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Newborn Bilirubin Screening for Preventing Severe Hyperbilirubinemia and Bilirubin Encephalopathy: A Rapid Review

[ Vol. 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   Pages 67 - 90 ( 24 )

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.

Keywords:

Bilirubin encephalopathy, hyperbilirubinemia, neonatal screening, universal bilirubin screening.

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

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