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.
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.
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