Development Of Significant Hyperbilirubinemia Research Articles

The early indicator of significant hyperbilirubinemia in healthy full-term infants at 72 hrs of age: A prospective cohort study

Introduction Hyperbilirubinaemia is a very common and frequently benign condition in newborns,but is a leading cause of hospitalisation in the first week of life. Many healthy full-term newbornsdevelop significant hyperbilirubinemia, often leading to serious complications as bilirubinencephalopathy and death. The present study was aimed to determine early predators and riskfactors in full-term healthy newborns developing significant hyperbilirubinemia. Methods - This wasa prospective observational cohort study conducted at the department of pediatrics at a tertiary careteaching hospital over 1 year enrolling 200 full-term healthy newborns and following them from birthto 72 hrs of life to determine early predictors of hyperbilirubinemia. The data were analysed usingthe Statistical Package of Social Science Software (SPSS) program. Bilirubin levels measured at 72hrs were compared to identify significant hyperbilirubinemia using cut off at or above highintermediate risk zone in Bhutani nomogram. Results- Neonates with birth weight <2.5 kg, bornthrough instrumental delivery, delayed feeding, dehydration, 24 Hr serum bilirubin >6mg/dl and 48Hr serum bilirubin >11 mg/dl were significantly associated with significant hyperbilirubinemia(p<0.05) Conclusion- These risk factors can be used as risk indicator to predict the development ofsignificant hyperbilirubinemia in such newborns and better pre-discharge counselling and followupcan be ensured in such newborns especially in resource-limited settings.

Cord Blood Albumin as a Predictor of Significant Hyperbilirubinemia in Term and Preterm Neonates

Background: Jaundice is the most common condition requiring medical attention and readmission. As neonates are discharged within 48 hours of birth, close follow up is very important to look for jaundice. In developing countries, follow up visits are difficult. Therefore, it is important to identify at risk neonates before discharge. This study helps in identifying neonates at risk for hyperbilirubinemia. This study includes both healthy pre-term and full term neonates.Aim & Objective:To find correlation between cord blood albumin level with serum bilirubin level in healthy term and preterm neonates and correlation between maternal serum albumin level with cord blood albumin.Subject and Method:This study included 106 neonates (full-term and pre-term) born in Lilavati Hospital, Mumbai during period of March to December 2017. Result:Out of 106 neonates, 42(39.6%) developed significant hyperbilirubinemia. 17 (58.6%) neonates with cord blood albumin below 2.8 g/dl required phototherapy against 24 (50%) with cord blood albumin between 2.8-3.3 g/dl. In this study, 11 (73.3%) out of 15 pre-term and 6 (42.9%) of 14 full-term neonates with cord blood albumin below 2.8 g/dl developed significant hyperbilirubinemia and required phototherapy. A significant association wasobserved between maternal and cord blood albumin level. Conclusion:Significant association observed between cord blood albuminand tendencies of significant hyperbilirubinemia. So, cord blood albumin can be used as a surrogate marker for screening newborns for development of significant hyperbilirubinemia

Cord serum albumin as a predictor of neonatal hyper bilirubinemia in healthy full-term neonates

Introduction: Neonatal jaundice or icterus neonatorum is one of the common problem that is seen in newborns during first week of neonatal life. Clinical jaundice is found in about 80% of preterm and in about 60-70% of term neonates. The main objective of the study was to determine the correlation between cord serum albumin levels and development of significant hyper bilirubinemia in healthy term neonates. Methods: A prospective study was conducted on 316 healthy term neonates. Gender, mode of delivery and birth weight were taken into consideration. It was ascertained that there was no other risk factor for neonatal hyperbilirubinemia among these newborns. These neonates were divided into 3 groups, Group A (cord serum albumin levels < 2.8 gm/dl), Group B (cord serum albumin levels between 2.8 to 3.4 gm/dl) and Group C (cord serum albumin levels 3.4 gm/dl). Result: Of the 316 babies included in the study, 102 babies were under Group A, 166 babies under Group B and 48 babies under Group C. 35 babies in Group A, 5 in Group B and none in Group C developed significant hyperbilirubinemia and required phototherapy. The sensitivity and specificity of cord serum albumin level 2.8 g/dl to predict risk of development of significant neonatal hyperbilirubinemia in our study was 87.50% and 75.72% respectively. Conclusion: Cord serum albumin levels can help us to predict the possibility of significant hyperbilirubinemia among neonates. Hence this can help us to identify the at-risk neonates and utilize our limited resources efficiently among these newborns.

Early predictors of significant hyper bilirubinemia in ABO incompatible newborns

ABO incompatibility have been singularly reported to be strong risk factors in the development of significant hyper bilirubinemia in newborns but usually a combination of these are seen to co-exist in the clinical scenarios commonly witnessed in day to day practice.

Umbilical cord blood acid-base analysis and the development of significant hyperbilirubinemia in near-term and term newborns: a cohort study

BackgroundThe recognition, follow-up, and early treatment of neonatal jaundice has become more difficult, since the earlier discharge of newborns from hospitals has become common practice. Since intrapartum hypoxic stress has been pointed as predisposing factor for the occurrence of hyperbilirubinemia risk, we tested the association with the cord blood acid-base index tests.MethodsA cohort of healthy term and near-term newborns underwent umbilical cord hemogasanalysis at birth and capillary heel total serum bilirubin (TSB) pre-discharge, scheduled at 36 h of life, to define the risk of significant hyperbilirubinemia, defined as >9 mg/dL TSB level, ≥ 75th percentile on nomogram of Bhutani et al.ResultsIt was found that among 537 studied neonates, 133 (24.8%) had pre-discharge TSB levels of >9 mg/dL. When the cord blood gas analysis index tests were compared, their acidemia levels were significantly higher than those of neonates with normal TSB levels: HCO3− (20.71 ± 2.37 vs. 21.29 ± 2.25 mEq/L, p < 0.010), base deficit (−3.52 ± 3.188 vs. -2.68 ± 3.266 mEq/L, p < 0.010), and lactacidemia (3.84 ± 1.864 vs. 3.39 ± 1.737 mEq/L, p < 0.012), respectively. However, logistic regression analysis showed that base deficit was the strongest index of the pre-discharge hyperbilirubinemia risk (OR, 95% CI 0.593; 0.411–0.856), and the hyperbilirubinemia risk increased by 40% with the decrease of 1 mEq/L of base deficit.ConclusionsUmbilical cord blood acidemia and lactacidemia are significant indexes of adaptive mechanisms at birth. The base deficit provides the strongest association with future development of high bilirubin on an hour specific bilirubin nomogram generating risk stratification score in term and near-term neonates.

Comparative study on prediction and course of significant hyperbilirubinemia in term and late preterm babies

Objectives: To study the course and prediction of significant hyperbilirubinemia in healthy late preterm and term newborns. Material and Methods: study comprises of 150 neonates: 92 term newborns and 58 late preterm neonates, each with birth weight >2000g, without Rh or ABO incompatibility or G6PD deficiency. A thorough clinical examination with biochemical measurement of serum bilirubin was done in both groups serially at 6th hour of birth, 2nd day of life, 3rd day, 4th day and on 7th day respectively and the pattern of rise of serum bilirubin and development of significant hyperbilirubinemia were compared in both groups. Results: Out of total 150 neonates, significant hyperbilirubinemia requiring phototherapy or exchange transfusion was noted in 28 patients (18.6%); 12 were term (13%) and 16 were late preterm babies (27.5%) i.e. late preterm babies were 2 times more likely to develop significant hyperbilirubinemia. Conclusion: Since late preterm babies are more vulnerable than their term counterparts, to the complications associated in early life especially hyperbilirubinemia, special attention is required in treating these babies.

Cord bilirubin as a predictor for development of hyperbilirubinemia in term neonates

Introduction: Hyperbilirubinemia is a common problem among term newborns. Cord bilirubin level has been found to correlate well with day 3 bilirubin level. We studied whether cord bilirubin could predict risk of development of significant hyperbilirubinemia among term neonates. Methodology: Prospective study from October 2009 -July 2010. All newborns between 37 weeks -42weeks, birth weight > 2500 gram, Apgar score > 7 at 1st& 5th minute of life were included in the study. Cord blood, day 3 & day 5 bilirubin was collected. Maternal data & bilirubin values were collected & analyzed using SPSS software. Results: About 115 babies were studied. There was no significant difference in cord bilirubin & day 3 bilirubin between babies born to mothers 30 years. There was no significant difference in bilirubin values bassed on mode of delivery. About 29.6% babies developed clinical jaundice & received phototherapy. Cord bilirubin levels had significant association with need of phototherapy. Cord bilirubin >/= 2.1 mg/dl predicted need for phototherapy with PPV of 90.3%. Maternal age, sex of baby, birth weight & gestational age had no significant effect on cord bilirubin levels. Cord bilirubin >/= 2.1 mg/dl predicted day 3 serum bilirubin > 15 mg/dl with sensitivity of 88 % & PPV of 77.49 %. The likelihood ratio with cord bilirubin > 2.1 mg/dl & day 3 serum bilirubin > 15 mg/dl was 9.316. Conclusion: Cord bilirubin is predictive of need of phototherapy & correlated well with day 3 bilirubin levels which would facilitate early management of neonatal hyperbilirubinemia.

Factors identifying babies at risk for significant hyperbilirubinemia: a prospective study conducted at a tertiary care center

Background: Hyperbilirubinemia is universally present in the newborn period and is recognized as clinical jaundice in approximately 50% infants. The aim was t o determine the risk factors and treatment modalities of newborns with significant hyperbilirubinemia admitted from September 2011 to August 2013. Methods: One hundred and fifty newborns with significant hyperbilirubinemia, both inborn and outborn were included in the study. Relevent information during hospitalisation was taken. American Academy of Pediatrics (AAP) guidelines were followed to determine the treatment modality. Treatment in the form of either phototherapy or exchange transfusion was given. Results: Out of 150 patients 90 were males and 60 females. Higher values of serum bilirubin were found in the female babies and this difference was statistically significant. One hundred and thirty four babies had a birth weight of more than 2 kgs and 16 less than 2 kgs. The serum bilirubin levels were more in babies more than 2 kgs and this was statistically significant. Ninety one babies were delivered vaginally and 59 by LSCS. Higher serum bilirubin levels were found in those delivered vaginally with the difference being statistically significant .ABO blood group incompatibility was seen in 70 babies, 6 babies with Rh incompatibility. ABO incompatibility resulted in higher serum bilirubin levels with the difference being statistically significant. Ninety six babies had a gestation of more than 37weeks and higher bilirubin levels were found in this group as compared to lesser gestational age baby, the difference was statistically significant. Eighty five patients were admitted before 72 hours of life and 65 after that. Higher serum bilirubin levels were found in those admitted later with a statistically significant difference. The presence of antenatal risk factors (P = 0.4), parity of the mother (P = 0.178) were not found to play a major role in development of significant hyperbilirubinemia. Phototherapy was used as treatment modality in 137 patients, whereas 13 required exchange transfusion. Conclusions: Significant hyperbilirubinemia was found to be more common in female babies, more than 37weeks of gestation, delivered vaginally, with birth weight of more than 2kgs, with ABO blood group incompatibility, admitted after 72hrs of life and with no identified antenatal risk factors. Most commonly used treatment modality found in these cases was phototherapy.

Trends of Transcutaneous Bilirubin in Neonates Who Develop Significant Hyperbilirubinemia

To provide data on the natural course of transcutaneous bilirubin (TcB) levels in neonates before the development of significant hyperbilirubinemia, and to assess the effect of different demographic and perinatal factors on the rate of TcB increase. We analyzed 2454 TcB measurements from 419 neonates before the development of significant hyperbilirubinemia. Mean TcB values and TcB percentiles for designated times were calculated, and the effect of different risk factors on the rate of TcB increase was assessed. TcB percentile curves were plotted for comparison on a population-based TcB nomogram. Blood incompatibilities and glucose-6-phosphate dehy-drogenase deficiency were associated with higher rates of TcB in-crease during the first 36 to 48 postnatal hours, whereas smaller gestational age, increased weight loss, and exclusive breastfeeding had a similar but later effect. Compared with general population norms, a different pattern of TcB increase was noted in neonates who developed significant hyperbilirubinemia, but with a sub-stantial overlap of TcB values during the first 24 to 48 postnatal hours. We provide data on the natural course of TcB levels before the development of significant hyperbilirubinemia in a white population of term and near-term neonates. Smaller gestational age, blood incompatibilities, glucose-6-phosphate dehydrogenase deficiency, increased weight loss, and exclusive breastfeeding significantly affected the rate of TcB increase in a time-dependent manner. These findings may assist in assessing the risk for significant hyperbilirubinemia and planning appropriate follow-up strategies for neonates with borderline bilirubin levels.

Prospective Validation of a Novel Strategy for Assessing Risk of Significant Hyperbilirubinemia

Our aim was to validate a strategy for assessing the risk of significant hyperbilirubinemia in newborns with gestational ages of ≥35 weeks by combining predischarge bilirubin percentile data with gestational age data, for a European, predominantly white population. We conducted a prospective cohort study with 463 newborns with gestational ages of ≥35 weeks who were admitted to the well-infant nursery. Total bilirubin levels were measured daily until discharge and once after discharge, between the third and eighth days of life, by using a Bilicheck device (Respironics, Murrysville, PA). The values obtained (<52 hours) were plotted on an hour-specific bilirubin nomogram to determine the infant's bilirubin percentile, expressed as a risk zone. Patients were assigned to 1 of 3 risk groups (very low, low, or high) on the basis of a combination of risk zone and gestational age data and were monitored prospectively for the development of significant hyperbilirubinemia. The 95% confidence interval (CI) for the prevalence of significant hyperbilirubinemia was estimated with the binomial distribution method. Forty-four infants (11%) developed significant neonatal hyperbilirubinemia. The risks of developing significant hyperbilirubinemia were 1.3% (95% CI: 0.2%-3.7%) for the very low risk group (n = 230 [58.1%]), 3.4% (95% CI: 0.7%-9.8%) for the low risk group (n = 86 [21.7%]), and 47.50% (95% CI: 36.2%-59.0%) for the high risk group (n = 80 [20.20%]). The proposed strategy, based on predischarge bilirubin level and gestational age data, was a valid method for significant hyperbilirubinemia risk assessment in our population.