Screening of Infants for Hyperbilirubinemia to Prevent Chronic Bilirubin Encephalopathy

• Published in: American family physician Vol. 82; no. 4; pp. 411 - 412
• Main Authors: Lin, Kenneth W., MD, Humphrey, Mark E., MD, MPH
• Format: Journal Article
• Language: English
• Published: Leawood American Academy of Family Physicians 15-08-2010
• Subjects: Asian Americans; Breastfeeding & lactation; Dehydrogenases; Glucose; Internal Medicine; Jaundice; Light therapy; Risk factors; United States > US
• ISSN: 0002-838X

Case Study Questions * Which one of the following conditions is a complication of severe neonatal hyperbilirubinemia? * A. Glucose-6-phosphate dehydrogenase deficiency. * B. Gastrointestinal problems. * C. Bruising. * D. Kernicterus. * E. Weight gain. * Based on the recommendation from the U.S. Preventive Services Task Force (USPSTF), which one of the following statements about hyperbilirubinemia is correct? * A. Chronic bilirubin encephalopathy is common in the United States. * B. Phototherapy does not interfere with breastfeeding or the development of the maternal-infant relationship. * C. Significant morbidity occurs in as many as 5 percent of patients who undergo exchange transfusion. * D. Screening for hyperbilirubinemia reliably identifies all infants who are at risk of developing chronic bilirubin encephalopathy. * E. Phototherapy is not associated with the possible growth of melanocytic nevi. * Based on K.J.'s risk factors for hyperbilirubinemia, what is the appropriate next step? * A. Do not screen K.J. because there is not enough evidence to recommend screening. * B. Screen K.J. because he is being exclusively breastfed. * C. Screen K.J. because he is Asian American. * D. Do not screen K.J. because his urine output is normal. Potential harms of phototherapy treatment include weight loss, gastrointestinal problems, interruption of breastfeeding, disruption of the maternal-infant relationship, and possible growth of melanocytic nevi. The correct answer is A. Risk factors for hyperbilirubinemia include exclusive breast-feeding, family history of neonatal jaundice, bruising, cephalohematoma, Asian or black ethnicity, maternal age older than 25 years, male sex, glucose-6-phosphate dehydrogenase deficiency, and gestational age of less than 38 weeks.