Preventing kernicterus: a wake-up call

Despite advances in neonatal care there has been a recent resurgence of bilirubin encephalopathy and clinical kernicterus in several parts of the world. In this issue Manning and colleagues provide worrying evidence to suggest that the UK and Republic of Ireland may be participants in this trend.1 While the aim of their study was to determine the incidence of severe hyperbilirubinaemia, and to identify clinical and demographic variables and short-term outcomes, the authors have extended discussion to some important risk management lessons. The results of this important surveillance study should be made known to all paediatricians and related health professionals responsible for the newborn.

The British Paediatric Surveillance Unit (BPSU) reporting system has been used for this prospective survey. The BPSU has a good reputation of providing a high response rate. The investigators sought to capture all cases of “severe” neonatal hyperbilirubinaemia, defined by them as an unconjugated serum bilirubin of ≥510 μmol/l in the first month of life, between May 2003 and May 2005. It could be argued that the level chosen was more than “severe”. The nomenclature of different degrees and forms of jaundice has been critiqued recently by Maisels.2 He suggests the term “extreme hyperbilirubinaemia” should be used to categorise this level of jaundice. As with the label “extreme sport” this signifies an element of risk, but it does not go as far as the proposal of Bhutani et al3 that levels >510 μmol/l should be referred to as “hazardous”. Whatever we choose to call it the incidence of this level of jaundice was quantified through this BPSU survey as 7.1/100 000 live births. …