Epidemiology

Universal bilirubin screening may cut rate of severe hyperbilirubinemia in newborns

Last Updated: 2009-09-28 12:39:43 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Bilirubin screening in all infants could reduce the incidence of severe hyperbilirubinemia, but at the same time increase use of phototherapy at bilirubin levels lower than are currently recommended, according to findings from a report in the October issue of Pediatrics.

Guidelines released by the American Academy of Pediatrics (AAP) in 2004 recommend that every newborn undergo bilirubin screening with predischarge total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) measurement, risk factor assessment, or a combination of these.

To assess the impact of universal bilirubin screening, Dr. Michael W. Kuzniewicz, from the University of California, San Francisco, and colleagues analyzed data from 358,086 infants who were born between January 1, 1995 and June 30, 2007. The subjects were at least 35 weeks' gestation at birth and weighed at least 2000 g.

Overall, 10.6% of infants were born at centers with universal bilirubin screening. In this group, 0.17% had a TSB level greater than that of the AAP exchange guideline, 9.1% received inpatient phototherapy, and the hospital length of stay was 50.9 hours. By contrast, the corresponding values in infants born at centers without universal screening were 0.45% (p < 0.001), 4.2% (p < 0.001), and 48.7 hours (p < 0.001).

In another study, appearing in the same issue of Pediatrics, Dr. Sotirios Fouzas, from the University Hospital of Patras, Greece, and colleagues analyzed data from 2039 healthy neonates to create a TcB nomogram for predicting significant neonatal hyperbilirubinemia.

Overall, 6% of subjects had significant hyperbilirubinemia. At 24 hours of life, high-risk values on the TcB nomogram were 73.9% sensitive and had a positive likelihood ratio of 12.1 for predicting significant hyperbilirubinemia. With low-risk values, the sensitivity was 97.7% with a negative likelihood ratio of 0.04.

In a related article, members of the US Preventive Services Task Force reviewed experimental and observational studies to assess screening strategies for preventing chronic bilirubin encephalopathy. Dr. Mary Barton and colleagues conclude that at present there are simply not enough data to evaluate the risks and benefits of hyperbilirubinemia screening to prevent this condition.

Pediatrics 2009.124:1031-1039,1052-1059,1172-1177.