Neonatal Hyperbilirubinaemia:Moving towards screening and treatment in primary care

Abstract

Jaundice is a common phenomenon in babies during the first days of life. In most babies, jaundice resolves spontaneously. However, in some babies, the substance that causes jaundice, bilirubin, may raise to extreme levels and may cause brain damage. Hence, it is important to recognise and treat these babies in time. In this thesis, we show that severe jaundice still occurs in the Netherlands. Guidelines are regularly not adhered to in babies with severe jaundice. Non-adherence to the guideline is often not mentioned as improvable factor. Additionally, a wait-and-see approach regarding neonatal jaundice is often performed, even in severely jaundiced babies. To improve recognition and treatment of neonatal jaundice, a large trial was conducted (STARSHIP Trial). In this trial, (1) daily measurements of the degree of jaundice of the skin and (2) treatment of neonatal jaundice were performed in seven primary care birth centres (rather than in the hospital). The first, preliminary results show that hospital admission was avoided in approximately 85% of the babies after implementation of treatment for neonatal jaundice in primary care birth centres. Parents were generally satisfied with this treatment. Not all babies in the Netherlands are cared for in a primary care birth centre during the first days of life. Consequently, it is important to improve recognition of severe jaundice at home as well. A new trial has been designed to research new screening and diagnostic methods at home (BEAT jaundice@home study). The design of this trial is also described in this thesis.The findings presented in this thesis may contribute to avoid severe jaundice and its potentially lifelong consequences in the future.<br/