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American Academy of Pediatrics
Article

Incidence, Etiology, and Outcomes of Hazardous Hyperbilirubinemia in Newborns

Michael W. Kuzniewicz, Andrea C. Wickremasinghe, Yvonne W. Wu, Charles E. McCulloch, Eileen M. Walsh, Soora Wi and Thomas B. Newman
Pediatrics September 2014, 134 (3) 504-509; DOI: https://doi.org/10.1542/peds.2014-0987
Michael W. Kuzniewicz
aDivision of Research, Kaiser Permanente Northern California, Oakland, California;
Departments of bPediatrics,
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Andrea C. Wickremasinghe
cDepartment of Pediatrics, Kaiser Permanente Santa Clara, Santa Clara, California
dEpidemiology and Biostatistics, and
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Yvonne W. Wu
Departments of bPediatrics,
eNeurology, University of California, San Francisco, San Francisco, California; and
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Charles E. McCulloch
dEpidemiology and Biostatistics, and
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Eileen M. Walsh
aDivision of Research, Kaiser Permanente Northern California, Oakland, California;
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Soora Wi
aDivision of Research, Kaiser Permanente Northern California, Oakland, California;
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Thomas B. Newman
aDivision of Research, Kaiser Permanente Northern California, Oakland, California;
Departments of bPediatrics,
dEpidemiology and Biostatistics, and
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Abstract

BACKGROUND AND OBJECTIVES: Total serum bilirubin (TSB) levels ≥30 mg/dL are rare but potentially hazardous. A better understanding of their incidence, causes, and outcomes could help inform preventive efforts.

METHODS: We identified infants born ≥35 weeks’ gestational age from 1995–2011 in Kaiser Permanente Northern California (n = 525 409) and examined the medical records of infants with a TSB ≥30 mg/dL to determine etiology and the occurrence of acute bilirubin encephalopathy. We reviewed inpatient and outpatient encounters through 2013 for evidence of sensorineural hearing loss (SNHL) or cerebral palsy (CP).

RESULTS: We identified 47 infants with TSB ≥30 mg/dL (8.6 per 100 000 births). In 44 infants (94%), the hyperbilirubinemia occurred after the initial birth hospitalization. The etiology was not identified in 33 (70%). Glucose-6-phosphate dehydrogenase (G6PD) activity was measured in only 25 (53%) of whom 10 (40%) were deficient. Four children had acute bilirubin encephalopathy of whom 2 developed both CP and SNHL, and 1 developed isolated SNHL. These 3 infants all had G6PD deficiency and TSB >40 mg/dL. One additional 35-week infant with TSB 38.2 mg/dL had SNHL.

CONCLUSIONS: Hazardous (≥30 mg/dL) hyperbilirubinemia is a rare event. No etiology could be identified from the clinical record in most cases. G6PD deficiency was the leading cause of hazardous hyperbilirubinemia when an etiology was identified, but many were not tested. Chronic, bilirubin-induced neurotoxicity was uncommon and occurred only in the setting of additional risk factors and TSB values well over (>15 mg/dL) the American Academy of Pediatrics exchange transfusion thresholds.

  • hyperbilirubinemia
  • kernicterus
  • neonate
  • neurotoxicity
  • Accepted May 27, 2014.
  • Copyright © 2014 by the American Academy of Pediatrics

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Pediatrics
Vol. 134, Issue 3
1 Sep 2014
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Incidence, Etiology, and Outcomes of Hazardous Hyperbilirubinemia in Newborns
Michael W. Kuzniewicz, Andrea C. Wickremasinghe, Yvonne W. Wu, Charles E. McCulloch, Eileen M. Walsh, Soora Wi, Thomas B. Newman
Pediatrics Sep 2014, 134 (3) 504-509; DOI: 10.1542/peds.2014-0987

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Incidence, Etiology, and Outcomes of Hazardous Hyperbilirubinemia in Newborns
Michael W. Kuzniewicz, Andrea C. Wickremasinghe, Yvonne W. Wu, Charles E. McCulloch, Eileen M. Walsh, Soora Wi, Thomas B. Newman
Pediatrics Sep 2014, 134 (3) 504-509; DOI: 10.1542/peds.2014-0987
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Subjects

  • Neurology
    • Neurology
    • Neurologic Disorders
  • Fetus/Newborn Infant
    • Fetus/Newborn Infant
    • Hyperbilirubinemia

Keywords

  • hyperbilirubinemia
  • kernicterus
  • neonate
  • neurotoxicity
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