Clinical and Laboratory ObservationsBlack Race Is Not Protective Against Hazardous Bilirubin Levels
Section snippets
Methods
We studied a cohort of infants ≥35 weeks' gestation, born in 20 Kaiser Permanente Northern California (KPNC) hospitals from January 1, 1995, through December 31, 2011. We used demographic and laboratory data from existing KPNC databases. Self-reported maternal race/ethnicity, our primary predictor, was obtained from 2 sources: a KPNC administrative database (1995-2011) and California birth certificates (1995-2006). Because infant race/ethnicity is not captured in the California birth
Results
The cohort consisted of 539 123 infants, 5% of who were late-preterm (35 to 36-6/7 weeks). Using KPNC race data, we found that 43% of mothers self-identified as white and 7% black. Birth certificate race data were available for 377 016 infants; of these, 40% identified as white and 8% black.
The risk of TSB ≥20 mg/dL was lower in black infants than in white infants (RR 0.62; 95% CI 0.56-0.69). There was no difference in risk of TSB ≥25 mg/dL. However, black infants were at greater risk of having
Discussion
Although black race was associated with a lower risk of TSB ≥20 mg/dL, it was associated with a greater risk of TSB ≥30 mg/dL. These results confirm the apparent discrepant findings that black race is associated with both a decreased risk of severe hyperbilirubinemia and an increased risk of kernicterus.
It is unclear why the relationship between black race and hyperbilirubinemia changes at TSB ≥25 mg/dL and ≥30 mg/dL; G6PD deficiency may mediate the relationship.8 G6PD deficiency occurs in 13%
References (10)
Hyperbilirubinemia in African American neonates: clinical issues and current challenges
Semin Fetal Neonatal Med
(2010)Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation
Pediatrics
(2004)- et al.
Management of hyperbilirubinemia in newborns: measuring performance by using a benchmarking model
Pediatrics
(2003) - et al.
Frequency of neonatal bilirubin testing and hyperbilirubinemia in a large health maintenance organization
Pediatrics
(1999) - et al.
A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants
Pediatrics
(2008)
Cited by (29)
Neonatal Hyperbilirubinemia and Kernicterus
2023, Avery's Diseases of the NewbornA New Hour-Specific Serum Bilirubin Nomogram for Neonates ≥35 Weeks of Gestation
2021, Journal of PediatricsCitation Excerpt :By making use of a different population of neonates, from a different geographic location, and with 140 times the amount of data, we created a nomogram with remarkable overall similarity to the 1999 version. Other gaps the new nomogram fill include (1) clarifying that there is no difference in TSB values between male and female neonates, (2) clarifying that there are higher TSB values among late-preterm vs term neonates, and (3) clarifying that neonates of Black race have lower initial TSB values20-23 and those of Asian race have higher initial TSB values.24,25 There have been criticisms that the 40th percentile in the 1999 nomogram was higher than on other nomograms that were available around that time.8,9
Hyperbilirubinemia in the Term Infant: Re-evaluating What We Think We Know
2021, Clinics in PerinatologyCitation Excerpt :Of 125 cases of kernicterus reported in the US-based Kernicterus Registry, 26% were black, overrepresented relative to the 12% overall black frequency in the US population.12 Recently, in a Californian survey, Wickremasinghe and colleagues54 confirmed that black infants were at greater risk than white infants of developing extreme hyperbilirubinemia levels greater than or equal to 30 mg/dL (RR 4.2; 95% CI, 1.33–13.2). Black newborns in the United Kingdom, Ireland,14 and Central and West Africa also have been shown to have a high incidence of severe neonatal hyperbilirubinemia and kernicterus.55,56
Association between Hyperbilirubinemia and Hearing Screen Failure in the Neonatal Intensive Care Unit in Infants Born Preterm
2021, Journal of PediatricsCitation Excerpt :Because universal CMV screening is not mandated, all infections may not have been caught. Another possible explanation is that Black infants are at increased risk for hemolytic diseases such as glucose-6-phosphate dehydrogenase deficiency, which may cause adverse outcomes at lower bilirubin levels.40 Yet another possibility is that Black and Hispanic children were treated for jaundice at a higher peak bilirubin level or older age.
Variation in Transcutaneous Bilirubin Nomograms across Population Groups
2019, Journal of PediatricsNursing Diagnosis of Neonatal Jaundice: Study of Clinical Indicators
2018, Journal of Pediatric NursingCitation Excerpt :This review found 121 articles, and only 9 were analyzed after the establishment of inclusion and exclusion criteria. These articles addressed the following topics: the influence of genetic factors in neonatal jaundice (Bisoi, Chakraborty, Chattopadhyay, Biswas, & Ray, 2012; Carvalho et al., 2011; Iglessias et al., 2010; Yusoff et al., 2010); the incidence of neonatal jaundice and its risk factors (Scrafford et al., 2013); the morbidity of ABO hemolytic disease in the newborn (Bhat & Kumar, 2012); the influence on direct bilirubin levels of neonates in four anesthetic strategies used during cesarean (Demiraran et al., 2011); the protective effect of the black race on hazardous bilirubin levels in neonates (Wickremasinghe, Kuzniewicz, & Newman, 2013); and the epidemiology of neonatal jaundice at the University Hospital of the West Indies (Henny-Harry & Trotman, 2012). The results revealed that none of articles evaluated neonatal jaundice as a nursing diagnosis and indicated no new clinical indicators, only those already in the NANDA-I taxonomy.
The authors declare no conflicts of interest.