Abstract
Background: Hyperbilirubinemia is common in neonates, with higher prevalence among preterm neonates, which can lead to severe hyperbilirubinemia. Assessment of total serum bilirubin (TSB) and use of a transcutaneous bilirubinometer (TcB) are existing methods to identify and predict hyperbilirubinemia. This study aimed to determine TcB cut-off values during the first day for preterm neonates to predict hyperbilirubinemia at 48 and 72 hours. Methods: A total of 90 neonates born ≤35 weeks were included in the study. They were divided into two groups (Group I: 1000-1500 grams; Group II: 1501-2000 grams). The bilirubin level was measured on the sternum using TcB at the ages of 12, 24, and 72h. TSB measurements were taken on the third day or if TcB level reached ± 1.24mg/dL phototherapy threshold and if TcB showed abnormal results (Group I: 5.76-8.24mg/dL; Group II: 8.76-11.24mg/dL). Hyperbilirubinemia was defined as TSB ≥7mg/dL for group I and >10mg/dL for group II. Results: In total, 38 group I neonates and 48 group II neonates were observed. Almost half of neonates in group I (44.7%) were suffering from hyperbilirubinemia at the age of 48 hours, with 45.8% of group II at the age of 72 hours. To predict hyperbilirubinemia at the age of 48 hours, the best 24-hour-age TcB cut-off values were calculated to be 4.5 mg/dL for group I and 5.8 mg/dL for group II. To predict hyperbilirubinemia at the age of 72 hours, we determined 24-hour-age TcB value of 5.15 mg/dL for group II. Conclusion: TcB values in the early days of life can be used as hyperbilirubinemia predictors on the following days for preterm neonates. Close monitoring should be managed for those with TcB values higher than the calculated cut-off values.
Highlights
Hyperbilirubinemia is a common condition occurring in neonatal periods[1], with a prevalence of around 60% in term neonates and 80% in preterm neonates
We found the Total serum bilirubin (TSB) mean in group I at the age of 24, 48, and 72 hours to be 7.9 mg/dL, 9.16 mg/dL, and 9.3 mg/dL respectively, and 11.01 mg/dL, 10.23 mg/dL, and 11.04 mg/dL respectively, in group II
We found that the AUC of the transcutaneous bilirubinometer (TcB) bilirubin level at the age of 12 hours to predict hyperbilirubinemia at the age of 48 hours for group I was 0.804 (p 0.002) with a cut-off point of 2.35 mg/dL
Summary
Hyperbilirubinemia is a common condition occurring in neonatal periods[1], with a prevalence of around 60% in term neonates and 80% in preterm neonates. Preterm neonates have greater risk of severe hyperbilirubinemia, which can lead to encephalopathy[2]. This condition is preventable if early detection and prompt treatment can be arranged and managed properly[1,3,4]. Total serum bilirubin (TSB) measurement remains the gold standard for diagnosing hyperbilirubinemia. The drawbacks of this procedure, are that it is painful, causes stress to the neonates, has a greater risk of infection, and needs a couple of hours to get the results[9,10,11]. Assessment of total serum bilirubin (TSB) and use of a transcutaneous bilirubinometer (TcB) are existing methods to identify and predict hyperbilirubinemia. Hyperbilirubinemia was defined as TSB ≥7 mg/dL for group I and >10 mg/dL for group II
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