25: Surveillance of Severe Neonatal Hyperbilirubinemia in Canada
Bibliographic record
Abstract
Hyperbilirubinemia is the most common cause of neonatal readmissions to hospital in Canada. The majority of neurological sequelae associated with severe neonatal hyperbilirubinemia can be avoided through early detection and proper treatment. Our previous surveillance study through the Canadian Pediatric Society (CPS) estimated the incidence of severe neonatal hyperbilirubinemia to be one in 2480 live births from 2002 to 2004. These and other studies influenced the 2007 CPS position statement “Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks gestation)”, which recommended routine bilirubin screening on all infants in the first 72 h of life. To compare rates of severe hyperbilirubinemia pre- and post- introduction of the Canadian guidelines and comment on their effectiveness. Data on infants (60 days of age or less) were collected prospectively through the Canadian Paediatric Surveillance Program. Infants born between March 2011 and February 2013 were included if they either had a peak serum total bilirubin >425 μmol/L or underwent neonatal exchange transfusion. Infants who have had exchange transfusion for well-documented Rh isoimmunization disease or who were born at less than 35 weeks' gestational age were excluded. A total of 141 cases were reported, of which 88 were confirmed to be severe neonatal hyperbilirubinemia. The cause of hyperbilirubinemia was identified in 54 cases and included ABO incompatibility (n=33), glucose-6-phosphate dehydrogenase deficiency (n=10), other antibody incompatibility (n=5) and sepsis (n=3). Mean (± SD) reported peak bilirubin was 482±92 μmol/L (range 181 μmol/L to 788 μmol/L). Twenty infants (37%) underwent an exchange transfusion. A total of 67 infants (76.1%) were readmitted to hospital, 35 (39.8%) of them within five days of age. Comparisons with our previous surveillance data (2002 to 2004) showed that an infant was 3.48 times more likely to be diagnosed with severe hyperbilirubinemia prior to the guidelines. Severe neonatal hyperbilirubinemia continues to occur in Canada with an estimated incidence of 1.2 per 10,000; our previous surveillance data had estimated the 2002 to 2004 incidence rate to be 4 per 10,000. This significant reduction (P<0.001) is likely the result of the new Canadian Paediatric Society guidelines combined with increased physician awareness of severe neonatal hyperbilirubinemia though numerous publications in the last 10 years.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".