1
|
Walz L, Brooks JC, Newman T. Evidence Suggests a Decrease in the Incidence of Kernicterus in California. J Pediatr 2022; 255:220-223.e1. [PMID: 36563899 DOI: 10.1016/j.jpeds.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/21/2022] [Accepted: 11/07/2022] [Indexed: 12/25/2022]
Abstract
We identified children diagnosed with kernicterus in the California Department of Developmental Services and estimated an incidence of 0.42 per 100 000 births from 1988 to 2014, significantly decreasing to 0.04 per 100 000 births after 2009. We also examined national infant kernicterus mortality from 1979 to 2016 using CDC data. It did not decrease significantly.
Collapse
Affiliation(s)
- Lucas Walz
- Life Expectancy Project, San Francisco, CA
| | | | - Thomas Newman
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA; Department of Pediatrics, University of California-San Francisco, San Francisco, CA
| |
Collapse
|
2
|
Cornet MC, Kemper AR, Maisels MJ, Watchko J, Newman TB. Neonatal hyperbilirubinemia and bilirubin neurotoxicity: what can be learned from the database analysis? Pediatr Res 2022; 92:1204. [PMID: 35136201 DOI: 10.1038/s41390-022-01973-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/30/2021] [Accepted: 01/23/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Marie-Coralie Cornet
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
| | - Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - M Jeffrey Maisels
- Department of Pediatrics, Oakland University William Beaumont School of Medicine, Beaumont Children's Hospital, Royal Oak, MI, USA
| | - Jon Watchko
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas B Newman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
3
|
Abstract
This article attempts to highlight contemporary issues relating to term neonatal hyperbilirubinemia and to focus attention on controversial issues and concepts with the potential to effect change in clinical approach. On the one hand, the focus is bilirubin neurotoxicity, which is now known to encompass a wide, diverse spectrum of features. The various aspects of this spectrum are outlined and defined. On the other hand, bilirubin also possesses antioxidant properties. As such, mild hyperbilirubinemia is suggested as actually offering the neonate some protective advantage.
Collapse
|
4
|
Vidavalur R, Bhutani VK. Economic evaluation of point of care universal newborn screening for glucose-6-Phosphate dehydrogenase deficiency in United States. J Matern Fetal Neonatal Med 2021; 35:5745-5753. [PMID: 33627013 DOI: 10.1080/14767058.2021.1892067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is frequent inherited enzymopathy that poses potentially preventable risk for extreme hyperbilirubinemia (EHB) which can, rarely, lead to acute bilirubin encephalopathy, childhood kernicterus and death. We aimed to estimate quality adjusted life years (QALY) lost due to G6PD deficiency associated with EHB and economic costs to best estimate value of universal pre-discharge screening. METHODS We did a cost utility analysis for US birth cohort utilizing pre-discharge screening decision tree model to estimate population burden and EHB outcomes, based on literature search and expert opinions. Employing human capital approach, we measured health benefits in terms of QALYs and economic losses. QALYs and costs were discounted at 3%; one-way sensitivity analysis was used for decision variables. RESULTS We determined for USA live births of 3.86 million in 2017, 1464 cases of EHB were estimated to be due to G6PD deficiency (CI 95%; range: 1270-1656) and contributed 2 deaths (CI 95%; range 1.3-3.2) and 14 (CI 95%; range: 9.1-21.5) cases of kernicterus. Over lifetime horizon, the model predicted undiscounted and discounted gains of 165 (102-252) life years; 241 (183-433) QALYs and 16 (9.9-24.5) life years; 89 (67.9-160.5) QALYs, respectively. Assuming 50% effectiveness, benefit cost ratios ranged from 0.19 to 3.42 for diverse operational settings. The cost to prevent a single case of kernicterus was $2.7 to 6.8 million per annum with cost per QALY gained at $35,946 to $89,159. CONCLUSION At incremental cost-effective threshold of $100,000/life year, pre-discharge screening would be expected to prove cost effective in preventing EHB related morbidities and mortality attributed to G6PD deficiency.
Collapse
Affiliation(s)
- Ramesh Vidavalur
- Department of Neonatology, Cayuga Medical Center, Ithaca, NY, USA
| | - Vinod K Bhutani
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford Children's Health, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
5
|
van der Geest BAM, Theeuwen IM, Reiss IKM, Steegers EAP, Been JV. Assessing knowledge and skills of maternity care professionals regarding neonatal hyperbilirubinaemia: a nationwide survey. BMC Pregnancy Childbirth 2021; 21:63. [PMID: 33468082 PMCID: PMC7814718 DOI: 10.1186/s12884-020-03463-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal hyperbilirubinaemia is a physiologic phenomenon, but, when severe, may cause lifelong disability. Maternity care assistants (MCAs) play an important role in timely recognition of severe neonatal jaundice. We assessed knowledge and skills of MCAs regarding neonatal hyperbilirubinaemia. METHODS All Dutch MCAs (n = 9065) were invited to fill out a questionnaire assessing knowledge, expertise, and handling of neonatal jaundice. Additionally, we developed an e-learning and provided training sessions to a subgroup of MCAs (n = 99), and assessed their knowledge on neonatal hyperbilirubinaemia before and after the training. RESULTS One thousand four hundred sixty-five unique online questionnaires were completed (response 16.2%). The median number of correctly answered knowledge questions was 5 (out of six; IQR 1). Knowledge was significantly better when respondents had had in-service training on neonatal hyperbilirubinaemia in the previous year (p = 0.024). Although 82% of respondents felt highly skilled or skilled to assess jaundice, accuracy of estimation of total serum bilirubin levels by assessing skin colour was generally poor and prone to underestimation. Among participants attending a training session, those who completed the e-learning beforehand had higher pre-training scores (5 (IQR 1) vs. 4 (IQR 2); p < 0.001). The median post-training score was higher than pre-training (6 (IQR 1) vs. 5 (IQR 2); p < 0.001). CONCLUSIONS Background knowledge of MCAs regarding neonatal hyperbilirubinaemia was adequate, but can be improved by further training. Estimation of total serum bilirubin levels based on skin colour was often inadequate. Approaches to improve timely recognition of jaundiced neonates are needed.
Collapse
Affiliation(s)
- Berthe A. M. van der Geest
- Department of Paediatrics, Division of Neonatology, Erasmus MC – Sophia Children’s Hospital, University Medical Centre Rotterdam, PO Box 2060, 3000 CB Rotterdam, Netherlands
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Imke M. Theeuwen
- Department of Paediatrics, Division of Neonatology, Erasmus MC – Sophia Children’s Hospital, University Medical Centre Rotterdam, PO Box 2060, 3000 CB Rotterdam, Netherlands
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Irwin K. M. Reiss
- Department of Paediatrics, Division of Neonatology, Erasmus MC – Sophia Children’s Hospital, University Medical Centre Rotterdam, PO Box 2060, 3000 CB Rotterdam, Netherlands
| | - Eric A. P. Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jasper V. Been
- Department of Paediatrics, Division of Neonatology, Erasmus MC – Sophia Children’s Hospital, University Medical Centre Rotterdam, PO Box 2060, 3000 CB Rotterdam, Netherlands
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
6
|
Alkén J, Håkansson S, Ekéus C, Gustafson P, Norman M. Rates of Extreme Neonatal Hyperbilirubinemia and Kernicterus in Children and Adherence to National Guidelines for Screening, Diagnosis, and Treatment in Sweden. JAMA Netw Open 2019; 2:e190858. [PMID: 30901042 PMCID: PMC6583272 DOI: 10.1001/jamanetworkopen.2019.0858] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
IMPORTANCE Neonatal hyperbilirubinemia can cause lifelong neurodevelopmental impairment (kernicterus) even in high-resource settings. A better understanding of the incidence and processes leading to kernicterus may help in the design of preventive measures. OBJECTIVES To determine incidence rates of hazardous hyperbilirubinemia and kernicterus among near-term to term newborns and to evaluate health care professional adherence to best practices. DESIGN, SETTING, AND PARTICIPANTS This population-based nationwide cohort study used prospectively collected data on the highest serum bilirubin level for all infants born alive at 35 weeks' gestation or longer and admitted to neonatal care at all 46 delivery and 37 neonatal units in Sweden from 2008 to 2016. Medical records for newborns with hazardous hyperbilirubinemia were evaluated for best neonatal practices and for a diagnosis of kernicterus up to 2 years of age. Data analyses were performed between September 2017 and February 2018. EXPOSURES Extreme (serum bilirubin levels, 25.0-29.9 mg/dL [425-509 μmol/L]) and hazardous (serum bilirubin levels, ≥30.0 mg/dL [≥510 μmol/L]) neonatal hyperbilirubinemia. MAIN OUTCOMES AND MEASURES The primary outcome was kernicterus, defined as hazardous neonatal hyperbilirubinemia followed by cerebral palsy, sensorineural hearing loss, gaze paralysis, or neurodevelopmental retardation. Secondary outcomes were health care professional adherence to national guidelines using a predefined protocol with 10 key performance indicators for diagnosis and treatment as well as assessment of whether bilirubin-associated brain damage might have been avoidable. RESULTS Among 992 378 live-born infants (958 051 term births and 34 327 near-term births), 494 (320 boys; mean [SD] birth weight, 3505 [527] g) developed extreme hyperbilirubinemia (50 per 100 000 infants), 6.8 per 100 000 infants developed hazardous hyperbilirubinemia, and 1.3 per 100 000 infants developed kernicterus. Among 13 children developing kernicterus, brain injury was assessed as potentially avoidable for 11 children based on the presence of 1 or several of the following possible causes: untimely or lack of predischarge bilirubin screening (n = 6), misinterpretation of bilirubin values (n = 2), untimely or delayed initiation of treatment with intensive phototherapy (n = 1), untimely or no treatment with exchange transfusion (n = 6), or lack of repeated exchange transfusions despite indication (n = 1). CONCLUSIONS AND RELEVANCE Hazardous hyperbilirubinemia in near-term or term newborns still occurs in Sweden and was associated with disabling brain damage in 13 per million births. For most of these cases, health care professional noncompliance with best practices was identified, suggesting that a substantial proportion of these cases might have been avoided.
Collapse
Affiliation(s)
- Jenny Alkén
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Stellan Håkansson
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
- Swedish Neonatal Quality Registry, Umeå, Sweden
| | - Cecilia Ekéus
- Division of Reproductive Health, Department of Women’s and Children’s Health, Karolinska Institutet, Sweden
| | | | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Swedish Neonatal Quality Registry, Umeå, Sweden
| |
Collapse
|
7
|
Yu TC, Nguyen C, Ruiz N, Zhou S, Zhang X, Böing EA, Tan H. Prevalence and burden of illness of treated hemolytic neonatal hyperbilirubinemia in a privately insured population in the United States. BMC Pediatr 2019; 19:53. [PMID: 30744649 PMCID: PMC6369553 DOI: 10.1186/s12887-019-1414-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/22/2019] [Indexed: 11/29/2022] Open
Abstract
Background Prevalence of hemolytic neonatal hyperbilirubinemia (NHB) is not well characterized, and economic burden at the population level is poorly understood. This study evaluated the prevalence, clinical characteristics, and economic burden of hemolytic NHB newborns receiving treatment in U.S. real-world settings. Methods This cohort study used administrative claims from 01/01/2011 to 08/31/2017. The treated cohort had hemolytic NHB diagnosis and received phototherapy, intravenous immunoglobulin, and/or exchange transfusions. They were matched with non-NHB newborns who had neither NHB nor related treatments on the following: delivery hospital/area, gender, delivery route, estimated gestational age (GA), health plan eligibility, and closest date of birth within 5 years. Inferential statistics were reported. Results The annual NHB prevalence was 29.6 to 31.7%; hemolytic NHB, 1.8 to 2.4%; treated hemolytic NHB, 0.46 to 0.55%, between 2011 and 2016. The matched analysis included 1373 pairs ≥35 weeks GA. The treated hemolytic NHB cohort had significantly more birth trauma and hemorrhage (4.5% vs. 2.4%, p = 0.003), vacuum extractor affecting newborn (1.9% vs. 0.8%, p = 0.014), and polycythemia neonatorum (0.8% vs. 0%, p = 0.001) than the matched non-NHB cohort. The treated hemolytic NHB cohort also had significantly longer mean birth hospital stays (4.5 vs. 3.0 days, p < 0.001), higher level 2–4 neonatal intensive care admissions (15.7% vs. 2.4, 15.9% vs. 2.8 and 10.6% vs. 2.5%, respectively, all p < 0.001) and higher 30-day readmission (8.7% vs. 1.7%, p < 0.001). One-month and one-year average total costs of care were significantly higher for the treated hemolytic NHB cohort vs. the matched non-NHB cohort, $14,405 vs. $5527 (p < 0.001) and $21,556 vs. $12,986 (p < 0.001), respectively. The average costs for 30-day readmission among newborns who readmitted were $13,593 for the treated hemolytic NHB cohort and $3638 for the matched non-NHB cohort, p < 0.001. The authors extrapolated GA-adjusted prevalence of treated hemolytic NHB in the U.S. newborn population ≥ 35 weeks GA and estimated an incremental healthcare expenditure of $177.0 million during the first month after birth in 2016. Conclusions The prevalence of treated hemolytic NHB was 4.6–5.5 patients per 1000 newborns. This high-risk hemolytic NHB imposed substantial burdens of healthcare resource utilization and incremental costs on newborns, their caregivers, and the healthcare system.
Collapse
Affiliation(s)
- Tzy-Chyi Yu
- Mallinckrodt Pharmaceuticals, Bedminster, NJ, 07921, USA
| | - Chi Nguyen
- HealthCore, Inc., An Independent Subsidiary of Anthem, Inc, Wilmington, DE, 19801, USA.
| | - Nancy Ruiz
- Mallinckrodt Pharmaceuticals, Bedminster, NJ, 07921, USA
| | - Siting Zhou
- HealthCore, Inc., An Independent Subsidiary of Anthem, Inc, Wilmington, DE, 19801, USA
| | - Xian Zhang
- HealthCore, Inc., An Independent Subsidiary of Anthem, Inc, Wilmington, DE, 19801, USA
| | - Elaine A Böing
- Mallinckrodt Pharmaceuticals, Bedminster, NJ, 07921, USA
| | - Hiangkiat Tan
- HealthCore, Inc., An Independent Subsidiary of Anthem, Inc, Wilmington, DE, 19801, USA
| |
Collapse
|
8
|
Le Pichon JB, Riordan SM, Shapiro SM. Hyperbilirubinemia and the Risk for Brain Injury. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
9
|
Taylor JA. Phototherapy and Seizures: Should We Change Practice? Pediatrics 2018; 142:peds.2018-2241. [PMID: 30249625 DOI: 10.1542/peds.2018-2241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- James A Taylor
- Department of Pediatrics, University of Washington, Seattle, Washington
| |
Collapse
|
10
|
Farouk ZL, Muhammed A, Gambo S, Mukhtar-Yola M, Umar Abdullahi S, Slusher TM. Follow-up of Children with Kernicterus in Kano, Nigeria. J Trop Pediatr 2018; 64:176-182. [PMID: 28605485 DOI: 10.1093/tropej/fmx041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Acute bilirubin encephalopathy (ABE) is associated with long-term sequelae (kernicterus). It continues to be a significant issue in our region of Nigeria, accounting for much morbidity and mortality. Herein we report the outcome of neonates with ABE seen at our centre. METHODOLOGY We established a surveillance of children who had ABE and returned to follow-up from prospective cases of ABE (2012-2014). ABE was diagnosed based on a bilirubin-induced neurologic dysfunction score of ≥ 1. Kernicterus was subsequently established based on a history of developmental delays, hearing impairments and abnormal physical and neurologic examinations at follow-up age ≥3 months. RESULT Five hundred fifty-one neonates had hyperbilirubinaemia of whom 104 (18.8%) had ABE. Mean transcutaneous bilirubin using the Ingram icterometer was 18.3 mg/dl ± SD 1.9 [(12.5-19.1), total serum bilirubin of 18.1 ± 10.9] (range: 10.3-64 mg/dl). Sixty-five infants returned for follow-up (41 males and 24 females); mean age 9 months (22 days to 17 months). Most (58 of 65; 89.2%) had abnormal neurological findings and 15 (25.9%) had probable kernicterus. CONCLUSION There is a critical need for a National Kernicterus Registry to document all cases of kernicterus and formulate an effective treatment and prevention policy.
Collapse
Affiliation(s)
| | | | - Safiya Gambo
- Department of Paediatrics Murtala Muhamed Specialist Hospital, Kano 7002 31, Nigeria
| | | | | | - Tina M Slusher
- Department of Pediatrics, Division of Global Pediatrics University of Minnesota, Minneapolis, MN 55415, USA
| |
Collapse
|
11
|
Prins TJ, Trip-Hoving M, Paw MK, Ka ML, Win NN, Htoo G, Hser MK, Chotivanich K, Nosten F, McGready R. A Survey of Practice and Knowledge of Refugee and Migrant Pregnant Mothers Surrounding Neonatal Jaundice on the Thailand-Myanmar Border. J Trop Pediatr 2017; 63:50-56. [PMID: 27576869 PMCID: PMC5301969 DOI: 10.1093/tropej/fmw055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND In populations with a high prevalence of glucose-6-phosphate dehydrogenase deficiency, practices that can induce haemolysis need to be identified to raise awareness of preventable risks. The aim of this survey was to determine the proportion of prospective mothers using haemolytic agents and their knowledge and practice surrounding neonatal jaundice. METHODS Pregnant mothers were invited to participate in a cross-sectional survey conducted at Shoklo Malaria Research Unit on the Thailand-Myanmar border. RESULTS From 12 April 2015 to 12 June 2015, 522 pregnant women completed the survey. Mothball use in the household was reported by 41.4% (216 of 522) of prospective mothers and menthol containing products on baby skin by 46.7% (244 of 522). CONCLUSION Just over 40% of the households reported use of naphthalene-containing mothballs. Future health promotion activities that focus on reducing naphthalene mothball and menthol-containing products use have the potential to reduce rates of severe neonatal jaundice in this population.
Collapse
Affiliation(s)
- Taco J Prins
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Margreet Trip-Hoving
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mar Le Ka
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Nyo Nyo Win
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Gay Htoo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mu Kaw Hser
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Kesinee Chotivanich
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
12
|
Extreme hyperbilirubinemia and rescue exchange transfusion in California from 2007 to 2012. J Perinatol 2016; 36:853-7. [PMID: 27442156 DOI: 10.1038/jp.2016.106] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the impact of statewide learning collaboratives that used national guidelines to manage jaundice on the serial prevalence of extreme hyperbilirubinemia (EHB, total bilirubin ⩾25 mg dl(-1)) and exchange transfusions introduced in California Perinatal Quality Care Collaborative (CPQCC) hospitals in 2007. STUDY DESIGN Adverse outcomes were retrieved from statewide databases on re-admissions for live births ⩾35 weeks' gestation (2007 to 2012) in diverse CPQCC hospitals. Individual and cumulative select perinatal risk factors and frequencies were the outcomes measures. RESULTS For 3 172 762 babies (2007 to 2012), 92.5% were ⩾35 weeks' gestation. Statewide EHB and exchange rates decreased from 28.2 to 15.3 and 3.6 to 1.9 per 100 000 live births, respectively. From 2007 to 2012, the trends for TB>25 mg dl(-1) rates were -0.92 per 100 000 live births per year (95% CI: -3.71 to 1.87, P=0.41 and R(2)=0.17). CONCLUSION National guidelines complemented by statewide learning collaboratives can decrease or modify outcomes among all birth facilities and impact clinical practice behavior.
Collapse
|
13
|
Waite WM, Taylor JA. Phototherapy for the Treatment of Neonatal Jaundice and Breastfeeding Duration and Exclusivity. Breastfeed Med 2016; 11:180-5. [PMID: 27057645 DOI: 10.1089/bfm.2015.0170] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Because neonatal jaundice remains one of the most commonly treated conditions of the newborn infant, it is important to assess the unintended consequences of treatment with phototherapy. The objective of this study was to evaluate whether treatment with phototherapy affects breastfeeding duration in newborns >35 weeks gestation. MATERIALS AND METHODS We analyzed data from the Infant Feeding Practices Study II. The exposure of interest was treatment of neonatal jaundice with phototherapy. The outcomes of interest were any breastfeeding through 12 months and exclusive breastfeeding through 4 months. Logistic regression models were developed to evaluate the association between the exposure and outcomes of interest. All models were adjusted for maternal age, race, education, household income, and gestational age, as well as for several potential markers of suboptimal breastfeeding. RESULTS Our study included 4,441 infants, of which 220 (5%) received phototherapy. We found no difference in the likelihood of any breastfeeding through 9 months of age, however, by 12 months, infants exposed to phototherapy were less likely to still be breastfed than those who were not exposed (adjusted odds ratio [aOR] 0.58, 95% confidence interval [95% CI] 0.37-0.92). Infants exposed to phototherapy were less likely to be exclusively breastfed throughout the first 4 months of life. CONCLUSION Although phototherapy use did not substantially impact rates of any breastfeeding during the first year, it was associated with decreased rates of exclusive breastfeeding in the first 4 months of life. This suggests that we need to tailor messaging to mothers of infants receiving phototherapy to promote exclusive breastfeeding.
Collapse
Affiliation(s)
- Whitney M Waite
- Department of Pediatrics, University of Washington , Seattle, Washington
| | - James A Taylor
- Department of Pediatrics, University of Washington , Seattle, Washington
| |
Collapse
|
14
|
Coon ER, Quinonez RA, Moyer VA, Schroeder AR. Overdiagnosis: how our compulsion for diagnosis may be harming children. Pediatrics 2014; 134:1013-23. [PMID: 25287462 DOI: 10.1542/peds.2014-1778] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Overdiagnosis occurs when a true abnormality is discovered, but detection of that abnormality does not benefit the patient. It should be distinguished from misdiagnosis, in which the diagnosis is inaccurate, and it is not synonymous with overtreatment or overuse, in which excess medication or procedures are provided to patients for both correct and incorrect diagnoses. Overdiagnosis for adult conditions has gained a great deal of recognition over the last few years, led by realizations that certain screening initiatives, such as those for breast and prostate cancer, may be harming the very people they were designed to protect. In the fall of 2014, the second international Preventing Overdiagnosis Conference will be held, and the British Medical Journal will produce an overdiagnosis-themed journal issue. However, overdiagnosis in children has been less well described. This special article seeks to raise awareness of the possibility of overdiagnosis in pediatrics, suggesting that overdiagnosis may affect commonly diagnosed conditions such as attention-deficit/hyperactivity disorder, bacteremia, food allergy, hyperbilirubinemia, obstructive sleep apnea, and urinary tract infection. Through these and other examples, we discuss why overdiagnosis occurs and how it may be harming children. Additionally, we consider research and education strategies, with the goal to better elucidate pediatric overdiagnosis and mitigate its influence.
Collapse
Affiliation(s)
- Eric R Coon
- Division of Inpatient Medicine, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah;
| | - Ricardo A Quinonez
- Baylor College of Medicine, San Antonio Children's Hospital, San Antonio, Texas
| | - Virginia A Moyer
- American Board of Pediatrics, Maintenance of Certification and Quality, Chapel Hill, North Carolina; and
| | - Alan R Schroeder
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
| |
Collapse
|
15
|
Kuzniewicz MW, Wickremasinghe AC, Wu YW, McCulloch CE, Walsh EM, Wi S, Newman TB. Incidence, etiology, and outcomes of hazardous hyperbilirubinemia in newborns. Pediatrics 2014; 134:504-9. [PMID: 25092943 DOI: 10.1542/peds.2014-0987] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Total serum bilirubin (TSB) levels ≥ 30 mg/dL are rare but potentially hazardous. A better understanding of their incidence, causes, and outcomes could help inform preventive efforts. METHODS We identified infants born ≥ 35 weeks' gestational age from 1995-2011 in Kaiser Permanente Northern California (n = 525409) and examined the medical records of infants with a TSB ≥ 30 mg/dL to determine etiology and the occurrence of acute bilirubin encephalopathy. We reviewed inpatient and outpatient encounters through 2013 for evidence of sensorineural hearing loss (SNHL) or cerebral palsy (CP). RESULTS We identified 47 infants with TSB ≥ 30 mg/dL (8.6 per 100000 births). In 44 infants (94%), the hyperbilirubinemia occurred after the initial birth hospitalization. The etiology was not identified in 33 (70%). Glucose-6-phosphate dehydrogenase (G6PD) activity was measured in only 25 (53%) of whom 10 (40%) were deficient. Four children had acute bilirubin encephalopathy of whom 2 developed both CP and SNHL, and 1 developed isolated SNHL. These 3 infants all had G6PD deficiency and TSB >40 mg/dL. One additional 35-week infant with TSB 38.2 mg/dL had SNHL. CONCLUSIONS Hazardous (≥ 30 mg/dL) hyperbilirubinemia is a rare event. No etiology could be identified from the clinical record in most cases. G6PD deficiency was the leading cause of hazardous hyperbilirubinemia when an etiology was identified, but many were not tested. Chronic, bilirubin-induced neurotoxicity was uncommon and occurred only in the setting of additional risk factors and TSB values well over (>15 mg/dL) the American Academy of Pediatrics exchange transfusion thresholds.
Collapse
Affiliation(s)
- Michael W Kuzniewicz
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Departments of Pediatrics,
| | - Andrea C Wickremasinghe
- Department of Pediatrics, Kaiser Permanente Santa Clara, Santa Clara, California Epidemiology and Biostatistics, and
| | - Yvonne W Wu
- Departments of Pediatrics, Neurology, University of California, San Francisco, San Francisco, California; and
| | | | - Eileen M Walsh
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Soora Wi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Thomas B Newman
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Departments of Pediatrics, Epidemiology and Biostatistics, and
| |
Collapse
|
16
|
Bhutani VK, Zipursky A, Blencowe H, Khanna R, Sgro M, Ebbesen F, Bell J, Mori R, Slusher TM, Fahmy N, Paul VK, Du L, Okolo AA, de Almeida MF, Olusanya BO, Kumar P, Cousens S, Lawn JE. Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatr Res 2013; 74 Suppl 1:86-100. [PMID: 24366465 PMCID: PMC3873706 DOI: 10.1038/pr.2013.208] [Citation(s) in RCA: 241] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rhesus (Rh) disease and extreme hyperbilirubinemia (EHB) result in neonatal mortality and long-term neurodevelopmental impairment, yet there are no estimates of their burden. METHODS Systematic reviews and meta-analyses were undertaken of national prevalence, mortality, and kernicterus due to Rh disease and EHB. We applied a compartmental model to estimate neonatal survivors and impairment cases for 2010. RESULTS Twenty-four million (18% of 134 million live births ≥ 32 wk gestational age from 184 countries; uncertainty range: 23-26 million) were at risk for neonatal hyperbilirubinemia-related adverse outcomes. Of these, 480,700 (0.36%) had either Rh disease (373,300; uncertainty range: 271,800-477,500) or developed EHB from other causes (107,400; uncertainty range: 57,000-131,000), with a 24% risk for death (114,100; uncertainty range: 59,700-172,000), 13% for kernicterus (75,400), and 11% for stillbirths. Three-quarters of mortality occurred in sub-Saharan Africa and South Asia. Kernicterus with Rh disease ranged from 38, 28, 28, and 25/100,000 live births for Eastern Europe/Central Asian, sub-Saharan African, South Asian, and Latin American regions, respectively. More than 83% of survivors with kernicterus had one or more impairments. CONCLUSION Failure to prevent Rh sensitization and manage neonatal hyperbilirubinemia results in 114,100 avoidable neonatal deaths and many children grow up with disabilities. Proven solutions remain underused, especially in low-income countries.
Collapse
Affiliation(s)
- Vinod K. Bhutani
- Programme for Global Paediatric Research (PGPR), Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, California
| | - Alvin Zipursky
- Programme for Global Paediatric Research (PGPR), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hannah Blencowe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rajesh Khanna
- Saving Newborn Lives/Save the Children, New Delhi, India
| | - Michael Sgro
- Keenan Research Centre, Li Ka Shing Knowledge Institute & Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Finn Ebbesen
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Jennifer Bell
- Programme for Global Paediatric Research (PGPR), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Tina M. Slusher
- Programme for Global Paediatric Research (PGPR), Hospital for Sick Children, Toronto, Ontario, Canada
- Center for Global Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Nahed Fahmy
- Department of Pediatrics, Kasr Al Aini University, El Mounira Children's Hospital, Cairo, Egypt
| | - Vinod K. Paul
- WHO Collaborating Centre for Training & Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India
| | - Lizhong Du
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, The People's Republic of China
| | | | | | | | - Praveen Kumar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Simon Cousens
- Saving Newborn Lives/Save the Children, New Delhi, India
| | - Joy E. Lawn
- Centre for Maternal Reproductive & Child Health, London School of Hygiene & Tropical Medicine, London, UK
- Saving Newborn Lives/Save the Children, Washington, DC
| |
Collapse
|
17
|
Opel DJ, Taylor JA, Phillipi CA, Diekema DS. The intersection of evidence and values in clinical guidelines: who decides what constitutes acceptable risk in the care of children? Hosp Pediatr 2013; 3:87-91. [PMID: 24340407 DOI: 10.1542/hpeds.2012-0090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA 98101, USA.
| | | | | | | |
Collapse
|
18
|
Ergaz Z, Ornoy A. Perinatal and early postnatal factors underlying developmental delay and disabilities. ACTA ACUST UNITED AC 2013; 17:59-70. [PMID: 23362026 DOI: 10.1002/ddrr.1101] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 06/13/2012] [Indexed: 12/26/2022]
Abstract
A delay in meeting developmental milestones may be secondary to perinatal events, involving complicated interactions between mother and fetus during delivery. Maternal factors including weight, diet, and morbidities can affect neonatal adaptation and later development. Prematurity, low birth weight, and previous intrauterine insults as well as complications during delivery of a previously normal fetus increase the risk for perinatal stress. In this article, the literature on perinatal and early postnatal factors that underlie risks for developmental delay and disabilities is reviewed. Studies that concern neuroprotective therapies and prediction of long-term neurologic outcome by clinical examination, neuroimaging techniques, and electroencephalographic studies are reviewed as well.
Collapse
Affiliation(s)
- Zivanit Ergaz
- Department of Neonatology, Hebrew University Hadassah Medical School, Jerusalem, Israel.
| | | |
Collapse
|
19
|
Gotink MJ, Benders MJ, Lavrijsen SW, Rodrigues Pereira R, Hulzebos CV, Dijk PH. Severe neonatal hyperbilirubinemia in the Netherlands. Neonatology 2013; 104:137-42. [PMID: 23887661 DOI: 10.1159/000351274] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 04/05/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The occurrence of severe neonatal hyperbilirubinemia (SH) is partly attributed to nonhospitalized perinatal care. The Netherlands have a high frequency of home births and nonhospitalized perinatal care, and the incidence of SH is unknown. OBJECTIVE To assess the effects of home births and early hospital discharge on the incidence of SH in term-born infants in the Netherlands. METHODS In this nationwide prospective surveillance study between 2005 and 2009, infants (≥37 weeks GA) were included if total serum bilirubin (TSB) was ≥500 µmol/l or if they received an exchange transfusion when TSB was ≥340 µmol/l. RESULTS Seventy-one infants had SH (incidence 10.4/100,000); 43 had a TSB ≥500 μmol/l (incidence 6.3/100,000) and 45 (63%) underwent an exchange transfusion. 26% of the infants with SH were born at home, which is similar to 22% of all term infants who are born at home in the Netherlands (p = 0.41). Maximum TSB levels were similar in infants born at home (523 ± 114 μmol/l) and infants born in hospital (510 ± 123 μmol/l; p = 0.70). Of the 51 infants born in hospital, 33 were discharged and readmitted with SH, with maximal TSB levels (567 ± 114 μmol/l), which were higher than in infants who remained hospitalized (406 ± 47 μmol/l; p = 0.0001). CONCLUSION The incidence of severe hyperbilirubinemia in term-born infants in the Netherlands is 10.4 per 100,000, which is similar to other developed countries. Home birth and early hospital discharge do not necessarily lead to a higher incidence of SH, provided that perinatal home care is well organized.
Collapse
Affiliation(s)
- Mark J Gotink
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | | | | | | |
Collapse
|
20
|
Flaherman VJ, Kuzniewicz MW, Escobar GJ, Newman TB. Total serum bilirubin exceeding exchange transfusion thresholds in the setting of universal screening. J Pediatr 2012; 160:796-800.e1. [PMID: 22133423 DOI: 10.1016/j.jpeds.2011.09.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 08/26/2011] [Accepted: 09/29/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the incidence and predictors of total serum bilirubin (TSB) levels that meet or exceed American Academy of Pediatrics (AAP) exchange transfusion (ET) thresholds in the setting of universal screening. STUDY DESIGN We conducted a retrospective cohort analysis of electronic data on 18 089 newborns ≥35 weeks gestation born at Northern California Kaiser Permanente Medical Care Program hospitals implementing universal TSB screening in 2005 to 2007, with chart review for subjects with TSB levels reaching the AAP threshold for ET. RESULTS The outcome developed in 22 infants (0.12%); 14 (63.6%) were <38 weeks gestation. Only one infant received an ET; none of the infants had documented sequelae. The first TSB was at least high-intermediate risk on the AAP risk-nomogram for all 22 infants and high-risk for those ≥38 weeks, but was less than the phototherapy level in 15 infants (68%). Of these 15 infants, 2 failed phototherapy and 13 did not have a TSB repeated in <24 hours. However, re-testing all infants at high-intermediate risk or greater would have required 2166 additional bilirubin tests. CONCLUSION Screening was sensitive but not specific for predicting exchange threshold.
Collapse
|
21
|
Affiliation(s)
- M. Jeffrey Maisels
- Beaumont Children's Hospital and Department of Pediatrics, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| |
Collapse
|
22
|
Kaplan M, Bromiker R, Hammerman C. Severe neonatal hyperbilirubinemia and kernicterus: are these still problems in the third millennium? Neonatology 2011; 100:354-62. [PMID: 21968213 DOI: 10.1159/000330055] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite efforts to eliminate permanent and irreversible brain damage due to bilirubin encephalopathy and kernicterus, these conditions continue to accompany us into the third millennium. This phenomenon occurs not only in developing countries with emerging medical systems, but in Westernized countries as well. Comprehensive guidelines to detect newborns with jaundice and treat those in whom hyperbilirubinemia has already developed have been formulated in several countries, but have not been successful in completely eliminating the problem. In this appraisal of the situation we review selected aspects of bilirubin encephalopathy and/or kernicterus. We highlight recent reports of severe hyperbilirubinemia and kernicterus, discuss some of the factors responsible for the continuing appearance of these conditions, and briefly review what can be done to decrease bilirubin-related morbidity and mortality to the minimum.
Collapse
Affiliation(s)
- Michael Kaplan
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.
| | | | | |
Collapse
|