Severe neonatal hyperbilirubinaemia: lessons learnt from a national perinatal audit

Arch Dis Child Fetal Neonatal Ed. 2022 Sep;107(5):527-532. doi: 10.1136/archdischild-2021-322891. Epub 2022 Jan 28.


Objectives: To describe characteristics of neonates with severe neonatal hyperbilirubinaemia (SNH) and to gain more insight in improvable factors that may have contributed to the development of SNH.

Design and setting: Descriptive study, based on national Dutch perinatal audit data on SNH from 2017 to 2019.

Patients: Neonates, born ≥35 weeks of gestation and without antenatally known severe blood group incompatibility, who developed hyperbilirubinaemia above the exchange transfusion threshold.

Main outcome measures: Characteristics of neonates having SNH and corresponding improvable factors.

Results: During the 3-year period, 109 neonates met the eligibility criteria. ABO antagonism was the most frequent cause (43%). All neonates received intensive phototherapy and 30 neonates (28%) received an exchange transfusion. Improvable factors were mainly related to lack of knowledge, poor adherence to the national hyperbilirubinaemia guideline, and to incomplete documentation and insufficient communication of the a priori hyperbilirubinaemia risk assessment among healthcare providers. A priori risk assessment, a key recommendation in the national hyperbilirubinaemia guideline, was documented in only six neonates (6%).

Conclusions: SNH remains a serious threat to neonatal health in the Netherlands. ABO antagonism frequently underlies SNH. Lack of compliance to the national guideline including insufficient a priori hyperbilirubinaemia risk assessment, and communication among healthcare providers are important improvable factors. Implementation of universal bilirubin screening and better documentation of the risk of hyperbilirubinaemia may enhance early recognition of potentially dangerous neonatal jaundice.

Keywords: audit; jaundice; neonatology.

MeSH terms

  • Bilirubin
  • Ethnicity
  • Humans
  • Hyperbilirubinemia, Neonatal* / diagnosis
  • Hyperbilirubinemia, Neonatal* / epidemiology
  • Hyperbilirubinemia, Neonatal* / therapy
  • Infant, Newborn
  • Jaundice, Neonatal* / etiology
  • Phototherapy / adverse effects


  • Bilirubin