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TcB, FFR, phototherapy and the persistent occurrence of kernicterus spectrum disorder

Journal of Perinatology volume 40, pages 177–179 (2020)Cite this article

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Four articles in this issue of the Journal of Perinatology highlight a broad range of neonatal hyperbilirubinemia topics [1,2,3,4] including the troublesome ongoing occurrence of kernicterus spectrum disorder (KSD) in Europe. The refractory nature of bilirubin-induced brain injury underscores the importance of continued work in this field.

Efforts to prevent KSD are dependent on many factors one of the most important being bilirubin surveillance. Increasingly transcutaneous bilirubin (TcB) measurement is utilized for this purpose. TcB is a reliable screen for hyperbilirubinemia in both inpatient and outpatient settings and is superior to visual estimation of total serum bilirubin (TSB) [5]. The study by Arman et al. adds to a growing literature on the accuracy of TcB measurements in preterm neonates [1]. Most NICUs, however, do not use TcB measurements [6] in part because treatment decisions are based on TSB and phototherapy is typically administered very early in the preterm NICU hospitalization [7]. In contrast to many prior investigations, the current study reports on bilirubin measurements made following phototherapy and show that 24 h post-phototherapy TcB levels accurately reflect TSB when measured on protected skin. This finding supports the potential for TcB to play a meaningful role in the NICU given the preterm neonates risk for recurrent hyperbilirubinemia and repeated courses of phototherapy. The limited number of infants in the postphototherapy cohort, however, warrants additional study of TcB accuracy during this period.

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References

  1. Arman D, Topcuoglu S, Gursoy T, Ovali F, Karatekin G. The accuracy of transcutaneous bilirubinometry in preterm infants. J Perinatol. 2019. https://doi.org/10.1038/s41372-019-0445-3. [Epub ahead of print]

  2. Musacchia G, Hu J, Bhutani VK, Wong RJ, Tong ML, Han S, et al. Frequency-following response among neonates with progressive moderate hyperbilirubinemia. J Perinatol. 2019. https://doi.org/10.1038/s41372-019-0421-y. [Epub ahead of print]

  3. Hansen TWR, Maisels MJ, Ebbesen F, Vreman HJ, Stevenson DK, Wong RJ, et al. Sixty years of phototherapy for neonatal jaundice – From serendipitous observation to standardized treatment and rescue for millions. J Perinatol. 2019. https://doi.org/10.1038/s41372-019-0439-1. [Epub ahead of print]

  4. Donneborg ML, Hansen BM, Vandborg PK, Domingo MR, Ebbesen F. Extreme hyperbilirubinemia and kernicterus spectrum disorder in Denmark during the years 2000-2015. J Perinatol. 2019. https://doi.org/10.1038/s41372-019-0566-8.

  5. Maisels MJ, Engle WD, Wainer S, Jackson GL, McManus S, Artinian F. Transcutaneous bilirubin levels in an outpatient and office population. J Perinatol. 2011;31:621–4.

    Article  CAS  Google Scholar 

  6. Bhatt DR, Kristensen-Cabrera AI, Lee HC, Weerasinghe S, Stevenson DK, Bhutani VK, et al. Transcutaneous bilirubinometer use and practices surrounding jaundice in 150 California newborn intensive care units. J Perinatol. 2018;38:1532–5.

    Article  Google Scholar 

  7. Mukherjee D, Coffey M, Maisels MJ. Frequency and duration of phototherapy in preterm infants <35 weeks gestation. J Perinatol. 2018;38:1246–51.

    Article  Google Scholar 

  8. Amin SB. Clinical assessment of bilirubin-induced neurotoxicity in preterm infants. Semin Perinatol. 2004;28:340–7.

    Article  Google Scholar 

  9. Alken J, Hakansson S, Ekeus C, Gustafson P, Norman M. Rates of extreme neonatal hyperbilirubinemia and kernicterus in children and adherence to national guidelines for screening, diagnosis, and treatment in Sweden. JAMA Netw Open. 2019;2:e190858.

    Article  Google Scholar 

  10. Maisels MJ, Newman TB. Prevention, screening, and postnatal management of neonatal hyperbilirubinemia. In: Stevenson DK, Maisels MJ, Watchko JF, editors. Care of the jaundiced neonate. New York: McGraw Hill; 2012. p. 178–94.

    Google Scholar 

  11. Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn ≥35 weeks’ gestation: an update with clarifications. Pediatrics. 2009;124:1193–8.

    Article  Google Scholar 

  12. Eggert LD, Wiedmeier SE, Wilson J, Christensen RD. The effect of instituting a prehospital-discharge newborn bilirubin screening program in an 18-hospital health system. Pediatrics. 2006;117:e855–e862.

    Article  Google Scholar 

  13. Kuzniewicz MW, Escobar GJ, Newman TB. Impact of universal bilirubin screening on severe hyperbilirubinemia and phototherapy use. Pediatrics. 2009;124:1031–9.

    Article  Google Scholar 

  14. Mah MP, Clark SL, Akhigbe E, Englebright J, Frye DK, Meyers JA, et al. Reduction of severe hyperbilirubinemia after institution of predischarge bilirubin screening. Pediatrics. 2010;125:e1143–1148.

    Article  Google Scholar 

  15. Christensen RD, Baer VL, MacQueen BC, O’Brien EA, Ilstrup SJ. ABO hemolytic disease of the fetus and newborn: thirteen years of data after implementing a universal bilirubin screening and management program. J Perinatol. 2018;38:517–25.

    Article  CAS  Google Scholar 

  16. Darling EK, Ramsay T, Manuel D, Sprague AE, Walker MC, Guttmann A. Association of universal bilirubin screening with socioeconomic disparities in newborn follow-up. Acad Pediatr. 2017;17:135–43.

    Article  Google Scholar 

  17. Kaplan M, Zimmerman D, Shoob H, Stein-Zamir C. Post-discharge neonatal hyperbilirubinemia surveillance. Acta Paediatr. 2019. https://doi.org/10.1111/apa.15096. [Epub ahead of print]

  18. Hansen TW, Nietsch L, Norman E, Bjerre JV, Hascoet JM, Mreihil K, et al. Reversibility of acute intermediate phase bilirubin encephalopathy. Acta Paediatr. 2009;98:1689–94.

    Article  Google Scholar 

  19. American Academy of Pediatrics, Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation [published correction appears in Pediatrics. 2004; 114:1138]. Pediatrics. 2004;114:297–316.

    Article  Google Scholar 

  20. Christensen RD, Nussenzveig RH, Yaish HM, Hentry E, Eggert LD, Agarwal AM. Causes of hemolysis in neonates with extreme hyperbilirubinemia. J Perinatol. 2014;34:616–9.

    Article  CAS  Google Scholar 

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  1. Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA

    Jon F. Watchko

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Correspondence to Jon F. Watchko.

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JFW reports serving as a consultant in medico-legal cases related to kernicterus and as a consultant for Mallinckrodt Pharmaceuticals.

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Watchko, J.F. TcB, FFR, phototherapy and the persistent occurrence of kernicterus spectrum disorder. J Perinatol 40, 177–179 (2020). https://doi.org/10.1038/s41372-019-0583-7

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