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May 20, 2019

Screening for Neonatal Hyperbilirubinemia—First Do No Harm?

Author Affiliations
  • 1National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 2Department of Health Management and Policy, University of Michigan, Ann Arbor
  • 3Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor
  • 4Department of Pediatrics, University of Utah, Salt Lake City
JAMA Pediatr. 2019;173(7):617-618. doi:10.1001/jamapediatrics.2019.1194

Screening of newborn infants for hyperbilirubinemia (NHB) is a common clinical practice in the United States. Since 2004, the American Academy of Pediatrics has endorsed either universal or risk-based predischarge screening of bilirubin levels in newborns of 35 weeks’ gestational age or older to evaluate the risk for NHB using a nomogram standardized to age in hours and follow-up management using consensus-based treatment guidelines.1 The anticipated benefits of screening for NHB, followed by phototherapy and/or exchange transfusion when indicated, are to prevent acute bilirubin encephalopathy, which has a direct burden of morbidity and can also progress to chronic bilirubin encephalopathy (CBE) with devastating neurodevelopmental consequences (also known as kernicterus). However, it is important to consider the balance of benefits and harms of screening and treatment; newly published evidence2 that treatment of NHB is associated with elevated risks of epilepsy might lead hospitals to reevaluate the balance of benefits and risks of referring newborns for phototherapy on the basis of screening for NHB.

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