Start Validating the assessment of glucose 6 phosphate dehydrogenase g6pd

Validating the assessment of glucose 6 phosphate dehydrogenase g6pd

If we assume that the entire 20% of infants with neurological findings at presentation had acute bilirubin encephalopathy, the incidence of this complication would be one in 10,000 live births, an incidence similar to that of phenylketonuria.

In addition, some infants with severe hyperbilirubinemia are found to have sepsis, but both sepsis and hyperbilirubinemia are common in the neonatal period, and sepsis appears to be uncommon in the well-appearing infant with severe hyperbilirubinemia.

Carefully timed TSB measurements can be used to predict the chances of developing severe hyperbilirubinemia.

A study [9] in a North American multiethnic population of appropriate weight for gestational age term and late preterm infants (35 weeks or greater) who did not have a positive direct Coombs test demonstrated that a timed measurement of TSB concentration at discharge (between 18 h and three days of age) could predict a later TSB measurement greater than the 95th percentile within stated confidence limits (the 95th percentile was approximately 300 µmol/L after 96 h of age) (evidence level 1b).

Acute bilirubin encephalopathy was first recognized in infants with rhesus hemolytic disease; this etiology is now largely avoidable and, consequently, has become rare.

Reports [22][23] indicate that acute bilirubin encephalopathy continues to occur in otherwise healthy infants with, and occasionally without, identifiable risk factors.

The collaborative perinatal project, examining 54,795 live births in the United States, was unable to find any consistent association between peak TSB concentrations below critical levels and IQ or other adverse outcomes [12].

Therefore, prevention of acute encephalopathy remains the justification for the prevention, detection and treatment of severe hyperbilirubinemia [16][17].

Prevention of this rare but serious disease requires appropriate clinical assessment, interpretation of TSB concentration and treatment, which must include all systems involved in the provision of health care and community support.