Predict, Prevent and Manage Severe Hyperbilirubinemia in Term and Late Preterm Newborns

Neonatal jaundice (NJ) refers to yellow discoloration of the skin and sclera of newborn babies ⁽⁷⁾. It is generally considered a benign self-limiting condition, affecting more than 60% of healthy term and 80% of preterm infants ^(8,9). However, in some cases, severe neonatal hyperbilirubinemia (SNH) can lead to irreversible brain damage and kernicterus ⁽¹⁰⁾. Surviving infants may acquire long-term neuro-developmental sequelae such as cerebral palsy, sensorineural hearing loss, intellectual difficulties or gross developmental delays. Acute bilirubin encephalopathy (ABE) and Chronic bilirubin encephalopathy (CBE) are largely preventable if SNH is identified early and treated promptly with effective phototherapy, or, if indicated, exchange transfusion.

In a recent systematic review in which SNH was defined as that associated with acute bilirubin encephalopathy, exchange transfusion or death; the incidence of SNH per 10,000  live births was found to be highest in the African region at 667.8, compared to 4.4/10,000 in the Americas ⁽¹¹⁾. In Egypt, the numbers are not known; however, in a recent study on 4000 well full-term newborns screened for jaundice, 1.9% had bilirubin levels in the high-risk zone on the Bhutani nomogram. This means that, in a population with 2.5 million new births / year, a large group could be at risk for SNH and its sequelae⁽¹²⁾. In the NICU of Cairo university Children’s hospital, in 2009, 44/249 admitted jaundiced newborns not only had extreme hyperbilirubinemia, but presented with moderate to severe bilirubin encephalopathy ⁽¹³⁾ and in a recently published follow up study in the same NICU, all 23/202 babies admitted with SNH had abnormal neurological examination at follow up⁽¹⁴⁾. The root causes for these shocking numbers within the Egyptian community include parental ignorance ⁽¹⁵⁾ of the risk of severe jaundice, absence of timely follow up for jaundiced newborns, as well as delay in proper intervention. ^(15,16)

While tactics to prevent and treat severe neonatal hyperbilirubinemia must be sensitive to cultural and resource variations, the universality of root causes suggests that a common strategy should be applied to make kernicterus, a very rare event throughout the world. A systematic approach should be developed in Egypt whereby newborn infants should be monitored for risk of  hyperbilirubinemia and prompt interventions should be followed to prevent acute bilirubin encephalopathy and kernicterus.