Title:Newborn Bilirubin Screening for Preventing Severe Hyperbilirubinemia and Bilirubin Encephalopathy: A Rapid Review
VOLUME: 13 ISSUE: 1
Author(s):Kalpana Bhardwaj, Tiffany Locke, Anne Biringer, Allyson Booth, Elizabeth K. Darling, Shelley Dougan, Jane Harrison, Stephen Hill, Ana Johnson, Susan Makin, Beth Potter, Thierry Lacaze-Masmonteil* and Julian Little
Affiliation:Children`s Hospital of Eastern Ontario Research Institute - BORN Ontario, Ottawa, Ontario, Children`s Hospital of Eastern Ontario Research Institute - BORN Ontario, Ottawa, Ontario, University of Toronto, Mount Sinai Hospital and Family and Community Medicine - Ray D Wolfe Department of Family Medicine, Toronto, Ontario, Association of Ontario Midwifes - Quality and Risk Management, Toronto, Ontario, University of Ottawa - Population Health Program, Ottawa, Ontario, Children`s Hospital of Eastern Ontario Research Institute - BORN Ontario, Ottawa, Ontario, Anishnawbe Health Ontario - WAASH-KESHUU-YAAN, Toronto, Ontario, Mc Master University - Department of Pathology and Molecular Medicine, Hamilton, Ontario, Queen`s University - ICES@Queen`s Health Services Research Facility, Department of Public Health Sciences, Kingston, Ontario, Toronto Public Health - Healthy Families, Toronto, Ontario, University of Ottawa - School of Epidemiology, Public Health and Preventive Medicine, Ottawa, Ontario, Children`s Hospital of Eastern Ontario Research Institute - BORN Ontario, Ottawa, Ontario, University of Ottawa - School of Epidemiology, Public Health and Preventive Medicine, Ottawa, Ontario
Keywords:Bilirubin encephalopathy, hyperbilirubinemia, neonatal screening, universal bilirubin screening.
Abstract:According to the 2004 American Academy of Pediatrics guideline on the management of
hyperbilirubinemia, every newborn should be assessed for the risk of developing severe hyperbilirubinemia
with the help of predischarge total serum bilirubin or transcutaneous bilirubin measurements
and/or assessments of clinical risk factors. The aim of this rapid review is 1) to review the evidence
for 1) predicting and preventing severe hyperbilirubinemia and bilirubin encephalopathy, 2) determining
the efficacy of home/community treatments (home phototherapy) in the prevention of severe
hyperbilirubinemia, and 3) non-invasive/transcutaneous methods for estimating serum bilirubin level.
Methods: In this rapid review, studies were identified through the Medline database. The main outcomes
of interest were severe hyperbilirubinemia and encephalopathy. A subset of articles was double
screened and all articles were critically appraised using the SIGN and AMSTAR checklists. This
review investigated if systems approach is likely to reduce the occurrence of severe hyperbilirubinemia.
Results: Fifty-two studies met the inclusion criteria. Included studies assessed the association
between bilirubin measurement early in neonatal life and the subsequent development of severe hyperbilirubinemia
and chronic bilirubin encephalopathy/kernicterus. It was observed that, highest
priority should be given to (i) universal bilirubin screening programs; (ii) implementation of community
and midwife practice; (iii) outreach to communities for education of prospective parents; and
(iv) development of clinical pathways to monitor, evaluate and track infants with severe hyperbilirubinemia.
Conclusions: We found substantial observational evidence that severe hyperbilirubinemia
can be accurately predicted and prevented through universal bilirubin screening. So far, there is no
evidence of any harm.
