Screening and early postnatal management strategies to prevent hazardous hyperbilirubinemia in newborns of 35 or more weeks of gestation

Summary 

Although kernicterus is a rare condition, it is still being reported in North America and Western Europe in addition to less developed parts of the world. The majority of affected infants are term and late-preterm newborns who have been discharged from the nursery as ‘healthy newborns’ yet have subsequently developed extreme hyperbilirubinemia and the classic neurodevelopmental findings associated with kernicterus. Published guidelines provide the basic tools for preventing hazardous hyperbilirubinemia and the two most important of these are a systematic assessment, prior to discharge, of each infant, for the risk of severe hyperbilirubinemia, and appropriate follow-up based on the time of discharge and the risk assessment. The most recent recommendations call for a predischarge measurement of the serum or transcutaneous bilirubin in all infants. When combined with the gestational age and other risk factors for hyperbilirubinemia, this provides the best estimate of the risk, or lack of risk, for subsequent hyperbilirubinemia, and determines the timing of follow-up and the need for further evaluation and treatment. The application of these principles to the management of the jaundiced newborn might not eliminate every case of kernicterus, but should contribute to a reduction in its occurrence.

Keywords: Breastfeeding, Kernicterus, Neonatal hyperbilirubinemia, Screening and risk identification, Transcutaneous bilirubin

• a The gestational age and the predischarge total serum bilirubin or transcutaneous bilirubin level are the most important factors that help to predict the risk of hyperbilirubinemia. The risk increases with each decreasing week of gestation from 42 to 35 weeks (see Fig. 4). (Reproduced with permission from Maisels et al.¹³)