Cord Bilirubin Research Articles

Intrauterine transfusions for maternofetal red‐blood‐cell incompatibility in monochorionic diamniotic twin pregnancy

Maternal alloimmunization to fetal red-blood-cell (RBC) antigens may cause hemolytic disease in the fetus with severe anemia. Intrauterine transfusions (IUTs) in twin pregnancy represent 1.5% of all fetal transfusions for RBC alloimmunization1, 2. Here, we present a case of a monochorionic diamniotic twin pregnancy complicated by severe anti-D maternofetal incompatibility, monitored by fetal middle cerebral artery (MCA) peak systolic velocity (PSV) and treated successfully by repeat IUTs of a single cotwin. The patient was referred to our center at 24 weeks' gestation for suspected fetal anemia. Fetal middle cerebral artery (MCA) peak systolic velocity (PSV) reached 1.64 multiples of the median (MoM) in Twin A and 2.02 MoM in Twin B. Both fetuses presented with ascites. Twin A was transfused with 30 mL of packed RBC. Pretransfusion hemoglobin (Hb) was 3.0 g/dL, with a Kleihauer–Betke test (KBT) result of 100% in fetal blood3, 4. Post-transfusion Hb increased to 8.8 g/dL and KBT decreased to 18%. MCA-PSV decreased from 1.64 to 1.19 MoM in Twin A and from 2.02 to 1.64 MoM in Twin B. Thirty minutes later, as MCA-PSV remained above 1.5 MoM in Twin B, an IUT of 15 mL was administered to Twin B, which enabled Hb level in Twin B to increase from 8.1 to 11.4 g/dL, and KBT in fetal blood decreased from 17% to 10%. The direct antiglobulin test showed a result of 3+ (high intensity) and cord bilirubin was over 70 µmol/L. These findings were suggestive of ongoing hemolytic disease. For subsequent IUTs at 25 + 4, 27 + 3 and 30 + 3 weeks' gestation, only Twin A was transfused. This strategy allowed for the normalization of MCA-PSV in both fetuses (Figure 1, Table 1). Cesarean section was performed at 31 weeks' gestation for non-reassuring fetal-heart tracing. The first delivered male neonate had birth weight of 1330 g, arterial cord blood pH of 7.37, Hb of 11.3 g/dL and bilirubin of 90 µmol/L. The second neonate had birth weight of 1310 g, arterial cord blood pH of 7.43, Hb of 11.5 g/dL and bilirubin of 88 µmol/L. Placental colored dye injection showed several arterioarterial anastomoses. The twins had respiratory distress syndrome which was treated by non-invasive ventilatory support. Severe jaundice worsened despite intensive phototherapy and albumin infusion, requiring exchange transfusion in both neonates. Two transfusions at 15 and 45 days were also needed. The neonates were discharged at 66 days postpartum. In this case, during the first IUT, transplacental intertwin anastomoses were demonstrated by (1) MCA-PSV values in Twin B decreasing after IUT of Twin A, (2) KBT in fetal blood already being reduced in Twin B after IUT of Twin A but before IUT of Twin B, and (3) Hb in Twin B being similar to that observed in Twin A after IUT of Twin A but before IUT of Twin B. To our knowledge, this is the first reported case demonstrating the contribution of MCA-PSV to monitoring monochorionic twin pregnancy complicated by RBC alloimmunization, treated by repeat IUTs of a single cotwin. One case of a monochorionic twin pregnancy in which IUTs performed in turn in each cotwin has been reported, without using MCA-PSV monitoring2. In cases of fetal anemia caused by Rh alloimmunization in monochorionic twin gestations, it appears sufficient to transfuse only one of the fetuses at 2–3 week intervals.

Predictive value of cord blood bilirubin in neonatal hyperbilirubinemia: A prospective study

Background: As there is a tendency for early discharge from a hospital, some babies may develop significant neonatal jaundice at home, which may go unrecognized and cause subclinical damage to the growing brain. If such babies could be identified early, their discharge can be postponed for timely and better management. Objectives: The objectives of the study were to evaluate the umbilical cord bilirubin (UCB) levels as a predictor for hyperbilirubinemia in full-term and near-term newborns up to the 3rd day of life. Materials and Methods: A prospective cohort study was carried out in a tertiary care hospital in South India. Data were collected from the enrolled cases by a pre-designed proforma. Statistical analysis was carried out with the help of statistical measures, such as percentages and proportions and the sensitivity, specificity, and negative and positive predictive values (NPV and PPV). Results: A total of 301 newborns were enrolled. A cutoff UCB 2 mg/dl had 94% sensitivity, 93% specificity, 61% PPV, and 99% NPV. A total of 61% of neonates who had UCB levels ?2 mg/dL required phototherapy by the 3rd day of life. However, 99% of neonates who had UCB <2 mg/dL did not require phototherapy, and these infants with low risk of hyperbilirubinemia could be discharged early from the hospital. Conclusion: The cutoff value of 2 mg/dL of UCB with 94% sensitivity and 93% specificity canbe used as a predictor for developing subsequent hyperbilirubinemia.

Are Cord Blood Bilirubin Values Trustable to Predict the Forthcoming Significant Hyperbilirubinemia Requiring Treatment in Healthy Term Newborns?

Background: Jaundice is a clinical condition that is often observed in pediatric practice and constitutes one of the major issues within the neonatal period. As severe jaundice causes neurotoxicity(kernicterus), the diagnosis and treatment of severe hyperbilirubinemia is very important. Early prediction will help in early discharge and will prevent hospitalization of babies and mothers. On the other hand, predicting outcome in high risk neonates for subsequent hyperbilirubinemia is required.Objectives: This study investigates the predictive value of umbilical cord serum bilirubin (UCSB) for subsequent hyperbilirubinemia which is a required treatment in healthy term newborns.Methods: In this prospective study, 238 healthy term newborns were inducted into the study. Soon after delivery, the cord blood was sent for serum bilirubin analysis. Newborns were followed up by TCB (transcutaneous bilirubinometry) until the third day post birth and those who showed significantly high TCB values, according to the hour-specific normogram, received the appropriate intervention and treatment. The data were analyzed using t-Test, ROC (receiver operating characteristic) curve, and chi-square tests.Results: Of 238 newborns, 27 (11.4%) cases developed hyperbilirubinemia (bilirubin >= 15 mg/dL), which required phototherapy. There were no significant differences between the cases who did and who did not develop hyperbilirubinemia (bilirubin = 2.25 mg/dl had high sensitivity (92.6%), good positive and negative predictive value (66% and 69% respectively).Conclusions: UCSB level >= 2.25 mg/dL can be a useful predictor of hyperbilirubinemia in healthy term newborns on the third day. Therefore, infants with UCSB level >= 2.25 mg/dL should be followed up strictly either in a hospital or in an outpatient department on the third day, whereas neonates with cord bilirubin level < 2.25 mg/dL are probably safe for early discharge.

Prediction of neonatal hyperbilirubinemia by cord blood analysis to diagnose subsequent hyperbilirubinemia

Background: the study was aimed to determine the predictive value of cord bilirubin and 24th hour serum bilirubin levels in identifying newborn babies at risk of developing significant hyperbilirubinemia.Methods: A total 300 term neonates with a mean birth weight of 2.58±0.23 kg ranging from 1.92 kg-4.1kg were included in this study. Under strict aseptic precautions cord blood sample were collected from all newborns for analysis of serum bilirubin levels, and haemoglobin levels.Results: The incidence of significant hyperbilirubinemia in this study was 14%. Among jaundiced newborns sex ratio M/F:1.6:1(male female ratio 1.1:1). Mean Cord bilirubin levels in babies who subsequently developed hyperbilirubinemia was 2.798±0.5559 mg/dl and in others were 1.511±0.3260 mg/dl and the difference was statistically significant. There was a statistically significant correlation between cord bilirubin and neonatal jaundice. Cord bilirubin ≥2 mg/dl had good predictive value in identifying newborns who are likely to develop significant hyperbilirubinemia later.Conclusions: Babies with cord blood bilirubin ≥2 mg/dl can be followed up in the hospital for 5 days, the time of peak neonatal hyperbilirubinemia to prevent the babies discharged early and later readmission for neonatal hyperbilirubinemia.

Umbilical cord bilirubin level and pre-discharge hyperbilirubinemia risk

Objectives To assess whether arterial umbilical cord bilirubin (aUCB) level at delivery predicts predischarge neonatal hyperbilirubinemia, facilitating a safe discharge from the hospital. Methods Prospective analysis of hospital biochemistry records identified near term and term infants with recorded aUCB and predischarge, at 36 h of life, capillary heal bilirubin (cHB), to identify those with a cutoff of bilirubin levels >9 mg/ml, >75th percentile on the nomogram of Bhutani et al. Results Of 616 study neonates, median (IQR) aUCB and cHB levels were 1.5 mg % (IQR 0.7–2.2) and 7.7 mg % (IQR 6.6–8.9), respectively. The values resulted statistically correlated (Pearson correlation coefficient 0.26, p < .0001) and an increment of 1 mg/dl in aUCB was associated with an increment (Regression coefficient, 95% confidence interval) of mean cHB 0.49 (0.33–0.65, p < .0001). Among these, 143 (23.2%) neonates developed bilirubin levels >9 mg/ml at 36 h of life and multivariable analysis confirmed that cHB levels (OR 1.49, 95% CI 1.22–1.82; p < .0001) and vaginal delivery (OR 2.34, 95% CI 1.33–4.36; p = .005) were significantly associated with bilirubin levels >9 mg/ml. Conclusions These data suggest that aUCB should be added to the list of major risk factors for neonatal hyperbilirubinemia.

Prediction of significant hyperbilirubinemia by estimating cord blood bilirubin in neonates with ABO incompatibility

Background: Neonatal hyperbilirubinemia is a common condition that may occur in 60-70 % of term babies and the most common pathological cause leading to hyperbilirubinemia is ABO incompatibility. ABO incompatible newborns are reported to be at greater risk of significant hyperbilirubinemia and are associated with significant morbidity like development of kernicterus. So early intervention, at proper time, is mandatory to prevent this sequel.Methods: A prospective study included 240 term new-borns with gestational age of &gt;37 weeks and birth weight &gt;2.5 kg born to ‘O’ blood group mothers. Soon after delivery, cord blood was sent for blood group, total bilirubin and direct coombs test. All enrolled new-borns were assessed clinically daily till day 5th for appearance of hyperbilirubinemia using Kramer method. The data was analysed using descriptive analysis, ROC curve in SPSS version 14.Results: Among two hundred forty ABO incompatible newborns, 40 (17%) had developed hyperbilirubinemia and among them most common blood group associated was B+ve (75%). Association between cord bilirubin content and maximum serum bilirubin content among newborn who developed hyperbilirubinemia was found to be significant (P value &lt;0.01). As per ROC curve analysis, cord blood total bilirubin cut off value of 1.79mg/dl had sensitivity (82.5%), specificity (55.5 %), PPV (27.04%) and NPV (94.06).Conclusions: Cord blood total bilirubin levels ≥1.79mg/dl has a good predictive ability for prediction of significant hyperbilirubinemia among ABO incompatible new-born. DCT is neither specific nor sensitive screening tool for development of Neonatal hyperbilirubinemia in ABO incompatibility.

Correlation of cord blood bilirubin values with neonatal jaundice in healthy newborns: A prospective observational study

Background and Objective: Hyperbilirubinemia is the most common clinical condition requiring evaluation and treatment in the newborn and a frequent reason for hospital readmission during the 1st week of life. Although generally a benign, postnatal, transitional phenomenon, a few neonates develop marked potentially hazardous bilirubin levels that can pose a direct threat of serious brain injury. The present study was conducted to investigate the predictability of pathological jaundice on cord blood bilirubin (CBB) values. Materials and Methods: This was a prospective observational study conducted on 289 healthy newborns. Babies were divided into two groups: Group A who developed physiological jaundice and Group B who developed pathological jaundice. CBB was estimated in all newborns who were then followed up to the 5th day of life. Babies who developed jaundice requiring treatment were admitted in neonatal intensive care unit for phototherapy. Other neonates were checked regularly up to the 5th day of life and values were recorded on the 5th day by estimation of serum bilirubin. Results: Incidence of pathological hyperbilirubinemia in our study was 11.2%. A statistically significant correlation between CBB and development of pathological jaundice was observed. Gender, age, mode of delivery, and birth weight has no correlation with cord bilirubin and the subsequent development of jaundice. CBB 3.5 mg/dl has high sensitivity (97.06%), specificity (99.22%), positive predictive value (94.29%), and negative predictive value (99.61%) in predicting future development of future pathological jaundice. Conclusion: The present study suggests that in healthy term babies (CBB ≤2.5 mg/dl), cord serum bilirubin can help to identify those newborns who are unlikely to require further evaluation and intervention. These newborns can be discharged with assurance to parents. Babies with CBB level ≥3 mg/dl should be followed more frequently. Thus, this study concludes that cord blood total bilirubin levels reliably predict the occurrence of pathological hyperbilirubinemia.

Cord blood albumin–bilirubin as a predictor for neonatal hyperbilirubinemia

Objective The aim was to evaluate the predictive value of cord blood albumin and bilirubin in identifying infants greater than or equal to 35 weeks for subsequent hyperbilirubinemia. Background Hyperbilirubinemia is the most common cause for readmission during the early neonatal period. Early discharge of healthy term newborns after delivery has become a common practice for socioeconomic reasons. Patients and methods A prospective cohort study was carried out on 75 neonates, greater than or equal to 35 weeks, with 34 female and 41 male neonates, delivered in Menoufia University hospital during the period from June 2016 to December 2017. Full history taking, clinical examination immediately after birth, and laboratory investigations were recorded. Results With cord albumin less than 2.8 g/dl, 81.8% of cases developed significant hyperbilirubinemia, whereas levels greater than 3.3 mg/dl were considered safe with no incidence of hyperbilirubinemia. Moreover, in the total group, the highest sensitivity (83.3%) was for cut-off value of cord bilirubin (CB) at 1.88 mg/dl, with positive predictive value of 72.9%, whereas the highest specificity (84.8%) was for cut-off value of CB–cord albumin at −0.6, with negative predictive value of 74.1. In high-risk group, the highest sensitivity (88.9%), highest positive predictive value (94.1%), highest specificity (85.7%), and negative predictive value (75%), were for cut-off value of CB–cord albumin at − 0.82. Conclusion Cord blood albumin and bilirubin examination can be used as an early useful indicator to predict significantly hyperbilirubinemia in neonates. Researches on large scale should be done for more clarification on the predictive value of cord blood albumin and bilirubin for early prediction of significant hyperbilirubinemia.

Cord serum bilirubin as a predictor of neonatal hyperbilirubinemia in healthy term and late preterm neonates

Background: Icterus neonatorum is the most common neonatal illness occurring in the first 7 days of life. It is the most important cause for hospital readmissions during the early neonatal period and also the cause for neonatal morbidity. In this study our main objective is, to find out that whether detecting umbilical cord blood bilirubin levels soon after birth, will help to identify the development of significant jaundice in early neonatal period which requires immediate interventionMethods: This was a prospective observational study carried out among 150 term and preterm babies. Their cord bilirubin level were estimated. Jaundice was determined by using yellowish appearance of eyes, skin and Kramer score. Statistics employed include Chi-square test and receiver operator characteristic curveResults: Study participants enrolled into the study was 150. Cord serum bilirubin was significantly associated with Kramer score and yellowish discoloration of eyes and skin and not significantly associated with sex, mode of delivery, gestational age and birth weight. When cord serum bilirubin was compared against the occurrence of clinical jaundice, sensitivity was found to be 58.33%, specificity was 96.49% positive predictive value was 84% and negative predictive value was 88%. Receiver operator characteristics curve indicated that the area below the curve was 0.842.Conclusions: Cord serum bilirubin can be used as a screening tool to identify the neonatal jaundice in both term and late preterm babies. Present study has shown increased specificity than sensitivity which warrants further exploration.

Early predictors of neonatal hyperbilirubinemia in full term newborn

Reliable predictive markers enabling physicians to identify which newborns will develop significant hyperbilirubinemia have become mandatory for prevention of severe hyperbilirunemia. We aimed at determining the critical cord serum bilirubin and albumin levels and bilirubin/albumin ratio early as reliable markers. This prospective study included 175 full-term neonates. Measurement of cord bilirubin, albumin and bilirubin/albumin ratio was done to predict significant hyperbilirubinemia in healthy term newborns based on serum bilirubin measurements made within 5 days of life. Most cases that developed significant neonatal hyperbilirubinemia (67.9%) had cord albumin level≤2.8gm/dl. Cord Bilirubin/albumin ratio cut off value>0.61 had a good predictive value with a sensitivity of 100% and specificity of 88.4%, and cord serum albumin cut off value≤3.0mg/dl also had a good predictive value with a sensitivity of 85.7% and specificity of 67.3%. ROC curve analysis of cord total bilirubin demonstrated that a cut off value of ≥1.84mg/dl had a good predictive value with a sensitivity of 100.0% and specificity of 87.1%. Cord bilirubin/albumin ratio, serum bilirubin and albumin could be early predictors for neonatal hyperbilirubinemia.

Cord blood bilirubin used as an early predictor of hyperbilirubinemia

Background: Neonatal hyperbilirubinemia is among the commonest symptoms found in neonates. The information about risk of high bilirubin in infants allows simpler methods for reduction of bilirubin to be implemented before hyperbilirubinemia becomes significant and could help to take a decision for early discharge from Hospital. Thus, the authors were aimed at the assessment of the usefulness of the cord blood bilirubin as an early predictor of neonatal hyperbilirubinemia and the usefulness of 1st day bilirubin in predicting the neonatal hyperbilirubinemia.Methods: The present study was planned to conduct in Department of Pediatrics, Government Thiruvarur Medical College and Hospital, Thiruvarur among neonates delivered from 1st August 2011 to 1st December 2013. These neonates were followed from birth to 2nd postnatal day. Cord blood was collected at birth and bilirubin estimation was done within 12 hours of collection of the blood.Results: Cord blood bilirubin level of ≥2.15 mg/dl has a sensitivity of 73.08% and specificity of 59.49%, positive predictive value 14.6% and negative predictive value of 95.88% in predicting the risk of neonatal hyperbilirubinemia. 1st day bilirubin level of ≥5 mg/dl has a sensitivity of 92.3% and specificity of 71.16% and positive predictive value of 23.3% and negative predictive value of 98.9% in predicting the risk of neonatal hyperbilirubinemia.Conclusions: The use of the critical cord bilirubin level of 2 mg/dl in all healthy term newborns will predict significant hyperbilirubinemia.

Cord bilirubin as a Predictor of Neonatal Hyper bilirubinemia in healthy term babies

Objectives: To assess the value of cord blood bilirubin in identifying term healthy babies who develop significant hyperbilirubinemia. Methodology: This Prospective cohort study, conducted from May 2016 to September 2016 in a tertiary care hospital included 100 term healthy breastfed babies without Rh incompatibility or significant illness. Cord bilirubin was estimated in all babies. Neonates were followed up daily for 5 days for hyperbilirubinemia. Serum bilirubin levels were estimated on day 5 in all babies. Significant hyperbilirubinemia was defined as bilirubin > 15 mg/dl after 72 hours. Results: Mean cord bilirubin was 2.8 +2.4 mg /dl in those who developed hyperbilirubinemia and 2.5+2.91 mg/dl in those who did not. Clinically detectable jaundice was present in 72%.Twenty-two percent babies developed hyperbilirubinemia. Peak serum bilirubin of babies who developed significant hyperbilirubinemia was 23+ 2.8mg/dl at 120 hours. Cord bilirubin of > 2mg /dl was present in 64 babies and 19 (29%) developed hyper bilirubinemia. Cord bilirubin 2mg/dl. ABO incompatibility was significantly associated with hyperbilirubinemia (p=0.0006). Conclusion: Cord bilirubin can be a good predictor of hyperbilirubinemia. Neonates with cord bilirubin 2 mg/dl need close follow up.

Race specific nomograms: time for change?

Background: Hyperbilirubinemia is a common problem in neonates. Because of the genetic differences in bilirubin metabolism, an hour specific nomogram is better in each geographical location. No studies in South India for creation and validation of a nomogram for significant hyperbilirubinemia. The aim of this study was to create and validate a bilirubin nomogram in South Indian infants.Methods: A prospective cross-sectional study. The data was collected in 2 parts, over 18 months (264 infants) and 20 months (450 infants) respectively. Babies with established direct hyperbilirubinemia, polycythemia, hypothyroidism, culture proven sepsis, major congenital anomalies and jaundice on day 1 of life were excluded. For all babies, cord bilirubin (for first set of infants), total serum bilirubin values were sent at 24 hours of life and at the time of discharge. An hour specific nomogram was created with 834 bilirubin values (first set of data). The predictive ability of this nomogram and Bhutani nomogram were tested and compared using 972 total serum bilirubin values (second set of data)Results: A nomogram was created with serum bilirubin values from the first set of infants and validated it with the serum bilirubin values from the second set of infants. Bhutani nomogram was also validated. Comparing with Bhutani nomogram, our nomogram was better in predicting significant hyperbilirubinemia in our population.Conclusions: Discharging neonates without risk assessment for severe hyperbilirubinemia may be dangerous. A nomogram generated and validated with our data is an accurate tool for predicting significant hyperbilirubinemia in our population.

Comparison of cord bilirubin and bilirubin albumin ratio to predict significant hyperbilirubinemia in healthy full-term neonates

Background: Early prediction and identification of severe hyperbilirubinemia for that age and appropriate treatment are must to prevent kernicterus. Objective: The objective is to study the predictive value of bilirubin albumin ratio (BAR) and to compare it with cord bilirubin alone for early identification of significant neonatal hyperbilirubinemia in healthy term neonates. Materials and Methods: This prospective cross-sectional study was done in a tertiary care center located in Central India on 543 healthy term neonates. Cord blood of 2 ml was collected during the delivery from the placental end and sent for BAR and cord bilirubin analysis. All the neonates had undergone total serum bilirubin estimation and neonates with serum bilirubin ≥17 mg/dl at ≥72 h of age were defined to have significant hyperbilirubinemia. Results: Among the study population, 44 neonates developed significant hyperbilirubinemia. Sensitivity and specificity of cord BAR were 95.45% and 89.78%. Sensitivity and specificity of cord blood bilirubin were 95.65% and 95.57%. Positive predictive value (PPV) and negative predictive value (NPV) of cord BAR were 45.16% and 99.55%. PPV and NPV of cord blood bilirubin were 64.70% and 99.58%. Considering mean as the cutoff value, cutoff value for cord BAR was 0.89 and it was 2.95 for cord blood bilirubin. Diagnostic accuracy of cord BAR and cord blood bilirubin in predicting the hyperbilirubinemia was 90.79% and 96.31%, respectively. Conclusion: Both cord BAR and cord blood bilirubin are the early predictors of neonatal significant hyperbilirubinemia, but cord blood bilirubin is the better diagnostic tool than the former in early detection of neonatal jaundice.

CORD BILIRUBIN LEVELS AS A PREDICTIVE MARKER FOR NEONATAL HYPERBILIRUBINEMIA: A PROSPECTIVE STUDY

Background: Hyperbilirubinemia is the most common medical problem in newborn infants. Early discharge is recommended but hospital readmission is a cause of concern among clinicians. This in turn carries a risk of delayed recognition of significant hyperbilirubinemia. Objective: A cross-sectional analytical study was done to evaluate the predictive value of cord bilirubin level for identifying term and near-term neonates for subsequent hyperbilirubinemia. Materials and Methods: Cord bilirubin levels at birth and subsequently serum bilirubin levels at 72 h were assessed in 100 neonates. The cutoff value was estimated beyond which there was significant hyperbilirubinemia. Results: The cutoff value of cord bilirubin >2.02 mg/dl had sensitivity and specificity of 87.5-70.8%, respectively, with positive predictive value of 0.39 and negative predictive value of 0.965 for subsequent hyperbilirubinemia. Conclusion: The cutoff value of cord bilirubin level estimated is 2.02 mg/dl can be used to predict significant neonatal hyperbilirubinemia.

Clinical input of anti-D quantitation by continuous-flow analysis on autoanalyzer in the management of high-titer anti-D maternal alloimmunization.

In addition to titration by indirect antiglobulin test most widely used, anti-D quantitation by continuous-flow analysis (CFA) may be performed to assess severity of maternal immunization. Only five studies have reported its added value in the management of pregnancies complicated by anti-D immunization. A retrospective study of 74 severe anti-D-immunized pregnancies was conducted from January 1, 2013, to December 31, 2014, in the Trousseau Hospital in Paris (France). Concentration of maternal anti-D was measured by titration and by CFA two-stages method (2SM; total amount of anti-D) and one-stage method (1SM; high-affinity IgG1 anti-D). These biologic data were analyzed according to the severity of the hemolytic disease of the fetus and the newborn. The value of 5 IU anti-D/mL in maternal serum is validated as a threshold to trigger ultrasonographic and Doppler fetal close follow-up. A high 1SM/2SM ratio was associated with a higher risk of intrauterine transfusion (IUT). For pregnancies requiring IUT and without increasing titer, maternal 1SM anti-D concentration tends to correlate with the precocity of fetal anemia. In the "without-IUT" group 1SM and 2SM anti-D concentrations correlate significantly with cord bilirubin levels of the newborn at birth. Altogether our results underline the importance of anti-D quantitation by CFA to optimize the management of anti-D-alloimmunized pregnancies.

Prospective study on cord bilirubin level as a predictor of Hyperbilirubinemia in term healthy neonates

Prospective study on cord bilirubin level as a predictor of Hyperbilirubinemia in term healthy neonates

Umbilical cord bilirubin as a predictor of neonatal jaundice: a retrospective cohort study

BackgroundHyperbilirubinaemia is a major cause of neonatal morbidity. Early identification of those infants most at risk might allow the development of targeted primary preventative therapy and follow-up. The objective of this study was to assess whether arterial umbilical cord bilirubin (aUCB) level at delivery predicts the development of neonatal jaundice in term deliveries.MethodsRetrospective analysis of hospital biochemistry records identified term deliveries with recorded aUCB. Infant medical records were reviewed to identify those who developed neonatal hyperbilirubinaemia (requiring treatment according to UK NICE guidelines) with/without a positive direct antiglobulin test (DAT).ResultsOf 1411 term deliveries with a clearly recorded aUCB, 30 infants developed clinically-significant jaundice (2.7%), of whom 8 were DAT + ve (0.6%) mostly due to ABO incompatibility. aUCB strongly predicted the development of DAT + ve jaundice (area under the ROC curve = 0.996), as well as all-cause jaundice (area under the ROC curve = 0.74). However, this effect was critically dependent on maternal blood group. Amongst infants at risk of ABO incompatibility (maternal blood groups O + ve/O-ve, 39.7%) the predictive value of aUCB for all cause jaundice was strengthened (area under the ROC curve = 0.88). Amongst those not at risk (defined maternal blood group not O + ve/O-ve, 51.0%) it disappeared completely (area under the ROC curve = 0.46). A cutoff of 35 μmol/l for mothers with blood group O + ve/O-ve increased the pre-test probability for all-cause jaundice of 4% to a post-test probability of 30%.ConclusionsFor infants of mothers with blood group O, aUCB predicts development of neonatal jaundice. There was no evident utility for infants of mothers with other blood groups. Estimation of aUCB should be considered as a strategy for early identification of those at risk of neonatal haemolytic jaundice.

Cord blood bilirubin level as a predictor of development of pathological hyperbilirubinemia in new-borns

Background: There may be a delay in recognition of pathological hyperbilirubinemia which may lead to serious consequences in the new born. The purpose of this study was to verify whether the cord bilirubin levels predicted the development of pathological hyperbilirubinemia.Methods: In this hospital based prospective cross-sectional study conducted at Central Referral Hospital, Gangtok from December 2014 to November 2015, 202 live new born meeting the inclusion criteria were enrolled. After birth, cord blood was collected for the estimation of cord blood bilirubin and the babies were followed up daily for the development of clinical jaundice. Peripheral venous blood was collected for the estimation of serum bilirubin levels in those who developed clinical jaundice.Results: The incidence of pathological hyperbilirubinemia in our study is 12.87%. The mean gestational age is 38.3 weeks. There is a significant association between cord blood total bilirubin levels and the development of pathological hyperbilirubinemia in newborns with a P-value of 0.000. A critical cord bilirubin level ≥ 2.50mg/dl has sensitivity of 84.1%, specificity of 88.5%, positive predictive value of 98% and negative predictive value of 45.1% for predicting the risk of developing pathological jaundice.Conclusions: This study concludes that cord blood total bilirubin levels reliably predict the occurrence of pathological hyperbilirubinemia as defined by current operational guidelines.

Legal Briefs: Was the Intracardiac Thrombus Secondary to an Unnecessary Umbilical Venous Catheter?

A 2,400-g, 34 6/7-week-gestation male infant was delivered by normal spontaneous vaginal delivery to a 32-year-old gravida 1, para 0 mother. Labor was induced secondary to maternal hypertension. Complications during pregnancy included severe preeclampsia, gestational diabetes, and known Rh incompatibility. The mother did not receive Rho(D) immune globulin for unclear reasons. On admission, her Rh titer was 1:32. A brief period of positive pressure ventilation was needed at birth. The infant’s Apgar scores were 1, 8, and 8 at 1, 5, and 10 minutes, respectively. The direct Coombs test result was positive. The complete blood cell count (CBC) was normal, except for a hematocrit of 36.9% (0.37). The mother’s blood type was B Rh negative and the infant’s was O Rh positive. A cord bilirubin concentration was ordered but not measured. The plaintiff neonatologist was critical of this omission. A peripheral intravenous line was placed, with 10% dextrose infused at a maintenance rate. At 5 hours, the nurse noticed that the infant was pale and jaundiced. At 8 hours, the nurse measured a transcutaneous bilirubin concentration, which was found to be 8 mg/dL (137 μmol/L). Phototherapy was started. Four hours later, a serum bilirubin concentration was measured, and found to be 9 mg/dL (154 μmol/L). The plaintiff neonatologist was critical of not conducting a timely evaluation of the bilirubin levels and not starting intensive phototherapy immediately. A second phototherapy unit was added and intravenous immune globulin (IVIG) was administered. Intensive phototherapy with blue spectrum lights and a portable phototherapy device were added. Feedings were started. Nasal swab culture was performed for methicillin-resistant Staphylococcus aureus (MRSA) and repeated daily. On the following day (day 1), the serum bilirubin concentration was 7.6 mg/dL (130 μmol/L). The infant was feeding 10 mL every 3 hours. When the mother was breastfeeding, the infant was …