Page 122 - 16Neonatal Jaundice_compressed

Serum bilirubin between 255 and 399 micromol/litre
Twelve studies 91-102 with 2333 participants contributed data to this analysis (Table 6.1). Two
studies each were carried out in Nigeria 92;94 and Singapore 96;97 and one apiece in India, Israel,
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91
95
98
99
Papua New Guinea, Iran, 100 Saudi Arabia, 102 Taiwan, Turkey and the United Arab
Emirates. 101 Bilirubin levels at entry ranged from > 170 micromol/litre to > 306 micromol/litre.
Jaundice at this level affected 2.2% of all live births in the five population-based studies 92-96
included in this analysis. The percentage of preterm babies (reported in six studies 91;93-95;97;101 )
ranged between 0% and 18.6% and the mean serum bilirubin levels (also reported in six
studies 91-93;97-99 ) ranged between 310 micromol/litre and 376 micromol/litre. Where reported, the
age of onset ranged from 0 to 15 days, and breastfeeding rates ranged from 63% to 100%. In
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one study, the mean gestational age was 39.3 ± 1.2 weeks and not reported in the other
11 studies. The mean birthweight was 3082 ± 530 g and 3206 ± 340 g in two studies 93;99 and
was not reported in the other ten studies. Males accounted for 52.2% of cases of moderate
jaundice in the six studies 91-93;95;99;100 that reported on gender.
Serum bilirubin > 400 micromol/litre or requiring exchange transfusion
Seventeen studies 84;88-90;94-96;100;103-111 with 1997 participants contributed data to this analysis
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(Table 6.1). There were three good-quality national surveillance studies from Canada,
Denmark 106;110 and the UK, while, of the rest, two studies each were carried out in India, 84;103
Nigeria 94;105 and Turkey 107;108 and one apiece in Australia, China, Ghana, 104 Greece, 109 Iran,
89
90
100
Pakistan, Papua New Guinea and Singapore. Bilirubin levels at entry ranged from
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95
96
> 425 micromol/litre to > 510 micromol/litre. Subjects in studies with lower entry levels of
serum bilirubin but who received exchange transfusions were also included in this analysis. Six
studies 104-108;111 reported mean serum bilirubin levels ranging from 471 micromol/litre to
595 micromol/litre. Hyperbilirubinaemia at these levels affected 0.02% of all live births in the
three population-based studies 88;89;95 included in this analysis. Seven studies 90;94;95;104;107;110
reported the proportion of preterm babies and these babies accounted for between 0% and
19.9% in the studies. Where reported, the age of onset of jaundice ranged from 0 to 60 days,
breastfeeding rates ranged from 81.4% to 100%, mean gestational age ranged from 38.2 weeks
to 38.6 weeks and mean birthweight ranged from 2943 g to 3560 g. Mean birthweight was not
reported in five studies. 103-105;108;109 Males accounted for 63.1% of cases of severe jaundice in the
eight studies 104-111 that reported on gender.
Kernicterus
Ten studies 20;90;97;99;104;106;108;109;112;113 with 467 participants contributed data to this analysis
(Table 6.1). Two studies each were carried out in Turkey 99;108 and the USA 20;113 and one apiece
90
97
in China, Ghana, 104 Greece, 109 Nigeria, 112 Singapore abd the UK. 106 One population-based
study 106 reported that kernicterus affected 0.001% of all live births in a UK-based sample. No
demographic details are available as the data on kernicterus are a subset of the complete
*
sample, not all of whom had kernicterus.
Description of included studies (6.1.5–6.1.7)

Overall, six articles contributed to these analyses. One literature review 114 and two case series
from India 115 and Canada 116 were included in the review on the Bilirubin/Albumin ratio. The
literature review 114 which included six studies was rated EL 1++, while the other two studies
115;116 were rated EL 3. One case series 117 of EL 3 from Brazil was included in the review of free
bilirubin. Two case series 118;119 OF EL 3 from the USA were included in the review of
conjugated hyperbilirubinaemia.

6.1.1 Blood group incompatibility

Review findings
The pooled prevalence rates of blood incompatibility increased as serum bilirubin levels rose.
This was identified as a cause of hyperbilirubinaemia in 16.9% of cases at serum bilirubin
< 254 micromol/litre, 23.9% at serum bilirubin between 255 micromol/litre and

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

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