Association of Transcutaneous Bilirubin Testing in Hospital with Decreased Readmission Rate for Hyperbilirubinemia (Evidence-Based Laboratory Medicine and Test Utilization‪)‬

The most common cause of jaundice in newborns is increased unconjugated Bilirubin in the blood that is in large part attributable to immaturity of hepatic uptake, conjugation, and secretion of Bilirubin. Neonatal hyperbilirubinemia is usually a benign condition, peaking 2-4 days after birth, that requires no intervention. However, severe neonatal hyperbilirubinemia (Bilirubin 308-342 [micro]mol/L) occurs in 4-10% of newborns (1-3) and requires treatment with phototherapy or, in extreme cases, exchange blood transfusion. If not treated promptly and efficiently, hyperbilirubinemia can lead to kernicterus. This staining of the basal ganglia is associated with severe and irreversible brain damage, including athetoid cerebral palsy and sensori-neural hearing loss. Although preventable, kernicterus has been increasing in prevalence in the United States (4). One possible reason for this increase is that, to reduce healthcare costs, babies are being discharged from hospitals within 1-2 days of birth (2, 3), before the time that hyperbilirubinemia usually becomes clinically evident or significant. Thus, early discharge has been associated with increased readmissions attributable to hyperbilirubinemia (1,2,5). It appears critical to identify, before discharge, those newborns who are at risk of developing hyperbilirubinemia that will require treatment. Indeed, the newly revised clinical practice guideline of the American Academy of Pediatrics (6) recommends that all infants who are jaundiced in the first 24 h should have bilirubin measurement, either serum or transcutaneous, and that all infants should be assessed for risk of significant hyperbilirubinemia before nursery discharge.