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Thomas B. Newman, MD, MPH; Blong Xiong, MPH; Veronica M. Gonzales, BS; Gabriel J. Escobar, MD

Arch Pediatr Adolesc Med. 2000;154:1140-1147.

Objective  To investigate biological and health services predictors of extreme neonatal hyperbilirubinemia in a health maintenance organization.

Design  Nested case-control study.

Setting  Eleven Northern California Kaiser Permanente hospitals.

Subjects  The cohort consisted of 51,387 newborns born at 36 weeks or later weighing 2000 g or more. Cases were newborns with peak total serum bilirubin levels greater than or equal to 428 µmol/L (25 mg/dL) (n = 73). Controls were a random sample of newborns from the cohort with peak bilirubin levels less than 428 µmol/L (<25 mg/dL) (n = 423).

Measurements  Review of medical records and telephone interviews.

Results  Early jaundice was most strongly associated with case status (odds ratio [OR] = 7.3). After excluding subjects with early jaundice, the strongest predictors of hyperbilirubinemia were family history of jaundice in a newborn (OR = 6.0), exclusive breastfeeding (OR = 5.7), bruising (OR = 4.0), Asian race (OR = 3.5), cephalhematoma (OR = 3.3), maternal age of 25 years or older (OR = 3.1), and lower gestational age (OR = 0.6/week). These variables identified 61% of newborns as very low risk (about 1/4200). However, the risk in the remaining 39% was still low (1/370). More cases (79%) than controls (59%) had newborn length-of-stay and follow-up consistent with the American Academy of Pediatrics guidelines, but phototherapy use within 8 hours of the time that the guidelines recommend was uncommon in both cases (26%) and controls (33%). There were no apparent cases of kernicterus.

Conclusions  Prevention of extreme hyperbilirubinemia may require closer follow-up than is currently recommended by the American Academy of Pediatrics and more use of phototherapy than was observed in this study. To prevent extreme hyperbilirubinemia (428 µmol/L [25 mg/dL]) in 1 newborn, many newborns would need to receive these interventions.

From the Departments of Epidemiology and Biostatistics, Pediatrics, and Laboratory Medicine, School of Medicine, University of California, San Francisco (Dr Newman), and the Division of Research, Kaiser Permanente Medical Care Program, Oakland, Calif (Dr Escobar, Mr Xiong, and Ms Gonzales).

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