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Universal Jaundice Screening
Kuzniewicz MW, Escobar GJ, Newman TB. Impact of universal bilirubin screening on severe hyperbilirubinemia and photo-therapy use. Pediatrics. 2009 Oct;124(4):1031-9. [Full text] [PDF]
OBJECTIVE: The goal was to assess the impact of universal bilirubin screening on severe hyperbilirubinemia and phototherapy use.
METHODS: In this retrospective cohort
study of 358086 infants of > or =35 weeks and > or =2000 g born between January
1, 1995, and June 30, 2007, we obtained demographic data, bilirubin levels, and
codes for inpatient phototherapy from existing databases. We compared the
incidence of high total serum bilirubin (TSB) levels and phototherapy before and
after implementation of universal screening and examined risk factors for high
TSB levels.
RESULTS: A total of 38182 infants (10.6%) were born at facilities that
had implemented universal bilirubin screening. Compared with infants born at
facilities that were not screening, these infants had a 62% lower incidence of
TSB levels exceeding the American Academy of Pediatrics exchange guideline
(0.17% vs. 0.45%; P < .001), received twice the inpatient phototherapy (9.1% vs.
4.2%; P < .001), and had slightly longer birth hospitalization lengths of stay
(50.9 vs. 48.7 hours; P < .001). Of those receiving phototherapy, 56% after
initiation of universal screening had TSB levels at which phototherapy was
recommended by the guideline, compared with 70% before screening. The adjusted
odds ratio for developing TSB levels exceeding the guideline value was 0.28 (95%
confidence interval: 0.20-0.40) for those born at a facility using TSB screening
and 0.28 (95% confidence interval: 0.19-0.42) for those born at a facility using
transcutaneous bilirubin screening.
CONCLUSIONS: Universal bilirubin screening was associated with a significantly lower incidence of severe hyperbilirubinemia but also with increased phototherapy use.
Comments: Hyperbilirubinemia is a common problem in neonates and kernicterus is still occurring in many countries including the United States, Canada, and Western Europe. Universal bilirubin screening was introduced aiming to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy. However, a recent report of the Agency for Healthcare Research and Quality evidence on the effectiveness of various screening strategies for preventing the development of chronic bilirubin encephalopathy (Pediatrics. 2009 Oct;124(4):1172-7.) showed that the evidence is insufficient to assess the balance of benefits and harms of screening for hyperbilirubinemia to prevent chronic bilirubin encephalopathy. The results of this large retrospective cohort study support the idea of universal screening; however more evidence is needed to support the cost and efficacy of these recommendations. SAA
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