Screening for bilirubin encephalopathy
Any adverse events or other effects from screening or phototherapy were also extracted. We also assessed the internal validity of the studies according to USPSTF criteria. DATA SYNTHESIS (RESULTS): There was no study that directly addressed the effectiveness of using risk factor assessment and/or bi...
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| Corporate Authors: | , |
| Format: | eBook |
| Language: | English |
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Rockville (MD)
Agency for Healthcare Research and Quality (US)
2009, 2009
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| Series: | Evidence syntheses
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| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Any adverse events or other effects from screening or phototherapy were also extracted. We also assessed the internal validity of the studies according to USPSTF criteria. DATA SYNTHESIS (RESULTS): There was no study that directly addressed the effectiveness of using risk factor assessment and/or bilirubin testing to reduce the incidence of kernicterus. Three fair quality studies (two nested case-control studies and a large retrospective cohort) examined the effectiveness of either using a risk score or a risk index to predict significant hyperbilirubinemia. The data suggest comparable predictability of the risk score (newborn and familial jaundice history and clinical characteristics) and the modified risk index (i.e., the risk score without family history of jaundice in a newborn) in predicting later significant hyperbilirubinemia. Three fair quality studies (one prospective and two retrospective cohorts) and one poor quality prospective study suggest comparable diagnostic abilities of early total serum bilirubin (TSB) measurements to predict late high TSB measurements. Results from one fair quality retrospective study comparing the ability of various screening strategies in predicting later hyperbilirubinemia suggest that the combination of using the modified risk index with early TSB levels significantly enhanced prediction than using either one of the strategies alone. None of the studies in this review assessed potential harms of screening. Studies in this review did not evaluate the effectiveness of phototherapy in reducing the risk of bilirubin encephalopathy. Our previous review reported that one needs to treat six to ten otherwise healthy jaundiced neonates with TSB Æ15 mg/dL by phototherapy in order to prevent the TSB in one infant from rising above 20 mg/dL. Three studies in two publications addressed key question 2 (Does risk factor assessment accurately identify infants who may benefit from bilirubin testing?), nine studies addressed key question 3 (Does bilirubin testing accurately identify infants who may benefit from phototherapy?), and nine studies addressed key question 6 (What are the harms of treatment with phototherapy?). Of the 11 studies that addressed key questions 2 and 3, five were of fair quality; six were of poor quality according to US Preventive Services Task Force (USPSTF) criteria. We did not grade the methodological quality for the nine studies that addressed key question 6. DATA EXTRACTION: Data elements were abstracted on to standardized forms and included information about the study setting, population, control, description of screening strategy, definitions of bilirubin encephalopathy and elevated bilirubin, and methods of analyses. No definitive harm could be attributed to phototherapy. One retrospective study found an association in children between sizes of melanocytic nevi and exposure to neonatal phototherapy. CONCLUSIONS: A study that directly evaluates the effectiveness of different strategies to reduce the incidence of kernicterus is not feasible given the rare occurrence of kernicterus. For practical consideration, studies on the effectiveness of different strategies to reduce the incidence of bilirubin encephalopathy could only rely on a surrogate outcome like serum bilirubin level. Based on retrospective analyses among infants who had both early and late TSB measurements available, the combination of risk factors and early TSB measurement has better diagnostic ability to predict clinically significant hyperbilirubinemia compared to risk factors alone BACKGROUND: Kernicterus or chronic bilirubin encephalopathy is a devastating disease. Thus, it is important to examine strategies to prevent the development of kernicterus. PURPOSE: To systematically review evidence for the effectiveness of strategies to prevent chronic bilirubin encephalopathy. This is an update of our previous evidence report. DATA SOURCES: We searched Medline for articles from September, 2001 to August, 2007 using the MeSH terms and keywords, such as "jaundice," "bilirubin," "hyperbilirubinemia," and "kernicterus." For additional studies, we examined the bibliographies in existing studies and also consulted the lead experts from USPSTF. STUDY SELECTION: We identified 18 articles that met our inclusion/exclusion criteria. |
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| Item Description: | Title from Bookshelf document home page |
| Physical Description: | 1 online resource |