Patient Care

Dr. Shen Responds to Kernicterus Letters


 

I sincerely appreciate the responses to my review of an article (“Incidence Rates of Kernicterus Remain Unchanged,” The Hospitalist, October 2011, p. 12) that raised questions regarding a “resurgence” of kernicterus in the 1990s. Kernicterus is a devastating illness, and family members bear an unquestionable burden from this disease. Because phototherapy appears to limit the burden of disease, evidence-based guidelines for appropriate treatment of hyperbilirubinemia are paramount to decreasing the incidence of kernicterus. True rates of kernicterus have been difficult to calculate for a variety of reasons, yet we must get a handle on “who” gets kernicterus if we are to appropriately decide which infants receive phototherapy. Thus, I would strongly agree that using the California database is a limitation of the study reviewed.

The mission of the monthly “Pediatric HM” literature review is to regularly summarize articles that might be of interest in the field of pediatric HM. The letters to the editor we received highlight a critical need to delve deeper into the epidemiology of kernicterus, a journey that must begin with accurate reporting of this disease. We appreciate the opportunity to raise awareness of family-centered concerns surrounding the interpretation and analysis of scientific evidence.

As a final note, Mr. Spencer Brown’s letter states that “nearly half of all babies born (44,000 out of every 100,000) have hyperbilirubinemia” based on an incidence of 0.44 per 100,000 mentioned in my review. I would clarify that 0.44 per 100,000 is a rate of kernicterus and is not a percentage. Thus, 0.44 out of 100,000 children (or 4.4 per million) will develop kernicterus, not 44,000 per 100,000.

Mark Shen, MD, FHM, director of hospital medicine, Dell Children’s Medical Center, Austin, Texas, pediatric physician editor, The Hospitalist

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