Evidence Report/Technology Assessment Number 65

Management of Neonatal Hyperbilirubinemia

File Inventory


Prepared by:

Tufts-New England Medical Center Evidence-based Practice Center
Stanley Ip, M.D.
Stephan Glicken, M.D.
John Kulig, M.D.
Rebecca O'Brien, M.D.
Robert Sege, M.D., Ph.D.
   Investigators


File Name	Description			Software	Version		File	Size
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01front.doc	Microsoft Word® Document	MS Word®	2002		36KB	4 pages
Contents: Title Page, Preface
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02abstr.doc	Microsoft Word® Document	MS Word®	2002		30KB	2 pages
Contents: Structured Abstract: Objectives, Search strategy, Selection criteria, 
Data collection and analysis, Main results/conclusions
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03conts.doc	Microsoft Word® Document	MS Word®	2002		148KB	6 pages
Contents: Table of Contents
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04summ.doc	Microsoft Word® Document	MS Word®	2002		62KB	8 pages
Contents: Summary: Overview, Reporting the Evidence, Methods, Methodological Quality, 
Results, Future Research
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05chap1.doc	Microsoft Word® Document	MS Word®	2002		32KB	4 pages
Contents: Chapter 1. Introduction: Purpose of Report, Background, Neonatal Hyperbilirubinemia, 
Burden of Disease
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06chap2.doc	Microsoft Word® Document	MS Word®	2002		113KB	10 pages
Contents: Chapter 2. Methodology: Key Questions, Literature Search and Review Parameters, 
Reporting the Results
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07chap3.doc	Microsoft Word® Document	MS Word®	2002		9.8MB	66 pages
Contents: Chapter 3. Results: 
Question 1. What is the relationship between peak bilirubin levels and/or duration of 
hyperbilirubinemia and neurodevelopmental outcome?
  Table 3.1. Feeding & Gender Status in Newborns Who Had Kernicterus; 
  Table 3.2 Racial or Ethnicity Compositions in Newborns Who Had Kernicterus; 
  Figure 3.1. Geographic distribution of kernicterus cases; 
  Figure 3.2. Distribution of Peak Total Serum Bilirubin Level in Term Newborns with Idiopathic 
   Jaundice Who Had Kernicterus; 
  Table 3.3. Summary of 35 Case Reports of Term Infants with Idiopathic Jaundice Who Had Kernicterus; 
  Figure 3.3. Cumulative Percentage of Peak Total Serum Bilirubin Levels in Term Newborns 
   with Idiopathic Jaundice Who Had Kernicterus; 
  Figure 3.4. Distribution of Peak Total Serum Bilirubin Level in Term Newborns with 
   Comorbid Factors Who Had Kernicterus; 
  Table 3.4. Summary of 88 Case Reports of Term Infants with Comorbid Factors Who Had Kernicterus; 
  Figure 3.5. Cumulative Percentage of Peak Total Serum Bilirubin Levels in Term Newborns 
   with Comorbid Factors Who Had Kernicterus; 
  Table 3.5.  Effect of Serum Bilirubin Levels on Neurological or Behavioral Outcomes 
   in Healthy Infants (GA ≥ 34 weeks of gestation); 
  Table 3.6. Effect of Serum Bilirubin Levels on Neurological or Behavioral Outcomes in All Infants; 
  Table 3.7. Effect of Serum Bilirubin Levels on Auditory Brainstem Response & Hearing deficit 
   in All Infants; 
  Table 3.8. Mean Latencies and Interpeak Latencies of Brainstem Auditory Evoked Response (BAER) 
   in All Infants (GA ≥ 34 weeks); 
  Table 3.9. Effect of Serum Bilirubin Level on Intelligence Outcome in All Infants (GA ≥ 34 weeks); 
  Table 3.10. Mean Intelligence Quotient of Children with a History of Hyperbilirubinemia; 
  Table 3.11. Effect of Serum Bilirubin on Neurodevelopmental Outcomes in Collaborative Perinatal 
   Project Subjects; 
  Table 3.12. Mean Intelligence Quotient of Children from Collaborative Perinatal Project Cohort; 
Question 2. What is the evidence for effect modification of the results in Question #1, 
by gestational age, hemolysis, serum albumin, and other factors?
Question 3. What are the quantitative estimates of efficacy of treatment at (1) reducing peak 
bilirubin levels (e.g., number needed to treat at 20 mg/dl to keep TSB from  rising); 
(2) reducing the duration of hyperbilirubinemia (e.g., average number of hours by which time 
TSB greater than 20 may be shortened by treatment); and (3) improving neurodevelopmental outcomes?
  Table 3.13. Summary Individual Studies of Efficacy of Phototherapy for Prevention of TSB Exceeding 
   20 mg/dl, in Healthy, Term or Near-Term (GA ≥ 34) Infants; 
  Table 3.14. Number Needed to Treat at TSB Level of 20 mg/dl to Keep TSB from Rising by Phototherapy 
   in Healthy a Jaundiced Term or Near-term (GA ≥ 34) Infants; 
  Table 3.15. Effectiveness of Decreasing Bilirubin Levels on Auditory Brainstem Response in 
   Jaundiced Infants (GA ≥ 34 weeks); 
  Table 3.16. Follow-up Results of Effectiveness of Decreasing Bilirubin Levels on Auditory Brainstem 
   Response in Jaundiced Infants (GA ≥ 34 weeks); 
  Table 3.17. Effect of Serum Bilirubin Levels on Neurodevelopmental Outcomes in Infants 
   with GA ≥ 34 weeks; 
  Table 3.18. Effect of Serum Bilirubin Levels on Visual Outcomes in Infants with GA ≥ 34 weeks; 
Question 4. What is the accuracy of various strategies for predicting hyperbilirubinemia, 
including hour-specific bilirubin percentiles?
  Table 3.19 - Part 1. Summary of Individual Studies of Prediction Strategies of Hyperbilirubinemia 
   in Healthy, Term or Near-Term (GA ≥ 34 weeks) Infants; 
  Table 3.19 - Part 2. Test Accuracy of Prediction Strategies of Hyperbilirubinemia in Healthy, 
   Term or Near-Term (GA ≥ 34 weeks) Infants; 
  Figure 3.6 Test Performance of Cord Bilirubin Levels; 
  Figure 3.7 Test Performance of Predischarge Risk Index; 
  Figure 3.8 Test Performance of Hour-Specific Bilirubin Percentile; 
Question 5. What is the accuracy of transcutaneous bilirubin measurements?
  Table 3.20. Description of Study Outcomes; 
  Table 3.21 - Part 1. Summary Studies of Minolta AirShields bilirubinometer in Healthy, Term or 
   Near-Term (GA ≥ 34) Infants not on phototherapy or Exchange Transfusion; 
  Table 3.21 - Part 2. Test Accuracy of Minolta AirShields bilirubinometer to Serum Bilirubin 
   Levels in Healthy, Term or Near-Term (GA ≥ 34) Infants not on phototherapy or Exchange Transfusion; 
  Table 3.22. Overall Correlation Coefficient of Minolta AirShields Measurements to Serum Bilirubin 
   Levels on Different Measurement Sites in Healthy Term Infants with (GA ≥ 34 weeks) 
   not on Phototherapy; 
  Table 3.23. Summary of Studies on the Effects of Gestational Age or Birth Weight to the 
   Accuracy of Minolta TcB measurements at Forehead in Term or Near-Term Infants not on Phototherapy; 
  Table 3.24. Summary of Studies on the Effects of Race / Skin Color to the Accuracy of Minolta TcB 
   measurements at Forehead in Term or Near-Term Infants not on Phototherapy; 
  Table 3.25. Summary of Studies on the Effects of Race / Skin Color to the Accuracy of Minolta TcB 
   measurements at Sternum in Term or Near-Term Infants not on Phototherapy; 
  Table 3.26. Summary of Studies on the Effects of Phototherapy to the Accuracy of Minolta TcB 
   measurements in Term or Near-Term Infants; 
  Table 3.27. Summary of Studies on the Effects of Other Factors to the Accuracy of Minolta TcB 
   measurements at Forehead in Term or Near-Term Infants not on Phototherapy; 
  Table 3.28. Summary of Studies on the Effects of Other Factors to the Accuracy of Minolta TcB 
   measurements at Sternum in Term or Near-Term Infants not on Phototherapy; 
  Table 3.29 - Part 1. Summary Studies of Bilicheck™ MMSR device in Healthy, Term or Near-Term 
   (GA ≥ 34) Infants not on Phototherapy or Exchange Transfusion; 
  Table 3.29 - Part 2. Test Accuracy of BiliCheck™ MMSR device in Healthy, Term or Near-Term 
   (GA ≥ 34) Infants not on Phototherapy or Exchange Transfusion; 
  Table 3.30 - Part 1. Summary Studies of Ingram Icterometer at Tip of Nose in Healthy, Term or 
   Near-Term (GA ≥ 34) Infants not on Phototherapy or Exchange Transfusion; 
  Table 3.30 - Part 2. Test Accuracy of Ingram Icterometer at Tip of Nose in Healthy, Term or 
   Near-Term (GA ≥ 34) Infants not on Phototherapy or Exchange Transfusion
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08chap4.doc	Microsoft Word® Document	MS Word®	2002		108KB	5 pages
Contents: Chapter 4. Conclusions: Association of Neonatal Hyperbilirubinemia to 
Neurodevelopmental Outcomes; Figure 4.1. Peak total serum bilirubin (TSB) values (mg/dl) 
obtained from case reports of 35 otherwise healthy infants with kernicterus superimposed on the 
distribution of peak TSB values from a birth cohort of 50,000 infants born in 11 California 
hospitals (Newman, Escobar, Gonzales et al., 1999); Treatment of Neonatal Hyperbilirubinemia 
in Relation to Neurodevelopmental Outcomes; Diagnosis of Neonatal Hyperbilirubinemia
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09chap5.doc	Microsoft Word® Document	MS Word®	2002		24KB	1 page
Contents: Chapter 5. Future Research
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10etbl1.doc	Microsoft Word® Document	MS Word®	2002		271KB	32 pages
Contents: Evidence Table 1. Question 1 - Studies evaluating association of neonatal 
hyperbilirubinemia to neurodevelopmental outcomes - Part I;
Evidence Table 1. Question 1 - Studies evaluating association of neonatal hyperbilirubinemia 
to neurodevelopmental outcomes - Part II
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11etbl1A.doc	Microsoft Word® Document	MS Word®	2002		35KB	1 page
Contents: Evidence Table 1A. Question 2: Study evaluating evidence for effect modification
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12etbl2.doc	Microsoft Word® Document	MS Word®	2002		80KB	7 pages
Contents: Evidence Table 2. Question 3: Treatment effect on decreasing bilirubin levels 
and changing auditory brainstem response in term or near-term jaundiced infants
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13etbl3.doc	Microsoft Word® Document	MS Word®	2002		93KB	11 pages
Contents: Evidence Table 3. Question 3: Studies evaluating treatments for neonatal 
hyperbilirubinemia in relation to later neurodevelopmental outcomes
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14etbl4.doc	Microsoft Word® Document	MS Word®	2002		117KB	13 pages
Contents: Evidence Table 4. Question 4: Studies evaluating the accuracy of various strategies 
for predicting hyperbilirubinemia
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15etbl5.doc	Microsoft Word® Document	MS Word®	2002		642KB	53 pages
Contents: Evidence Table 5.1. Question 5: Studies evaluating the accuracy of Minolta AirShields 
TcB bilirubinometer; 
Evidence Table 5.2. Studies evaluating the accuracy of Bilicheck™;
Evidence Table 5.3. Studies evaluating the accuracy of Ingram Icterometer; 
Evidence Table 5.4. Studies evaluating the accuracy of Colormate III
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16etbl6.doc	Microsoft Word® Document	MS Word®	2002		461KB	18 pages
Contents: Evidence Table 6.1. Kernicterus: Clinical data on term newborns with idiopathic 
jaundice who had kernicterus; 
Evidence Table 6.2. Kernicterus: Clinical data on term newborns with comorbid factors 
who had kernicterus
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17meta.doc	Microsoft Word® Document	MS Word®	2002		454KB	9 pages
Contents: Meta-Analyses: 
SROC and Combined Sensitivity and Specificity Analyses:
  Figure S1. SROC curve of AirShields Minolta bilirubinometer Measuring at Forehead as a 
   Screening Tool for Serum Bilirubin Level ≥ 13 mg/dL in Healthy Infants with GA ≥ 34 weeks 
   not on Phototherapy or Exchange Transfusion; 
  Table S1. Pooled Estimates of the Test Performance of AirShields Minolta TcB measurements 
   to Serum Bilirubin Level of 13 mg/dL at Forehead in Healthy Infants with GA ≥ 34 weeks 
   not on Phototherapy or Exchange Transfusion; 
  Table S2. Pooled Estimates of Test Performance of AirShields Minolta TcB measurements 
   to Serum Bilirubin Level of 11 mg/dL at Forehead in Healthy Infants with GA ≥ 34 weeks 
   not on Phototherapy or Exchange Transfusion; 
  Figure S2. Summary ROC of AirShields Minolta bilirubinometer to Serum Bilirubin Level of 
   11 mg/dL at Forehead in Healthy, Term or Near-Term Infants not on Phototherapy or Exchange 
   Transfusion; 
  Table S3. Pooled Estimates of Test Performance of AirShields Minolta TcB measurements 
   to Serum Bilirubin Level of 15 mg/dL at Forehead in Healthy Infants with GA ≥ 34 weeks 
   not on Phototherapy or Exchange Transfusion; 
Meta-analysis of Correlation Coefficients:
  Figure S3. Overall Meta-Analysis of Correlation Coefficients for Minolta AirShields 
   bilirubinometer; 
  Figure S4. Meta-analysis of Correlation Coefficients for Minolta AirShields Bilirubin 
   Measurements on Different Measurement Sites; 
  Figure S5. Effect of Gestational Age or Birth Weight; 
  Figure S6. Effect of Race or Skin Color Measured at Forehead; 
  Figure S7. Effect of Phototherapy; 
  Figure S8. Overall Meta-Analysis of Correlation Coefficients for BiliCheck™ Measurements; 
  Figure S9. Overall Meta-Analysis of Correlation Coefficients for Ingram Icterometer 
   Bilirubin Measurements
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18refs.doc	Microsoft Word® Document	MS Word®	2002		54KB	8 pages
Contents: References and Bibliography
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19apps.doc	Microsoft Word® Document	MS Word®	2002		222KB	22 pages
Contents: Appendix A. Search Strategy, Appendix B. Data Abstraction Forms, Appendix C. 
Acronyms and Abbreviations, Appendix D. Contributors
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AHRQ Publication No. 03-E011
Current as of January 2003


Internet Citation:

Management of Neonatal Hyperbilirubinemia. File Inventory, Evidence Report/Technology Assessment Number 65. AHRQ Publication No. 03-E011, January 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/neohypinv.htm


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