Early detection of hyperbilirubinemia in newborns, along with timely initiation of therapy, can help prevent bilirubin-induced brain injury (kernicterus). As part of a strategy to prevent such brain injury, Intermountain Health Care, an 18-hospital system in the West, implemented a system-wide predischarge bilirubin screening program. The program was coupled with use of a bilirubin nomogram that stratified each infant's level of risk for hyperbilirubinemia, triggering any necessary follow-up.
Investigators compared data on rates of significant hyperbilirubinemia and rehospitalization during two two-year periods-one, the period before the screening program was begun; the other, after its initiation.
The bilirubin screening program called for transcutaneous bilirubin measurement on every newborn when clinical jaundice was recognized or, if no jaundice was observed, before discharge. Bilirubin values were then plotted on an hour-specific bilirubin nomogram for assessment of hyperbilirubinemia in the context of postnatal age. For values above the 40th percentile (those in the 40th to 95th percentiles represented an "intermediate risk" of hyperbilirubinemia; those above the 95th percentile, high risk), the provider was notified and arranged necessary intervention, evaluation, and follow-up.
Before the bilirubin screening program was introduced, one in 77 newborns had one or more serum bilirubin measurements >20 mg/dL-a rate that dropped to one in 142, after the screening program went into effect (a reduction of almost 50%). Extreme hyperbilirubinemia (25 ≥mg/dL or higher) was seen in one in 1,522 before the program was initiated; this rate fell nearly threefold, to one in 4,037, after the program was established. In addition, the readmission rate for jaundice was 5.5 newborns for every 1,000 before the program began; after implementation, the readmission rate fell to 4.3 for every 1,000 (Eggert LD et al: Pediatrics 2006;117:e855).
Commentary Approximately 1,200 babies needed to be screened to prevent one hospitalization in this study. The approach is probably still worthwhile, however-especially with the availability of transcutaneous bilirubin meters.