Page 214 - 16Neonatal Jaundice_compressed

Neonatal jaundice

Bibliographic details Study type and Patient characteristics Methodology and interventions Results Reviewers Comments
Evidence level
between the cases and the controls for risk
Exclusion criteria: factors ethnicity, sex, gestational age,
Babies with conjugated breastfeeding, cephalhematoma or the birth
hyperbilirubinaemia cohorts

Relationship between jaundice noted
within 24 hours of birth and phototherapy/
hyperbilirubinaemia (Mantel–Haenszel OR
with 95% CI)

Phototherapy
Cases: 18.9%
Controls: 1.7%
M-H OR 10.1 (4.2–24.4)

Hyperbilirubinaemia
Cases: 14.3%
Controls: 5.9%
M-H OR 2.9 (1.6–5.2)

Kuzniewicz MW et al.; Study Type: Cohort of all babies with Cases and controls matched on 1) Variables associated with severe Nested case–control study Cases and
Nested case- BW = 2000 g and GA = 34 weeks risk group status (low, medium hyperbilirubinaemia (those with P < 0.1 in controls taken from comparable
Year: 2008 control study born alive at hospitals of a health and high risk based on the hour- bivariate analysis) populations with well defined exclusion
maintenance organisation during a specific bilirubin centiles, criteria
Country: USA Evidence Level: II 10 year period (n = 285 295). gestational age and DAT results) Demographic factors Confounding variables controlled
and difference between their Methodology described adequately
11 From this cohort 13 843 babies TSB levels and the TSB When compared to 40+ weeks
with qualifying TSB level of 291 threshold levels for phototherapy GA 38–39 weeks (P = 0.01)
to 392 micromol/litre measured as defined by the AAP GA 34–37 weeks (P = 0.06)
birth hospitalisation < 48 hours (P = 0.07)
at = 48 hours of age taken as
reference population 1) Relationship of clinical and
demographic factors associated History & physical examination factors
Cases: Babies with maximum TSB with hyperbilirubinaemia Bruising (P = 0.007)
levels = 427 micromol/litre after evaluated by bivariate analysis
the qualifying TSB (n = 62) Laboratory values
2) Risk factors significant in the Qualifying TSB occurring during birth
Mean BW: 3374 ± 527 g bivariate model (at P < 0.1) hospitalisation (P = 0.04)
Mean GA: 38.3 + 1.7 weeks entered into multiple regression TSB increase ≥ 102 micromol/litre
(P = 0.002)
Mean age at entry: analysis to find independent
71.5 ± 19.4 hours predictors of hyperbilirubinaemia Interventions

Gender: Males = 58.9% 3) Predictive accuracy of the Inpatient phototherapy (p < 0.001)
Ethnicity: Intravenous fluids after qualifying TSB
asian = 27.4% final risk factor model evaluated (P = 0.002)
black = 8.1% by the c-statistic (equal to area exclusive breastfeeding after qualifying
under ROC curve)
TSB (P = 0.005)

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