Authors' objectives:

This report summarizes the evidence on the effect of bilirubin on neurodevelopmental outcomes. It also examines the role of various effect modifiers on neurodevelopment, the efficacy of phototherapy, the accuracy of transcutaneous bilirubin (TcB) measurements, and the various strategies for predicting hyperbilirubinemia.

Authors' recommendations: A summary of 28 reports, which spanned over 30 years, on 123 cases of kernicterus in term or near-term infants affirms the role of elevated bilirubin level in kernicterus. The disease, although infrequent, has significant mortality (at least 10 percent) and long-term morbidity (at least 70 percent). Except in cases of kernicterus with sequelae, use of a single total serum bilirubin (TSB) level (within the range described in the studies) to predict long-term behavioral or neurodevelopmental outcomes for infants >= 34 weeks gestation is inadequate and will lead to conflicting results. Six to ten jaundiced, otherwise healthy neonates with TSB >= 15 mg/dl, would need to be treated with phototherapy to prevent TSB from rising above 20 mg/dl in one infant. Phototherapy combined with cessation of breastfeeding and substitution with formula was found to be the most efficient treatment protocol. Based on the evidence from the systematic review, TcB measurements by each of the three devices described in the literature - the Minolta AirShields bilirubinometer, the Ingram Icterometer, and the SpectRx BiliCheck(TM) - have a linear correlation to total serum bilirubin and may be useful as screening devices to detect clinically significant jaundice and decrease the need of serum bilirubin determinations.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/epcsums/neonatalsum.htm

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)