[Neonatal Hyperbilirubinemia - Bridging the Care Gap in the Early Neonatal Period].

BACKGROUND

Kernicterus resulting from excessive bilirubin concentrations can be effectively prevented by early diagnosis and therapy. The postnatal rise of bilirubin peaks at a time of life most newborn infants have been discharged home while the next scheduled well baby visit is several weeks ahead.

AIM: Evaluating a post-discharge bilirubin follow-up program established in 2010.

METHODS

Retrospective analysis of newborns seen 2010-2024 at the Berlin University Medical Center bilirubin outpatient clinic, exchange transfusions performed in the same time period, and infants admitted for phototherapy in 2022.

RESULTS

The median annual number of infants consulting the outpatient clinic was 616 in 2010-2016, as compared to 1858 in 2017-2024. In 2022, 6% of newborns seen at the outpatient clinic were admitted for treatment of hyperbilirubinemia at a median age of 6 [5-7] days, with a total serum bilirubin concentration of 20.5 [19.3-21.4] mg/dl). The 2 top indications for the 81 exchange transfusions performed in 78 patients were rhesus incompatibility (n=44; 56%) and gestational alloimmune liver disease (n=24; 31%). The bilirubin level immediately prior to exchange transfusion was 15.5 [12.5-20.0] mg/dl (highest measured value 38.1 mg/dl).

CONCLUSION

A post-discharge program attached to a neonatal unit can effectively bridge the gap in care between discharge and scheduled well-baby visits several weeks ahead. A mandatory U2a could standardize follow-up care for neonatal hyperbilirubinemia in the future.