Neonatal Jaundice Management  -  Background
Management Background		In the 1950s and 60s, severe neonatal hyperbilirubinemia caused by Rh-hemolytic disease leading to acute and chronic bilirubin encephalopathy was a common neonatal occurrence. Over the years, major advances in neonatology and obstetrics led to a virtual disappearance of Rh-hemolytic disease. Coincident with this, kernicterus prevalence declined dramatically. So much so that by 1994, the AAP issued a practice parameter that revised upward the indications for exchange transfusion and phototherapy. This was in response to literature suggesting that the aggressive use of phototherapy, exchange transfusion and even diagnostic testing in the jaundiced newborn was unjustified considering the extremely low incidence of kernicterus. However, over the subsequent 5 years, as physicians began to treat jaundiced newborns less intensively and even measure bilirubins less often, case reports of kernicterus began appearing with increasing frequency. A kernicterus pilot registry in Pennsylvania reported 90 cases in 21 states from 1984 to 2001; numerators without denominators, certainly, but still a lot of babies with a devastating chronic problem that had supposedly disappeared. In 2000, PICK (Parents of Infants and Children with Kernicterus) was formed in response to increased publicity surrounding cases of kernicterus. They have become a potent grass-roots advocate for health policy changes related to neonates and jaundice. Their web site has information about kernicterus for the lay public, a downloadable educational video on kernicterus and links to the web sites of the AAP and several governmental agencies. Concurrent with, or because of, their efforts, JCAHO has issued a sentinel event alert on kernicterus prevention, the CDC has published a Morbidity and Mortality Weekly Report on kernicterus and the National Quality Forum has classified kernicterus as a "never event" in their report on preventable adverse outcomes. As a result of all the above, the AAP has recently issued a new Clinical Practice Guideline on Management of Neonatal Hyperbilirubinemia in Term and Near-term Newborns. Return to top of page