Aggressive treatment of hyperbilirubinemia from the 1950s to the 1970s led to a marked decrease in the occurrence of kernicterus, a rare but devastating neurologic disease. In the 1990s, managed care practices shortened the postpartum length of hospital stay, leading to infant discharge before the typical peak in serum bilirubin level. Decreased screening and treatment have combined to result in an increase in the incidence of kernicterus. In a review of neonatal jaundice, Dennery and colleagues summarize the causes, prevention and treatment of hyperbilirubinemia.
Common causes of hyperbilirubinemia include premature birth, ABO and Rh blood-type incompatibility and peripartum infection. The authors recommend using a percentile-based nomogram to predict which infants are at highest risk of severe hyper-bilirubinemia. They emphasize the value of a follow-up examination two to three days after discharge to check for jaundice.
Transcutaneous measurements for estimating serum bilirubin concentrations were hampered in the past by machines that gave erroneous estimates for infants with darker skin pigmentation. The authors mention that newer transcutaneous instruments, using multi-wavelength spectral reflectance, have been shown to correlate well with serum bilirubin levels regardless of skin pigmentation.
Phototherapy remains the mainstay of treatment for neonatal jaundice, and newer recommendations reserve exchange transfusion for only the most severe cases of hyper-bilirubinemia. Exchange transfusion has its own, occasionally severe, complications.