1 / 60

B.I.N.D. Center at Pennsylvania Hospital Bilirubin Induced Neurologic Dysfunction University of Pennsylvania, Philadelph

Does hyperbilirubinemia damage the brain of healthy full term infants ? .

yosefu
Download Presentation

B.I.N.D. Center at Pennsylvania Hospital Bilirubin Induced Neurologic Dysfunction University of Pennsylvania, Philadelph

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    3. Potential Adverse Clinical Outcomes for Newborn Jaundice Death: respiratory failure (n = 6 in Pilot KI Registry) Acute bilirubin encephalopathy Post-icteric sequelae (neuromotor / auditory) Subtle manifestations (extra-pyramidal and central processing disorders) CLINICAL SPECTRUM Bilirubin Induced Neurologic Dysfunction (BIND)

    5. Settling for a Reduced Occurrence of Extreme Hyperbilirubinemia TSB level >20 mg/dl 99th percentile ( <72hrs) TSB level >25 mg/dl 99.99th percentile ( >72hrs)

    11. Occurrence of Kernicterus In babies who are jaundiced In babies who have hyperbilirubinemia Increased in babies with co-morbidities: hemolysis, prematurity, hypoalbuminemia, asphyxia / blood-brain barrier disruption, infection, hypoglycemia, decreased binding affinity of albumin to bilirubin, etc There is no evidence for a specific bilirubin level that causes neuro-toxicity (likely to be influenced by postnatal age, duration, rate of rise and presence of co-morbidities).

    15. Attitudes regarding the toxic potential of bilirubin “Jaundice does not cause brain damage in healthy babies” “Kinder and gentler approach to jaundice” “Do not worry all babies get jaundice” “You can easily get rid of jaundice with sunshine” “Bilirubin is an anti-oxidant”

    16. The Under-reporting of Occurrence of Kernicterus No national reporting system Lack of diagnosis on death certificate Lack of diagnosis on discharge diagnosis Limited and voluntary reporting to the Pilot Kernicterus Registry Delayed recognition of babies with signs of acute bilirubin encephalopathy who are admitted to emergency rooms

    18. Incidence of Kernicterus Related to Total Serum Bilirubin Levels (Rh disease; n = 60)

    24. Are Moderate* Degrees of Hyperbilirubinemia in Healthy Term Neonates Really Safe for the Brain? Soorani-Lunsing et al: Pediatric Research 2001, 50: 701-705 COMMENTARIES: Pediatric Research: 2001 (50): 674-677 Neonatal Jaundice: Continuing Concern and Need for Research: Ohlsson, A (Editor) Just when you thought it was safe..Hintz, S & Stevenson, DK Bilirubin and Neurological Dysfunction- Do we need to change what we are doing? Maisels, MJ & Newman, TB Neonatal Hyperbilirubinemia and the Potential Risk for Subtle Neurologic Dysfunction. Bhutani, VK

    28. TSB Levels Associated with different B:A Ratios Risk of BIND

    29. How does this affect my practice ?

    30. Clinical Vectors Visual Jaundice: poor vector of severity Bruising: recurrent useful clinical risk factor Risk Score for “Dangerous” levels (Newman et al) TcB: Maisels et al, Bhutani et al, Rubaltelli et al TSB: Bhutani et al, Alpay et al, Kaplan et al TSB and ETCO : Stevenson, Fanaroff, Maisels et al (Multinational Jaundice Study Group) Others under study: unbound bilirubin Preventive Management: Pre-discharge Prediction for Severe Hyperbilirubinemia

    32. Prediction and Prevention of “Dangerous” Hyperbilirubinemia Predictors for TSB >25 mg/dl (73/51,387; 0.14%): Early Jaundice…………………….Odds Ratio = 7.3 Family history:…………………….Odds Ratio = 6.0 Exclusive breast feeding………..Odds Ratio = 5.7 Bruising……………………….……Odds Ratio = 4.0 Asian race………………………….Odds Ratio = 3.5 Cephalhematoma…………………Odds Ratio = 3.3 Maternal age…………………….…Odds Ratio = 3.1 Lower Gestation…………….…….Odds Ratio = 0.6/wk Conclusions: Prevention may require a closer follow-up than presently recommended by AAP Newman TB et al: Arch Pediatr Adolesc Med 2000; 154: 1140-7

    34. Objective Measurement by Total Serum Bilirubin Testing Based on Percentiles Based on Post-natal Age in hours Based on Accuracy and Precision

    47. Incidence of “extreme” hyperbilirubinemia: Well babies with TSB > 25 mg/dl

    50. Pooled Analysis of incidence of extreme hyperbilirubinemia: Pre-discharge screening strategies

    59. PUBLIC HEALTH MESSAGES “We” should “worry” about neonatal jaundice Neurotoxicity of bilirubin is confounded by: a) early postnatal age (<72 hours), b) prematurity (<38 weeks GA), c) “jumping” upwards across percentile tracks; d) rate of TSB rise of (>0.20 mg/dl/hr) Kernicterus can occur in babies discharged as healthy (TSB levels >95th percentile) Unmonitored hyperbilirubinemia is UNSAFE

More Related