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Press Release Date: March 28, 2003
More research is needed to determine whether the use of standardized data charts used to plot results from bilirubin measurements based on hours since birth can help clinicians do a better job of predicting potentially serious cases of jaundice in newborns, according to a new evidence report released today by the Agency for Healthcare Research and Quality.
Although the report did not directly address the appropriateness of universal screening for hyperbilirubinemia, a condition caused by excessive concentrations of bilirubin in the blood, it did examine the various strategies for identifying the condition. High bilirubin levels cause jaundice and are a major cause for readmission of newborns to the hospital in the first 2 weeks of life. Jaundice, usually indicated by yellow-colored skin and eyes, affects over half of the infants born in the United States each year, but is generally a temporary condition that clears up without any clinical intervention. However, in rare instances, some babies with high bilirubin levels could develop a potentially fatal disorder known as kernicterus. Kernicterus has a death rate of at least 10 percent and causes brain damage and other serious long-term complications in at least 70 percent of newborns who have it.
This evidence report is based on a review of almost 5,000 abstracts and articles, including a summary of 123 cases on kernicterus in term/near-term infants that spanned more than 30 years. The report was requested by the American Academy of Pediatrics, which last published guidelines on managing hyperbilirubinemia in 1994.
The current practice for diagnosing and treating significant hyperbilirubinemia begins with a visual assessment of the infant for jaundice. If significant hyperbilirubinemia is suspected, a blood test is performed to determine the level of bilirubin. Phototherapy (light therapy) is then performed in babies with high bilirubin levels.
Researchers reviewed the literature to determine whether measurements by non-invasive instruments are reliable in identifying babies who need blood tests to confirm high bilirubin levels. They found that measurements by several non-invasive devices traditionally used to examine the pigment of a baby's skin correlated well with bilirubin levels directly measured from blood. They concluded that use of these devices could serve as reliable screening tools to determine which infants should have blood tests performed and, if necessary, be treated with phototherapy. This could lead to earlier detection of potentially serious cases of hyperbilirubinemia and may decrease the need for invasive blood tests in those infants found to be at lower risk. Researchers also suggested that future research is needed to validate newer non-invasive measurement devices and to address issues of cost-effectiveness and reproducibility in clinical practice.
In addition, future research should be conducted to validate an hourly age-specific data chart (nomogram) for bilirubin blood levels in healthy full-term infants. An important part of this validation should be an evaluation of potential differences by gender, race and ethnicity, as well as prenatal, natal, and postnatal factors. Finally, future research in kernicterus would benefit from a uniform definition of the disease, they said.
The summary of the report, prepared for AHRQ by its Tufts-New England Medical Center Evidence-based Practice Center, can be found online, and also from the National Guideline Clearinghouse™ at http://www.guideline.gov (select "NGC Resources"). Printed copies of the summary and full report, Management of Neonatal Hyperbilirubinemia, are available by calling AHRQ's Publications Clearinghouse at 1-800-358-9295 or by sending an E-mail to AHRQPubs@ahrq.hhs.gov.
For more information, please contact AHRQ Public Affairs, (301) 427-1364: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov); Farah Englert, (301) 427-1865 (FEnglert@ahrq.gov).