Objective

The objective of this study was to assess the prevalence and trends for neonatal hyperbilirubinemia, and the development of bilirubin neurotoxicity in the USA.

Study Design

We used a de-identified national dataset for the years 2002–2017. The study included all newborn inpatients with postnatal age ≤28 days. Cochran–Armitage trend test was used for trend analyses. Regression analyses were performed and adjusted odds ratios (aOR) were reported.

Results

The study included 57,989,476 infants; of them 53,259,758 (91.8%) were term infants and 4,725,178 (8.2%) were preterm infants. Bilirubin neurotoxicity decreased over the years in term infants (Z = 0.36, p = 0.03) without change in preterm infants (Z = 42.5, p = 0.12). Black neonates were less likely to be diagnosed with hyperbilirubinemia than White neonates (aOR = 0.77, 95% confidence interval (CI): 0.77–0.78, p < 0.001) and more likely to develop bilirubin neurotoxicity than White neonates (aOR = 3.0.5, 95% CI: 2.13–4.36, p < 0.001). Bilirubin neurotoxicity rate in the overall population was 2.4 per 100,000 live births.

Conclusions

Bilirubin neurotoxicity has significantly decreased in term infants and did not change in preterm infants. Despite the less diagnosis of hyperbilirubinemia in Black newborns, they are disproportionately at increased risk of developing bilirubin neurotoxicity when compared to White newborns.

Impact

In this article, we analyzed the National Inpatient Database. This is the largest study of its kind using data on 57,989,476 neonates. The article has multiple novel findings: (1) it demonstrated that utilization of phototherapy has increased significantly over the years, (2) the rate of kernicterus for neonates decreased in term infants and did not change in preterm babies, (3) kernicterus was mostly encountered in infants without isoimmunization jaundice, and (4) there is a clear racial disparity in neonatal jaundice; although Black newborns have less neonatal jaundice, they are at increased risk of developing kernicterus.

中文翻译：

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住院新生儿的新生儿高胆红素血症和胆红素神经毒性：美国数据库分析

客观的

本研究的目的是评估美国新生儿高胆红素血症的患病率和趋势，以及胆红素神经毒性的发展。

学习规划

我们使用了 2002-2017 年去识别的国家数据集。该研究包括所有出生后年龄≤28天的新生儿住院患者。Cochran-Armitage 趋势检验用于趋势分析。进行了回归分析并报告了调整优势比（aOR）。

结果

该研究包括 57,989,476 名婴儿；其中足月儿53,259,758人（91.8%），早产儿4,725,178人（8.2%）。足月儿的胆红素神经毒性多年来下降（Z  = 0.36，p  = 0.03），而早产儿没有变化（Z  = 42.5，p  = 0.12）。黑人新生儿被诊断为高胆红素血症的可能性低于白人新生儿（aOR = 0.77, 95% 置信区间 (CI): 0.77–0.78, p  < 0.001）并且比白人新生儿更可能发生胆红素神经毒性（aOR = 3.0.5 , 95% CI: 2.13–4.36, p  < 0.001)。总人口中胆红素神经毒性率为 2.4/100,000 活产儿。

结论

胆红素神经毒性在足月儿中显着降低，而在早产儿中没有变化。尽管黑人新生儿的高胆红素血症诊断较少，但与白人新生儿相比，他们发生胆红素神经毒性的风险不成比例地增加。

影响

在本文中，我们分析了全国住院患者数据库。这是同类研究中规模最大的一项，使用了 57,989,476 名新生儿的数据。这篇文章有多个新发现：（1）它证明光疗的利用多年来显着增加，（2）新生儿核黄疸的发生率在足月婴儿中下降，而在早产儿中没有变化，（3）核黄疸主要是未发生同种免疫黄疸的婴儿，（4）新生儿黄疸存在明显的种族差异；尽管黑人新生儿的新生儿黄疸较少，但他们患核黄疸的风险增加。