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Learning from claims: hyperbilirubinaemia and kernicterus
  1. Janet M Rennie1,
  2. Jeanette Beer2,
  3. Michele Upton3
  1. 1 Neonatal Unit, University College Hospital, London, UK
  2. 2 Obstetrics, NHS Resolution, London, UK
  3. 3 Maternity and Newborn, NHS Improvement, London, UK
  1. Correspondence to Dr Janet M Rennie, Neonatal Services, University College Hospital, London, NW1 2PG, UK; jmr{at}janetrennie.com

Abstract

We examined claims made against the National Health Service (NHS) involving neonatal jaundice in order to determine whether there were lessons that could be learnt from common themes.

This was a retrospective anonymised study using information from the NHS Resolution database for 2001–2011.

Twenty cases (16 males) had sufficient information for analysis. Fifteen had confirmed cerebral palsy and two young children had damage to the globus pallidus without confirmed CP. In three cases, the outcome was uncertain. Two were extremely preterm, five were born at 34–36 weeks’ gestation. Jaundice was typically present very early in life; in four cases, it was noted at less than 24hours of age, and in 14 cases, it was first noted on the second to third day. There was a lag between recognition and readmission, with a range of 26–102 hours. The peak serum bilirubin level was over 600 µmol/L in all the babies born at term. An underlying diagnosis was found in all but two; six had glucose-6-phosphatase deficiency (one also had Gilbert’s syndrome); five were diagnosed with ABO incompatibility; three with Rh haemolytic disease; one with spherocytosis and three preterm. The total cost of these claims by August 2017 was almost £150.5 million. This figure is likely to rise.

These data show that, in the group who litigate, babies who develop kernicterus generally have an underlying diagnosis. We recommend adherence to theNational Institute for Health and Care Excellence guideline that recommends measuring the bilirubin level within 6 hours in all babies who are visibly jaundiced.

  • jaundice
  • neonatology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors JMR extracted and analysed the data and wrote the paper. JB extracted the data, designed the spreadsheet and contributed costings and comments to the paper. MU contributed regarding the NHS perspective and to the writing of the paper.

  • Funding None declared.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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