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Universal bilirubin screening for severe neonatal hyperbilirubinemia

Journal of Perinatology volume 30, pages S6–S15 (2010)Cite this article

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Abstract

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.

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Authors and Affiliations

  1. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA, USA

    V K Bhutani, R J Vilms & L Hamerman-Johnson

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  1. V K Bhutani
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  2. R J Vilms
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  3. L Hamerman-Johnson
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Correspondence to V K Bhutani.

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The authors declare no conflict of interest.

Additional information

This paper resulted from the Evidence vs Experience in Neonatal Practices conference, 19 to 20 June 2009, sponsored by Dey, LP.

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Bhutani, V., Vilms, R. & Hamerman-Johnson, L. Universal bilirubin screening for severe neonatal hyperbilirubinemia. J Perinatol 30 (Suppl 1), S6–S15 (2010). https://doi.org/10.1038/jp.2010.98

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