Velazquez 1
Emilie Velazquez
Wolcott
ENC 1102
March 14, 2013
Annotated Bibliography
The neonatal discourse community is such an enormous community that for the purposes
of this document it would be narrowed down into the cases of hyperbilirubinemia in newborns.
Hyperbilirubinemia is a very common disease and it deals with the total serum bilirubin (TSB)
levels on infants. Once the TSB levels increase over 5 milligrams per deciliter
hyperbilirubinemia can be diagnosed. It can be classified into 3 types depending on the
accumulation of bilirubin. The three types are overproduction, decreased bilirubin conjugation,
and impaired excretion. In order to diagnose this problem, specialists recommend a
hyperbilirubinemia evaluation after the birth of the infant. This evaluation is a physical one
followed by a laboratory one if there is a reason to believe hyperbilirubinemia might occur. In
this document we discuss the points of view of experts in relation to how hyperbilirubinemia is
detected. There are various methods discussed such as the use of nomograms, clinical
assessments, the Kramer, the Minolta JM-102, and the BiliCheck. It is advised by the American
Academy of Pediatrics that these methods are to be used before the discharge of the newborn.
This will give an idea to whether the newborn has a high risk or low risk of developing
hyperbilirubinemia. The importance of these tests is so great that places such as Italy it is
mandated by the law to check for bilirubin levels prior to discharge.
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Arlettaz, Romaine, et al. "Detection Of Hyperbilirubinaemia In Jaundiced Full-Term Neonates
By Eye Or By Bilirubinometer?." European Journal Of Pediatrics 163.12 (2004): 722727. MEDLINE. Web. 12 Mar. 2013.
In "Detection Of Hyperbilirubinaemia In Jaundiced Full-Term Neonates By Eye Or By
Bilirubinometer?." Romaine Arlettaz, Neonatologist and Professor at the University of
Zurich, Martin Wolf, leader of the Biomedical Optics Research Laboratory at the Clinic
of Neonatology at the University Hospital Zurich, Hans Ulrich Bucher neonatologist and
professor in the University of Zurich, amongst others, compare three noninvasive
methods of detecting hyperbilirubinemia. They used the Kramer, the Minolta JM-102,
and the BiliCheck methods. They compared the bilirubin values collected from these
methods to the values received from a nomogram. In their study, the Minolta JM-102 was
the most accurate and had the best performance. The use of these non-invasive methods
is a breakthrough in detecting hyperbilirubinaemia in newborns. The newborns will not
have to go through painful extractions of blood samples to detect their bilirubin levels,
which can also leave scaring.
De Luca, Daniele, Virgilio P Carnielli, and Piermichele Paolillo. "Neonatal Hyperbilirubinemia
And Early Discharge From The Maternity Ward." European Journal Of Pediatrics 168.9
(2009): 1025-1030. MEDLINE. Web. 12 Mar. 2013.
In the article by Drs. Daniele De Luca, a neonatal consultant as well as a doctor at the
Division of Neonatology of the Casilino General Hospital in Rome, Italy, Virgilio P
Carnielli, Director of Neonatal Medicine at the pediatric hospital G. Salesi in Acona,
Italy, and Piermichele Paolillo, specialist in Infant Care Pediatrics and in Neonatal
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intensive care, titled "Neonatal Hyperbilirubinemia And Early Discharge From The
Maternity
Ward."
the
doctors
discussed
various
approaches
to
detecting
hyperbilirubinemia and the effects of early discharge. In this article we once again see the
mentioning of the decline in postpartum hospitalization after the 1990’s. Now the
American Academy of Pediatrics recommends that unless the infant can be seen for a
follow up 48 hours after discharge, the infant should remain hospitalized. It has been
recorded that at least half of the rehospitalization cases of infants have been because of
neonatal jaundice, which is caused by the over production of bilirubin.
The authors strongly believe in the following recommendations for a safe discharge. The
first is to recognize physical factors that might show that the infant can be on the risk of
developing neonatal jaundice. Second, they stressed that a test for hyperbilirubinemia is
done before discharge and they recommend the hour specific nomogram since it is the
most accurate. While diagnosing, the doctors should follow the population’s averages
and the specific race of the infant. The detection of hyperbilirubinemia is an important
part of the discharge of infants. In Rome, if an infant is discharged before 48 hours, the
law mandates that a serum bilirubin check is performed.
Hammerman, Cathy, et al. "Evaluation Of Discharge Management In The Prediction Of
Hyperbilirubinemia: The Jerusalem Experience." The Journal Of Pediatrics 150.4 (2007):
412-417. MEDLINE. Web. 12 Mar. 2013.
In "Evaluation Of Discharge Management In The Prediction Of Hyperbilirubinemia: The
Jerusalem Experience." Cathy Hammerman, et al. , a group of doctors and researchers
from the Department of Neonatology and Clinical Biochemistry Laboratory of the Shaare
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Zedek Medical Center, the Hebrew University of Jerusalem and the University of the
Negev in Be’er Sheva, Israel determine the efficiency of their methods after discharging
neonatal pertaining to hyperbilirubinemia. In this area of Jerusalem newborns go through
a clinical assessment to determine how likely they are to develop hyperbilirubinemia. The
results of the study indicated that the rate of readmission due to hyperbilirubinemia has
decreased. The reason for this is the services outside of the hospitals the mothers and
newborns can receive such as postnatal homes. The mothers can be up to two weeks in
these homes and have nurses to assist and check on the newborns. There will always be
the potential for hyperbilirubinemia but with the risk assessment administered before
discharge, the availability of follow-up services and the community and religious support
system, there have been less readmission of newborns.
Lauer, Bryon J, and Nancy D Spector. "Hyperbilirubinemia In The Newborn." Pediatrics In
Review / American Academy Of Pediatrics 32.8 (2011): 341-349. MEDLINE. Web. 21
Feb. 2013.
Drs. Byron J. Lauer, assistant Professor of Pediatrics at the Drexel University College of
Medicine and Nancy D. Spector, Professor of Pediatrics at the Drexel University College
of Medicine, state in the article present insight into what are the causes to
hyperbilirubinemia in infants. Aside from the most understandable cause which is
prematurity, the causes range from family history to specific physical problems the infant
may have. The most common cause of hyperbilirubinemia is breast feeding jaundice. If
the infant is not fed at least 8 times during the first few days after his birth, he might
suffer from “caloric depravation” and increasing the infant’s enterohepatic circulation.
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Lauer and Spector believe that evaluation for hyperbilirubinemia is important right after
the infant is born. They cannot stress more that all infants should undergo this evaluation
before discharge. The earlier it is done, the better it would be since the new born would
be quickly treated. They both believe that this evaluation is can only benefit the infant as
well as the family.
It is a grand idea the one they state that all children should have a hyperbilirubinemia
evaluation before being discharged. Now a day, hospitals allow people the minimum time
possible in it and discharge individuals quickly and this clearly cause a problem. Before
the 1990’s hyperbilirubinemia was almost disappearing but hospitals began to decrease
the time patients spent in the facility and hyperbilirubinemia rates began to rise.
Newman, Thomas B, et al. "Risk Factors For Severe Hyperbilirubinemia Among Infants With
Borderline Bilirubin Levels: A Nested Case-Control Study." The Journal Of Pediatrics
153.2 (2008): 234-240. MEDLINE. Web. 12 Mar. 2013.
Drs. Thomas Newman, et al. from the University of California San Francisco and the
Kaiser Permanente Medical Center in Walnut Creek, California state in the article "Risk
Factors For Severe Hyperbilirubinemia Among Infants With Borderline Bilirubin Levels:
A Nested Case-Control
Study." the guidelines
for treating newborns
with
hyperbilirubinemia. Management decisions of newborns with total serum bilirubin (TSB)
well above or below the American Academy of Pediatricians (AAP) guidelines (based on
age and TSB levels) for jaundice treatment is simple. Marked variability exists in the
treatment of infants with TSB levels within a few mg/dl of AAP ‘s age specific
phototherapy threshold. When determining the optimal treatment approach for infants
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within this group, the most important predictors of developing a TSB level within AAP’s
guidelines are gestational age, bruising on examination, family hisrory, exclusive breast
feeding and a rapid rise in TSB. Inpatient phototherapy is very effective in preventing the
development of hyperbilirubinemia. Although breast feeding is the optimal infant
feeding, supplementation with formula may help reduce the risk of hyperbilirubinemia.
Failure to initiate phototherapy could lead to an infant necessitating an exchange
transfusion.
Schwartz, J S,et al. "Identifying Newborns At Risk Of Significant Hyperbilirubinaemia: A
Comparison Of Two Recommended Approaches." Archives Of Disease In Childhood
90.4 (2005): 415-421. MEDLINE. Web. 28 Feb. 2013.
Drs J.S. SchwartzI et al., researchers at the Division of General Pediatrics, at The
Children's Hospital of Philadelphia, conduct a series of studies in their scholarly article
"Identifying Newborns At Risk Of Significant Hyperbilirubinaemia: A Comparison Of
Two
Recommended
Approaches."
to
identify
explain
the
importance
of
hyperbilirubinaemia testing before discharge. They begin by stating how the American
Academy of Pediatrics recognizes the challenges in diagnosing hyperbilirubinaemia in
infants after their discharge. The reason for this is the fact that parents do not have follow
ups right after being discharged. The follow ups usually happen a few days or even
weeks. Since they do not test for the TSB levels immediately, the newborn’s TBS levels
may rise and have or be at a high risk of developing hyperbilirubinaemia.
The results indicated that a higher percentage of infants with hyperbilirubinaemia in the
group who was tested post discharge. The experts believed that if a follow up cannot be
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reached within the first few hours, these infants in 95th percentile, should remain in the
hospital until their bilirubin trajectory is clarified.
Stark, Ann R, et al. "Delayed Pediatric Office Follow-Up Of Newborns After Birth
Hospitalization." Pediatrics 124.2 (2009): 548-554. MEDLINE. Web. 12 Mar. 2013.
In "Delayed Pediatric Office Follow-Up Of Newborns After Birth Hospitalization." a
group of Neonatologist and researchers at the Texas Children's Hospital in Houston,
Texas, explain the effects of missing or delayed follow-ups correlating to the onset of
hyperbilirubinemia. Among a large group of urban and suburban pediatricians practices
in Houston Texas, implementation of recommendations of the American Academy of
Pediatrics guidelines for management of severe hyperbilirubinemia is inconsistent.
Follow-up is delayed and many infants may be exposed to the risk of severe
hyperbilirubinemia. Although most birth hospitals in the studied geographic area have
predischarge risk assessment policies that includes bilirubin measurement; more than half
of vaginally delivered and breastfed infants did not receive timely follow-up. Without
these follow ups the incidence of hyperbilirubinemia increase, which will lead on to
neonatal jaundice.
Vogtmann, Christoph, et al. "Predictive Value Of Umbilical Cord Blood Bilirubin For Postnatal
Hyperbilirubinaemia." Acta Paediatrica (Oslo, Norway: 1992) 94.5 (2005): 581-587.
MEDLINE. Web. 12 Mar. 2013.
Christoph Vogtmann et al. who are professors and doctors in Pediatrics and Neonatology
in the Department of Neonatology at the Children's Hospital and the University Hospital
in Leipzig, Germany, worked to explain a different approach to detecting
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hyperbilirubinemia in the article "Predictive Value Of Umbilical Cord Blood Bilirubin
For Postnatal Hyperbilirubinaemia." Their new approach was based on a non invasive
technique to calculate the total serum bilirubin of the infant. They believed that by using
blood samples from the umbilical cord immediately after birth they could gather the
information needed to detect the newborn’s risk of developing hyperbilirubinemia, which
would lead to neonatal jaundice. Just as the predicted this technique prevailed. It helped
detect those infants who were at high risk and those who were at low risk of developing
hyperbilirubinemia. The two values, one from the umbilical cord blood and one from the
newborn, were highly accurate and concordant. With this finding, physicians can now
start the treatment earlier.
Watchko, Jon F, et al. "Hyperbilirubinemia In The Newborn Infant >35 Weeks' Gestation: An
Update With Clarifications." Pediatrics 124.4 (2009): 1193-1198. MEDLINE. Web. 12
Mar. 2013.
In "Hyperbilirubinemia In The Newborn Infant >35 Weeks' Gestation: An Update With
Clarifications." a group of doctors and professors from the Department of Pediatrics from
the William Beaumont School of Medicine and Division of Neonatology of Beaumont
Children's Hospital explain that the knowledge of the clinical implementation of the
American Academy of Pediatrics (AAP) guidelines on the management of
hyperbilirubinemia suggest that some areas require clarification. The AAP guideline
includes 2 categories of risk factors: severe hyperbilirubinemia factors and
hyperbilirubinemia toxicity factors. Understanding predisposition provides guidance for
timely follow-up as well as the need for additional clinical laboratory evaluation and
decision to initiate phototherapy or an exchange transfusion. In addition to clarifying the
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guidelines, the authors recommend universal predischarge bilirubin screening using total
serum bilirubin (TSB) or transcutaneous bilirubin (TcB) to assess the risk of subsequent
severe hyperbilirubinemia. A more structured approach to management and follow-up
according to predischarge TSB/TcB, gestational age and other risk factors for
hyperbilirubinemia is also recommended. The quality of evidence is limited; therefore
these recommendations are based on expert opinion. Nevertheless, because kernicterus is
a devastating condition that can lead to serious neurological damage, and because
published reports and case reviews suggest many of these cases could have been
prevented, a reasonable argument for implementing these recommendations is made.
Yigit, Sule, et al. "Incidence, Course, And Prediction Of Hyperbilirubinemia In Near-Term And
Term Newborns." Pediatrics 113.4 (2004): 775-780. MEDLINE. Web. 28 Feb. 2013.
In the scholarly article "Incidence, Course, And Prediction Of Hyperbilirubinemia In
Near-Term And Term Newborns." Drs Yigit Sule et al. from the Division of Neonatology
of the Department of Pediatrics at the Gülhane Military Medical Academy in Ankara,
Turkey demonstrate the difference ways of diagnosing and treating hyperbilirubinemia in
near-term and term newborns. The study took place at the Division of Neonatology of
Hacettepe University Faculty of Medicine. The study was made during the first seven day
of life of the newborn. They also explain the different outcomes of the TSB values in
different hours. There were vast differences between the 2 groups. Those in the near term
group had low birth weights with higher levels of TSB and were more than twice as
likely to develop hyperbilirubinemia.
The researchers concluded that the treatment for those in the near term group should be
based on the high risk status. Their TSB levels rise at a faster rate than the term newborns
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during the 5th and 7th day of life. A nomogram should be adquire for the normal TSB
values of the age group and used as a guide to determine the safe values of TSB for the
newborn.
Sule Yigit, et al. "An Early (Sixth-Hour) Serum Bilirubin Measurement Is Useful In Predicting
The Development Of Significant Hyperbilirubinemia And Severe ABO Hemolytic
Disease In A Selective High-Risk Population Of Newborns With ABO Incompatibility."
Pediatrics 109.4 (2002): e53. MEDLINE. Web. 12 Mar. 2013.
The study conducted by Dr. Sarusi, et. al from the division of neonatology at the
University of Medicine Ihsan Dogramaci Children’s Hospital, emphasizes the importance
of early testing for high levels of bilirubin, which is used to determine the presence of
hyperbilirubinemia and severe hemolytic disease in newborns. The study used a sample
of 136 newborns with the ABO blood group and monitored the babies’ levels of bilirubin
for the first 5 days of life. If the babies’ levels of bilirubin were higher than normal then
the infants were started on a phototherapy treatment. The study showed that twenty-nine
newborns, a 21.3%, had significant hyperbilirubinemia. The study revealed the
significance of monitoring a newborn’s bilirubin levels during the first days of life to
prevent the development of severe hyperbilirubinemia after discharge as well as the
critical serum total bilirubin level that can in theory be used to predict significant
hyperbilirubinemia.
Zecca, Enrico, et al. "Skin Bilirubin Nomogram For The First 96 H Of Life In A European
Normal Healthy Newborn Population, Obtained With Multiwavelength Transcutaneous
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Bilirubinometry." Acta Paediatrica (Oslo, Norway: 1992) 97.2 (2008): 146-150.
MEDLINE. Web. 12 Mar. 2013.
In "Skin Bilirubin Nomogram For The First 96 H Of Life In A European Normal Healthy
Newborn Population, Obtained With Multiwavelength Transcutaneous Bilirubinometry,"
Enrico Zecca, et al, a group of neonatologists and pediatrics, worked at the Division of
Neonatology in Department of Paediatrics of the University Hospital “A. Gemelli” in
Rome, Italy to conduct a study which recorded the levels of bilirubin of healthy neonates.
By recording these levels they were able to map out the course of development of
hyperbilirubinemia. They took a sample of European or Caucasian infants with a
gestational age of 35 weeks or higher and performed hour-specific nomograms after the
first 48 hours of life. This approach provided an efficient recollection of data since it was
recorded every two hours instead of a test performed every day. The American Academy
of Pediatrics deeply recommended this approach because of the reliability of the data.
The authors greatly believe that the availability of hour-specific nomograms should be
mandatory for the evaluation of neonates.
By having these nomograms available it will help collect bilirubin data from all infants
regardless of their background. These nomograms will help diagnose children who are
Hispanic or African American since not enough data has been collected from these two
ethnicity groups.