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Jaundice in newborns is common; chronic condition isn't. So what to do?

September 28, 2009 |  3:23 pm

Heel

To reduce the number of newborns who develop severe jaundice, screen them all for high amounts of a blood pigment known as bilirubin. That's the word from researchers at UC San Francisco Children's Hospital and Kaiser Permanente.

If the conclusion seems fairly straightforward, consider the fuller picture....

In that new study, published today (here's the abbreviated version and the news release) in the journal Pediatrics, the researchers compared bilirubin levels in two groups of infants -- those born at hospitals that routinely screen for high bilirubin, or hyperbilirubinemia, and those born at non-screening hospitals.

Infants born at the screening hospitals were considerably less likely to have severe hyperbilirubinemia. They were also considerably more likely to have undergone treatment -- phototherapy -- for the condition, regardless of whether it may have been by-the-book necessary.

Before we proceed, a primer on bilirubin.... This pigment, created in the breakdown of red blood cells, is normally excreted via bile, which is made by the liver. But newborns' livers sometimes don't work at full power right off the bat, and the bilirubin can build up in the blood, leading to hyperbilirubinemia and the yellowish skin and yellowed eyes of jaundice. That condition is fairly normal, affecting about 60% of all newborns. It's also  fairly benign -- often resolving on its own. Here's more on jaundice in healthy newborns from KidsHealth.

Levels that are extremely high, however, can lead to a rare neurological condition known as chronic bilirubin encephalopathy, or kernicterus. The resulting brain damage can cause cerebral palsy, hearing and vision problems and death. Here's information from the Centers for Disease Control and Prevention on warning signs and risk factors:

Back to the fuller picture...

The U.S. Preventive Services Task Force has concluded that though screening may have its benefits, there just isn't enough proof that universal screening would prevent the more dire condition.

Those recommendations, or lack thereof, are published in the same issue of Pediatrics. As the task force's website notes:

"There is evidence that screening using risk factor assessment or bilirubin level measurement can identify infants at risk of developing hyperbilirubinemia, but there is no known screening test that will reliably identify all infants at risk of developing chronic bilirubin encephalopathy. Not all infants with chronic bilirubin encephalopathy have a history of hyperbilirubinemia, and not all infants who have extremely high levels of bilirubin develop chronic bilirubin encephalopathy."

The articles, just two in a larger collection, are part of the journal's wider look at the issue -- an issue with pros and cons yet to be resolved.

-- Tami Dennis

Photo: In a newborn, the blood test for bilirubin is usually taken from the heel, prompting a howl from the newborn and corresponding anguish from the new parent.

Credit: Los Angeles Times

 

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