Clinical and Laboratory Observations
Black Race Is Not Protective Against Hazardous Bilirubin Levels

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Although black race is considered protective against hyperbilirubinemia, black infants appear at increased risk of kernicterus. We found that although black infants have a lower risk of developing total serum bilirubin levels ≥20 mg/dL than white infants, they appear at greater risk of developing levels ≥30 mg/dL.

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%

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The authors declare no conflicts of interest.

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