Extreme neonatal hyperbilirubinemia and kernicterus spectrum disorder in Denmark during the years 2000-2015

Objective To determine the incidence and etiology of extreme neonatal hyperbilirubinemia, defined as total serum bilirubin (TSB) >= 450 mu mol/L, and kernicterus spectrum disorder (KSD) in Denmark between 2000 and 2015. Study design We identified all infants born between 01.01.2000 and 31.12.2015 with TSB >= 450 mu mol/L, ratio of conjugated to TSB <0.30, gestational age >= 35 weeks, and postnatal age <= 4 weeks, using Danish hospitals' laboratory databases. Result We included 408 infants. The incidence of extreme neonatal hyperbilirubinemia among infants with gestational age >= 35 weeks was 42/100,000 during the study period with a seemingly decreasing incidence between 2005 and 2015. Twelve of the 408 infants developed KSD, (incidence 1.2/100,000) Blood type ABO isohemolytic disease was the most common explanatory etiology. Conclusions Our study stresses the importance of a systematic approach to neonatal jaundice and ongoing surveillance of extreme neonatal hyperbilirubinemia and KSD.