Elsevier

Clinics in Perinatology

Volume 31, Issue 3, September 2004, Pages 555-575
Clinics in Perinatology

Understanding and preventing severe neonatal hyperbilirubinemia: is bilirubin neurotoxity really a concern in the developed world?

https://doi.org/10.1016/j.clp.2004.05.001Get rights and content

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The kernicterus pendulum

Kernicterus was first described in the nineteenth century, although the condition must have existed long before that period. Interesting historical accounts of the condition and its pathophysiology are available for the reader [2], [3]. Kernicterus was commonly encountered in the first half of the twentieth century when it was predominantly caused by Rh isoimmunization. Additional causes of severe hyperbilirubinemia also existed, but these causes were overshadowed by the frequency of the cases

Drawing public attention to the situation

Following dissemination of some of the data on the increased incidence of kernicterus, public attention was drawn to the situation. The Joint Commission for Accreditation of Hospital Organizations and the Centers for Disease Control issued alerts [38], [39], the latter stressing that kernicterus was a preventable condition. The National Quality Forum (Agency for Healthcare Regulation of Quality) declared kernicterus and STB concentrations of 30.0 mg/dL or greater as “never events” [40]. The

What does the serum total bilirubin tell us?

The keystone of assessment of neonatal hyperbilirubinemia is measurement of the STB. This concentration is used, frequently in conjunction with additional factors, some of which are discussed herein, to decide whether to institute therapy, the type of therapy, and the rapidity and intensity with which it should be administered.

Clinical features of bilirubin encephalopathy

Because most readers will not have encountered a case of kernicterus, a description of the clinical features of the condition follows in the hope of allowing the pediatrician to recognize it in the early stages when it is still reversible.

Racial, familial, and environmental influences

Racial and environmental influences may have an effect on STB concentrations. For example, diminished STB concentrations are found in black neonates when compared with white neonates [94]. In contrast, a high incidence of hyperbilirubinemia is encountered in neonates of East Asian [95], Japanese [96], [97], or Navajo Indian parentage [98]. Neonatal jaundice frequently occurs in more than one sibling in the same family. Repetition of blood group incompatibility within a family is perhaps to be

Prevention and treatment of hyperbilirubinemia

The AAP has published guidelines for the management and prevention of hyperbilirubinemia in healthy term neonates [41]. These guidelines are in the process of revision, and the new recommendations should be available shortly. Overall, these recommendations, if adhered to, should be instrumental in preventing kernicterus in the majority of cases. Nevertheless, some evidence suggests that not all pediatricians adhere to these guidelines [119].

The guidelines do not apply to neonates with

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