Trends in hospitalizations of newborns with hyperbilirubinemia and kernicterus in United States: an epidemiological study

Abstract

Background

Hyperbilirubinemia is one of the most common diagnosis in newborn nurseries in United States. Universal pre-discharge bilirubin screening decreased the incidence of extreme hyperbilirubinemia and risk of kernicterus.

Objectives

We sought to assess temporal population trends of hyperbilirubinemia, kernicterus and usage of phototherapy, intravenous immunoglobulin (IVIG), and exchange transfusion.

Design/methods

Data from Healthcare Cost and Utilization Project (HCUP)-the Kids’ Inpatient Database (KID) obtained for years 1997–2012. All neonatal discharges with ICD-9 codes for neonatal jaundice (774.2, 774.6), kernicterus (773.4, 774.7) and procedure codes for phototherapy (99.83), IVIG infusion (99.14), exchange transfusion (99.01) were extracted. We compared the trends of diagnosis of hyperbilirubinemia, kernicterus, use of phototherapy, IVIG, and exchange transfusion.

Results

During the study period, the proportion of infants diagnosed with hyperbilirubinemia increased by 65% (9.4% vs. 15.5%; p<.001) in term infants and 34.5% (33.5% vs. 45%; p<.001) in preterm infants, respectively. Rate of kernicterus discharges significantly reduced from 7 to 1.9 per 100,000 newborns. Overall, the number of exchange transfusions has decreased by 67% during study period while phototherapy and IVIG use increased by 83% and 170%, respectively.

Conclusions

In last two decades, there was a significant decrease in neonatal discharges with a history of exchange transfusion or with a diagnosis of kernicterus. However, there was a significant increase in number of neonates discharged home with a history of phototherapy during birth hospitalization and decreased number of exchange transfusions were observed during the study period. Incremental implementation of universal predischarge bilirubin screening and treatments based on 2004 AAP recommended risk-based strategies might have contributed to timely interventions in infants with significant hyperbilirubinemia.

Keywords:

• Hyperbilirubinemia
• kernicterus
• phototherapy
• exchange transfusion
• United States
• newborns

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

The authors acknowledge the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality, Rockville, MD and its partner organizations that provide data to the HCUP.