Screening for Bilirubin Encephalopathy. Evidence Synthesis Number 72

摘要

Background: Kernicterus or chronic bilirubin encephalopathy is a devastating disease. Thus, it is important to examine strategies to prevent the development of kernicterus. Purpose: To systematically review evidence for the effectiveness of strategies to prevent chronic bilirubin encephalopathy. This is an update of our previous evidence report. Data Sources: We searched Medline for articles from September, 2001 to August, 2007 using the MeSH terms and keywords, such as jaundice, bilirubin, hyperbilirubinemia, and kernicterus. For additional studies, we examined the bibliographies in existing studies and also consulted the lead experts from USPSTF. Study Selection: We identified 18 articles that met our inclusion/exclusion criteria. Three studies in two publications addressed key question 2 (Does risk factor assessment accurately identify infants who may benefit from bilirubin testing), nine studies addressed key question 3 (Does bilirubin testing accurately identify infants who may benefit from phototherapy), and nine studies addressed key question 6 (What are the harms of treatment with phototherapy). Of the 11 studies that addressed key questions 2 and 3, five were of fair quality; six were of poor quality according to US Preventive Services Task Force (USPSTF) criteria. We did not grade the methodological quality for the nine studies that addressed key question 6. Data Extraction: Data elements were abstracted on to standardized forms and included information about the study setting, population, control, description of screening strategy, definitions of bilirubin encephalopathy and elevated bilirubin, and methods of analyses.