Prevention of severe neonatal hyperbilirubinemia in healthy infants of 35 or more weeks of gestation: implementation of a systems-based approach

Abstract

Newborns with jaundice or unrecognized hyperbilirubinemia are a vulnerable population which is likely to be deprived from preventive and/or therapeutic healthcare services in their transition from birthing hospital to their homes. Of the 4 million infants born each year in the United States over 3.5 million are born at 35 or more weeks of gestation. Most have benign outcomes with little or no threat of neurological compromise from medical conditions during their first year of life. Over the past 4 decades proven preventive health measures provided at well-baby nurseries and at delivery rooms have been effective in reducing infant mortality and morbidity. However nearly all healthy infants have some degree of hyperbilirubinemia and over 60% develop jaundice during their first week of life. When unmonitored or untreated in a timely manner hyperbilirubinemia can become excessive and may be unrecognized if the infant is not under medical supervision. An adverse outcome could be a spectrum of bilirubin-induced neurologic dysfunction (BIND) and its severest manifestation: kernicterus a lifelong athetoid cerebral palsy with sensorineural auditory impairment. (excerpt)