Universal Screening Lowers Risk of Severe

Jaundice In Infants
ScienceDaily (Sep. 30, 2009) Screening all newborns for excessive bilirubin
in the blood can significantly decrease the incidence of severe jaundice
which, in extreme cases, can lead to seizures and brain damage, according to
researchers at UCSF Children's Hospital and Kaiser Permanente's Division of
Research in Oakland, CA.
The study, one of the first to examine the effectiveness of universal screening
for hyperbilirubinemia, appears in the current issue of Pediatrics, the official
journal of the American Academy of Pediatrics. The study is one of six in this
issue to explore the topic of bilirubin and hyperbilirubinemia.
Hyperbilirubinemia is caused by an elevation of a bile pigment, called
bilirubin, in the blood. Bilirubin is made when the body breaks down old red
blood cells, and high levels can cause jaundice, a condition that makes the
newborn's skin and the white part of the eyes look yellow.
The researchers explain that most newborns have a rise in bilirubin in the
days following birth. However, very high blood levels can be toxic to the
nervous system. Monitoring these levels in babies with jaundice is important
so that treatment can be started before levels become excessive, explain the
researchers. They add that high bilirubin levels can be treated with light
therapy, which converts the bilirubin into a form that the body can remove.
"While we know that early identification of bilirubin levels before reaching
toxic levels is important, bilirubin screening has not been universal, as
physicians have decided which infants to screen based upon their degree of
jaundice and clinical risk factors," said Michael Kuzniewicz, MD, MPH, the lead
author of the study and a neonatologist at UCSF Children's Hospital. "This
study provides evidence that universal screening during the birth
hospitalization is a more effective method for monitoring bilirubin levels in

order to prevent them from rising to a point that can damage an infant's
brain."
The study evaluated the impact of implementation of the 2004 American
Academy of Pediatrics (AAP) guideline on the management of jaundice in the
Northern California facilities operated by Kaiser Permanente. The guideline
recommends that every newborn be assessed for the risk of developing
severe jaundice with a bilirubin level before discharge home and/or an
assessment of clinical risk factors.
With universal screening, researchers noted a 62 percent decrease in the
number of newborns with very high bilirubin levels. The study also describes
an increase in the use of phototherapy to treat infants with elevated bilirubin
levels, sometimes even when the AAP guidelines did not call for it.
Researchers in this study evaluated both blood tests and devices that
estimate the bilirubin level from the color of the baby's skin as methods of
screening. "The method didn't seem to matter as much as changing the
standard operating procedure, such that all babies are screened," said study
co-author Gabriel Escobar, MD, regional director for hospital operations
research and a research scientist with the Kaiser Permanente Division of
Research's Perinatal Research Unit in Oakland, CA. "With additional education
to help avoid excessive use of phototherapy, we think universal screening is a
very good tool to reduce cases of serious hyperbilirubinemia."
"This research highlights the power of laboratory databases in supporting
research and quality improvement," according to senior author Thomas B.
Newman, MD, MPH, with the UCSF Department of Epidemiology and
Biostatistics and the UCSF Division of General Pediatrics.
The study was funded by a grant from the National Institute of Child Health
and Human Development.

Summary:

Universal screening on infants for excessive bilirubin in the blood can

decrease the incidence of severe jaundice that can affect their body and
brain. This illness can cause seizures so all infants must be screened in order
to decrease the incidence of having this disease. Too much Bilirubin in the
blood can cause jaundice, a condition that makes the newborn's skin and the
white part of the eyes look yellow. Most newborns have a rise in bilirubin in
the days following birth, very high blood levels can be toxic to the nervous
system so monitoring infants at these levels in babies with jaundice is
important so that treatment can be started before levels become excessive.
Bilirubin screening has not been universal, infants are screened based upon
their degree of jaundice and clinical risk factors. The study also describes an
increase in the use of phototherapy to treat infants with elevated bilirubin
levels with additional education to help avoid excessive use of phototherapy,
we think universal screening is a very good tool to reduce cases of serious
hyperbilirubinemia. Hyperbilirubinemia is caused by an elevation of a bile
pigment, called bilirubin, in the blood. Before discharging a newborn from a
hospital they must be screen and assessed for the risk of developing severe
jaundice with a high bilirubin level in blood.
Reaction:
The screening for newborns to prevent the incidence of having severe
jaundice before discharging in hospital is required so this incidence will be
decreased. All babies should be screened to decrease the number of
newborns having high levels of bilirubin. The study helps the mothers in
giving their infant a good health they can give. They must comply with their
responsibility to have their newborn a screening for high levels of bilirubin in
blood so the health care provider will monitor the levels of bilirubin and that
treatment can be started before levels become excessive. It can also give the
newborn a healthy starting life because it prevents seizure and brain
damage. This research will be widely accepted universally for its very
important role on preventing a severe disease of occurring.
Recommendation:

I recommend this article for my fellow nursing students because they it can
help in giving health teachings and mothers who are having pregnancy so
they may have their newborn a screening for this disease. It will prevent their
newborn from having severe jaundice which, in extreme cases, can lead to
seizures and brain damage. Together with other screening and other
immunization this screening will be done before discharging a newborn from
a hospital. It will monitor the newborn bilirubin level so before the levels
become excessive, treatment will be done immediately. I can also
recommend it to the health care team provider for them to be informed about
this new technology that can help them in preventing the newborn from
jaundiced.
Source:
http://www.sciencedaily.com/releases/2009/12/091208162648.htm

Angeles University Foundation

Angeles City
College of Nursing

Journal Reading: Universal Screening

Lowers Risk Of Severe Jaundice In
Infants

Submitted to:
Christlyne Jaisy Rivera, R.N.

Submitted by:
Ira Mae Nunag

January19, 2009

A.Y. 2009-2010