In 2004, the American Academy of Pediatrics has given the recommendation to make newborns undergo the measurement of bilirubin levels, since kernicterus – even if extremely rare – implies dramatic and dreadful consequences. This recommendation, at least in the USA, has not been universally put into action and some trials have been recently performed in order to evaluate the spreading of this simple screening. In a retrospective trial performed in California, the incidence of neonatal hyperbilirubinemia before and after the screening was compared on at least 35-week-gestation newborns. Between 1995 and 2007, 319,904 children have been born and 38,182 have been born after the introduction of screening through blood sample or percutaneous evaluation. Screening was associated with a 62% reduction in bilirubin levels which, according to the recommendation of the American Academy of Pediatrics, require exchange transfusion. In the same time, there has been a more frequent use of phototherapy (9.1% vs. 4.2%). In a systematic review on 11 trials (involving about 125,000 children), the screening presented a good sensitiveness and specificity in discovering hyperbilirubinemia. In no trial the association between screening and hyperbilirubinemia-related encephalopathy has been evaluated. As to the U.S. Preventive Services Task Force (USPSTF), we can read that “the evidence is insufficient to recommend screening”. The discussion is still open.
kernicterus prevention is imperative, but this situation is very rare (1 case out of 100,000 newborns) and so the usefulness of screening is very difficult to establish, given the fact that parameters to be considered are many. An aspect not to be underestimated concerns the possible damages related to the screening (an increase in the use of phototherapy and an increase in hospitalizations). It would be opportune to perform a randomized trial to clear up the matter in a definitive way.
