Kristie McNealy, MD

A retrospective study of over 350,000 infants has shown that universal screening for high bilirubin significantly decreases the incidence of dangerously high bilirubin levels.  The study compared over 38,000 infants who were born in hospitals with universal bilirubin screening policies to over 300,00 infants born in hospitals without a universal screening policy.

Researchers found that hospitals which used universal screening had 62% fewer cases of babies with bilirubin levels over the American Academy of Pediatrics guidelines, and had twice the rate of phototherapy use.  Despite the increase in phototherapy, babies in the universal screening group only spent about two hours longer in the hospital at birth.

The reduction in numbers of babies with severe hyperbilirubinemia is important, because in extreme cases high bilirubin can lead to seizures and permanent brain damage.  While newborn jaundice is common, we need an accurate and consistent way to identify babies with bilirubin levels that require treatment with phototherapy.

Just looking at a baby and assessing their level of jaundice isn’t enough, because depending on lighting and skin tone, it is very difficult, even for experienced newborn nurses, to accurately predict which babies will need phototherapy. It seemed like nearly every day that I worked in the nursery during medical school, we found a baby who needed phototherapy who really didn’t look that jaundiced on physical exam.  There were always others who surprised us by with much lower than expected bilirubin levels.

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