Purpose The primary purpose of this study was to evaluate whether or not universal newborn bilirubin screening reduces the risk of significant hyperbilirubinemia in healthy term and near term newborn infants.
Methods Intermountain Health Care (IHC) deployed a system wide newborn bilirubin screening program in October 2002. All infants 35 weeks gestation or greater cared for in well-baby nurseries had a total serum bilirubin (TSB) measurement performed at the onset of clinical jaundice and prior to discharge, whether clinically jaundiced or not. Bilirubin values were plotted on a bilirubin nomogram and physicians were notified if an infant's bilirubin value plotted above the 40th percentile. The subjects screened in the study include 42,194 infants born in 18 IHC hospitals between January 2003 and July 2004. Data files were collected and analyzed monthly through IHCs' electronic data base.
Results Data collected during the first several months of screening demonstrated that when evaluated between 24 and 48 hours of age significantly more than 60% of the newborns of the study population had hour-specific TSB values that plotted above the 40th percentile of the nomogram that was being employed [Pediatrics 1999;103(1):6-14]. The 40th, 75th, and 95th percentiles of the hour-specific TSB values of initial 4,518 newborns screened were calculated and these population specific data points were utilized to modify the percentile tracks of the bilirubin nomogram. In 2002 a total of 320/26,222 (1.2%) newborns had a documented TSB level equal to or greater than 20mg/dl. Eighteen of these infants (0.07%) had a level measured that was greater than or equal to 25mg/dl. Subsequent to the initiation of the bilirubin screening program a progressive decline in the number of newborns identified as having a TSB level equal to or greater than 20mg/dl was noted. In 2003 a total of 185/26,121 (0.71%) newborns had a documented TSB level equal to or greater than 20mg/dl and a level greater than or equal to 25mg/dl was noted in 10 (0.04%) infants. In the first six months of 2004, 106/16,073 (0.66%) newborns were identified as having a TSB level equal to or greater than 20mg/dl and of those only 2 (0.01%) had a documented level equal to or greater than 25mg/dl.
Conclusion Universal bilirubin screening, when applied across a large, multi-state hospital system, reduces the number of infants who develop potentially damaging levels of bilirubin.