Prospective Surveillance of Extreme Neonatal Hyperbilirubinemia in Australia.

Objectives: To determine the incidence, causes, associated factors, and short-term outcomes of extreme neonatal hyperbilirubinemia in Australia in order to identify opportunities for prevention.

Study Design: This was a prospective population-based surveillance study in collaboration with the Australian Pediatric Surveillance Unit between April 1, 2010, and March 31, 2013. Case definition was: infants >34 weeks gestation with a peak total serum bilirubin ≥450 μmol/L and or clinical evidence of bilirubin encephalopathy. Clinicians completed questionnaires detailing demographic and clinical data including: peak serum bilirubin, signs of bilirubin encephalopathy, etiology, associated pathology, management, and short-term outcomes.

Results: The questionnaire return rate was 95%, and 87 infants met the case definition. The Australian incidence of extreme neonatal hyperbilirubinemia is estimated to be 9.4/100,000 live births. Main etiologies were: idiopathic ABO blood group incompatibility, glucose-6-phosphate dehydrogenase deficiency, and Rhesus isoimmunization. There were no significant differences in short-term outcomes between inpatient and outpatient cases. Cases with a hemolytic etiology were significantly more likely to have extremely high levels of hyperbilirubinemia (P < .002).

Conclusion: The incidence of extreme neonatal hyperbilirubinemia in Australia is comparable with previous studies. Robust pre- and post-discharge assessment and management strategies of neonatal hyperbilirubinemia are essential to prevent neurodisability. Universal glucose-6-phosphate dehydrogenase screening and serial bilirubin monitoring may optimize preventative strategies.