47).
  
  
  CONCLUSIONS
  The minimum estimated incidence of severe neonatal hyperbilirubinemia in Canada is 1 in 8352 live births. Introduction of the Canadian Pediatric Society guidelines and improved physician awareness of severe neonatal hyperbilirubinemia in the last 10 years likely made positive contributions to this trend.
authors: Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. Electronic address: sgrom@smh.ca.
authors: Michael
authors: M
authors: Sgro
authors: Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada.
authors: Sharmilaa
authors: S
authors: Kandasamy
authors: Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Vibhuti
authors: V
authors: Shah
authors: Dalla Lana Faculty of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors: Marianna
authors: M
authors: Ofner
authors: Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors: Douglas
authors: D
authors: Campbell
mesh_terms: D000017:ABO Blood-Group System; D001663:Bilirubin / Q000097:blood*; D001787:Blood Group Incompatibility; D002170:Canada; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000150:complications; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000453:epidemiology* / Q000628:therapy*; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012955:Societies, Medical
chemical_list: D000017:ABO Blood-Group System; D001663:Bilirubin