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Published on: August 24, 2011
Universal screening for hyperbilirubinemia in term healthy newborns at discharge: A systematic review and
Faiza Khurshid1, Suman Pn Rao2, Caroline Sauve3
1Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Queens University, Kingston, Ontario, Canada.
Insights
Universal transcutaneous bilirubin (TcB) screening at hospital discharge may reduce readmissions for jaundice and severe hyperbilirubinemia in healthy newborns. Evidence for universal total serum bilirubin (TSB) screening remains uncertain.
Area of Science:
- Neonatal Medicine
- Pediatric Screening
- Evidence-Based Practice
Background:
- Jaundice screening in term healthy neonates before hospital discharge is standard practice.
- Current screening methods include visual inspection, risk assessment, transcutaneous bilirubin (TcB), and total serum bilirubin (TSB) testing, with variations based on clinical settings.
Approach:
- A systematic review evaluated the effectiveness of universal TcB and TSB screening at discharge compared to clinical screening alone for term healthy neonates.
- The review analyzed randomized and non-randomized studies, assessing outcomes such as neonatal mortality, readmission for jaundice, severe hyperbilirubinemia, exchange transfusion, and bilirubin-induced neurological dysfunction (BIND).
Key Points:
- Universal TcB screening may decrease readmission for jaundice and severe hyperbilirubinemia, though evidence certainty is low.
- The impact of TcB screening on jaundice requiring exchange transfusion and BIND was uncertain.
- Meta-analysis of non-randomized studies suggested TcB may reduce severe hyperbilirubinemia and jaundice requiring exchange transfusion, but its effect on readmission was uncertain.
- Evidence regarding the effectiveness of universal TSB screening for severe hyperbilirubinemia, exchange transfusion, and readmission was uncertain.
Conclusions:
- Universal transcutaneous bilirubin (TcB) screening at discharge shows potential for improving clinical outcomes in term healthy neonates.
- The evidence supporting universal total serum bilirubin (TSB) screening is currently uncertain.
Background:
All term healthy neonates are screened for jaundice before hospital discharge as a standard clinical practice, but methods vary from clinical screening (visual inspection and/or risk factor assessment) to transcutaneous bilirubin (TcB) or total serum bilirubin (TSB) testing, depending on the setting.
Methods:
This systematic review of randomized and non-randomized studies evaluated the effectiveness of universal TcB and universal TSB screening at discharge compared to clinical screening alone for term healthy neonates. The outcomes were neonatal mortality, readmission for jaundice, severe hyperbilirubinemia (>20 mg/dL), jaundice requiring exchange transfusion, and bilirubin-induced neurological dysfunction (BIND). We searched MEDLINE via Ovid, EBM reviews, Embase, CINAHL, clinical trials databases, and reference lists of retrieved articles. Two authors separately evaluated the risk of bias, extracted data, and synthesized effect estimates using relative risk (RR) for randomized and odds ratio (OR) for non-randomized studies.
Results:
For universal TcB at discharge, we included one randomized trial enrolling 1858 participants and four non-randomized studies enrolling 375 956 participants. No study reported neonatal mortality. The randomized trial suggested that universal TcB at discharge may decrease readmission for jaundice (risk ratio (RR) = 0.24, 95% confidence interval (CI) = 0.13 to 0.46; low certainty evidence) and severe hyperbilirubinemia (RR = 0.27, 95% CI = 0.08 to 0.97; low certainty evidence), but the effect on jaundice requiring exchange transfusion (RR = 0.20, 95% CI = 0.01 to 41.6) and BIND (RR = 0.33, 95% CI = 0.01 to 8.17) was uncertain. Meta-analysis of non-randomized studies suggested that TcB may decrease severe hyperbilirubinemia (odds ratio (OR) = 0.25, 95% = CI 0.12 to 0.52; low certainty evidence) and jaundice requiring exchange transfusion (OR = 0.28, 95% CI = 0.19 to 0.42; low certainty evidence), but the effect on readmission for jaundice was uncertain (OR = 1.01, 95% CI = 0.38 to 2.7; very low certainty evidence). For universal TSB, we included three studies from the United States enrolling 490 426 participants. The effect on severe hyperbilirubinemia (OR = 0.37, 95% CI = 0.15 to 0.88), jaundice requiring exchange transfusion (OR = 0.53, 95% CI = 0.13 to 2.25) and readmission for jaundice (OR = 1.01, 95% CI = 0.62 to 1.67) was uncertain.
Conclusions:
Universal TcB at discharge may improve clinical outcomes for term healthy neonates. Evidence for universal TSB is uncertain.
Registration:
PROSPERO 2020 CRD42020187279.
