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 ________________________________________________________________________________________________ 01front.doc Microsoft Word® Document MS Word® 2002 36KB 4 pages Contents: Title Page, Preface ________________________________________________________________________________________________ 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 ________________________________________________________________________________________________ 03conts.doc Microsoft Word® Document MS Word® 2002 148KB 6 pages Contents: Table of Contents ________________________________________________________________________________________________ 04summ.doc Microsoft Word® Document MS Word® 2002 62KB 8 pages Contents: Summary: Overview, Reporting the Evidence, Methods, Methodological Quality, Results, Future Research ________________________________________________________________________________________________ 05chap1.doc Microsoft Word® Document MS Word® 2002 32KB 4 pages Contents: Chapter 1. Introduction: Purpose of Report, Background, Neonatal Hyperbilirubinemia, Burden of Disease ________________________________________________________________________________________________ 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 ________________________________________________________________________________________________ 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 ________________________________________________________________________________________________ 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 ________________________________________________________________________________________________ 09chap5.doc Microsoft Word® Document MS Word® 2002 24KB 1 page Contents: Chapter 5. Future Research ________________________________________________________________________________________________ 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 ________________________________________________________________________________________________ 11etbl1A.doc Microsoft Word® Document MS Word® 2002 35KB 1 page Contents: Evidence Table 1A. Question 2: Study evaluating evidence for effect modification ________________________________________________________________________________________________ 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 ________________________________________________________________________________________________ 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 ________________________________________________________________________________________________ 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 ________________________________________________________________________________________________ 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 ________________________________________________________________________________________________ 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 ________________________________________________________________________________________________ 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 ________________________________________________________________________________________________ 18refs.doc Microsoft Word® Document MS Word® 2002 54KB 8 pages Contents: References and Bibliography ________________________________________________________________________________________________ 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 ________________________________________________________________________________________________
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
Return to Evidence-based Practice
Clinical Information
AHRQ Home Page
Department of Health and Human Services