ORIGINAL ARTICLE

Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland

Donal Manning¹, Peter Todd¹, Melanie Maxwell² and Mary Jane Platt³

¹ Department of Paediatrics, Arrowe Park Hospital, Wirral, Merseyside, UK
² Clinical Practice Research Unit, Arrowe Park Hospital, Wirral, Merseyside, UK
³ Division of Public Health, University of Liverpool, Liverpool, UK

Correspondence to:
Donal Manning, Department of Paediatrics, Arrowe Park Hospital, Wirral, Merseyside CH49 5PE, UK; donal.manning{at}whnt.nhs.uk

Objectives: To determine the incidence of severe hyperbilirubinaemia in the newborn, and to identify associated clinical and demographic variables, and short-term outcomes.

Design: Prospective, population-based study.

Setting: UK and Republic of Ireland, between 1 May 2003 and 31 May 2005.

Participants: Infants in the first month of life with severe hyperbilirubinaemia (maximum unconjugated serum bilirubin 510 µmol/l).

Results: 108 infants met the case definition, 106 from the UK and 2 from the Republic of Ireland. The UK incidence of severe hyperbilirubinaemia was 7.1/100 000 live births (95% CI 5.8 to 8.6). Only 20 cases presented in hospital; 88 were admitted with severe jaundice. 64 (60.4%) cases were male, and 56 (51.8%) were of ethnic minority origin. 87 (80.5%) cases were exclusively breast fed. Co-morbidity included haemolysis, dehydration, infection and bruising. 14 infants showed evidence of bilirubin encephalopathy, of whom 3 died. The UK incidence of bilirubin encephalopathy was 0.9/100 000 live births (95% CI 0.46 to 1.5).

Conclusions: This is the first large, prospective, population-based study of the incidence of severe hyperbilirubinaemia in the newborn. The clinical and demographic associations, and short-term outcomes identified, are the same as those reported recently in North America and Europe.

Keywords: Hyperbilirubinaemia; neonate; bilirubin encephalopathy; kernicterus

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