Hyperbilirubinemia In Term Newborns Research Articles

Umbilical Cord Blood Hemoglobin as a Predictor of Significant Neonatal Hyperbilirubinemia in Term Newborns in a Tertiary Care Centre in North Kerala

Aims: Neonatal hyperbilirubinemia is one of the most common problems during first week of life and is the most common cause of readmission in early neonatal period. The present study aimed to predict the development of significant hyperbilirubinemia in term neonates using cord blood hemoglobin.
 Study Design: Prospective study.
 Place and Duration of Study: Department of Paediatrics, MMCH & RC, Kozhikode, Kerala from March 2021 to July 2022.
 Methodology: The prospective study enrolled 162 appropriate for gestational age term newborns, delivered at MMCH & RC. Cord blood hemoglobin was measured and bilirubin estimation was done at 48-72 hours of life. Hyperbilirubinemia was considered significant if serum bilirubin value was above standard as per American Academy of Pediatrics guidelines. Data was entered in Microsoft Excel and analysed using SPSS 20.0 version. The relationship between cord hemoglobin in predicting significant neonatal hyperbilirubinemia was studied using appropriate statistical tests. Sensitivity and specificity of the variables were defined using ROC curve and Pearson correlation coefficient to determine the correlation between the variables.
 Results: Out of the total 162 neonates enrolled, 86 were boys (53.1%) and 76 were girls (46.9%). The mean cord hemoglobin value was 15.3g/dl. 20 neonates (12.3%) had developed significant hyperbilirubinemia and required phototherapy while none of them needed exchange transfusion. Correlation between cord hemoglobin with serum bilirubin showed weak correlation (r=0.194) but the correlation was statistically significant (p<0.05). On ROC curve analysis, cord hemoglobin cut off value ≥14.9g/dl showed 75% sensitivity and 39.4% specificity to predict significant neonatal hyperbilirubinemia.
 Conclusion: There is significant correlation between umbilical cord blood hemoglobin level and neonatal hyperbilirubinemia. Cord hemoglobin ≥14.9g/dl can predict future development of significant neonatal hyperbilirubinemia. This will be useful in very low resource centres to plan early discharge of newborns without fear of hyperbilirubinemia.

Etiology analysis for term newborns with severe hyperbilirubinemia in eastern Guangdong of China

Neonatal hyperbilirubinemia is one of the common diseases of newborns that typically presents with yellow staining of skin, resulting in sequelaes such as hearing loss, motor and intellectual development disorders, and even death. The pathogenic factors of neonatal hyperbilirubinemia are complex. Different cases of hyperbilirubinemia may have a single or mixed etiology. To explore the etiological characteristics of severe hyperbilirubinemia in term newborns of eastern Guangdong of China. Term newborns with severe hyperbilirubinemia in one hospital from January 2012 to December 2021 were retrospectively analyzed. The etiology was determined according to the laboratory results and clinical manifestations. Among 1602 term newborns with hyperbilirubinemia in eastern Guangdong of China, 32.20% (580/1602) was severe hyperbilirubinemia. Among the causes of severe hyperbilirubinemia, neonatal hemolysis accounted for 15.17%, breast milk jaundice accounted for 12.09%, infection accounted for 10.17%, glucose-6-phosphate dehydrogenase (G6PD) deficiency accounted for 9.14%, and the coexistence of multiple etiologies accounted for 6.55%, unknown etiology accounted for 41.72%. ABO hemolysis and G6PD deficiency were the most common causes in the 20 cases with bilirubin encephalopathy. 94 severe hyperbilirubinemia newborns were tested for uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1)*6 variant (rs4148323, c.211G>A, p.Arg71Gly), 9 cases were 211 G to A homozygous variant, 37 cases were 211 G to A heterozygous variant, and 48 cases were wild genotypes. The main cause for severe hyperbilirubinemia and bilirubin encephalopathy in eastern Guangdong of China were the hemolytic disease of the newborns, G6PD deficiency and infection. UGT1A1 gene variant was also a high-risk factor for neonatal hyperbilirubinemia. Targeted prevention and treatment according to the etiology may reduce the occurrence of bilirubin encephalopathy and kernicterus.

Long-Awaited AAP Hyperbilirubinemia Guidelines Have Arrived.

Long-Awaited AAP Hyperbilirubinemia Guidelines Have Arrived.

The Effect of Breastfeeding and an Intensive Breast Milk Nutritional Support Program on Hospitalization Rates for Hyperbilirubinemia in Term Newborns: An Open Randomized Controlled Trial.

The aim of this study was to determine the effect of breastfeeding and intensive breast milk nutritional support program (IBNSP) on hospitalization rates for hyperbilirubinemia in normal term newborns. This study's sample consisted of 68 newborn infants (experimental group: 34; control group: 34) born at a university hospital from October 2020 to April 2021. Five steps of breastfeeding and IBNSP were administered to the experimental group for the first 48 h after birth. This program starts at the postpartum first hour and continues until the 48th hour. It includes face-to-face training, practical support on breastfeeding, and one-to-one demonstration and practice methods. The control group received the standard care recommended by the World Health Organization. Both groups' bilirubin levels were measured 24 and 72 h after birth. Participants in both groups were hospitalized for risky (according to bilirubin values) situations. The groups' bilirubin levels and hospitalization rates for hyperbilirubinemia were compared. There was no statistically significant difference between the experimental (5.19 ± 1.27) and the control (5.83 ± 1.52) groups' bilirubin levels at 24 h after birth, (t = -1.881, p = 0.064); however, the control group infants (12.03 ± 3.67 mg/dl) had higher bilirubin levels than the infants in the experimental group 72 h after birth (9.55 ± 2.82 mg/dl) (t = -3.122, p = 0.003). The experimental group's hospitalization rate for hyperbilirubinemia (n: 1, 2.9%) was lower than the control group's rate (n: 8, 23.5%), and this difference was statistically significant (X2 = 6.275, p = 0.014). Breastfeeding and IBNSP effectively prevent hospitalization for hyperbilirubinemia and reduce newborns' bilirubin levels.

To study the correlation between various levels of cord blood albumin & serum bilirubin at 48 hrs of age in term healthy newborns

Introduction: Neonatal Hyperbilirubinemia is the most common abnormal physical finding and themajor cause of neonatal morbidity during the early neonatal period. Early identification of infants atrisk might help in providing preventative therapy and follow-up. We aimed to assess whether arterialumbilical cord albumin level at birth predicts the development of neonatal hyperbilirubinemia in termnewborns at 48 hrs of life. Methods: This prospective observational cohort study was conducted ina tertiary care hospital over 1 year in 200 term healthy neonates. Cord blood albumin was estimatedat birth followed by serum bilirubin level on the 3rd postnatal day(48 hrs of age). Results: Total of200 neonates were divided into three groups based on cord blood albumin level of <2.8 g/dl(groupI), 2.8-3.4 g/dl(group II) and >3.4 g/dl(groupIII) with 32, 100 and 68 in three respective groups.19 newborns (59.4%) in group I,14 in group II, and 7 newborns (10.3%) in group III developedserum bilirubin levels above an intermediate high-risk zone in Bhutani nomogram at 48 hrs of age.newborn with low cord albumin (<2.8g/dl) were significantly associated with higher bilirubin levelsat 48 hrs of age. Conclusion: Neonates with cord blood albumin <2.8 gm/dl had a significantassociation of the development of hyperbilirubinemia at or above intermediate high-risk zoneaccording to Bhutani nomogram at 48 hrs of life.

The effect of Maternal Vitamin D Deficiency on Increased Risk for Hyperbilirubinemia in Term Newborns

Background Neonatal jaundice is prevalent, and the presence of hyperbilirubinemia frequently requires medical attention and hospital readmission. The aim of the present study was to determine the effect of maternal vitamin D deficiency on increased risk for hyperbilirubinemia in term newborns. Materials and Methods This cross-sectional study was conducted on all pregnant women with gestational age of 38-42 weeks from southwestern Iran who referred to Hafez Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran, from March 2018 to August 2018. Serum 25-hydroxyvitamin D was measured from 300 included pregnant women during birth time. The level of bilirubin was measured in their newborns at 3rd to 5th days of life. The obtained data were analyzed using SPSS software version 22.0. Results The level of 25-hydroxyvitamin D was low in 277 (92.3%) pregnant women. Hyperbilirubinemia was detected in 38 (12.6%) newborns at the 3rd to 5th days of life. Maternal vitamin D during pregnancy showed a significant correlation with the levels of bilirubin in newborns (r= - 0.458, P<0.001). Conclusion The results of this study showed that maternal vitamin D deficiency could be associated with the increased risk for neonatal hyperbilirubinemia.

A study to determine the level of cord blood albumin in predicting neonatal jaundice

Background: Most unconjugated bilirubin formed by the fetus is cleared by the placenta into the maternal circulation. Albumin constitutes 70 - 75% of Plasma oncotic pressure. Another important function of albumin is its antioxidant property. Bilirubin binds to albumin in an equimolar ratio. Free bilirubin is anticipated when the molar bilirubin- to- albumin (B: A) ratio is &gt;0.8 Objective of the study was to predict the proportion of newborn requiring intervention for NH (phototherapy or exchange transfusion) based on cord serum albumin level at birth.Methods: The present prospective study was conducted at Navodaya Medical College, Raichur from October 2018 to November 2019. A total of 180 babies which were born during the study period were included in the study. INCLUSION CRITERIA• Term babies both genders• Mode of delivery (normal and C-section)• Birth weight ≥2.5kg.• APGAR ≥7/10 at 1 min. Cord Serum Albumin level was estimated at birth. Total Serum Bilirubin (TSB) estimation was done at 72-96 hours of age. All the babies were followed up daily for first 4 postnatal days and babies were daily assessed for NH and its severity.Results: In our study nearly 54.4% of them had Cord Serum Albumin levels of less than 2.8 gm/dl, 27.3% of them had albumin levels of 2.9 to 3.3 gm/dl, 18.3% of them had Serum Albumin of 3.4 gm/dl. Out of 180 study subjects, 13.9% of them required phototherapy to treat neonatal hyper bilirubinemia and 2.8% of the study subjects required exchange transfusion.Conclusions: From the present study, cord serum albumin level of ≤2.8g/dl has a correlation with incidence of significant hyperbilirubinemia in term newborns. So, this ≤2.8g/dl of cord serum albumin level can be used as risk indicator to predict the development of significant hyperbilirubinemia.

Evaluation of critical cord blood bilirubin level as a predictor of significant hyperbilirubinemia in term newborns

Evaluation of critical cord blood bilirubin level as a predictor of significant hyperbilirubinemia in term newborns

The effects of antenatal corticosteroid exposure on the rate of hyperbilirubinemia in term newborns.

Objective:Neonatal hyperbilirubinemia is a short-lasting benign condition that affects approximately 60% of infants born at term infants. This study aimed to evaluate the effects of antenatal corticosteroid (ACS) exposure on the rate of hyperbilirubinemia in term newborns.Methods:This retrospective study was conducted at the Health Sciences University Kayseri Education and Research Hospital, Turkey from June 2017 to June 2018. A total of 6254 pregnant participants aged between 18 and 35 years with a singleton pregnancy were included in the study. The study group included 354 women with low-risk pregnancies (no perinatal risk except threatened preterm labor) who received ACS treatment and were hospitalized because of the threat of preterm labor before the 34th gestational week but delivered after 37 weeks of gestation. The control group was composed of 5900 women with low-risk pregnancies who did not receive ACS treatment throughout their pregnancy and delivered after 37 weeks of gestation.Results:Maternal age, mean body mass index, gestational week at delivery, nulliparity, previous cesarean history, sex of the baby, fetal weight, labor induction, vaginal delivery, and five minutes. Apgar score were similar in both groups. The neonatal hyperbilirubinemia rate was 20/354 (5.6%) in the ACS treatment group and 564/5900 (9.6%) in the control group.Conclusions:The neonatal hyperbilirubinemia was significantly decreased in term-born babies exposed to ACS before 34 weeks.

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

ABO Hemolytic Disease Leading to Hyperbilirubinemia in Term Newborns: Value of Immunohematological Tests

Introduction ABO hemolytic disease of the newborn is most common cause of neonatal jaundice; previous studies have shown a poor correlation between serologic tests and clinical course in affected infants. The aim of this study was to identify the value of direct and indirect Coombs’ immunohematological tests, to identify the incidence of hemolytic disease in newborns (ABO-HDN). Methods : This two-year retrospective study of 1800 jaundiced term-neonates studied 355 cases due to ABO incompatibility divided into two groups: with and without hemolytic disease. Relation of laboratory parameters and immunohematological tests to severity of disease were studied. We did not analyze the maternal antibody titer or elusion test, and this was a limitation of the study. Results: In this study, 355 (19.7%) of all jaundiced newborn infants were ABO incompatibles; 98 (27.6%) of the newborns who had ABO incompatibility showed ABO-HDN (5.4% of total icteric patients). The positive direct antiglobulin (direct Coombs’ test) and indirect antiglobulin (indirect Coombs’ test) were diagnostic in 18.2% and 25.5% respectively in affected infants. The overall prevalence of immunohematological tests associated with ABO-HDN was 43.7%. There was significant correlation between positive antiglobulin tests and severity of jaundice (P=0.000); also there was a significant difference between indirect and direct Coombs’ test and severity of jaundice (P= 0.002). Conclusion:The antiglobulin tests, namely the indirect Coombs’ (IC) test and direct Coombs’ (DC) test are very useful to detect the newborns liable to serious jaundice.

Does Type of Infant Feeding Affect Phototherapy for Neonatal Hyperbilirubinemia?

Phototherapy is the most common method used to treat and prevent neonatal hyperbilirubinemia. Breastfeeding compared with formula feeding is associated with an increased risk of jaundice and kernicterus. The main mechanism is failure of successful initiation of breastfeeding. Breast failure jaundice usually leads to significant weight loss resulting in hyperbilirubinemia. The aim was to determine the relation between type of infant feeding and the efficacy of phototherapy for treatment of hyperbilirubinemia in term newborns. The authors included 90 full-term neonates diagnosed with nonhemolytic, unconjugated hyperbilirubinemia. According to their total bilirubin level, they received conventional phototherapy for treatment. They were divided into 3 groups according to type of feeding: group 1, mixed feeding (MF; breast and formula); group 2, formula feeding (FF; formula); and group 3, breastfeeding (BF). Rebound bilirubin was checked 24 hours after stopping phototherapy. The mean duration of phototherapy was more in the BF group, followed by the MF and FF groups (P &lt; .01). There was a significant positive correlation between bilirubin level and weight loss at the start of phototherapy in the groups studied (r = 0.635; P &lt; .001). Rebound bilirubin level was higher in BF followed by FF and MF newborns, with significant differences (P = .005). These results indicate that phototherapy effectively reduces bilirubin levels in BF newborns with hyperbilirubinemia. These infants show a significantly slower response to this treatment than FF or MF newborns. Prevention of breast milk failure would decrease weight loss, which is associated with high bilirubin at the start of phototherapy.

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.

Single vs. double phototherapy in the treatment of full-term newborns with nonhemolytic hyperbilirubinemia

To compare the effectiveness of single (1 panel) vs. double (2 panels) phototherapy in reducing nonhemolytic hyperbilirubinemia in term newborns. Term newborns with hyperbilirubinemia were prospectively randomized to receive double or single phototherapy. Bilirubin levels were measured at admission and at 12-hour intervals, as well as at a follow-up 48 hours after discharge. Thirty-seven patients received single and 40 double phototherapy. The mean decrease in bilirubin level in the first 24 hours of treatment was greater in the double phototherapy group (5.1+/-2.2 mg/dL vs. 4.3+/-2.1 mg/dL), but without statistical significance (p = 0.18). Readmission rates were similar and no adverse effects were found in either group. Double-surface was not more effective than single-surface phototherapy in the treatment of nonhemolytic hyperbilirubinemia in term newborns. However, our results suggest that double phototherapy may be more effective in those term newborns with higher bilirubin levels at admission.

Fototerapia simples versus dupla no tratamento de recém-nascidos a termo com hiperbilirrubinemia não-hemolítica

OBJETIVO: Comparar a eficacia da fototerapia simples (1 painel) versus dupla (2 paineis) na reducao da hiperbilirrubinemia nao-hemolitica em recem-nascidos a termo. METODOS: Os recem-nascidos a termo foram randomizados prospectivamente para receber fototerapia simples ou dupla. Os niveis de bilirrubina foram medidos no momento da internacao e em intervalos de 12 horas, assim como em seguimento 48 horas apos a alta. RESULTADOS: Trinta e sete pacientes receberam fototerapia simples, e 40, dupla. A reducao media dos niveis de bilirrubina nas primeiras 24 horas de tratamento foi maior no grupo que recebeu fototerapia dupla (5,1±2,2 mg/dL versus 4,3±2,1 mg/dL), porem sem significância estatistica (p = 0,18). As taxas de readmissao foram similares e nenhum dos grupos apresentou efeitos adversos. CONCLUSAO: A fototerapia dupla nao foi mais eficaz do que a fototerapia simples no tratamento da hiperbilirrubinemia nao-hemolitica em recem-nascidos a termo. Entretanto, nossos resultados sugerem que a fototerapia dupla possa ser mais eficaz em recem-nascidos a termo com niveis de bilirrubina mais altos no momento da internacao.

Percentage birth weight loss and hyperbilirubinemia during the first week of life in term newborns

Background Hyperbilirubinemia is the most common problem interm newborns during the first week of life. Hyperbilirubinemiain term newborns without other risk factors is usually causedby dehydration and reduced calorie intake that is marked byexcessive weight loss.Objective To determine the relationship between percentage birthweight loss and hyperbilirubinemia during the first week of lifein term newborns.Methods A cross sectional study was conducted at the Departmentof Child Health, Medical School, Udayana University, SanglahHospital, Denpasar, Indonesia. The weight of term newbornswas measured on the first, third, and seventh day after birth.In addition, a complete blood count, reticulocyte count, andperipheral blood smear, were carried out on the first day. Serumbilirubin level was measured on the first, third, and seventh day.Clinical signs, jaundice, type and frequency of intake, and timeof meconium transit were followed during the stay in hospital.Linear regression, correlation, and logistic regression analysis wereperformed to determine variables related to hyperbilirubinemia.Results 68 newborns were enrolled in this study, with 7 developedhyperbilirubinemia by the third day. There was a significant(P&lt;0.001) but weak to moderate correlation (r = 0.39)between percentage birth weight loss and total serum bilirubinconcentration on the third day. Logistic regression analysisshowed that percentage birth weight loss on the third day wassignificantly related to hyperbilirubinemia [OR 38.18 (95% CI2.29 to 637.61), P=0.011].Conclusion Percentage birth weight loss is related to hyperbilirubinemiain term newborn during the first week of life.

Hyperbilirubinemia in term newborns

Der Neugeborenenikterus ist ein aktuelles Thema fur jeden Padiater. Uber 60% aller reifen gesunden Neugeborenen werden in den ersten Lebenstagen ikterisch. Nur ein geringer Anteil muss mit Phototherapie oder Austauschtransfusion behandelt werden. Durch sichere Therapiegrenzwerte konnen neurologische Schaden wie die akute Bilirubinenzephalopathie und der irreversible Kernikterus vermieden werden. Eine Zunahme von Letzterem wird diskutiert. Eine der Hauptursachen, neben unerkannten nichtimmunologischen Risikofaktoren, sind die immer kurzeren stationaren Aufenthalte von Mutter und Kind nach der Entbindung und das Uberwachungsdefizit in der Folgezeit. Es mussen deshalb sichere Interventionsgrenzen fur reife Neugeborenen definiert, Neugeborene mit dem Risiko fur eine schwere Hyperbilirubinamie vor der Entlassung erkannt und die Aufmerksamkeit bei Kinderarzten, Hebammen und Eltern fur das Problem geschult werden.

Trends in neonatal exchange transfusions at Yodogawa Christian Hospital.

A review was conducted to determine the trends in exchange transfusion (ET) of newborn infants at the Yodogawa Christian Hospital during the past 18 years. At that hospital in 1957, the first ET was performed on a term infant with severe hemolytic jaundice caused by rhesus factor (Rh) incompatibility. By 1989, ET had been performed in more than 1400 newborn infants. These cases of newborns who had had ET were retrospectively reviewed, with a focus on every 3 year period from 1974 to 1992. The total number of infants requiring ET noticeably decreased from 68 cases (14.0% of total admissions) in 1974 to 19 cases (6.1% of total admissions) in 1992. (chi 2, P < 0.001) There were three major significant changes in ET during those years. The first was a change in the subjects for ET. The incidence of ET for term infants showed a marked decrease, while the incidence of ET for preterm infants, especially for very low birthweight (VLBW) infants (< 1500 g), noticeably increased. The second was a change in indications for ET. There was a marked decrease in the need for ET as a result of hyperbilirubinemia, while the incidence of ET because of other etiologies, such as septicemia and/or disseminated intravascular coagulopathy, noticeably increased. The third was a change in the technical methods of ET. Now at the Yodogawa Christian Hospital, 100% of the infants are given ET with an automated peripheral two-site method, instead of the Diamond method. Although ET might still be a useful treatment for severe hyperbilirubinemia and other acute problems, the total number of ET noticeably decreased in accord with a decrease in the number of severe hyperbilirubinemia in term newborns. On the other hand, the incidence of ET in preterm infants increased relatively, accompanied by an increase in the survival of VLBW infants. The automated two-site method is the preferred technique for ET at the Yodogawa Christian Hospital, rather than the Diamond method. Further changes in ET might occur in accord with new alternative measures in future.

Practice Parameter: Management of Hyperbilirubinemia in the Healthy Term Newborn

Each year approximately 60% of the 4 million newborns in the United States become clinically jaundiced. Many receive various forms of evaluation and treatment. Few issues in neonatal medicine have generated such long-standing controversy as the possible adverse consequences of neonatal jaundice and when to begin treatment. Questions regarding potentially detrimental neurologic effects from elevated serum bilirubin levels prompt continuing concern and debate, particularly with regard to the management of the otherwise healthy term newborn without risk factors for hemolysis. Although most data are based on infants with birth weights ≥2500 g, "term" is hereafter defined as 37 completed weeks of gestation. Under certain circumstances, bilirubin may be toxic to the central nervous system and may cause neurologic impairment even in healthy term newborns. Most studies, however, have failed to substantiate significant associations between a specific level of total serum bilirubin (TSB) during nonhemolytic hyperbilirubinemia in term newborns and subsequent IQ or serious neurologic abnormality (including hearing impairment). Other studies have detected subtle differences in outcomes associated with TSB levels, particularly when used in conjunction with albumin binding tests and/or duration of exposure. In almost all published studies, the TSB concentration has been used as a predictor variable for outcome determinations. Factors influencing bilirubin toxicity to the brain cells of newborn infants are complex and incompletely understood; they include those that affect the serum albumin concentration and those that affect the binding of bilirubin to albumin, the penetration of bilirubin into the brain, and the vulnerability of brain cells to the toxic effects of bilirubin.

Vigintiphobia, Unbound Bilirubin, and Auditory Brainstem Responses

The management of nonhemolytic hyperbilirubinemia in term newborns is controversial. To evaluate the usefulness of serum unbound bilirubin concentrations (UBCs) in the management of hyperbilirubinemia, we compared the concentrations with abnormal auditory brainstem responses (ABRs). ABRs and serum UBCs in 37 hyperbilirubinemic term newborns (total bilirubin concentrations [TBCs] > or = 20 mg/dL and direct bilirubin concentrations < 2 mg/dL) were measured before treatment with either phototherapy or exchange transfusions. Eight of these newborns had blood incompatibilities. These hyperbilirubinemic newborns were divided into three groups according to the findings of ABR: group A, normal ABR (n = 18); group B, prolonged latency of wave I only (n = 8); and group C, prolonged interpeak latency of wave I-III/I-V and/or poor amplitude (n = 11). The peak TBC was significantly different between groups A and C (22.8 +/- 2.2 mg/dL and 25.4 +/- 2.5 mg/dL, respectively; P < .05), though there were no differences between groups A and B and between groups B and C. The peak UBCs in groups B (1.27 +/- 0.7 micrograms/dL) and C (1.34 +/- 0.37 micrograms/dL) were significantly higher than in group A (0.78 +/- 0.26 microgram/dL) (P < .05 and P < .01, respectively), though there was no significant difference in the peak UBC between groups B and C. Abnormal ABR findings were more clearly associated with the level of UBC at 1.0 microgram/dL than that of TBC at 23 mg/dL by multiple logistic regression analysis (odds ratio = 16.6, P = .0026, vs 4.2, P = .1272). These results suggest that measuring UBC may help in evaluating the possible risk of bilirubin encephalopathy in full-term newborns when there is vigintiphobia (fear of 20).