Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland

Abstract

Objectives: To determine the incidence of severe hyperbilirubinaemia in the newborn, and to identify associated clinical and demographic variables, and short-term outcomes. Design: Prospective, population-based study. Results: 108 infants met the case definition, 106 from the UK and 2 from the Republic of Ireland. The UK incidence of severe hyperbilirubinaemia was 7.1/100 000 live births (95% CI 5.8 to 8.6). Only 20 cases presented in hospital; 88 were admitted with severe jaundice. 64 (60.4%) cases were male, and 56 (51.8%) were of ethnic minority origin. 87 (80.5%) cases were exclusively breast fed. Co-morbidity included haemolysis, dehydration, infection and bruising. 14 infants showed evidence of bilirubin encephalopathy, of whom 3 died. The UK incidence of bilirubin encephalopathy was 0.9/100 000 live births (95% CI 0.46 to 1.5).Conclusions: This is the first large, prospective, population-based study of the incidence of severe hyperbilirubinaemia in the newborn. The clinical and demographic associations, and short-term outcomes identified, are the same as those reported recently in North America and Europe.

Systems changes to prevent severe hyperbilirubinemia and promote breastfeeding: pilot approaches

“…Of these, approximately 5% develop hyperbilirubinemia severe enough to require treatment with phototherapy and approximately one in 15 000 develop serum bilirubin concentrations exceeding 30 mg per 100 ml. 1,2 Lack of appropriate treatment places these infants at risk for kernicterus, the devastating, irreversible neurological condition that affects approximately one in 50 000 to 100 000 newborns in developed countries. An important challenge of the health care system is to maintain sufficient vigilance to reduce the incidence of these relatively rare but serious events while minimizing unintended consequences, such as increased parental anxiety, decreased breastfeeding or unnecessary treatment leading to excessive cost.…”

Israel guidelines for the management of neonatal hyperbilirubinemia and prevention of kernicterus

“…G-6-PD deficiency is associated with acute hemolytic episodes that may result in extreme hyperbilirubinemia 28,29 and is a major contributing factor to bilirubin encephalopathy. 5,9,10,14,30,31 In Israel, G-6-PD deficiency is found in a high percentage of Sephardic Jews whose families immigrated from the Middle East and Asia Minor. North African Jews are affected to a lesser extent, whereas Ashkenazi Jews (Central and East Europe) are minimally affected.…”

“…However, kernicterus continues to occur. Recently published cases emanate from countries with advanced medical care services, including the United States, 5,6 Canada, 9,10 Holland, 11 Denmark, 12 Italy, 13 the United Kingdom, 14 New Zealand, 15 Germany 16 and South Africa. 17 The proposed reasons for the continued appearance of kernicterus include adoption of a more liberal policy toward neonatal jaundice, earlier discharge of mother-infant dyads prior to the STB peaking, an increase in the number of breastfeeding neonates, the assumption, subsequently disproved, 18 that increased hemolysis is essential for kernicterus to occur and the practice of managing hyperbilirubinemia in late-preterm infants (34 0/7 to 36 6/7 weeks gestation) as if they were term counterparts.…”

“…19 Frequently, the severe hyperbilirubinemia or bilirubin encephalopathy does not occur during, but rather following, the birth hospitalization. 5,6,12,14 Identifiable predischarge predictive risk factors of impending extreme icterus may be absent. The emphasis in the prevention of extreme hyperbilirubinemia may therefore lie equally in the resolute post-discharge follow-up of all neonates as in abiding by guidelines for the institution of phototherapy or performing of exchange transfusion.…”

Neonatal jaundice: a critical review of the role and practice of bilirubin analysis

“…33 Their results reported after two years described the UK incidence of severe hyperbilirubinaemia as 7.1/ 100,000. 34 The majority of cases presented after the infant had been discharged, and over 80% were breast-fed. The mean presenting bilirubin was 580 mmol/L at 4.3 days of age.…”