Aggressive treatment may be warranted in some newborns with jaundice

May 06, 2001

Philadelphia, Pa. -- In a small fraction of newborns with jaundice, aggressive medical treatment may be necessary to avoid long-term neurological injury, say researchers from The Children's Hospital of Philadelphia. Reporting in the May issue of the journal Pediatrics, the researchers also suggest that early hospital discharge and inadequate counseling about breastfeeding played a role in the jaundice, also called hyperbilirubinemia, found in the infants they studied.

Hyperbilirubinemia is an excessive amount of the blood compound bilirubin, which at severe levels can lead to brain damage, called kernicterus. Hyperbilirubinemia is more common among babies who breastfeed. It also is more common in premature babies, although the newborns in the current study were term or near-term.

Reported cases of kernicterus have increased in the United States since 1990. On May 2, the Joint Commission on Accreditation of Healthcare Organizations issued a special alert to 5,000 U.S. hospitals drawing their attention to existing guidelines for identifying and following newborns with high bilirubin levels. Children who survive kernicterus may suffer cerebral palsy, hearing loss and other neurological problems.

"Before 1990, kernicterus in a previously healthy term infant was extraordinarily rare, and most pediatricians were unlikely to see the disease in a lifetime of practice," said Mary Catherine Harris, M.D., an attending neonatologist at The Children's Hospital of Philadelphia, and lead author of the study. "The increase in reported cases may result from more relaxed guidelines for treatment of hyperbilirubinemia, combined with shorter hospital stays, increased breastfeeding and reduced opportunity for adequate breastfeeding counseling," added Dr. Harris.

Approximately 60 percent of newborns in the United States become jaundiced each year, according to the American Academy of Pediatrics. Jaundice appears as a yellow color in the skin, a sign of excess bilirubin, a chemical normally produced by the breakdown of red blood cells. In the vast majority of cases, jaundice disappears in one to two weeks as the baby's liver rids the body of excess bilirubin. High levels of bilirubin in newborns are treatable, although physicians may disagree about the timing and extent of therapy.

The Children's Hospital team retrospectively reviewed the charts of all term and near-term infants admitted to Children's Hospital between 1993 and 1996 with blood levels of bilirubin higher than 25 milligrams per deciliter during the first week of life. They found six such infants, five of whom had had neurological symptoms, such as lethargy and abnormal muscle tone. After aggressive treatment using intravenous fluids, phototherapy (exposure to light rays, which help to break down bilirubin), and blood transfusions, all but one of the children had normal neurological examinations at follow-up three months to two years later.

The study is the first to show that abnormalities of the brain on magnetic resonance imaging (MRI) images revert to normal by the time of follow-up examinations. "We suspect that these changes reflect early, aggressive treatment of the problem, although the significance of those MRI findings for revealing brain injury in such cases remains largely unexplored," said Dr. Harris.

All six infants in the study had been breastfed. For reasons that are not fully understood, breastfeeding is a risk factor for hyperbilirubinemia. When breastfeeding is not fully established, a newborn may become dehydrated, which also raises the risk of hyperbilirubinemia. "We certainly don't want to discourage new mothers from breastfeeding," said Dr. Harris. "We believe that early hospital discharge, along with inconsistent follow-up, may contribute to this condition, because new mothers may not receive adequate breastfeeding counseling, and thus may not be adequately breastfeeding at home."

The authors speculate that less aggressive treatment of infants with hyperbilirubinemia may contribute to long-term neurological problems, such as hearing loss. Dr. Harris added that further studies are needed comparing treatments and outcomes for infants with moderate hyperbilirubinemia.
-end-
Co-authors of the study with Dr. Harris, all from Children's Hospital, are Judy C. Bernbaum, M.D., director of the Neonatology Follow-up Program; Robert Zimmerman, M.D., chief of the Division of Neuroradiology; and Richard A. Polin, M.D., and Jessica R. Polin, of the Division of Neonatology.

Founded in 1855 as the nation's first pediatric hospital, The Children's Hospital of Philadelphia is ranked today as the best pediatric hospital in the nation by a comprehensive Child Magazine survey. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding.

Children's Hospital of Philadelphia

Related Hearing Loss Articles from Brightsurf:

Proof-of-concept for a new ultra-low-cost hearing aid for age-related hearing loss
A new ultra-affordable and accessible hearing aid made from open-source electronics could soon be available worldwide, according to a study published September 23, 2020 in the open-access journal PLOS ONE by Soham Sinha from the Georgia Institute of Technology, Georgia, US, and colleagues.

Ultra-low-cost hearing aid could address age-related hearing loss worldwide
Using a device that could be built with a dollar's worth of open-source parts and a 3D-printed case, researchers want to help the hundreds of millions of older people worldwide who can't afford existing hearing aids to address their age-related hearing loss.

Understanding the link between hearing loss and dementia
Scientists have developed a new theory as to how hearing loss may cause dementia and believe that tackling this sensory impairment early may help to prevent the disease.

Study uncovers hair cell loss as underlying cause of age-related hearing loss
In a study of human ear tissues, scientists have demonstrated that age-related hearing loss is mainly caused by damage to hair cells.

Hair cell loss causes age-related hearing loss
Age-related hearing loss has more to do with the death of hair cells than the cellular battery powering them wearing out, according to new research in JNeurosci.

How hearing loss in old age affects the brain
If your hearing deteriorates in old age, the risk of dementia and cognitive decline increases.

Examining associations between hearing loss, balance
About 3,800 adults 40 and older in South Korea participating in a national health survey were included in this analysis that examined associations between hearing loss and a test of their ability to retain balance.

Veterinarians: Dogs, too, can experience hearing loss
Just like humans, dogs are sometimes born with impaired hearing or experience hearing loss as a result of disease, inflammation, aging or exposure to noise.

Victorian child hearing-loss databank to go global
A unique databank that profiles children with hearing loss will help researchers globally understand why some children adapt and thrive, while others struggle.

Hearing loss, dementia risk in population of Taiwan
A population-based study using data from the National Health Insurance Research Database of Taiwan suggests hearing loss is associated with risk of dementia.

Read More: Hearing Loss News and Hearing Loss Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.