Infants with bilirubin levels of 30 mg/dL or more in a large managed care organization.

OBJECTIVE To describe the incidence, etiology, treatment, and outcome of newborns with total serum bilirubin (TSB) levels >or=30 mg/dL (513 micro mol/L). DESIGN Population-based case series. SETTING Eleven Northern California Kaiser Permanente Medical Care Program hospitals and 1 affiliated hospital. PATIENTS Eleven infants with TSB levels of >or=30 mg/dL in the first 30 days after birth, identified using computer databases from a cohort of 111,009 infants born 1995-1998. OUTCOME MEASURES Clinical data from the birth hospitalization, rehospitalization, and outpatient visits in all infants; psychometric testing at age 5 (N = 3), neurologic examinations by child neurologists at age 5 (N = 3), or primary care providers (N = 7; mean age: 2.2 years); Parent Evaluation of Developmental Status (N = 8; mean age: 4.2 years). RESULTS Maximum TSB levels of the 11 infants ranged from 30.7 to 45.5 mg/dL (525 micro mol/L to 778 micro mol/L; mean: 34.9 mg/dL [597 micro mol/L]). Four were born at 35 to 36 weeks gestation, and 7 were exclusively breastfed. Two had apparent isoimmunization; the etiology for the other 9 remained obscure, although only 4 were tested for glucose-6-phosphate dehydrogenase deficiency and 1 was bacteremic. None had acute neurologic symptoms. All received phototherapy and 5 received exchange transfusions. One infant died of sudden infant death syndrome; there was no kernicterus at autopsy. Two were lost to follow-up but were neurologically normal when last seen for checkups at 18 and 43 months. One child was receiving speech therapy at age 3. There were no significant parental concerns or abnormalities in the other children. CONCLUSIONS In this setting, TSB levels >or=30 mg/dL were rare and generally unaccompanied by acute symptoms. Although we did not observe serious neurodevelopmental sequelae in this small sample, additional studies are required to quantify the known, significant risk of kernicterus in infants with very high TSB levels.

[1]  B. Mellen,et al.  Rates of hospitalization for respiratory syncytial virus infection among children in medicaid. , 2000, The Journal of pediatrics.

[2]  J. Drew,et al.  Perhaps vigintiphobia should only apply to infants with Rhesus erythroblastosis , 1994, Journal of paediatrics and child health.

[3]  TV Stanley.  A case of kernicterus in New Zealand: A predictable tragedy? , 1997, Journal of paediatrics and child health.

[4]  V. Bhutani,et al.  Predictive Ability of a Predischarge Hour-specific Serum Bilirubin for Subsequent Significant Hyperbilirubinemia in Healthy Term and Near-term Newborns , 1999, Pediatrics.

[5]  M. Serdar,et al.  The Value of First-Day Bilirubin Measurement in Predicting the Development of Significant Hyperbilirubinemia in Healthy Term Newborns , 2000, Pediatrics.

[6]  Aap Subcommittee on Neonatal Hyperbilirubinemia.  Neonatal jaundice and kernicterus. , 2001, Pediatrics.

[7]  L I Kramer,et al.  Advancement of dermal icterus in the jaundiced newborn. , 1969, A M A Journal of Diseases of Children.

[8]  T B Newman,et al.  Frequency of neonatal bilirubin testing and hyperbilirubinemia in a large health maintenance organization. , 1999, Pediatrics.

[9]  G. Escobar,et al.  Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization. , 2000, Archives of pediatrics & adolescent medicine.

[10]  F. Ebbesen.  Recurrence of kernicterus in term and near‐term infants in Denmark , 2000, Acta paediatrica.

[11]  K. Nelson,et al.  Cerebral palsy in four northern California counties, births 1983 through 1985. , 1993, The Journal of pediatrics.

[12]  T. Hansen.  Acute management of extreme neonatal jaundice–––the potential benefits of intensified phototherapy and interruption of enterohepatic bilirubin circulation , 1997, Acta paediatrica.

[13]  T. Newman,et al.  Yield of Reticulocyte Counts and Blood Smears in Term Infants , 1994, Clinical pediatrics.

[14]  F. Glascoe.  Evidence-based approach to developmental and behavioural surveillance using parents' concerns. , 2000, Child: care, health and development.

[15]  B Hagberg,et al.  Changing panorama of cerebral palsy in Sweden. VIII. Prevalence and origin in the birth year period 1991–94 , 2001, Acta paediatrica.

[16]  Rebound bilirubin levels in infants receiving phototherapy. , 1998, The Journal of pediatrics.

[17]  J. Harding,et al.  Another outcome of neonatal intensive care: First year mortality and hospital morbidity , 1995, Journal of paediatrics and child health.

[18]  K. Merritt,et al.  HYPERBILIRUBINEMIA IN THE NEWBORN , 1941 .

[19]  B. Starfield,et al.  Rehospitalization in the first year of life for high-risk survivors. , 1980, Pediatrics.

[20]  K. Holden,et al.  Hemolytic jaundice due to G6PD deficiency causing kernicterus in a female newborn. , 1995, Southern medical journal.

[21]  T. Achenbach.  Manual for the child behavior checklist/4-18 and 1991 profile , 1991 .

[22]  G. Escobar,et al.  Postdischarge utilization of medical services by high-risk infants: experience in a large managed care organization. , 1996, Pediatrics.

[23]  M. G. Macdonald,et al.  Hidden risks: early discharge and bilirubin toxicity due to glucose 6-phosphate dehydrogenase deficiency. , 1995, Pediatrics.

[24]  R S Evans,et al.  Computerized surveillance of adverse drug events in hospital patients. 1991. , 1991, Quality & safety in health care.

[25]  M. J. Maisels,et al.  Kernicterus in otherwise healthy, breast-fed term newborns. , 1995, Pediatrics.

[26]  A. Litwin,et al.  Phototherapy for Neonatal Nonhemolytic Hyperbilirubinemia , 1993, Clinical pediatrics.

[27]  R. Zimmerman,et al.  Developmental follow-up of breastfed term and near-term infants with marked hyperbilirubinemia. , 2001, Pediatrics.

[28]  K. Gwynne,et al.  Use of an occupational therapy motor performance checklist by a school health service: A pilot study , 1996, Journal of paediatrics and child health.

[29]  V. Bhutani,et al.  System-based approach to management of neonatal jaundice and prevention of kernicterus. , 2002, The Journal of pediatrics.

[30]  Bruce F. Folck,et al.  Rehospitalization in the First Two Weeks After Discharge From the Neonatal Intensive Care Unit , 1999, Pediatrics.

[31]  D. Enzmann,et al.  Kernicterus in a full term infant. , 1994, Pediatrics.

[32]  M. Kramer,et al.  The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. , 2000, JAMA.