Severe Neonatal Hyperbilirubinemia in the Netherlands

Gotink, Mark; Benders, Manon J. N. L.; Lavrijsen, Selma W.; Pereira, Rob Rodrigues; Hulzebos, Christian V.; Dijk, Peter H.

doi:10.1159/000351274

Cited by 36 publications

(23 citation statements)

References 20 publications

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“…As assessed by population-based studies and registries, the incidence of severe hyperbilirubinemia in HICs is currently estimated to be about 31.6/100,000 live births (95% CI 11.8-51.3) [23,24,25,26,27], while the incidences of ABE and CBE have been estimated as being in the range of 1.0-3.7 and 0.4-2.7/100,000 live births, respectively [28,29,30]. …”

Section: Introductionmentioning

confidence: 99%

Neonatal Jaundice in Low- and Middle-Income Countries: Lessons and Future Directions from the 2015 Don Ostrow Trieste Yellow Retreat

Greco¹,

et al. 2016

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Severe neonatal hyperbilirubinemia, defined as total serum bilirubin (TSB) ≥20 mg/dl, is associated with a higher risk of permanent neurological sequelae and death. Jaundice can and should be promptly diagnosed and treated. Reliable methods for TSB assay are not always readily available, particularly in low- and middle-income countries, making the true incidence of severe neonatal jaundice (NNJ) difficult to estimate. To gather a more comprehensive picture, a symposium addressing NNJ worldwide was organized during the 2015 Don Ostrow Trieste Yellow Retreat. Data collected by several researchers in different regions of the world were presented and differences/similarities discussed. This report points out the need for: (1) a coordinated worldwide effort to define the burden and the causes of severe NNJ and its consequences; (2) aggressive educational programs for families and health personnel to facilitate timely care-seeking, and (3) accurate diagnostics and effective phototherapy.

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Section: Introductionmentioning

confidence: 99%

Neonatal Jaundice in Low- and Middle-Income Countries: Lessons and Future Directions from the 2015 Don Ostrow Trieste Yellow Retreat

Greco¹,

et al. 2016

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“…The incidence of severe hyperbilirubinaemia in industrialised countries based on objective assessment of bilirubin levels ranges from 2.0 to 45 per 100 000 live births and of acute bilirubin encephalopathy (ABE)/kernicterus from 0.4 to 2.7 3 4. Unfortunately, similar estimates using population-based data are lacking in low-income and middle-income countries (LMIC) as severity of hyperbilirubinaemia is commonly based on clinical judgement and the need for phototherapy and/or exchange transfusion 5.…”

Section: Introductionmentioning

confidence: 99%

Why is kernicterus still a major cause of death and disability in low-income and middle-income countries?

Olusanya

Ogunlesi

Slusher

2014

Archives of Disease in Childhood

144

152

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Neonatal jaundice is predominantly a benign condition that affects 60%-80% of newborns worldwide but progresses to potentially harmful severe hyperbilirubinaemia in some. Despite the proven therapeutic benefits of phototherapy for preventing extreme hyperbilirubinaemia, acute bilirubin encephalopathy or kernicterus, several low-income and middle-income countries (LMIC) continue to report high rates of avoidable exchange transfusions, as well as bilirubin-induced mortality and neurodevelopmental disorders. Considering the critical role of appropriate timing in treatment effectiveness, this review set out to examine the contributory factors to the burden of severe hyperbilirubinaemia and kernicterus based on the 'three delays model' described by Thaddeus and Maine in the 91 most economically disadvantaged LMICs with Gross National Income per capita ≤US$6000 and median human development index of 0.525 (IQR: 0.436-0.632). Strategies for addressing these delays are proposed including the need for clinical and public health leadership to curtail the risk and burden of kernicterus in LMICs.

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“…[1][2][3][4] Although there is no single threshold at which bilirubin becomes neurotoxic, 5 a 2003 Eunice Kennedy Shriver National Institute of Child Health and Human Development sponsored conference proposed that TSB levels $30 mg/dL be defined as "hazardous" hyperbilirubinemia because of the perceived higher risk of neurologic injury. 6 The incidence of hazardous hyperbilirubinemia in populations in Western Europe [7][8][9][10][11][12] and the United States [13][14][15][16][17] ranges from 2 to 12/100 000, with the lowest rates in Switzerland (where the mean postpartum stay after a vaginal delivery was 5.6 days) 11 and in US hospital systems after implementation of universal bilirubin screening. 14,15,17 The distribution of causes of hazardous hyperbilirubinemia varies in different populations, with isoimmunization more common in Europe 9,10,12 and glucose-6-phosphate dehydrogenase (G6PD) deficiency predominating in the United States and Canada.…”

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confidence: 99%

Incidence, Etiology, and Outcomes of Hazardous Hyperbilirubinemia in Newborns

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Total serum bilirubin levels $30 mg/dL have been labeled as "hazardous." Levels this high are rare, occurring in 3 to 10 per 100 000 births. Few studies have examined etiologies and long-term outcomes in these infants.WHAT THIS STUDY ADDS: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a major identifiable cause, but is underassessed. Chronic, bilirubin-induced neurotoxicity is rare and only occurred in the setting of additional risk factors (prematurity, G6PD deficiency, sepsis) and at levels far above recommended exchange transfusion thresholds. abstract BACKGROUND AND OBJECTIVES: Total serum bilirubin (TSB) levels $30 mg/dL are rare but potentially hazardous. A better understanding of their incidence, causes, and outcomes could help inform preventive efforts. METHODS:We identified infants born $35 weeks' gestational age from 1995-2011 in Kaiser Permanente Northern California (n = 525 409) and examined the medical records of infants with a TSB $30 mg/dL to determine etiology and the occurrence of acute bilirubin encephalopathy. We reviewed inpatient and outpatient encounters through 2013 for evidence of sensorineural hearing loss (SNHL) or cerebral palsy (CP). RESULTS:We identified 47 infants with TSB $30 mg/dL (8.6 per 100 000 births). In 44 infants (94%), the hyperbilirubinemia occurred after the initial birth hospitalization. The etiology was not identified in 33 (70%). Glucose-6-phosphate dehydrogenase (G6PD) activity was measured in only 25 (53%) of whom 10 (40%) were deficient. Four children had acute bilirubin encephalopathy of whom 2 developed both CP and SNHL, and 1 developed isolated SNHL. These 3 infants all had G6PD deficiency and TSB .40 mg/dL. One additional 35-week infant with TSB 38.2 mg/dL had SNHL.CONCLUSIONS: Hazardous ($30 mg/dL) hyperbilirubinemia is a rare event. No etiology could be identified from the clinical record in most cases. G6PD deficiency was the leading cause of hazardous hyperbilirubinemia when an etiology was identified, but many were not tested. Chronic, bilirubin-induced neurotoxicity was uncommon and occurred only in the setting of additional risk factors and TSB values well over (.15 mg/dL)

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Severe Neonatal Hyperbilirubinemia in the Netherlands

Cited by 36 publications

References 20 publications

Neonatal Jaundice in Low- and Middle-Income Countries: Lessons and Future Directions from the 2015 Don Ostrow Trieste Yellow Retreat

Neonatal Jaundice in Low- and Middle-Income Countries: Lessons and Future Directions from the 2015 Don Ostrow Trieste Yellow Retreat

Why is kernicterus still a major cause of death and disability in low-income and middle-income countries?

Incidence, Etiology, and Outcomes of Hazardous Hyperbilirubinemia in Newborns

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