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