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Combating the Hidden Health Disparity of Kernicterus in Black Infants: A Review.
JAMA Pediatr. 2020 Jul 06 [Online ahead of print]JP

Abstract

Importance

Kernicterus is a devastating, permanently disabling neurologic condition resulting from bilirubin neurotoxicity. Black neonates account for more than 25% of kernicterus cases in the US, despite making up only approximately 14% of all births. This is a largely overlooked health disparity.

Observations

The black kernicterus health disparity exists despite a lower overall incidence of clinically significant hyperbilirubinemia among black neonates, a paradox recently explained by a previously unrecognized risk for hazardous hyperbilirubinemia. Aligned with national and global health initiatives to reduce or eliminate health disparities, this review highlights the multiple biologic and nonbiologic factors contributing to kernicterus risk in black infants and approaches to reduce this health disparity. This includes both parent-level and clinician-level kernicterus prevention strategies, with an emphasis on improving parental health literacy on neonatal jaundice and acute bilirubin encephalopathy and clinician awareness of the key factors that contribute to hazardous hyperbilirubinemia risk in this vulnerable group. Parent-level prevention strategies include efforts to improve their health literacy on neonatal jaundice and acute bilirubin encephalopathy and empower care seeking for jaundice. Clinician-level prevention strategies include efforts to eliminate community and institutional barriers that impede access to care, heighten clinician awareness of the factors that contribute to kernicterus risk in this vulnerable patient group, and strengthen newborn hyperbilirubinemia management and bilirubin surveillance.

Conclusions and Relevance

There are multiple opportunities for intervention to reduce black kernicterus risk. Although kernicterus is a rare disorder, the incidence among black infants is not a trivial matter nor are efforts to prevent kernicterus. While the multiple interacting biologic and nonbiologic contributors to increased kernicterus risk among black infants pose a considerable challenge to clinicians, there are opportunities for intervention to reduce this risk and health disparity. Continued study is imperative to understand the current scope of kernicterus and its occurrence in black neonates.

Authors+Show Affiliations

Division of Neonatology, Department of Pediatrics, Columbia University, New York, New York.Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32628268

Citation

Okolie, Francesca, et al. "Combating the Hidden Health Disparity of Kernicterus in Black Infants: a Review." JAMA Pediatrics, 2020.
Okolie F, South-Paul JE, Watchko JF. Combating the Hidden Health Disparity of Kernicterus in Black Infants: A Review. JAMA Pediatr. 2020.
Okolie, F., South-Paul, J. E., & Watchko, J. F. (2020). Combating the Hidden Health Disparity of Kernicterus in Black Infants: A Review. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2020.1767
Okolie F, South-Paul JE, Watchko JF. Combating the Hidden Health Disparity of Kernicterus in Black Infants: a Review. JAMA Pediatr. 2020 Jul 6; PubMed PMID: 32628268.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combating the Hidden Health Disparity of Kernicterus in Black Infants: A Review. AU - Okolie,Francesca, AU - South-Paul,Jeannette E, AU - Watchko,Jon F, Y1 - 2020/07/06/ PY - 2020/7/7/entrez JF - JAMA pediatrics JO - JAMA Pediatr N2 - Importance: Kernicterus is a devastating, permanently disabling neurologic condition resulting from bilirubin neurotoxicity. Black neonates account for more than 25% of kernicterus cases in the US, despite making up only approximately 14% of all births. This is a largely overlooked health disparity. Observations: The black kernicterus health disparity exists despite a lower overall incidence of clinically significant hyperbilirubinemia among black neonates, a paradox recently explained by a previously unrecognized risk for hazardous hyperbilirubinemia. Aligned with national and global health initiatives to reduce or eliminate health disparities, this review highlights the multiple biologic and nonbiologic factors contributing to kernicterus risk in black infants and approaches to reduce this health disparity. This includes both parent-level and clinician-level kernicterus prevention strategies, with an emphasis on improving parental health literacy on neonatal jaundice and acute bilirubin encephalopathy and clinician awareness of the key factors that contribute to hazardous hyperbilirubinemia risk in this vulnerable group. Parent-level prevention strategies include efforts to improve their health literacy on neonatal jaundice and acute bilirubin encephalopathy and empower care seeking for jaundice. Clinician-level prevention strategies include efforts to eliminate community and institutional barriers that impede access to care, heighten clinician awareness of the factors that contribute to kernicterus risk in this vulnerable patient group, and strengthen newborn hyperbilirubinemia management and bilirubin surveillance. Conclusions and Relevance: There are multiple opportunities for intervention to reduce black kernicterus risk. Although kernicterus is a rare disorder, the incidence among black infants is not a trivial matter nor are efforts to prevent kernicterus. While the multiple interacting biologic and nonbiologic contributors to increased kernicterus risk among black infants pose a considerable challenge to clinicians, there are opportunities for intervention to reduce this risk and health disparity. Continued study is imperative to understand the current scope of kernicterus and its occurrence in black neonates. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/32628268/Combating_the_Hidden_Health_Disparity_of_Kernicterus_in_Black_Infants:_A_Review L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2020.1767 DB - PRIME DP - Unbound Medicine ER -
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