Cord Blood Bilirubin Research Articles

Post-test probability for neonatal hyperbilirubinemia based on umbilical cord blood bilirubin, direct antiglobulin test, and ABO compatibility results.

Many hospitals opt for early postnatal discharge of newborns with a potential risk of readmission for neonatal hyperbilirubinemia. Assays/algorithms with the possibility to improve prediction of significant neonatal hyperbilirubinemia are needed to optimize screening protocols and safe discharge of neonates. This study investigated the predictive value of umbilical cord blood (UCB) testing for significant hyperbilirubinemia. Neonatal UCB bilirubin, UCB direct antiglobulin test (DAT), and blood group were determined, as well as the maternal blood group and the red blood cell antibody status. Moreover, in newborns with clinically apparent jaundice after visual assessment, plasma total bilirubin (TB) was measured. Clinical factors positively associated with UCB bilirubin were ABO incompatibility, positive DAT, presence of maternal red cell antibodies, alarming visual assessment and significant hyperbilirubinemia in the first 6 days of life. UCB bilirubin performed clinically well with an area under the receiver-operating characteristic curve (AUC) of 0.82 (95 % CI 0.80-0.84). The combined UCB bilirubin, DAT, and blood group analysis outperformed results of these parameters considered separately to detect significant hyperbilirubinemia and correlated exponentially with hyperbilirubinemia post-test probability. Post-test probabilities for neonatal hyperbilirubinemia can be calculated using exponential functions defined by UCB bilirubin, DAT, and ABO compatibility results. • The diagnostic value of the triad umbilical cord blood bilirubin measurement, direct antiglobulin testing and blood group analysis for neonatal hyperbilirubinemia remains unclear in literature. • Currently no guideline recommends screening for hyperbilirubinemia using umbilical cord blood. What is New: • Post-test probability for hyperbilirubinemia correlated exponentially with umbilical cord blood bilirubin in different risk groups defined by direct antiglobulin test and ABO blood group compatibility results. • Exponential functions can be used to calculate hyperbilirubinemia probability.

Effectiveness of early clinical assessment and bilirubin estimation for prediction of neonatal hyperbilirubinemia

Background: Neonatal hyperbilirubinemia is common cause of neonatal morbidity seen in 60% term and 80% preterm neonate. Early clinical assessment and bilirubin estimation is important in preventing long term sequale of hyperbilirubinemia, preventable cause of neurological sequale (kernicterus). Methods: Clinical assessments of all Preterm and term neonate born in our medical college were studied for effectiveness of early clinical assessment (Kramer’s index) compared to it gold standard test serum bilirubin (TB). Results: A total of 500 neonates were studied in which 11.4 % developed significant hyperbilirubinemia. Cord blood bilirubin has a PPV-63.9% and specificity-99.1%. Kramer’s index is less effective clinically if serum bilirubin is in lower range, comparatively kramer’s index effectiveness increases as serum bilirubin increases with p value 0.001. Conclusions: 11.4% of neonates had significant hyperbilirubinemia requiring treatment. Umbilical cord bilirubin >3 mg/dl showed a good predictor for early detection of hyperbilirubinemia. Kramer’s index at 48 hours correlates significantly with higher levels of serum bilirubin with p value of 0.001.

Correlation of cord blood bilirubin and neonatal hyperbilirubinemia in healthy newborns

Background: Jaundice is one of the commonest problems that can occur in a newborn. During the first week of life all new-borns have increased bilirubin levels by adult standards, with approximately 60% of term babies 1 and 85% of preterm babies having visible jaundice. This physiological rise in bilirubin causes indirect hyperbilirubinemia after 24 hours of birth, rises progressively with age and resolves gradually with no intervention in majority of cases. A small percentage may however require phototherapy or exchange transfusion when the bilirubin levels exceed the normal range. Methods: This study was performed at the Neonatal Intensive Care Unit, Department of Pediatrics of Rohilkhand Medical College and Hospital, Bareilly. All the healthy newborns , delivered at this hospital fulfilling the inclusion and exclusion criteria were enrolled in the study during One year from January 2014 to January2015. Inclusion criteria was healthy new-borns (37weeks-41weeks) delivered at Rohilkhand Medical College and Hospital and exclusion criteria was Setting of ABO incompatibility, ABO incompatibility, Rhesus blood factor incompatibility. The present study was conducted on 100 term healthy neonates delivered at tertiary care hospital. Serum bilirubin level was estimated at birth (cord blood) and at 3rd day of life. The main outcome measured was significant hyperbilirubinemia requiring treatment (phototherapy/exchange transfusion). Serum bilirubin was estimated clinically as indicated and on day 3 of life. Results: The area under curve was observed to be 0.75, i.e., the predictive accuracy of the criteria is 75% which implies a fair predictive value of the criteria. Receiver operator curve analysis revealed that a cut-off of 1.875 was 61.3% sensitive and 76.8% specific. Conclusions: Cord blood bilirubin level of more >1.87mg/dl can reliably predict neonatal hyperbilirubinemia in healthy term neonates.

Predictive value of cord blood bilirubin for hyperbilirubinemia in neonates at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn.

To determine the predictive ability of cord blood bilirubin (CBB) for hyperbilirubinemia in a population at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn. This is a single center retrospective case-control study. Cases received phototherapy; controls did not. Cases were matched 1:3 to controls by gender and treating physician. Inclusion criteria included: ≥35 weeks gestation, CBB, and one or more total serum bilirubin (TSB) concentrations. The primary outcome was CBB. Secondary outcomes were a TSB >75th percentile, length of stay, and neonatal intensive care unit admission. The prognostic ability of CBB for phototherapy and TSB >75th percentile was assessed using area under the receiver operating characteristic (ROC) curve. Logistic regression analyses were performed to determine predictors for phototherapy and TSB >75th percentile. When compared to controls (n = 142), cases (n = 54) were more likely to have a positive Coombs' test (82% vs. 41% , p < 0.001) and TSB >75th percentile (85% vs. 21% , p < 0.001). When compared to controls, cases had a higher mean (±SD) CBB (2.5 ± 0.5 vs. 1.8 ± 0.4 mg/dL, p < 0.001). The area under the ROC curve (±SEM) for CBB for phototherapy and TSB >75th percentile was 0.87 ± 0.03 (p < 0.001, 95% CI 0.82, 0.93) and 0.87 ± 0.03 (p < 0.001, 95% CI 0.82, 0.92), respectively. In this study, the mean CBB concentration was higher in neonates who received phototherapy compared to those who did not. CBB concentrations may help predict severe hyperbilirubinemia and phototherapy in a population at risk for hemolytic disease of the newborn.

Advances in prediction of neonatal hyperbilirubinemia

Neonatal jaundice is one of the most commonly diseases in newborns.Severe indirect hyperbilirubinemia may lead to neurotoxicity, or death.Hence, predicting the neonates especially high risk neonates for subsequent bilirubin level is required.This paper gives an account of the predictive value of umbilical cord blood bilirubin level, umbilical cord alpha-fetoprotein level, cord blood hydrogen peroxide and end-tidal CO for neonatal hyperbilirubinemia. Key words: Hyperbilirubinemia; Neonate; Prediction

To Assess Predictive Value of Cord Blood Bilirubin and Albumin for Significant Neonatal Hyperbilirubinemia: A Prospective Study from India

Aim: To assess the usefulness of the cord blood bilirubin and cord albumin estimation as a predictor of subsequent neonatal hyperbilirubinemia in a healthy term infants and to compare their predictive abilities: a prospective study. Material and Method: This study enrolled 200 full term neonates during the study period. Bilirubin and albumin estimation was done from cord blood, 1st day, 3rd day and 5th day bilirubin estimation was done from peripheral venous blood. Relationship was seen between level of albumin and bilirubin. Result: Cord blood bilirubin level of >2 mg/dl had a sensitivity of 90% and specificity of 53.89%, positive predictive value 17.8% and negative predictive value of 98% in predicting the risk of neonatal hyperbilirubinemia. (p<.001). Cord blood albumin level of ≤2.6 gm/dl had a sensitivity of 80% and specificity of 86.67%, positive predictive value 40% and negative predictive value of 97.5% in predicting the risk of neonatal hyperbilirubinemia (p<.0001) 1st day bilirubin level of ≥5.7 mg/dl had a sensitivity of 90% and specificity of 82.22%, positive predictive value of 36% and negative predictive value of 98.7% in predicting the risk of neonatal hyperbilirubinemia(p<.0001). Conclusion: Cord bilirubin and albumin can be used as predictor for hyperbilirubinemia and for early review for jaundice especially in developing countries where regular follow up is difficult.

Predictive value of cord blood bilirubin level for subsequent neonatal hyperbilirubinemia in ABO hemolytic term infants

Objective To evaluate the predictive value of cord blood bilirubin levels for subsequent neonatal hyperbilirubinemia in term infants with ABO hemolytic disease. Methods A total of 292 term newborns with ABO hemolytic disease admitted from August 1, 2011 to July 31, 2012 were enrolled. Cord blood bilirubin levels were analyzed and the clinical characteristics of the neonatal hyperbilirubinemia group (n=34) and non-hyperbilirubinemia group (n=258) were compared. A receiver operating characteristic (ROC) curve analysis was performed to identify the predictive value of the occurrence and cut-off point of hyperbilirubinemia in term infants with ABO hemolytic disease. Paired-t-test, Chi-square test and Spearman correlation were used for statistical analysis. Results Of the 292 term infants with ABO hemolytic disease, 34 cases had hyperbilirubinemia, with an incidence of 11.6%. Cord blood bilirubin levels were significantly associated with the presence of hyperbilirubinemia. The mean cord blood bilirubin level in infants who developed hyperbilirubinemia was (52.4±13.2) μmol/L, and was (35.0±8.0) μmol/L for those who did not develop hyperbilirubinemia (t=7.540, P=0.001). When cord blood bilirubin concentration increased, the incidence of hyperbilirubinemia gradually increased (χ2=113.715, P<0.001; rs=7.19, P<0.001). The ROC area under the curve of 0.882 (standard error 0.005, 95%CI: 0.873-0.891, P<0.001) was significant in predicting neonatal hyperbilirubinemia by cord blood bilirubin, and the occurrence of hyperbilirubinemia increased with increasing cord blood bilirubin level. Neonatal cord blood total bilirubin ≥50 μmol/L predicted hyperbilirubinemia, and the positive predictive value was 0.683, negative predictive value was 0.959, sensitivity was 0.690 and specificity was 0.958. Conclusions Cord blood bilirubin level is useful in predicting subsequent neonatal hyperbilirubinemia in term infants with ABO hemolytic disease. Key words: ABO blood-group system; Blood group incompatibility; Hyperbilirubinemia, neonatal; Bilirubin; Fetal blood

The value of serum umbilical cord blood bilirubin and hemolysis three test in the prediction of neonatal hyperbilirubinemia

Objective To study the application value of serum umbilical cord blood bilirubin and hemolysis three test in the prediction of neonatal hyperbilirubinemia. Methods 1 200 cases of healthy newborn were selected, whose mothers were type O blood and fathers were not type O blood. According to the situation of maternal and infant blood type, they were divided into the same maternal and child blood type group with 539 cases and different blood type group with 661 cases; According to the umbilical cord blood bilirubin concentration range was divided into five groups, and analyzed umbilical cord blood bilirubin and hemolysis three test in the prediction of neonatal hyperbilirubinemia. Results (1)The concentrations of umbilical cord blood bilirubin, the incidence of ABO- HDN, the incidence of hyperbilirubinemia in the maternal- fetal blood(O-A/B)group were(38.1±10.3)μmol/L,47.35%,26.02%,respectively, which were all significantly higher than(33.4±7.9) μmol/L,15.21%,14.66% in the maternal blood type(O- O) group(t= 5.8,χ2= 120.7,χ2= 20.1,all P= 0.000);(2)When the concentrations of umbilical cord blood bilirubin was higher, the incidence of hyperbilirubinemia was higher,but the sensitivity and the specificity both were bad;(3)According to the result of hemolysis three to predict the neonatal hyperbilirubinemia, when the concentrations of umbilical cord blood bilirubin was less than 21μmol/L or more than 55μmol/L, the positive predictive value and the specificity both were 100.00%,and the sensitivity was not low(75.00% and 86.96%). Conclusion Detection of umbilical cord blood bilirubin and hemolysis three test in the maternal- fetal blood group incompatibility could predict early hyperbilirubinemia of newborn, which had certain clinically practical value. Key words: Hyperbilirubinemia; Hemolysis; Fetal Blood

English

Hyperbilirubinemia is one of the common causes of admission in newborns. There is concern about an increasing incidence of hyperbilirubinemia and possibility of kernicterus even in healthy term newborns. Thus, early prediction of newborns at risk for developing significant hyperbilirubinemia may be helpful in early intervention. This study was done to find out the association between cord blood bilirubin and hyperbilirubinemia at 72 hours of life and also the association between cord Hb and Hb at sixth month of life along with screening babies for congenital hypothyroidism by TSH assay at birth. MATERIALS AND METHODS: 120 term healthy newborn babies delivered in a tertiary care centre (MES Medical College, Perinthalmanna), were included in this study. They were screened at birth for cord blood Hb, bilirubin and TSH values. These values were compared with bilirubin values at 72 hours of life and Hb at sixth month. Chi-square and correlation tests were used and data analyzed using Epi Info software. RESULTS: Our study showed a strong association between cord blood bilirubin (>2 mg/dL) and significant hyperbilirubinemia (>14 mg/dL) at 72 hours of life with a p value of 0.009. No association was found between cord Hb and Hb at sixth month. CONCLUSION: A cord blood bilirubin value above 2 mg/dL is a useful predictor of significant hyperbilirubinemia (>14 mg/dL) in healthy term newborns.

Umbilical Cord Blood Bilirubin Level Measurement in Predicting the Development of Significant Hyperbilirubinemia

Objectives: This prospective study was undertaken to identify the newborns at risk for developing significant hyperbilirubinemia using cord blood serum bilirubin levels. Methodology: This was prospective study with total of 282 healthy term newborns delivered at MNR Hospital, were included in study with birth weight more than 2,500 grams during one year period from March 2013 to March 2014. Soon after delivery cord blood was sent for serum bilirubin analysis. The data was analyzed using t-test, ROC curve and chi test and was considered statically significant, if value is P 0.05, while in cord bilirubin level there is highly significant difference P <0.05. In our study on the amount of umbilical cord bilirubin cut off point of 2 mg/dl had good sensitivity (94.12), specificity (90.9%), positive predictive value (69.57%) and negative predictive value (98.59%). Conclusion: The present study led to the conclusion that the bilirubin levels that were equal to or greater than 2 mg/100 ml umbilical cord blood can predict significant hyperbilirubinemia with high negative and positive predictive values and high levels of sensitivity and specificity.

Predictive ability of first-day serum bilirubin and haptoglobin for subsequent significant hyperbilirubinemia in healthy-term and near-term newborn

Objective Predicting significant neonatal hyperbilirubinemia using cord blood haptoglobin and bilirubin on the first day of life. Background Neonatal jaundice is the result of an imbalance between the production and elimination of bilirubin. Bilirubin conjugation in newborns is significantly impaired in the first few days; even a small increase in the rate of production can contribute toward the development of hyperbilirubinemia. Hemolysis plays a significant role in bilirubin increase in newborns. When hemolysis takes place, a decrease in the haptoglobin blood level-binding hemoglobin in the environment occurs. Patients and methods A total of 61 healthy newborns of at least 35 weeks' gestation were followed in the first 5 days of life for the development of significant hyperbilirubinemia. All newborns were subjected to cord blood haptoglobin and bilirubin measurement soon after delivery. Total serum bilirubin (TSB) was measured on the fifth day of life. Only 46 newborns were brought in on the fifth day for follow-up. Results A total of 25/46 newborns (54.3%) developed significant hyperbilirubinemia (TSB on the fifth day≥17 mg/dl) and were considered as positive cases. A significant negative correlation was found between cord blood haptoglobin levels and the TSB values on the fifth day. A significant positive correlation was found between cord blood bilirubin levels and the TSB levels on the fifth day. A cut-off level of haptoglobin in cord blood of 7.5 mg/dl was determined to have the highest sensitivity (100%), specificity (81%), and positive predictive value (89%) in the prediction of occurrence of significant hyperbilirubinemia, whereas a cut-off level of cord blood TSB 2.73 mg/dl had the highest sensitivity (100%), specificity (90%), and positive predictive value (93%) in the prediction of significant neonatal hyperbilirubinemia. Conclusion The haptoglobin value and TSB value taken from the blood of the umbilical cord can be used as a guiding indicator to demonstrate the future occurrence of significant hyperbilirubinemia in newborns.

Predictive value of umbilical cord blood bilirubin in neonatal hyperbilirubinemia

IntroductionJaundice is a clinical condition that is often present in pediatric practice and constitutes one of the major issues within the neonatal period. It occurs in both the physiological and pathological processes in newborns.1 Although most newborns with jaundice are otherwise healthy, they need to be monitored because bilirubin is potentially toxic to the central nervous system.2 The American Academy of Pediatrics (AAP) in 2004 recommended that newborns discharged within 48h should have follow up visits after 2–3days to detect significant jaundice.3 Aim of the workThis study was done to evaluate the predictive value of umbilical cord bilirubin in identifying infants for subsequent hyperbilirubinemia, in full-term (FT) and late pre-term (PT) newborns. Subjects and methodsThis study is a prospective clinical study which was carried out on 94 newborns taken from the delivery room (DR) and neonatal intensive care unit (NICU) of Ismailia General Hospital at Ismailia Governorate. The study population was followed up clinically and by laboratory investigations from birth and daily during the first week of life. ResultsThe study population consisted of 50 males and 44 females with the mean gestational age of 38.70±1.38weeks in FT compared to 35.62±0.64 in late PT. It was shown that 40.4% of PT needed treatment in the form of phototherapy compared to 29.8% of FT, and no one of both groups needed exchange transfusion. The mean total cord bilirubin was higher among males, preterm, cesarean deliveries, and ABO and RH incompatibility positive newborns. It was found that when cord blood in late PT newborns was ⩾1.75mg/dl and ⩾1.85mg/dl in FT newborns, there was a probability that those newborns may need phototherapy and when the levels of total cord bilirubin were ⩾2.05mg/dl in PT newborns and ⩾2.15mg/dl in FT it means that those babies are in actual need of phototherapy. Thus the cut-off points for total cord bilirubin level in PT and FT groups were 2.05 and 2.15mg/dl respectively. ConclusionIt was concluded that total serum bilirubin in cord blood was indicative of the jaundice severity developed by healthy FT and late PT newborns without complications, during the first week of life. RecommendationsCord blood bilirubin could be a useful indicator of developing jaundice in newborns and the use of cut off cord bilirubin levels could be a useful predictor of significant hyperbilirubinemia.

1298 Predictive Value of Umbilical Cord Blood Bilirubin Level for Subsequent Hyperbilirubinemia in ABO Incompatibility

ObjectivesTo establish a correlation between umbilical cord blood bilirubin levels and the development of subsequent hyperbilirubinemia in healthy term newborn ABO incompatible infants of blood group “O” mothers.Subject & methodsOne...

Does cord blood bilirubin level help the physician in the decision of early postnatal discharge?

Objective: Early postnatal discharge of newborns leads to the risk of readmission to the hospital, mostly for neonatal hyperbilirubinemia. Increasing the length of hospital stay is not an acceptable solution for medical, social and economic constraints. Hence, predicting the high risk neonates for subsequent hyperbilirubinemia is required. This study was planned to investigate the predictive value of umbilical cord blood bilirubin (CBBil) level for significant neonatal hyperbilirubinemia. Methods: Cord blood bilirubin, serum total/direct bilirubin levels and newborn/mother’s blood groups were obtained from 350 term neonates. Total/direct serum bilirubin levels were reevaluated in 95 newborns at 72 hours of age when jaundice appeared according to Kramer’s dermal zones. Results: Phototherapy treatment was needed in 14.7% of 95 patients. For recognition the newborns at high risk for developing hyperbilirubinemia, using a CBBil cut-off level of 2.60 mg/dl, we found a positive predictive value of 41.18%, negative predictive value of 97.9% and sensitivity of 50%. Conclusion: Newborns with CBBil values below 2.6 mg/dl are at very low risk of developing hyperbilirubinemia and further need of phototherapy. Knowledge of low risk of hyperbilirubinemia in a newborn could encourage the physicians in the decision of early postnatal discharge.

Index Of Suspicion In The Nursery

A 2.9-kg female infant is born at 35 weeks' gestation to a 33-year-old G4P3 woman via cesarean section due to chronic hypertension complicated by superimposed preeclampsia. The mother's blood type is A-negative; the antibody screen is positive for anti-D, anti-C, and anti-G antibodies; she has no prior history of sensitization; and her serologies are negative. The Apgar scores are 7 and 9 at 1 and 5 minutes, respectively. At birth, the infant appears pale and exhibits tachycardia, moderate hepatosplenomegaly, tachypnea, and mild respiratory distress requiring supplemental oxygen. Complete blood count and blood cultures are obtained, and ampicillin and gentamicin are started. The admission hematocrit is 21% (0.21), with a reticulocyte count of 64%. An umbilical venous catheter is placed for intravenous (IV) access. The infant receives a transfusion of packed red blood cells for significant anemia associated with tachycardia. Prophylactic phototherapy is started because of Rh sensitization. The cord blood bilirubin measures 11.4 mg/dL (195 mcmol/L). The infant's blood type is A-negative, and the antibody screen is positive for anti-D and anti-C antibodies, with a positive direct Coombs test. The red blood cell phenotype reveals the presence of “C” antigen. This is a very uncommon antigen in an Rh-negative infant, but the antigen had stimulated the anti-C antibodies that traversed the placenta and caused severe hemolysis of the newborn. At 7 hours of age, the infant's bilirubin is 16 mg/dL (273.6 mcmol/L). She is given two doses of intravenous immune globulin, and phototherapy is intensified. After 24 hours of intensive phototherapy, the infant develops a large reddish-purple discoloration on her abdomen that resembles a severe burn (Fig. 1). The well-demarcated, erythematous, purpuric rash is present over the areas closely exposed to the phototherapy lights and does not blanch with diascopy. No vesiculobullous eruptions, edema, or tenderness is noted. The unexposed …

Correlation between cord blood bilirubin level and incidence of hyperbilirubinemia in term newborns

Background Discharging healthy term newborns from thehospital after delivery at increasingly earlier postnatal ages hasrecently become a common practice due to medical, social, andeconomic reasons, however it contributes to readmission becauseof jaundice.Objective To investigate the correlation between level of cordblood bilirubin and development of hyperbilirubinemia amonghealthy term newborns.Methods Prospective observational study was performed on88 healthy term newborns. Cord blood was collected for thetotal bilirubin, conjugated bilirubin, unconjugated bilirubinlevel measurement and blood group test. Measurements of totalbilirubin, conjugated bilirubin, and unconjugated bilirubin wererepeated on the 5th day with serum sampling, or as soon as thenewborn appeared to be jaundice.Results Subjects were categorized into hyperbilirubinemia andnon-hyperbilirubinemia newborns. There was a correlationbetween cord blood and the 5th day bilirubin level. By ROCanalysis, cord blood bilirubin level of 2:2.54 md/dL was determined to have high sensitivity (90.5%), specificity of 85%, and accuracy of 86.4%.Conclusions There is a correlation between cord blood bilirubinlevel and hyperbilirubinemia in healthy term newborns. Cordblood bilirubin level at or greater than 2.54 mg/dL can predictthe development of hyperbilirubinemia.

Cord blood bilirubin level in relation to bilirubin UDP‐glucuronosyltransferase gene missense allele in Chinese neonates

To investigate bilirubin UDP-glucuronosyltransferase (UGT1A1) gene allele in healthy Chinese neonates, their cord bilirubin level and the subsequent hyperbilirubinemia to determine relationships among them. Cord blood of 48 neonates was obtained to determine the exon 1 of UGT1A1 gene, total serum bilirubin, albumin, glutamic-pyruvic transaminase (GPT), glutamic-oxalacetic transaminase (GOT) and haemoglobin (Hb) concentration. Neonatal jaundice was assessed by measurement of transcutaneous bilirubin (TCB) and serum bilirubin. Neonates were divided into two groups according to mutant or normal allele to compare the variables. Nineteen infants had the nucleotide 211 G-->A allele, 3 had the heterozygous variation (686C-->A, 845 A-->T, 231G-->A). In the 211 A allele group, cord bilirubin was significantly higher than in the 211 G allele group (p = 0.034), but there were no differences in albumin (p = 0.678), GPT (p = 0.460), GOT (p = 0.440) and Hb (p = 0.886). The TCB (at 48, 96 h), the frequency of the hyperbilirubinemia and prolonged jaundice were also significantly higher in the 211 A allele group. The UGT1A1 gene codon G71R allele is a risk factor for neonatal hyperbilirubinemia in the Chinese population. Its effect on bilirubin metabolism may present early on, as well as late in foetal life.

Clinical trial: modulation of human placental multidrug resistance proteins in cholestasis of pregnancy by ursodeoxycholic acid

The effects of ursodeoxycholic acid on human placental bile acids and bilirubin transporters in intrahepatic cholestasis of pregnancy are still undefined. To evaluate whether ursodeoxycholic acid affects MRP2, MRP3 and MRP4 expression in the placenta. Forty-three pregnant women were enrolled; fourteen subjects had physiological pregnancies. Intrahepatic cholestasis of pregnancy patients were divided into two groups: (i) 13 received ursodeoxycholic acid (20 mg/kg/day) and (ii) 16 untreated. Total bile acid and bilirubin in serum and cord blood were determined in each subject. Multidrug resistance proteins expression (immunoblot, quantitative real-time PCR) was evaluated in placentas collected at delivery. anova test was used for statistical analysis of data. Ursodeoxycholic acid administration significantly improved maternal serum bile acid and cord blood bilirubin and bile acid levels. MRP2 protein and RNA expression was significantly increased in placentas from treated patients compared to controls (P < 0.001 and P < 0.01, respectively). MRP3 protein expression was not significantly different between the groups while RNA expression was significantly decreased in treated patients (P < 0.01). MRP4 did not show significant differences between the groups. Ursodeoxycholic acid administration induces placental MRP2 expression, and reduces bilirubin and bile acid levels in cord blood.

Bilirubin dosage in cord blood: could it predict neonatal hyperbilirubinemia?

With early discharge, many newborns have to be readmitted to hospital for hyperbilirubinemia to be treated, and this has been held responsible for the reappearance of kernicterus. To evaluate whether bilirubin levels in cord blood could predict neonatal hyperbilirubinemia that would require treatment, in full-term newborns up to their third day of life. Prospective study. Neonatal Unit of Hospital Israelita Albert Einstein, São Paulo, Brazil. 380 full-term newborns considered normal: with or without ABO/Rh blood group incompatibility and without other complications. Blood was taken from the umbilical cord for analysis of conjugated, unconjugated and total bilirubin serum levels. The newborns were followed up until discharge, and unconjugated bilirubin that required phototherapy was compared to the cord bilirubin assay. Discriminant analysis was used to classify newborns: with or without risk of needing phototherapy by the third day of life. Bilirubin assay in cord blood; mother's and newborn's blood groups; phototherapy indication. The mean value for unconjugated bilirubin in cord blood was significantly higher in newborns whose unconjugated bilirubin required phototherapy. The presence of ABO blood group incompatibility was a significant variable in relation to unconjugated bilirubin that required phototherapy. The most useful cutoff point for unconjugated bilirubin in cord blood was 2.0 mg/100 ml. Cord blood could be collected, stored and used for further analysis of unconjugated bilirubin levels as a means for considering whether or not to discharge a moderately jaundiced child from hospital, in association with other resources. Blood incompatibility between mother and child was a predictor for the appearance of hyperbilirubinemia that required treatment. Considering a cutoff point of 2.0 mg/100 ml, it could be concluded that 53% of the newborns who had greater unconjugated bilirubin levels in cord blood would reach levels requiring phototherapy by the third day of life.

Prediction of hyperbilirubinaemia in the healthy term newborn.

The aim is to establish the correlation between transcutaneous bilirubin (TCB) and serum bilirubin (TSB) and its predictive value for significant hyperbilirubinaemia > or = 290 mcmol/L (17 mg/dL). We studied a total of 2004 healthy full-term newborns, weight 3.230 g +/- 491 g; 90% received breast milk. The study was performed in two phases. In the first phase (610 newborns), the following tests were carried out: hematocrit and bilirubin in umbilical cord blood; TCB at 24 h, 48 h and between 60 h and 96 h at the forehead and over the sternum; TSB was measured along with this last test. In the second phase (1394 newborns), the predictive value of TCB and TSB was validated. The incidence of bilirubin > or = 290 mcmol/L was 2.95% and 3.2%. The correlation between TSB and TCB is high (n = 996; r = 0.92; y = 5.916 + 0.804x; p < 0.000). There was a better correlation between TCB and TSB with sternal compared to forehead determination (< 24 h: 0.81 vs 0.77; 24-48 h: 0.887 vs 0.83; and > 48 h: 0.94 vs 0.83). The study showed the scant sensitivity of umbilical cord blood bilirubin and good predictive value at 24 h of TSB > or = 102 mcmol/L (6 mg/dL) and at 48 h of TSB > or = 154 mcmol/L (9 mg/dL) and TCB > or = 13 (equivalent to 154 mcmol/L). There is a good correlation between TCB and TSB. In infants with TSB > or = 102 mcmol/L at 24 h or TSB > or = 154 mcmol/L or transcutaneous readings > or = 13 h at 48 h, a TSB test must be performed after 48 h of life.