Page 77 - 16Neonatal Jaundice_compressed

Neonatal jaundice

birthweight babies found a weak association between high serum bilirubin levels
(> 340 micromol/litre) and neurodevelopmental impairment, hearing impairment and
psychomotor impairment.
There was no evidence to support race, sex or maternal age as significant risk factors.
The GDG has made a research recommendation for surveys of severe hyperbilirubinaemia and
kernicterus which would lead to better understanding of the risk factors for kernicterus.

Recommendation – 3.2 Risk factors for kernicterus/or adverse sequelae

Identify babies with hyperbilirubinaemia as being at increased risk of developing kernicterus
if they have any of the following:
• a serum bilirubin level greater than 340 micromol/litre in babies with a gestational age of
37 weeks or more
• a rapidly rising bilirubin level of greater than 8.5 micromol/litre per hour
• clinical features of acute bilirubin encephalopathy.

Research recommendation
National registries are needed of cases of significant hyperbilirubinaemia, kernicterus and
exchange transfusions.
Why this is important
Evidence: There is good evidence that prospective surveys in the UK and from a national
Kernicterus Register in the US can help is identify root-causes of kernicterus and acute
bilirubin encephalopathy. Population: All children with a peak bilirubin level greater than
450 micromol/litre which is the threshold for an exchange transfusion recommended by
NICE. Exposure: All maternal, prenatal, peri-natal and neonatal factors. Comparison: Not
applicable. Outcome: Shortcomings in clinical and service provision to prevent recurring
themes in kernicterus cases. Time stamp: Sept 2009

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