CLINICAL SUMMARY OF U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATION

PopulationHealthy newborn infants ≥35 weeks’ gestational age
RecommendationNo recommendation.
Grade: I (Insufficient Evidence)
Risk AssessmentRisk factors for hyperbilirubinemia include family history of neonatal jaundice, exclusive breastfeeding, bruising, cephalohematoma, ethnicity (Asian, black), maternal age >25 years, male gender, G6PD deficiency, and gestational age <36 weeks.
The specific contribution of these risk factors to chronic bilirubin encephalopathy in healthy children is not well understood.
ImportanceChronic bilirubin encephalopathy is a rare but devastating condition. Not all children with chronic bilirubin encephalopathy have a history of hyperbilirubinemia.
Balance of Benefits and HarmsEvidence about the benefits and harms of screening is lacking. Therefore, the USPSTF could not determine the balance of benefits and harms of screening newborns for hyperbilirubinemia to prevent chronic bilirubin encephalopathy.
Considerations for PracticeIn deciding whether to screen, clinicians should consider the following:
  • Potential preventable burden. Bilirubin encephalopathy is a relatively rare disorder. Hyperbilirubinemia alone does not account for the neurologic condition of chronic bilirubin encephalopathy. There is no known screening test that will reliably identify all infants at risk of developing chronic bilirubin encephalopathy.
  • Potential harms. Potential harms of screening are unmeasured but may be important. Evidence about the potential harms of phototherapy is lacking. Harms of treatment by exchange transfusion may include apnea, bradycardia, cyanosis, vasospasm, thrombosis, necrotizing enterocolitis, and, rarely, death.
  • Current practice. Universal screening is widespread in the United States.
Screening TestsScreening may consist of risk-factor assessment, measurement of bilirubin level either in serum or by transcutaneous estimation, or a combination of methods.
InterventionsPhototherapy is commonly used to treat hyperbilirubinemia.
Exchange transfusion is used to treat extreme hyperbilirubinemia.
Relevant USPSTF RecommendationsUSPSTF recommendations on screening newborns for hearing loss, congenital hypothyroidism, hemoglobinopathies, and phenylketonuria (PKU) can be found at http://www​.uspreventiveservicestaskforce.org.

From: Recommendations for Children and Adolescents

Cover of The Guide to Clinical Preventive Services 2012
The Guide to Clinical Preventive Services 2012: Recommendations of the U.S. Preventive Services Task Force.

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