Trends of extreme hyperbilirubinemia related infant mortality in select European countries (1990-2019)

Ramesh Vidavalur; Karl F Schettler; Carlo Dani; Sotirios Fouzas; Gabriela Mimoso; Manuel Sanchez-Luna; Vinod K Bhutani; Daniele deLuca

doi:10.1038/s41390-024-03695-2

Trends of extreme hyperbilirubinemia related infant mortality in select European countries (1990-2019)

Pediatr Res. 2024 Nov 14. doi: 10.1038/s41390-024-03695-2. Online ahead of print.

Authors

Ramesh Vidavalur^{1

2}, Karl F Schettler³, Carlo Dani⁴, Sotirios Fouzas⁵, Gabriela Mimoso⁶, Manuel Sanchez-Luna⁷, Vinod K Bhutani⁸, Daniele deLuca^{9

10}

Affiliations

¹ Department of Neonatology, Cayuga Medical Center of Ithaca, Ithaca, NY, USA. rav2016@med.cornell.edu.
² Weill Cornell Medicine, New York, NY, USA. rav2016@med.cornell.edu.
³ Childrens Hospital St. Marien gGmbH, Teaching Affiliate of the Ludwig-Maximilians University of Munich, Germany Grillparzerstreet 9, 84036, Landshut, Germany.
⁴ Director of Neonatal Intensive Care Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy.
⁵ Department of Pediatrics, University of Patras, Rio, Patras, Greece.
⁶ Department of Neonatology, University of Coimbra, Coimbra, Portugal.
⁷ Director of the Neonatology Division and NICU, Hospital General Universitario "Gregorio Marañón", Madrid, 28009, Spain.
⁸ Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
⁹ Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris; Saclay University Hospital, APHP-Paris, Paris, France.
¹⁰ Physiopathology and Therapeutic Innovation Unit, Paris Saclay University-Paris, Paris, France.

PMID: 39543402
DOI: 10.1038/s41390-024-03695-2

Abstract

Background: Limited data exist on population-level mortality outcomes related to extreme neonatal hyperbilirubinemia (EHB) and this study examines trends in annual infant mortality rate (IMR) attributed to hemolytic and perinatal jaundice among Germany, France, Italy, Portugal, Greece and Spain from 1990 to 2019.

Methods: Data on annual incident cases and disability-adjusted life years were collected from the 2019 Global Burden of Disease study. Live birth cohort data were sourced from UN World Population Prospects. We quantified temporal trends, with relative percent changes. Average annual percent changes (AAPCs) were evaluated using the Joinpoint Regression Program.

Results: EHB-related infant mortality decreased from 21.4 (95%CI: 16.1, 27.1) in 1990 to 4.2 (95%CI: 1.9, 7.6) per million live births in 2019. Germany demonstrated lowest AAPC of -3.2% (95% CI: -3.8, -2.5), while Portugal had the highest AAPC of -8.6% (95% CI -11.9, -5.1) in reducing infant mortality due to EHB. There were distinct divergences in the trajectories of declining EHB mortality among the studied countries.

Conclusion: This study highlights a significant decline in infant mortality due to extreme hyperbilirubinemia, emphasizing the need for national surveillance and tailored guidelines to prevent bilirubin induced neurological damage.

Impact: This cross-sectional analysis revealed a marked decline in infant mortality rates attributed to extreme hyperbilirubinemia across the selected European countries. The rates of decline varied significantly between countries, demonstrating notable heterogeneity in mortality trends when stratified by age at death. Implementing data-driven surveillance systems can optimize the alignment of equitable healthcare services, strengthen accountability measures, and identify critical operational inefficiencies. In the European Union, country-specific hyperbilirubinemia guidelines should be reinforced to ensure effective screening and post-discharge follow-up protocols that are tailored to risk burden and available healthcare resources.