Closer adherence to guidelines would help prevent kernicterus

Last Updated: 2019-03-26

By Reuters Staff

NEW YORK (Reuters Health) - Most cases of kernicterus could be avoided if health care professionals followed best practice guidelines, according to new findings from Sweden.

"Among infants who developed brain damage associated with hazardous hyperbilirubinemia, 85% were deemed avoidable by the criteria used in the present study," Dr. Jenny Alken of Karolinska University Hospital in Stockholm and colleagues write in JAMA Network Open, online March 22.

"Given effective tools for risk assessment and prevention as well as for diagnosis and treatment, devastating neonatal hyperbilirubinemia should be a preventable condition," the authors write. "However, kernicterus occurs in high-resource settings despite evidence-based guidelines and under what could be considered optimal conditions."

The researchers investigated the incidence of extreme and hazardous hyperbilirubinemia in more than 992,000 infants born in 2008-2016, including some 958,000 term births and 34,327 near-term births. Sweden released national guidelines on neonatal hyperbilirubinemia in 2008.

Extreme hyperbilirubinemia (25.0-29.9 mg/dL) occurred in 494 infants (50 per 100,000), hazardous hyperbilirubinemia (30 mg/dL or higher) in 6.8 per 100,000 and kernicterus in 1.3 per 100,000.

Among the 13 kernicterus cases, the authors concluded that brain injury was avoidable in 11 due to one or more possible causes: untimely or lack of predischarge bilirubin screening (n=6); misinterpretation of bilirubin results (n=2); untimely or delayed start of treatment with intensive phototherapy (n=1); untimely or no treatment with exchange transfusion (n=6); or lack of repeated exchange transfusions despite indication (n=1).

"The challenge and the way forward to prevent kernicterus include not only evidence-based guidelines advocating bilirubin level determination before hospital discharge but also improved digital solutions and automated safeguards for decision making regarding follow-up, diagnosis, and treatment," Dr. Alken and colleagues write. "Finally, seeking explanations for cases of hazardous hyperbilirubinemia and kernicterus in which no underlying cause can be found should be given priority."

SOURCE: https://bit.ly/2FA3BRw

JAMA Netw Open 2019.