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Does Routine Bilirubin Screening Make for Healthier Babies?

A government-sponsored task force has determined that there's not enough evidence to suggest that the benefits of routinely screening newborns for elevated levels of bilirubin outweigh the potential risks or that routine screening leads to better health for babies across the board.

Bilirubin screening tests (evaluating skin or blood samples) are commonly administered to babies whose jaundiced, yellowish hue indicates they have too much bilirubin (a by-product created when the body destroys excess red blood cells) circulating in their bloodstream. Many healthy newborns experience some jaundice until their livers develop sufficiently to process bilirubin on their own, a task that is handled before birth by the mother's liver. Most babies' jaundice passes within a few days and without incident.

But some babies continue to have elevated bilirubin -- or hyperbilirubinemia -- beyond those few days. Hyperbilirubinemia is treated with light therapy and, in extreme cases, blood transfusions. Risks associated with light therapy include interruption of breast-feeding, weight loss and gastrointestinal problems. Transfusions carry more dire risks, including that of death.

In extremely rare cases, excess bilirubin crosses the immature blood-brain barrier and causes a condition called chronic bilirubin encephalopathy, which can lead to serious neurological damage; some affected babies end up with chronic, irreversible conditions such as cerebral palsy.

But the U.S. Preventive Services Task Force, working under the auspices of the federal Agency for Healthcare Research and Quality (AHRQ), found in reviewing existing scientific research that it's not clear how many babies with elevated bilirubin develop chronic bilirubin encephalopathy. Nor is it clear that most babies who develop that condition have experienced hyperbilirubinemia as newborns. While gaps in the evidence need to be filled, the task force reports in the October issue of Pediatrics that too many questions remain unanswered for the task force to support or dismiss routine bilirubin screenings, at least for babies born at or near full term.

Of course, that doesn't mean that some babies might not benefit from such screening. The task force lays the burden of deciding whether to screen in the hands of physicians, who should evaluate each child's case individually.

The question of whether to screen routinely for hyperbilirubinemia has implications beyond each baby's individual health: Insurers often use recommendations from the USPSTF to guide decisions about whether to offer coverage for certain procedures. Screening for possible disease in the absence of symptoms is a gray area, with many consumers clamoring for information about potential health risks while insurers balk at paying for tests whose results may or may not lead to better health.

One of my babies was jaundiced enough to warrant screening. I had no idea what bilirubin was or the implications of the screening. I just remember feeling relieved when the results came back and I could cross that off the list of vague new-mom worries.

Sure, cutting back on routine screening might save money. But that's not the way your mind works when you're holding a new baby in your arms.

By Jennifer LaRue Huget  |  September 28, 2009; 7:00 AM ET
Categories:  Family Health , Neurological disorders  
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Comments

The article fails to mention the early discharge policies of insurance companies. Routine vaginal deliveries rarely are allowed to stay more than 24 hours in hospital post delivery because the insurance companies will not pay for the extra days.
First time mothers often do not have the instincts and tools to establish good breast feeding patterns to maintain the infants hydration in the first 72 hours of life. Most parents cannot recognize jaundice in darkened bedrooms at home. The baby should be seen in by the pediatrician or in a clinic by 48-72 hours of life. The screening blood test is mean to identify those infants who are at risk for developing dangerous levels of jaundice and avoid the the risk of brain damage.
Submitted by a retired pediatrician who has published on this topic in the Pediatric Journals

Posted by: Baldeagle1381 | September 28, 2009 2:24 PM | Report abuse

I second Baldeagle1381 on early discharge and its effects on the treatment of infant jaundice. I delivered my daughter naturally, went home, had a pediatrician's appointment the next day, and was told I had to take my newborn into the hospital the next three days for blood tests to monitor her bilirubin. I'm sorry; I've just given birth, I feel like I've been run over by a semi, I'm sleep-deprived, I can't drive for two weeks following delivery, and you want me to go to the hospital three days in a row? This would not have been nearly as much of an issue had I still been there. Of course I took care of my baby, but between my breastfeeding issues and concerns about her bilirubin, it was a trying time at best.

Posted by: clairemdc1 | September 28, 2009 2:43 PM | Report abuse

My newborn daughter is just over 2 weeks old. We just spent our first weekend at home. She was born on a Saturday morning, Sunday AM discharged from hospital (after bilirubin levels were considered normal)and first pediatrician appt on Wed eve. We informed about our fear of jaundice and then she was checked. High levels ~24 - chances of affecting the brain and blood exchange high at this time. Wed night, leaving aside food on our dinner plates, we rushed to the NICU. Daughter under lights, IV fluids, formula fed, until Sat morning. Then no lights, breast milk supplemented with formula until Sun morning, then discharged.... That's too much for a newborn and her parent. How do you evaluate the "potential risks" for the newborn? I think they ought to eliminate the chances of this happening... if it requires a couple of additional days at the hospital constantly monitoring the bilirubin levels, then so be it. If not, have a nurse conduct the test at home for the first week, when the chances are supposedly the highest.

Posted by: keviv_litap | September 28, 2009 3:47 PM | Report abuse

Does anyone know if this is a hereditary condition? My sister and I were both jaundiced enough at birth to need to receive light therapy (this was in the mid-1970s) and I am pregnant now with my first so I am very concerned about this.

Posted by: tsp2 | September 28, 2009 4:27 PM | Report abuse

tsp2- Do you and your sister have a different blood type than your mother? All 3 of my kids were jaundiced (the oldest very mildly, and my twins much more so), and I've read that a frequent cause of infant jaundice is ABO incompatability, in which the mother is O and the baby is A/B/AB, and the mother's antibodies to the A or B proteins pass through the placenta. In my case, I am O and all my kids have A-type blood, like their father. I asked my MIL about this (she is O and all her kids are A as well), and she said all of her babies were jaundiced.

http://en.wikipedia.org/wiki/Hemolytic_disease_of_the_newborn_(ABO)

Posted by: floof | September 28, 2009 7:07 PM | Report abuse

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