Neonatal Hyperbilirubinemia Screening Risks and Benefits
Screening of newborns for hyperbilirubinemia is common practice in the United States. Since 2004, the American Academy of Pediatrics has recommended either universal or risk-based screening of bilirubin levels in newborns of 35 weeks gestational age or older to prevent acute bilirubin encephalopathy. Although phototherapy effectively reduces serum bilirubin levels, it has recently been associated with some harms.
Studies from Denmark and Kaiser Permanente of Northern California have found that phototherapy for hyperbilirubinemia is associated with a significantly increased risk of epilepsy in boys, but not girls. The epilepsy hazard ratio was 1.55 (95% CI, 0.83-2.66). In a hypothetical cohort of 1 million infants, of whom 76,000 are treated with phototherapy, 182 are projected to develop epilepsy as a result of therapy. Screening 1 million infants for hyperbilirubinemia and treatment would prevent up to 7 cases of kernicterus.
Although kernicterus is more devastating than epilepsy, the balance of benefit to harm is not clearly favorable to phototherapy for all infants diagnosed with hyperbilirubinemia through universal screening. More selective use of bilirubin testing and phototherapy could reduce the risk of harm without necessarily reducing the number of children who benefit.
The US Preventive Services Task Force in 2009 and the American Academy of Family Physicians (AAFP) in 2014 have concluded that insufficient evidence exists to warrant universal screening of term or near-term infants for hyperbilirubinemia. Also, the Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC) in 2012 decided not to recommend addition of hyperbilirubinemia screening to the Recommended Universal Screening Panel of the U.S. Department of Health and Human Services.
References
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297-316.
Knapp AA et al. Health Services and Resources Administration. Evidence review: neonatal hyperbilirubinemia. https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/heritable-disorders/rusp/previous-nominations/hyperbilirubinemia-evidence-review-report.pdf. Published January 5, 2012.
Muchowski KE. Evaluation and treatment of neonatal hyperbilirubinemia. Am Fam Physician. 2014;89(11):873-878.
Newman TB et al. Childhood seizures after phototherapy. Pediatrics. 2018;142(4):e20180648.
Maimburg RD, Olsen J, Sun Y. Neonatal hyperbilirubinemia and the risk of febrile seizures and childhood epilepsy. Epilepsy Res. 2016;124:67-72.
Grosse SD et al. Screening for Neonatal Hyperbilirubinemia-First Do No Harm? JAMA Pediatr. Published online May 20, 2019. doi:10.1001/jamapediatrics.2019.1194
