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- bilirubin encephalopathy
- British Paediatric Surveillance Unit
- community management
- early discharge
Severe neonatal jaundice and bilirubin encephalopathy have been reported with increasing frequency from North America and Europe.1–3 There are no published reports of similar trends in Britain. We therefore examined trends in moderate neonatal hyperbilirubinaemia in Wirral Hospital between 1991 and 2001. Neonates of ⩾ 34 weeks gestation with a serum bilirubin of ⩾ 340 μmol/l were identified from the laboratory database. Trends in hyperbilirubinaemia were analysed using the χ2 test for trend.
A total of 184 infants were identified; 122 presented before initial discharge, and 62 were readmitted. Median (interquartile range) gestational age was 38 (37–39) weeks, and 69% of affected infants were breast fed. The incidence of moderate jaundice increased from 2.4/1000 live births in 1991 to 5.5/1000 in 2001 (p < 0.0001). Despite a progressive fall in annual births, readmissions for jaundice increased from seven in the first six years of study to 55 in the second five years (p < 0.0001). Five infants needed exchange transfusion; all had haemolytic diseases. All were identified before initial discharge. No infants developed bilirubin encephalopathy, and none died.
Ours is the only report of recent trends in neonatal jaundice in Britain. Whether our experience is representative is not known, nor is the national incidence of bilirubin encephalopathy. These questions may be answered by this continuing study, supported by the British Paediatric Surveillance Unit, of severe neonatal jaundice.