Shining a Light on Neonatal Jaundice

TOPLINE:

Approximately 1% of neonates born to O+, antibody-negative mothers qualified for phototherapy within 24 hours of birth, with most identified through routine bilirubin screening. The visual detection of jaundice was not a common trigger for starting phototherapy.

METHODOLOGY:

• Researchers reviewed the birth records of 6098 neonates (≥ 35 weeks’ gestation) born to O+, antibody-negative mothers, to identify those qualifying for phototherapy within 24 hours of birth.
• Neonates were screened to determine if they needed phototherapy on the basis of visual jaundice detection and 24-hour bilirubin screening (transcutaneous bilirubin or total serum bilirubin measurements).
• Phototherapy was initiated based on total serum bilirubin, according to the 2004 guidelines from the American Academy of Pediatrics.
• ABO hemolytic disease was defined by a positive direct antiglobulin test in offspring with blood type A or B born to O+, antibody-negative mothers.
• Neonates with total serum bilirubin within 3 mg/dL of exchange transfusion thresholds were identified as those with severe hyperbilirubinemia requiring potential intravenous immune globulin treatment.

TAKEAWAY:

• From the entire cohort, 1% qualified for phototherapy within 24 hours of birth. Early bilirubin screening identified 83% of neonates needing phototherapy at a median postnatal age of 24 hours, whereas 17% were identified using visual detection of jaundice at a median postnatal age of 13 hours.
• A majority of newborns (81%) who required phototherapy within 24 hours of birth were ABO incompatible and had a positive result on a direct antiglobulin test, highlighting ABO hemolytic disease as a key cause of early neonatal hyperbilirubinemia.
• Seventeen neonates had total serum bilirubin levels within the exchange transfusion thresholds; 14 of these cases were identified using 24-hour bilirubin screening, and three were identified using early jaundice detection.
• The total serum bilirubin levels in six of the 17 neonates exceeded the exchange transfusion thresholds, with four cases identified using bilirubin screening.

IN PRACTICE:

“These data suggest that visual assessment of jaundice is of limited value as a surveillance tool to consistently detect hyperbilirubinemia meriting treatment at ≤ 24 hours after birth,” the authors of the study wrote. “Our findings support routine birth hospitalization bilirubin screening and suggest screening no later than 24 hours may be beneficial,” they added.

SOURCE:

The study was led by Gysella B. Muniz, MD, MBA, of the Division of General Academic Pediatrics at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. It was published online on October 16, 2024, in The Journal of Pediatrics.

LIMITATIONS:

The study did not include any limitations.

DISCLOSURES:

The study did not receive any specific funding. One author disclosed having a financial relationship with McGraw Hill.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.