Prediction of severe neonatal hyperbilirubinemia using cord blood hydrogen peroxide: a prospective study.

Hung-Chieh Chou,Wu-Shiun Hsieh,Chien-Yi Chen,Chiang-Ting Chien,Mei-Hwei Chang,Po-Nien Tsao,Giovambattista Pani

doi:10.1371/journal.pone.0086797

Hung-Chieh Chou, Wu-Shiun Hsieh + Show 5 more

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https://doi.org/10.1371/journal.pone.0086797

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Abstract

BackgroundWe hypothesized that cord blood hydrogen peroxide (H2O2) could be utilized to predict the severity of neonatal hyperbilirubinemia.MethodsWe prospectively enrolled term or near-term healthy neonates. Cord blood and capillary blood at three days of age were measured for hydrogen peroxide and bilirubin concentrations. For newborns with hyperbilirubinemia, further blood samples were obtained at five and seven days of age. Newborns were divided into severe or less severe hyperbilirubinemic groups (peak bilirubin ≥17 mg/dL or not). The sensitivity, specificity, and negative predictive values were determined.ResultsThere were 158 neonates enrolled. The incidence of neonatal hyperbilirubinemia was 30.5% for a concentration ≥15 mg/dl. The rising patterns were similar among bilirubin concentrations and hydrogen peroxide levels during the first few days of life. There was a strong positive correlation between bilirubin concentrations and hydrogen peroxide levels after correlation analysis. The rate of severe hyperbilirubinemia was 13.3%. It revealed that a cord blood hydrogen peroxide signal level of 2500 counts/10 seconds was an appropriate cut-off for predicting severe hyperbilirubinemia. Sensitivity and the negative predictive value were 76.2% and 93.3%, respectively.ConclusionsOur findings confirm that hydrogen peroxide levels and bilirubin concentrations in cord and neonatal blood are closely related. A cord blood hydrogen peroxide level above 2500 counts/10 seconds associated with a high predictive value for severe hyperbilirubinemia. This method provides information about which neonate should be closely followed after discharge from the nursery.

Highlights

The incidence of neonatal jaundice is around 60,70% in Western countries [1]. and even higher among newborns of Asian ethnicity
Neonatal jaundice is associated with increased unconjugated bilirubin concentrations caused by the breakdown of red blood cells
Researchers have been enthusiastic about identifying predictors of neonatal hyperbilirubinemia to assist in the early detection of neonates at high risk of severe hyperbilirubinemia

Summary

Introduction

The incidence of neonatal jaundice is around 60,70% in Western countries [1]. and even higher among newborns of Asian ethnicity. The incidence of neonatal jaundice is around 60,70% in Western countries [1]. Neonatal jaundice is associated with increased unconjugated bilirubin concentrations caused by the breakdown of red blood cells. Several cases of kernicterus have been reported [13] Another prominent concern is that neonates may be discharged from hospital too early, before the onset of neonatal jaundice. This may delay the diagnosis of severe neonatal hyperbilirubinemia and thereby increase the incidence of kernicterus [14]. The hourspecific bilirubin nomogram [15] is widely accepted by most clinicians, but has a low sensitivity and may vary by ethnicity. We hypothesized that cord blood hydrogen peroxide (H2O2) could be utilized to predict the severity of neonatal hyperbilirubinemia

Methods

Results

Conclusion