Tb. Newman et al., Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization, ARCH PED AD, 154(11), 2000, pp. 1140-1147
Objective: To investigate biological and health services predictors of extr
eme neonatal hyperbilirubinemia in a health maintenance organization.
Design: Nested case-control study.
Setting: Eleven Northern California Kaiser Permanente hospitals.
Subjects: The cohort consisted of 51 387 newborns born at 36 weeks or later
weighing 2000 g or more. Cases were newborns with peak total serum bilirub
in levels greater than or equal to 428 mu mol/L (greater than or equal to 2
5 mg/dL) (n=73). Controls were a random sample of newborns from the cohort
with peak bilirubin levels less than 428 mu mol/L (<25 mg/dL) (n=423).
Measurements: Review of medical records and telephone interviews.
Results: Early jaundice was most strongly associated with case status (odds
ratio [OR] =7.3). After excluding subjects with early jaundice, the strong
est predictors of hyperbilirubinemia were family history of jaundice in a n
ewborn (OR=6.0), exclusive breastfeeding (OR=5.7), bruising (OR=4.0), Asian
race (OR=3.5), cephalhematoma (OR=3.3), maternal age of 25 years or older
(OR=3.1), and lower gestational age (OR=0.6/week). These variables identifi
ed 61% of newborns as very low risk (about 1/4200). However, the risk in th
e remaining 39% was still low (1/370). More cases (79%) than controls (59%)
had newborn length-of-stay and follow-up consistent with the American Acad
emy of Pediatrics guidelines, but phototherapy use within 8 hours of the ti
me that the guidelines recommend was uncommon in both cases (26%) and contr
ols (33%). There were no apparent cases of kernicterus.
Conclusions: Prevention of extreme hyperbilirubinemia may require closer fo
llow-up than is currently recommended by the American Academy of Pediatrics
and more use of phototherapy than was observed in this study. To prevent e
xtreme hyperbilirubinemia (<greater than or equal to>428 mu mol/L [greater
than or equal to 25 mg/dL]) in 1 newborn, many newborns would need to recei
ve these interventions.