Published online September 28, 2009
PEDIATRICS Vol. 124 No. 4 October 2009, pp. 1162-1171 (doi:10.1542/peds.2008-3545)
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REVIEW ARTICLE

Systematic Review of Screening for Bilirubin Encephalopathy in Neonates

Thomas A. Trikalinos, MD, Mei Chung, MPH, Joseph Lau, MD and Stanley Ip, MD

Tufts Evidence-Based Practice Center and Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts

CONTEXT: Severe neonatal hyperbilirubinemia is associated with chronic bilirubin encephalopathy (kernicterus).

OBJECTIVE: To systematically review the effectiveness of specific screening modalities to prevent neonatal bilirubin encephalopathy.

METHODS: We identified studies through Medline searches, perusing reference lists and by consulting with US Preventive Services Task Force lead experts. We included English-language publications evaluating the effects of screening for bilirubin encephalopathy using early total serum bilirubin (TSB), transcutaneous bilirubin (TcB) measurements, or risk scores. Severe hyperbilirubinemia was used as a surrogate for possible chronic bilirubin encephalopathy, because no studies directly evaluated the latter as an outcome. We calculated the sensitivity and specificity of early TSB, TcB measurements, or risk scores in detecting hyperbilirubinemia.

RESULTS: Ten publications (11 studies) were eligible. Seven (2 prospective) studies evaluated the ability of risk factors (n = 3), early TSB (n = 3), TcB (n = 2), or combinations of risk factors and early TSB (n = 1) to predict hyperbilirubinemia (typically TSB > 95th hour-specific percentile 24 hours to 30 days postpartum). Screening had good ability to detect hyperbilirubinemia: reported area-under-the-curve values ranged between 0.69 and 0.84, and reported sensitivities and specificities suggested similar diagnostic ability. Indirect evidence from 3 descriptive uncontrolled studies suggests favorable associations between initiation of screening and decrease in hyperbilirubinemia rates, and rates of treatment or readmissions for hyperbilirubinemia compared with the baseline of no screening. No study assessed harms of screening.

CONCLUSIONS: Effects of screening on the rates of bilirubin encephalopathy are unknown. Although screening can predict hyperbilirubinemia, there is no robust evidence to suggest that screening is associated with favorable clinical outcomes.

Key Words: hyperbilirubinemia • kernicterus • bilirubin encephalopathy • screening

Abbreviations: Tufts EPC—Tufts Evidence-Based Practice Center • AHRQ—Agency for Healthcare Research and Quality • USPSTF—US Preventive Services Task Force • TcB—transcutaneous bilirubin • TSB—total serum bilirubin • AUC—area under the curve • LR—likelihood ratio

Accepted Mar 11, 2009.


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