Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization

Arch Pediatr Adolesc Med. 2000 Nov;154(11):1140-7. doi: 10.1001/archpedi.154.11.1140.


Objective: To investigate biological and health services predictors of extreme neonatal hyperbilirubinemia in a health maintenance organization.

Design: Nested case-control study.

Setting: Eleven Northern California Kaiser Permanente hospitals.

Subjects: The cohort consisted of 51,387 newborns born at 36 weeks or later weighing 2000 g or more. Cases were newborns with peak total serum bilirubin levels greater than or equal to 428 micromol/L (> or =25 mg/dL) (n = 73). Controls were a random sample of newborns from the cohort with peak bilirubin levels less than 428 micromol/L (<25 mg/dL) (n = 423).

Measurements: Review of medical records and telephone interviews.

Results: Early jaundice was most strongly associated with case status (odds ratio [OR] = 7.3). After excluding subjects with early jaundice, the strongest predictors of hyperbilirubinemia were family history of jaundice in a newborn (OR = 6.0), exclusive breastfeeding (OR = 5.7), bruising (OR = 4.0), Asian race (OR = 3.5), cephalhematoma (OR = 3.3), maternal age of 25 years or older (OR = 3.1), and lower gestational age (OR = 0.6/week). These variables identified 61% of newborns as very low risk (about 1/4200). However, the risk in the remaining 39% was still low (1/370). More cases (79%) than controls (59%) had newborn length-of-stay and follow-up consistent with the American Academy of Pediatrics guidelines, but phototherapy use within 8 hours of the time that the guidelines recommend was uncommon in both cases (26%) and controls (33%). There were no apparent cases of kernicterus.

Conclusions: Prevention of extreme hyperbilirubinemia may require closer follow-up than is currently recommended by the American Academy of Pediatrics and more use of phototherapy than was observed in this study. To prevent extreme hyperbilirubinemia (> or =428 micromol/L [> or =25 mg/dL]) in 1 newborn, many newborns would need to receive these interventions.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Bilirubin / blood
  • Case-Control Studies
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Guidelines as Topic
  • Health Maintenance Organizations*
  • Hospitalization
  • Humans
  • Infant, Newborn
  • Jaundice, Neonatal / diagnosis
  • Jaundice, Neonatal / epidemiology
  • Jaundice, Neonatal / prevention & control*
  • Jaundice, Neonatal / therapy
  • Length of Stay
  • Male
  • Phototherapy / methods
  • Phototherapy / statistics & numerical data
  • Retrospective Studies


  • Bilirubin