Severe neonatal hyperbilirubinemia can occur without apparent reason i
n term healthy breast-fed infants and some develop kernicterus. The ai
m of our study was to assess the incidence of severe hyperbilirubinemi
a in term healthy newborns discharged from the hospital. From January
1 through December 31, 1994, 6705 infants were delivered at Bikur-Chol
im and Misgav-Ladach Community Hospitals. All 1448 newborns discharged
with a serum bilirubin level >10.0 mg/dL were instructed to return to
the hospital within 3 days for follow-up, as well as bilirubin determ
ination. Twenty-one newborns with a bilirubin level >18.0 mg/dL were i
dentified and readmitted at mean +/- standard deviation (SD) 5.5 +/- 1
.8 (range, 5 to 10 days of life). This represents 1.7% of the 1220 inf
ants who returned for follow-up examination. Mean +/- SD serum bilirub
in levels at readmission were 19.6 +/- 2.5 mg/dL. All but one of the i
nfants were breast-fed. No cases of ABO incompatibility were found and
two newborns were glucose-6-phosphate dehydrogenase (G6PD)-deficient.
Sepsis work-up and direct Coomb's tests were negative in all cases. N
one had hemolysis or were found to have any cause for hyperbilirubinem
ia other than breast-feeding. Phototherapy was provided in all but two
cases, and an exchange transfusion was performed in one case. Three a
dditional infants, with bilirubin levels <10 mg/dL at discharge, were
readmitted due to hyperbilirubinemia. One was diagnosed with neonatal
hepatitis. We conclude that, based on our study population, 0.36% of t
erm infants may subsequently develop severe neonatal hyperbilirubinemi
a in the first postnatal week. Adequate follow-up programs should be a
vailable when early discharge of healthy term newborns is considered.