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Published on: August 25, 2014
Systematic review of screening for bilirubin encephalopathy in neonates
Thomas A Trikalinos1, Mei Chung, Joseph Lau
1Tufts Evidence-Based Practice Center and Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts 02111, USA.
Insights
Screening for neonatal hyperbilirubinemia can predict high bilirubin levels. However, evidence is lacking to confirm if this screening effectively prevents bilirubin encephalopathy (kernicterus) or improves clinical outcomes.
Area of Science:
- Neonatal care
- Pediatric screening
- Public health interventions
Background:
- Severe neonatal hyperbilirubinemia poses a risk for chronic bilirubin encephalopathy, known as kernicterus.
- Effective screening methods are crucial for early detection and intervention.
Purpose of the Study:
- To systematically review the effectiveness of screening modalities for preventing neonatal bilirubin encephalopathy.
- To evaluate the diagnostic accuracy of early total serum bilirubin (TSB) and transcutaneous bilirubin (TcB) measurements, and risk scores.
Main Methods:
- Systematic review of English-language publications identified via Medline and expert consultation.
- Inclusion of studies evaluating TSB, TcB, or risk scores for detecting hyperbilirubinemia.
- Calculation of sensitivity and specificity for screening methods, using severe hyperbilirubinemia as a surrogate outcome.
Main Results:
- Eleven studies met eligibility criteria, evaluating risk factors, TSB, TcB, or combinations.
- Screening methods demonstrated good ability to detect hyperbilirubinemia, with AUC values ranging from 0.69 to 0.84.
- Indirect evidence suggested a decrease in hyperbilirubinemia rates with screening, but no harms were assessed.
Conclusions:
- The impact of screening on bilirubin encephalopathy rates remains unknown.
- While screening can predict hyperbilirubinemia, robust evidence linking it to favorable clinical outcomes is absent.
Context:
Severe neonatal hyperbilirubinemia is associated with chronic bilirubin encephalopathy (kernicterus).
Objective:
To systematically review the effectiveness of specific screening modalities to prevent neonatal bilirubin encephalopathy.
Methods:
We identified studies through Medline searches, perusing reference lists and by consulting with US Preventive Services Task Force lead experts. We included English-language publications evaluating the effects of screening for bilirubin encephalopathy using early total serum bilirubin (TSB), transcutaneous bilirubin (TcB) measurements, or risk scores. Severe hyperbilirubinemia was used as a surrogate for possible chronic bilirubin encephalopathy, because no studies directly evaluated the latter as an outcome. We calculated the sensitivity and specificity of early TSB, TcB measurements, or risk scores in detecting hyperbilirubinemia.
Results:
Ten publications (11 studies) were eligible. Seven (2 prospective) studies evaluated the ability of risk factors (n = 3), early TSB (n = 3), TcB (n = 2), or combinations of risk factors and early TSB (n = 1) to predict hyperbilirubinemia (typically TSB > 95th hour-specific percentile 24 hours to 30 days postpartum). Screening had good ability to detect hyperbilirubinemia: reported area-under-the-curve values ranged between 0.69 and 0.84, and reported sensitivities and specificities suggested similar diagnostic ability. Indirect evidence from 3 descriptive uncontrolled studies suggests favorable associations between initiation of screening and decrease in hyperbilirubinemia rates, and rates of treatment or readmissions for hyperbilirubinemia compared with the baseline of no screening. No study assessed harms of screening.
Conclusions:
Effects of screening on the rates of bilirubin encephalopathy are unknown. Although screening can predict hyperbilirubinemia, there is no robust evidence to suggest that screening is associated with favorable clinical outcomes.
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