International Perspectives: Hyperbilirubinemia and Kernicterus in Neonates in China

Lizhong Du; Xiaolu Ma

doi:10.1542/neo.13-3-e141

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Objectives

After completing this article, readers should be able to:

Describe the unique characteristics of neonatal jaundice in Chinese infants.
Describe the major findings from a recent epidemiological survey of bilirubin encephalopathy or kernicterus in China.
Understand the primary causes and current problems for decreasing the incidence of bilirubin encephalopathy or kernicterus in China.
Outline future directions for obtaining population based data on bilirubin encephalopathy or kernicterus and formulating optimal management of neonatal jaundice.

Introduction

Hyperbilirubinemia is the number one reason for neonatal admission in most Chinese neonatal units. Early severe neonatal hyperbilirubinemia, resulting in bilirubin encephalopathy, may cause kernicterus, with residual hearing loss, cerebral palsy, neurodevelopmental disabilities, and other complications. It inflicts a heavy burden on both families and society. With the use of phototherapy, exchange transfusion, and other treatment technologies, kernicterus became less common, but an upward trend in incidence has been observed in recent years. China's large population, the very uneven distribution of medical resources between regions, and Asians being at high risk for hyperbilirubinemia suggest that the incidence of bilirubin encephalopathy and kernicterus should be higher than that in Western countries. Because of the lack of large-sample epidemiological surveys and population-based disease reporting systems, the specific incidence is not clear.

Characteristics of Chinese Neonatal Jaundice

In 1998, Yeung (1) summarized the characteristics of neonatal jaundice in China: 1) high unconjugated hyperbilirubinemia causing neonatal jaundice is particularly prevalent in South China; 2) he believes there is a “Chinese nonspecific neonatal jaundice” characterized by the clinical jaundice being more severe and longer lasting and having a delayed peak that occurs after the fourth day; 3) hemolytic disease of the newborn due to ABO incompatibility is the most common form of hemolytic jaundice; 4) in neonates with glucose-6-phosphate dehydrogenase (G6PD) deficiency, an acute bilirubin encephalopathy can appear late in the neonatal period; and 5) resolution of …