Hyperbilirubinemia In Healthy Term Newborns Research Articles

Risk Stratification of Term Neonates for Development of Significant Hyperbilirubinemia by Cord Serum Bilirubin and Albumin Ratio

ABSTRACT Background: Neonatal hyperbilirubinemia is a common neonatal problem. Although benign in the majority of the cases, few neonates develop bilirubin-induced neurological dysfunction further progressing to kernicterus. Due to early hospital discharge of healthy-term neonates, there is need of a reliable tool for early prediction of significant hyperbilirubinemia in them. Aim: The aim of this study is to determine the utility of cord total serum bilirubin/albumin ratio as an early predictor of significant neonatal hyperbilirubinemia in healthy-term newborns. Settings and Design: This is a tertiary care hospital-based prospective cohort study. Subjects and Methods: The study was conducted on 100 sequentially born healthy-term neonates. Cord bilirubin/albumin ratio was calculated and neonates were divided into two groups on the basis of 50th percentile value. Serum bilirubin was also measured at 72 h of life in all neonates and value ≥17 mg/dl was taken as significant requiring intervention. Statistical Analysis Used: Continuous variables were summarized as mean and standard deviation while nominal/categorical variables as percentage. Association between total serum bilirubin at 72 h of life and cord bilirubin/albumin ratio was assessed using two-sample independent t-test and Pearson correlation coefficient formula. Cutoff value of the ratio was derived using receiver operating characteristics (ROC) curve analysis. Results: Statistically significant association was observed between cord bilirubin/albumin ratio with the development of neonatal hyperbilirubinemia. On ROC analysis, cutoff point to predict significant hyperbilirubinemia was found to be >0.66 (92.9% sensitivity, 60.5% specificity, and PPV 79.61%). Conclusions: Cord total serum bilirubin/albumin ratio is a good parameter to predict significant neonatal hyperbilirubinemia in healthy-term neonates.

Evaluation of the cord blood albumin for the early prediction of neonatal jaundice

Background and Aim: Neonatal Hyperbilirubinemia (NH) is the most common cause for readmission during the early neonatal period. There are reports of bilirubin induced brain damage occurred in healthy term infants even without haemolysis and the sequalae could be serious. Aim of the study was to predict the development of Neonatal Hyperbilirubinemia at birth using Cord Serum Albumin as a risk indicator.Material and Methods: Observation study was performed on 348 healthy term new-borns. Cord blood was collected from the healthy term new-borns delivered either vaginally or caesarean section for cord serum albumin level measurements. Total serum bilirubin and direct serum bilirubin were measured during 72-96 hours of life with serum sampling of peripheral venous blood. Newburn was assessed clinically daily for Neonatal Hyperbilirubinemia or for any other complication during the study period. Results: Study cohort is grouped into Group1, Group2 and Group 3 based on Cord Serum Albumin level 2.8g/dl, 2.9-3.3g/dl and 3.4g/dl, respectively. In these groups, new-borns with total serum bilirubin level 17mg/dl after 72 hours are taken as Neonatal Hyperbilirubinemia, requiring interventions like phototherapy or exchange transfusion. Conclusion: There is a correlation between Cord serum albumin level and neonatal hyperbilirubinemia in healthy term new-borns. Cord serum albumin level of 2.8 g/dl can predict the development of neonatal 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.

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.

PREDICTIVE VALUE OF CORD BLOOD BILIRUBIN IN DEVELOPMENT OF NEONATAL HYPERBILIRUBINEMIA

Introduction: The early detection of neonatal hyperbilirubinemia (NNH) can be done by various methods; however, the most reliable is cord blood bilirubin (CBB). Objective: The objective of this study is to evaluate the predictive value of the CBB levels for the subsequent hyperbilirubinemia in healthy term newborns and its association with various maternal and neonatal factors. Materials and Methods: Two hundred healthy term-neonates between 37 and 42 weeks of gestation were included in the study. A thorough antenatal, perinatal, and natal history was obtained. Cord blood was collected from all newborns, and the samples were sent for the estimation of serum bilirubin, blood grouping, and Rh typing. Results: Various risk factors such as gender difference (p 2.5 mg/dl. At a cutoff of 2.5 mg/dl, sensitivity and specificity came out to be 33.33% and 96.25%, respectively. Conclusion: NNH and CBB level were found to be associated with several maternal and neonatal risk factors. Hence, total serum bilirubin in cord blood was indicative of the jaundice severity among neonates.

The first 24-hour bilirubin level as a predictor of hyperbilirubinemia in healthy term newborns

Background Early discharging healthy term newborns results ina difficulty to recognize hyperbilirubinemia.Objective The aim of this study was to determine the value of thefirst 24-hour total and unbound bilirubin levels in predicting hyper-bilirubinemia in healthy term newborns.Methods The first 24-hour and the 5 th day total and unboundbilirubin levels were measured in 84 healthy term newborns. Thetotal bilirubin level was measured spectrophotometrically, whereasunbound bilirubin level was determined by peroxidase-oxidationmethod. Hyperbilirubinemia was defined as serum total bilirubin of&gt;12.9 mg/dL or serum unbound bilirubin of &gt;0.5 mg/dL after 24hours of life.Results A correlation between the first 24-hour and the 5 th daytotal bilirubin levels was found (r= 0.53) with a regression equa-tion: Y (total bilirubin on day 5) = 4.69 + 1.15X (total bilirubin in thefirst 24 hours). In unbound bilirubin (r=0.31), the regression equa-tion was Y (unbound bilirubin on day 5) = 0.13 + 0.95X (unboundbilirubin in the first 24-hours). The relative risk for developing hy-perbilirubinemia in newborns whose TB 1 was &gt;4.5 mg/dL was 12(95% CI 2.9;48.4), whereas newborns whose UB 1 was &gt;0.09 mg/dL was 9.5 (95% CI 1.2;77.4).Conclusion Total bilirubin level of &gt;4.5 mg/dL in the first 24 hourscan predict the development of hyperbilirubinemia in term new-borns in the first week of life. Newborns with such level of totalbilirubin need a longer stay or should visit the hospital on day 5-7

First day bilirubin as a predictor of development of significant jaundice in term healthy neonates: a tertiary care hospital based study

Background: Neonatal jaundice is common and usually benign self-limited condition, but if severe can cause severe neurological damage. 1 This prospective study was undertaken to determine the critical serum bilirubin level to predict the significant hyperbilirubinemia in healthy term new-borns based on the serum bilirubin measurement made within 24 hours of postnatal life. Present study was done to study the first day bilirubin as a predictor of development of significant jaundice in healthy term neonates. Methods: The present study was conducted in the post graduate department of paediatrics Government Medical College Srinagar, tertiary care referral hospital. Total of 152 healthy term new-borns were included in the study. Micro capillary sample was taken on heel prick and centrifuge. Bilirubin estimation was done spectophotometrically using twin beam method (575-455) wave length bilinmicrometer. The infants were followed up clinically every 12 hours after initial bilirubin estimation till discharge the babies were recalled after discharge at 5 days of age. This study is a Prospective observational study. Results: Initial bilirubin estimation was done on first postnatal day, and the range of initial bilirubin estimation was between 2.9-8 mg/dl. Clinically detectable jaundice was present in 110 (72.36%) patients. Out of 152 new-borns, 101 (66.44%) with serum bilirubin 6 mg/dl 13 (25.46%) developed significant hyperbilirubinemia. Conclusions: The present study found that a total serum bilirubin level of ≤6 mg/dl can be used to predict decreased risk for subsequent hyperbilirubinemia (TSB >17 mg/dl) with a sensitivity of 92.8% and negative predictive value of 99%. Such infants could thus be discharged early without need to follow up for hyperbilirubinemia later.

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.

Management of hyperbilirubinemia in the healthy term newborn.

This month's clinical practice guideline review is on hyperbilirubinemia in healthy term newborns. Due to the large number of newborns that experience clinical jaundice each year in the United States and the controversy that continues to surround the treatment of hyperbilirubinemia in healthy newborns, this guideline should be of great interest to nurse practitioners that treat this population.

The Value of First-Day Bilirubin Measurement in Predicting the Development of Significant Hyperbilirubinemia in Healthy Term Newborns

The 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. This prospective study was undertaken to identify the newborns at risk for developing significant hyperbilirubinemia later during the first days of life by measuring the serum bilirubin levels of the first 5 days of life to determine the critical predictive serum bilirubin value on the first day of life. A total of 498 healthy term newborns were followed with daily serum total bilirubin measurements for the first 5 days of life, and cases with serum bilirubin levels of >/=17 mg/dL after 24 hours of life were defined to have significant hyperbilirubinemia. No newborns had a serum total bilirubin level of >/=17 mg/dL in the first 72 hours of life. Sixty of 498 cases (12.05%) had significant hyperbilirubinemia after 72 hours of life, and these cases had significantly higher bilirubin levels than those who did not develop significant hyperbilirubinemia on each of the first 5 days' measurements. Of the 206 newborns who had a serum bilirubin level of >/=6 mg/dL in the first 24 hours, 54 (26.21%) developed significant hyperbilirubinemia, whereas only 6 of the 292 newborns (2.05%) who had a serum bilirubin level of <6 mg/dL on the first day developed significant hyperbilirubinemia. A mean serum bilirubin level of >/=6 mg/dL on the first day had the highest sensitivity (90%). At this critical serum bilirubin value, the negative predictive value was very high (97.9%) and the positive predictive value was fairly low (26.2%). Furthermore, because no cases with a serum bilirubin level of <6 mg/dL in the first 24 hours of life required a subsequent phototherapy treatment and because all of those infants requiring a phototherapy treatment with serum bilirubin levels of >/=20 mg/dL were just among the cases whose first-day bilirubin levels were >/=6 mg/dL, the critical bilirubin level of 6 mg/dL on the first day made it possible, with the highest (100%) sensitivity and negative predictive value, to definitely predict all of the infants who would have a bilirubin level of >20 mg/dL, requiring a phototherapy treatment later during the first days of life. A serum bilirubin measurement and the use of the critical bilirubin level of 6 mg/dL in the first 24 hours of life will predict nearly all of the term newborns who will have significant hyperbilirubinemia and will determine all those who will require a phototherapy treatment later during the first days of life.

Neonatal Bilirubin Nomogram: A Tool to Facilitate Practical Application of AAP Guidelines for Management of Hyperbilirubinemia in Healthy Term Newborns. † 970

Neonatal Bilirubin Nomogram: A Tool to Facilitate Practical Application of AAP Guidelines for Management of Hyperbilirubinemia in Healthy Term Newborns. † 970

Neonatal Hyperbilirubinemia in Healthy Term Infants and Cognitive Outcome in Late Adolescence † 1128

The new guidelines concerning management of hyperbilirubinemia in healthy term newborns recommend treatment only for severe jaundice. However, few data are available regarding the long-term effect of exposure to hyperbilirubinemia on cognitive abilities. To address this issue we performed a historical prospective study. Total serum bilirubin (TSB) levels had been prospectively obtained on days 3 and 5 from all 3772 consecutive singleton newborns delivered between Jan. 1975 and Feb. 1976. All infants were treated clinically as indicated including phototherapy and exchange transfusion (n=15). Only one infant reached a TSB ≥25 mg/dL. Intelligence test scores at age 17 were available for 1792 (85.0%) of the males and 748 (44.9%) of the females. A multiple linear regression analysis was used to adjust for the confounding effect of birth weight, gestational age, birth asphyxia, instrumental or cesarean delivery, birth order, and blood type, as well as parental educational attainment, ethnic origin and social status. A logistic regression showed no significant association between low intelligence scores ( 17 mg/dL, odds ratio 0.65 (95% C.I. 0.30-1.43) for males and 1.79(0.47-6.74) for females. We conclude that moderate hyperbilirubinemia in healthy term infants was not associated with adverse cognitive outcome at 17 years of age. The intelligence test scores at 17 years of age by maximal TSB categories (mg/dL) were: Table

IMPLEMENTATION OF THE NEW PRACTICE PARAMETER FOR THE MANAGEMENT OF HYPERBILIRUBINEMIA IN HEALTHY TERM INFANTS. † 1040

In October 1994, the Provision Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia of the American Academy of Pediatrics published a Practice Parameter for the management of hyperbilirubinemia in healthy term newborns (Pediatrics 1994;94:558-62). It was expected that if these guidelines are followed, a significant reduction in unnecessary intervention could be safely achieved. The aim of the present study was to compare the management of neonatal jaundice in the periods immediately before and after the introduction of the new guidelines. We examined the rate of phototherapy and exchange transfusion in two university affiliated community hospitals in Jerusalem, Bikur-Cholim and Misgav Ladach, during two periods from June 1, 1992 through September 1, 1993, and from June 1, 1995 through September 1, 1996. All data were prospectively recorded in a computerized database. The rate of phototherapy, in the two study periods, significantly decreased (p 37 weeks gestation) infants, and from 22.9% (88/383) to 8.5%(27/316) in preterm ( 2000 g) infants in Bikur-Cholim. For Misgav Ladach a similar decrease was observed from 4.4%(126/2807) to 2.2% (108/4879) among full term infants (p<0.0001) and from 13.2% (14/106) to 10.7% (20/186) in preterm infants (not significant). The use of exchange transfusion was significantly higher (p<0.001) in the first period compared with the second period, 0.2% (15/6499) vs. 0.03% (3/8650). There was no statistically significant difference in the mean birth weight(3264 vs. 3273 g) and in the mean duration of hospitalization (3.1 vs 3.5 days) in the two study periods. We conclude that a significant decrease in the use of phototherapy and exchange transfusion occurred since the introduction of the new practice parameters. This trend was observed for both term and preterm newborns, although the new guidelines were not intended for infants born before term.