Understanding and preventing severe neonatal hyperbilirubinemia: is bilirubin neurotoxity really a concern in the developed world?
Section snippets
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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Comparison between maternal and neonatal serum vitamin D levels in term jaundiced and nonjaundiced cases
2016, Journal of the Chinese Medical AssociationCitation Excerpt :In neonates, jaundice generally results from an imbalance between the production and conjugation of bilirubin.1,2
Guideline-Based Educational Intervention to Decrease the Risk for Readmission of Newborns With Severe Hyperbilirubinemia
2013, Journal of Pediatric Health CareProfile of minocycline neuroprotection in bilirubin-induced auditory system dysfunction
2011, Brain ResearchCitation Excerpt :Excessive neonatal jaundice can lead to devastating permanent neurological sequelae involving basal ganglia, auditory system and occulomotor system dysfunction (for review see: Bhutani, et al., 2004; Kaplan and Hammerman, 2004; Larroche, 1968; Shaia et al., 2002; Shapiro, 2005; Stevenson, et al., 2004; Perlstein, 1960; Volpe, 2001; Maisels, 2000).
Identification of Neonates at Risk for Hazardous Hyperbilirubinemia: Emerging Clinical Insights
2009, Pediatric Clinics of North AmericaAn Emergency Medicine Approach to Neonatal Hyperbilirubinemia
2007, Emergency Medicine Clinics of North AmericaCitation Excerpt :Ethnicity is a factor in determining the likelihood of hyperbilirubinemia. Individuals of East Asian descent, certain tribes of Native Americans such as the Navajo, and those of Greek ancestry have a higher incidence of hyperbilirubinemia [3,15,23]. It is important to inquire about siblings with jaundice, because there is a 12.5 times greater risk for severe jaundice in newborns who have one or more siblings affected with severe neonatal hyperbilirubinemia when compared with newborns who have prior siblings without severe neonatal hyperbilirubinemia [24].