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Severe neonatal hyperbilirubinaemia: lessons learnt from a national perinatal audit
  1. Berthe A M van der Geest1,2,
  2. Ageeth N Rosman3,4,
  3. Klasien A Bergman5,
  4. Bert J Smit6,
  5. Peter H Dijk5,
  6. Jasper V Been1,2,
  7. Christian V Hulzebos5
  1. 1 Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC Sophia, Rotterdam, The Netherlands
  2. 2 Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia, Rotterdam, The Netherlands
  3. 3 Department of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
  4. 4 Foundation Perined, Utrecht, The Netherlands
  5. 5 Department of Neonatology, University Medical Centre Groningen Beatrix Children's Hospital, Groningen, The Netherlands
  6. 6 Directorate Quality and Patient Care, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Berthe A M van der Geest, Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC Sophia, 3015 GD Rotterdam, The Netherlands; b.vandergeest{at}


Objectives To describe characteristics of neonates with severe neonatal hyperbilirubinaemia (SNH) and to gain more insight in improvable factors that may have contributed to the development of SNH.

Design and setting Descriptive study, based on national Dutch perinatal audit data on SNH from 2017 to 2019.

Patients Neonates, born ≥35 weeks of gestation and without antenatally known severe blood group incompatibility, who developed hyperbilirubinaemia above the exchange transfusion threshold.

Main outcome measures Characteristics of neonates having SNH and corresponding improvable factors.

Results During the 3-year period, 109 neonates met the eligibility criteria. ABO antagonism was the most frequent cause (43%). All neonates received intensive phototherapy and 30 neonates (28%) received an exchange transfusion. Improvable factors were mainly related to lack of knowledge, poor adherence to the national hyperbilirubinaemia guideline, and to incomplete documentation and insufficient communication of the a priori hyperbilirubinaemia risk assessment among healthcare providers. A priori risk assessment, a key recommendation in the national hyperbilirubinaemia guideline, was documented in only six neonates (6%).

Conclusions SNH remains a serious threat to neonatal health in the Netherlands. ABO antagonism frequently underlies SNH. Lack of compliance to the national guideline including insufficient a priori hyperbilirubinaemia risk assessment, and communication among healthcare providers are important improvable factors. Implementation of universal bilirubin screening and better documentation of the risk of hyperbilirubinaemia may enhance early recognition of potentially dangerous neonatal jaundice.

  • audit
  • neonatology
  • jaundice

Data availability statement

The dataset is available (from Perined) on reasonable request.

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Data availability statement

The dataset is available (from Perined) on reasonable request.

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  • BAMvdG and ANR contributed equally.

  • Contributors The Perinatal Audit Assistant database is managed by ANR, who also prepared data and provided the anonymous dataset from the Perinatal Audit Assistant database for these analyses. ANR and BAMvdG checked collected data. Statistical analyses were performed by BAMvdG. BAMvdG, ANR and CVH wrote the first draft of the manuscript. BAMvdG, ANR, KAB, BJS, PD, JVB and CVH were involved in interpretation of the results, critically revised the manuscript and gave approval to the final version to be published. CVH is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.