{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:36:36Z","timestamp":1791290196816,"version":"4.3.0"},"reference-count":36,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,9,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title><jats:p>Total serum bilirubin (TSB) levels \u226530 mg\/dL are rare but potentially hazardous. A better understanding of their incidence, causes, and outcomes could help inform preventive efforts.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>We identified infants born \u226535 weeks\u2019 gestational age from 1995\u20132011 in Kaiser Permanente Northern California (n = 525\u2009409) and examined the medical records of infants with a TSB \u226530 mg\/dL to determine etiology and the occurrence of acute bilirubin encephalopathy. We reviewed inpatient and outpatient encounters through 2013 for evidence of sensorineural hearing loss (SNHL) or cerebral palsy (CP).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>We identified 47 infants with TSB \u226530 mg\/dL (8.6 per 100\u2009000 births). In 44 infants (94%), the hyperbilirubinemia occurred after the initial birth hospitalization. The etiology was not identified in 33 (70%). Glucose-6-phosphate dehydrogenase (G6PD) activity was measured in only 25 (53%) of whom 10 (40%) were deficient. Four children had acute bilirubin encephalopathy of whom 2 developed both CP and SNHL, and 1 developed isolated SNHL. These 3 infants all had G6PD deficiency and TSB &amp;gt;40 mg\/dL. One additional 35-week infant with TSB 38.2 mg\/dL had SNHL.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Hazardous (\u226530 mg\/dL) hyperbilirubinemia is a rare event. No etiology could be identified from the clinical record in most cases. G6PD deficiency was the leading cause of hazardous hyperbilirubinemia when an etiology was identified, but many were not tested. Chronic, bilirubin-induced neurotoxicity was uncommon and occurred only in the setting of additional risk factors and TSB values well over (&amp;gt;15 mg\/dL) the American Academy of Pediatrics exchange transfusion thresholds.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2014-0987","type":"journal-article","created":{"date-parts":[[2014,8,5]],"date-time":"2014-08-05T02:34:15Z","timestamp":1407206055000},"page":"504-509","source":"Crossref","is-referenced-by-count":118,"title":["Incidence, Etiology, and Outcomes of Hazardous Hyperbilirubinemia in Newborns"],"prefix":"10.1542","volume":"134","author":[{"given":"Michael W.","family":"Kuzniewicz","sequence":"first","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, California;"},{"name":"Departments of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea C.","family":"Wickremasinghe","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kaiser Permanente Santa Clara, Santa Clara, California"},{"name":"Epidemiology and Biostatistics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne W.","family":"Wu","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"},{"name":"Neurology, University of California, San Francisco, San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles E.","family":"McCulloch","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen M.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soora","family":"Wi","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas B.","family":"Newman","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, California;"},{"name":"Departments of Pediatrics,"},{"name":"Epidemiology and Biostatistics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2014,9,1]]},"reference":[{"issue":"1","key":"2021120908535611400_B1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1542\/peds.114.1.297","article-title":"Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.","volume":"114","author":"Maisels","year":"2004","journal-title":"Pediatrics"},{"issue":"4","key":"2021120908535611400_B2","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1542\/peds.2009-0329","article-title":"Hyperbilirubinemia in the newborn infant \u226535 weeks\u2019 gestation: an update with clarifications.","volume":"124","author":"Maisels","year":"2009","journal-title":"Pediatrics"},{"key":"2021120908535611400_B3"},{"issue":"3","key":"2021120908535611400_B4","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1542\/peds.2004-1260","article-title":"Classifying recommendations for clinical practice guidelines.","volume":"114","author":"American Academy of Pediatrics Steering Committee on Quality Improvement and Management","year":"2004","journal-title":"Pediatrics"},{"issue":"21","key":"2021120908535611400_B5","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1056\/NEJMra1308124","article-title":"Bilirubin-induced neurologic damage\u2014mechanisms and management approaches.","volume":"369","author":"Watchko","year":"2013","journal-title":"N Engl J Med"},{"issue":"10","key":"2021120908535611400_B6","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1038\/sj.jp.7211152","article-title":"Kernicterus: epidemiological strategies for its prevention through systems-based approaches.","volume":"24","author":"Bhutani","year":"2004","journal-title":"J Perinatol"},{"issue":"8","key":"2021120908535611400_B7","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1111\/j.1651-2227.2008.00879.x","article-title":"Surveillance of extreme hyperbilirubinaemia in Denmark. 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