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Clinical question: What is the incidence of kernicterus over the past few decades?

Background: Recent guidelines for hyperbilirubinemia have recommended a systematic approach to management in order to prevent the occurrence of severe hyperbilirubinemia and, potentially, kernicterus. There has been concern that rates of kernicterus might have increased in the 1990s, when a “kindler, gentler” approach to hyperbilirubinemia was advocated by earlier guidelines.

Study design: Retrospective observational study.

Setting: California registry of developmental services enrollees.

Synopsis: Of 64,346 children born from 1988 to 1997 who received services from the California Department of Developmental Services (DDS) from 1988 to 2002, 25 met a strict definition of kernicterus. The time trend of incidence remained stable during the study years at 0.44 (95% confidence interval [CI]: 0.28-0.65) per 100,000 live births. There were no significant differences in rates before and after 1994.

Data from a national database of death certificates revealed a similar stable trend in deaths attributed to kernicterus.

A primary limitation of this study is the lack of clarity surrounding enrollment in California’s DDS by children with kernicterus. Although all children with developmental disabilities are eligible, the exact enrollment rate likely is unknown. However, this is one of the first studies to put a denominator on kernicterus in this country.

Updated guidelines on the management of hyperbilirubinemia in 2004 advocated a safer, more systematic approach to management, in part because of concerns that there had been a resurgence of kernicterus. This now seems less likely and this article adds to a body of literature that raises questions about whether a large population of patients with hyperbilirubinemia who are at extremely low risk for kernicterus are being overtreated.

Bottom line: Kernicterus rates remained unchanged in the 1990s.

Citation: Brooks JC, Fisher-Owens SA, Wu YW, Strauss DJ, Newman TB. Evidence suggests there was not a “resurgence” of kernicterus in the 1990s. Pediatrics. 2011;127:672-679.

Reviewed by Pediatric Editor Mark Shen, MD, FHM, medical director of hospital medicine at Dell Children’s Medical Center, Austin, Texas.

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