Abstract
Neonatal hyperbilirubinemia can cause lifelong neurodevelopmental impairment (kernicterus) even in high-resource settings. A better understanding of the incidence and processes leading to kernicterus may help in the design of preventive measures. To determine incidence rates of hazardous hyperbilirubinemia and kernicterus among near-term to term newborns and to evaluate health care professional adherence to best practices. This population-based nationwide cohort study used prospectively collected data on the highest serum bilirubin level for all infants born alive at 35 weeks' gestation or longer and admitted to neonatal care at all 46 delivery and 37 neonatal units in Sweden from 2008 to 2016. Medical records for newborns with hazardous hyperbilirubinemia were evaluated for best neonatal practices and for a diagnosis of kernicterus up to 2 years of age. Data analyses were performed between September 2017 and February 2018. Extreme (serum bilirubin levels, 25.0-29.9 mg/dL [425-509 μmol/L]) and hazardous (serum bilirubin levels, ≥30.0 mg/dL [≥510 μmol/L]) neonatal hyperbilirubinemia. The primary outcome was kernicterus, defined as hazardous neonatal hyperbilirubinemia followed by cerebral palsy, sensorineural hearing loss, gaze paralysis, or neurodevelopmental retardation. Secondary outcomes were health care professional adherence to national guidelines using a predefined protocol with 10 key performance indicators for diagnosis and treatment as well as assessment of whether bilirubin-associated brain damage might have been avoidable. Among 992 378 live-born infants (958 051 term births and 34 327 near-term births), 494 (320 boys; mean [SD] birth weight, 3505 [527] g) developed extreme hyperbilirubinemia (50 per 100 000 infants), 6.8 per 100 000 infants developed hazardous hyperbilirubinemia, and 1.3 per 100 000 infants developed kernicterus. Among 13 children developing kernicterus, brain injury was assessed as potentially avoidable for 11 children based on the presence of 1 or several of the following possible causes: untimely or lack of predischarge bilirubin screening (n = 6), misinterpretation of bilirubin values (n = 2), untimely or delayed initiation of treatment with intensive phototherapy (n = 1), untimely or no treatment with exchange transfusion (n = 6), or lack of repeated exchange transfusions despite indication (n = 1). Hazardous hyperbilirubinemia in near-term or term newborns still occurs in Sweden and was associated with disabling brain damage in 13 per million births. For most of these cases, health care professional noncompliance with best practices was identified, suggesting that a substantial proportion of these cases might have been avoided.
Highlights
Neonatal hyperbilirubinemia is a major cause of lifelong neurodevelopmental impairment.1 Given effective tools for risk assessment and prevention2-4 as well as for diagnosis and treatment,5-8 devastating neonatal hyperbilirubinemia should be a preventable condition
Hazardous hyperbilirubinemia in near-term or term newborns still occurs in Sweden and was associated with disabling brain damage in 13 per million births
Previous studies report diagnoses associated with kernicterus, such as hemolytic or nonhemolytic diseases,11,15 bilirubin levels,14,18 and root cause analysis,19 but there is no previous study, to our knowledge, on hyperbilirubinemia resulting in kernicterus using population-based epidemiology to establish incidence rates with analysis of adherence to best practice guidelines
Summary
Neonatal hyperbilirubinemia is a major cause of lifelong neurodevelopmental impairment. Given effective tools for risk assessment and prevention as well as for diagnosis and treatment, devastating neonatal hyperbilirubinemia should be a preventable condition. Neonatal hyperbilirubinemia is a major cause of lifelong neurodevelopmental impairment.. Given effective tools for risk assessment and prevention as well as for diagnosis and treatment, devastating neonatal hyperbilirubinemia should be a preventable condition. Kernicterus occurs in high-resource settings despite evidence-based guidelines and under what could be considered optimal conditions.. A better understanding of the processes leading to kernicterus is needed. There are a few population-based studies (from Denmark, the United Kingdom, the United States, and Canada) of the incidence of extreme neonatal hyperbilirubinemia and kernicterus.. Previous studies report diagnoses associated with kernicterus, such as hemolytic or nonhemolytic diseases, bilirubin levels, and root cause analysis, but there is no previous study, to our knowledge, on hyperbilirubinemia resulting in kernicterus using population-based epidemiology to establish incidence rates with analysis of adherence to best practice guidelines There are a few population-based studies (from Denmark, the United Kingdom, the United States, and Canada) of the incidence of extreme neonatal hyperbilirubinemia and kernicterus. Previous studies report diagnoses associated with kernicterus, such as hemolytic or nonhemolytic diseases, bilirubin levels, and root cause analysis, but there is no previous study, to our knowledge, on hyperbilirubinemia resulting in kernicterus using population-based epidemiology to establish incidence rates with analysis of adherence to best practice guidelines
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
