Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants

Question 1

What are the levels for severe and critical hyperbili <28do?

Answer 1

340, 425

It is estimated that 60% of term newborns develop jaundice and 2% reach a TSB >340 µmol/L

Question 2

What are signs of acute biliribin encephalopathy?

Answer 2

A clinical syndrome, in the presence of severe hyperbilirubinemia, of

lethargy, hypotonia and poor suck, –> hypertonia (with opisthotonos and retrocollis), high-pitched cry and fever –> seizures and coma.

First recognized in kids with rhesus hemolytic disease, now rare

Question 3

What are signs of chronic bilirubin encephalopathy?

Answer 3

The clinical sequelae of acute encephalopathy with athetoid cerebral palsy +/- seizures, developmental delay, hearing deficit, oculomotor disturbances, dental dysplasia and mental deficiency

Question 4

What are risk factors for severe hyperbili?

Answer 4

Hemolysis (DAT+ ABO incompatibility/isoimmunization, G6PD-X-linked but females can inactivate>50%)
Asian/European background
Cephalohematoma/bruising
25yo, male infant
Dehydration

Babies whose mothers are blood group O have an OR of 2.9 for severe hyperbilirubinemia (so check blood group and DAT in baby)

Question 5

What about umbilical bili and hgb?

Answer 5

A TSB concentration greater than 30 µmol/L in umbilical cord blood [29] is statistically correlated with a peak neonatal TSB concentration greater than 300 µmol/L, but the positive predictive value is only 4.8% for the term infant, rising to 10.9% in the late preterm infant, and the specificity is very poor (evidence level 1b).

Although bilirubin is derived from the breakdown of hemoglobin, routine umbilical cord blood hemoglobin or hematocrit measurement does not aid in the prediction of severe hyperbilirubinemia