Screening newborns' blood can lower risk of severe jaundice in infants

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Washington, September 28 (ANI): The incidence of severe jaundice in infants can be significantly decreased by screening all newborns for excessive bilirubin in the blood, according to a study.

This proposition attains significance as jaundice may, in some cases, lead to seizures and brain damage in infants.

Researchers at UCSF Children's Hospital and Kaiser Permanente's Division of Research in Oakland, CA, claim that their study is the firs to examine the effectiveness of universal screening for hyperbilirubinemia.

Writing about hteir work in the American Academy of Pediatrics, they say that their study is one of six in this issue to explore the topic of bilirubin and hyperbilirubinemia.

Hyperbilirubinemia is caused by an elevation of a bile pigment, called bilirubin, in the blood.

Bilirubin is made when the body breaks down old red blood cells, and high levels can cause jaundice, a condition that makes the newborn's skin and the white part of the eyes look yellow.

The researchers say that most newborns have a rise in bilirubin in the days following birth, but very high blood levels can be toxic to the nervous system.

They say that monitoring these levels in babies with jaundice is important because that can help start treatment before levels become excessive.

They add that high bilirubin levels can be treated with light therapy, which converts the bilirubin into a form that the body can remove.

"While we know that early identification of bilirubin levels before reaching toxic levels is important, bilirubin screening has not been universal, as physicians have decided which infants to screen based upon their degree of jaundice and clinical risk factors," said Dr. Michael Kuzniewicz, the lead author of the study and a neonatologist at UCSF Children's Hospital.

"This study provides evidence that universal screening during the birth hospitalization is a more effective method for monitoring bilirubin levels in order to prevent them from rising to a point that can damage an infant's brain," he added.

During the study, the researchers also evaluated the impact of implementing the 2004 American Academy of Pediatrics (AAP) guideline on the management of jaundice in the Northern California facilities, operated by Kaiser Permanente, which recommends that every newborn be assessed for the risk of developing severe jaundice with a bilirubin level before discharge home and/or an assessment of clinical risk factors.

They observed that universal screening could lead to a 62 percent decrease in the number of newborns with very high bilirubin levels.

The study also describes an increase in the use of phototherapy to treat infants with elevated bilirubin levels, sometimes even when the AAP guidelines did not call for it.

The researchers evaluated both blood tests and devices that estimate the bilirubin level from the color of the baby's skin as methods of screening.

"The method didn't seem to matter as much as changing the standard operating procedure, such that all babies are screened. With additional education to help avoid excessive use of phototherapy, we think universal screening is a very good tool to reduce cases of serious hyperbilirubinemia," said study co-author Dr. Gabriel Escobar, regional director for hospital operations research and a research scientist with the Kaiser Permanente Division of Research's Perinatal Research Unit in Oakland, CA.

"This research highlights the power of laboratory databases in supporting research and quality improvement," said senior author Dr. Thomas B. Newman, with the UCSF Department of Epidemiology and Biostatistics and the UCSF Division of General Pediatrics. (ANI)

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