Page 117 - 16Neonatal Jaundice_compressed

Neonatal jaundice

unconjugated free bilirubin in the circulation, and it is free bilirubin that crosses the blood–
brain barrier. Although there is a substantial literature on the B/A ratio, it is not often used in
clinical practice. The GDG is aware of an ongoing RCT in the Netherlands that is specifically
directed at evaluating the use of the B/A ratio as an adjunct to serum bilirubin levels in the
management of jaundice, but the work is continuing and no results are as yet available.
Hyperbilirubinaemia
Identified studies were subdivided into three groups as follows:
● a group with an entry level of serum bilirubin > 154 micromol/litre but no mean serum
bilirubin for the entire sample (used here as a proxy for ‘mild’ hyperbilirubinaemia)
● a group including studies where either the serum bilirubin threshold for inclusion or the
mean serum bilirubin of the entire sample was between 255 and 399 micromol/litre (used
here as a proxy for ‘moderate’ hyperbilirubinaemia)
● a group including studies where the serum bilirubin threshold for inclusion was
> 400 micromol/litre, the mean serum bilirubin of the entire sample was
> 400 micromol/litre or studies where exchange transfusions were required (used here as a
proxy for ‘severe’ hyperbilirubinaemia).
Kernicterus
Identified studies included babies who met recognised criteria for kernicterus including the
following clinical features:
● poor feeding
● lethargy
● high-pitched cry
● increased tone
● opisthotonos
● seizures
● sensorineural hearing loss,
● motor delay, extrapyramidal disturbance
● gaze palsy
● dental dysplasia.

6.1 Tests to detect underlying disease in all babies with

hyperbilirubinaemia

Description of included studies (6.1.1–6.1.4)
Overall, 33 articles contributed to this analysis and some have been included in more than one
group.* The median sample size was 109 (range 21–3099). For population-based studies, the
incidence of jaundice by live births was recorded.
Serum bilirubin > 154 micromol/litre
Nine studies 82-90 with 10 204 participants contributed data to this analysis (Table 6.1). Three
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studies each were carried out in Nigeria 82;83;85 and India 84;86;87 and one apiece in Australia,
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Pakistan and China. The entry levels ranged from bilirubin levels > 154 micromol/litre to
> 205 micromol/litre. Mean serum bilirubin levels were not reported in any study. Jaundice at
this level affected 10.4% of all live births in the three population-based studies included in this
analysis. 82;88;89 Where reported, the age of onset of jaundice ranged from 0 to 10 days. Preterm
babies were included in all but three studies 82;83;86 and accounted for between 3.6% and 36.3%
of the study sample. Breastfeeding rates and the mean gestational age were not reported in any
study. Only one study reported mean birthweight, which was 2.73 ± 0.74 kg. Males accounted
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for 57.9% of cases in the three studies 83;86;90 that reported gender.

* If a study was included in more than one category, sample demographics are only provided for the first category.

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