|Care of the Jaundiced Neonate|
Chapter 12. Public Policy to Prevent Severe Neonatal Hyperbilirubinemia
Vinod K. Bhutani
Topics Discussed: gastroenterology and hepatology; hyperbilirubinemia; kernicterus; neonatal jaundice; neonatology; neurology; public policy.
Sections: Background, Recent Changes in Preventive Approaches, Progress in Reducing Risk of Adverse Outcomes, Recent Multinational Reviews, The Societal Role, Maternal Child Health Care Infrastructure and Public Policy, Research Needs, Policy Issues to Prevent Severe Neonatal Hyperbilirubinemia, Conclusions, Useful Web Sites, Useful Policies and Their Access, Acknowledgment, References.
Excerpt:"Newborn jaundice, regardless of its etiology, is a matter of newborn safety, and when it is unrecognized or unmonitored or progresses untreated, it can lead to severe hyperbilirubinemia.15 Because kernicterus is preventable, but not treatable, public health policies need to be focused and rooted in a preventive approach.6 Thus, neonatal hyperbilirubinemia not only is an important public health issue but also has significant clinical, societal, and economic consequences for both maternalchild health care and educational systems in the United States. Of the approximately 4 million live births each year, over 80% of term infants, and most preterm infants, manifest jaundice during the first week after birth.68 Progression to severe hyperbilirubinemia is due to either increased bilirubin production or impaired bilirubin elimination.911 From 1967 to 2000, about 0.140.16% of term infants without known Rh disease (140160/100,000 live births) developed severe hyperbilirubinemia (total serum bilirubin [TSB] levels >20 mg/dL) that required emergency treatment, such as an exchange transfusion, and were at risk for adverse neurologic outcomes.10,1214 Kernicterus, the ultimate manifestation of irreversible bilirubin-induced neurologic dysfunction (BIND), is more evident among infants with concurrent hemolytic disorders, prematurity, sepsis, and glucose-6-phosphate dehydrogenase (G6PD) deficiency. In about half of the reported cases of kernicterus in the United States, the cause is..."
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