Occurrence Of Hyperbilirubinemia Research Articles

Correlation between gestational age and incidence of hyperbilirubinemia in neonates

The incidence of hyperbilirubinemia in neonates is a significant concern worldwide, with potential implications for morbidity and mortality. This study aims to investigate the correlation between gestational age and the occurrence of hyperbilirubinemia in neonates. Secondary data were collected from the Neonatal Intensive Care Unit of Buleleng Regional Hospital from October 2022 to March 2024. The study employed an observational-analytical design with a cross-sectional approach. Pearson correlation analysis examined the relationship between bilirubin levels and gestational age. The results revealed a negative linear correlation between neonatal bilirubin levels and gestational age, indicating a higher risk of elevated bilirubin levels in preterm neonates. The majority of neonates included in the study were preterm (72.3%), with 98.3% experiencing hyperbilirubinemia. This study contributes valuable insights into the relationship between gestational age and hyperbilirubinemia in neonates, particularly in resource-limited settings. Early identification of at-risk neonates and appropriate interventions are crucial for preventing complications associated with hyperbilirubinemia.

Cord Blood Bilirubin as an Early Marker of Hyperbilirubinemia in Term and Late Preterm Newborns at 48 Hours of Life: A Prospective Cohort Study

Introduction: Jaundice is a common clinical condition present during the neonatal period, which can be either physiological or pathological. Early discharge of newborns is a common practice in our country due to medico-social and economic reasons, making post-discharge follow-up of infants challenging compared to developed countries. Aim: To determine the correlation between cord blood bilirubin levels and the occurrence of hyperbilirubinemia at 48 hours of life in newborns with a gestational age of ≥35 weeks. Materials and Methods: This cohort study was conducted in the Department of Pediatrics at Dr SMCSI Medical College, Karakonam, Trivandrum, Kerala, India, over a one-year period from June 2017 to June 2018. The exposure variables included the mother’s blood group, baby's blood group, mode of delivery, gestational age, gender, and weight of the baby. The outcome variables included cord blood and 48-hour serum total and direct bilirubin levels. The data was coded and entered into Microsoft Excel and analysed using Statistical Package for Social Science (SPSS) version 16.0. Descriptive measures were calculated, and the correlation between cord and 48- hour bilirubin levels was assessed using Pearson's correlation coefficient formula. Other statistical tests applied were chisquare test and independent t-test. Results: Total subjects of 500 (243 female and 257 were males) participants were included in the study.Among the 21 babies who underwent phototherapy, 11 were female and 10 were male, and 15 were full term and six were late preterm for their gestational age . Of the 21 babies needing phototherapy, 15 were delivered by normal vaginal delivery, and six were delivered by LSCS. Correlation between cord blood bilirubin and serum bilirubin at 48hr is 0.477 with a p-value <0.001; which indicates mild correlation between the cord blood Total Bilirubin (TB)and serum TB. A cord TB value of 1.45 mg/dL had a sensitivity of 95.2% and specificity of 32.5%. A value of 1.55 mg/dL had a sensitivity of 90.5% and specificity of 40.9%. A cord TB value of 1.65 mg/dL had a sensitivity of 66.7% and specificity of 53.9%. These findings suggest that cord bilirubin levels can be used to predict which babies require further evaluation and treatment. Conclusions: Cord blood serum bilirubin can serve as a useful screening test for predicting neonatal hyperbilirubinemia and ensuring safe post-natal hospital discharge.

Factors associated with the occurence of hyperbilirubinemia in infants

Hyperbilirubinemia is a problem that often occurs in newborns characterized by icterus, yellowish pigmentation of the skin, sclera, and nails. Many factors cause hyperbilirubinemia in infants such as the type of labor, birth weight, gestational age, gender, and asphyxia.This research aimed to discover the factors associated with the occurrence of hyperbilirubinemia in infants.This was a quantitative research with a retrospective cohort design. There were 83 respondents as the research sample taken using a random sampling technique. The research data were analyzed using the chi-square test and multivariate logistic regression. The majority of respondents underwent labor with actions (59 respondents / 71.1%), delivered male babies (51 respondents / 61.4%), delivered babies with normal birth weight (56 respondents / 67.5%), had a full-term pregnancy (54 respondents / 65.1%), and did not experience asphyxia (65 respondents / 78.3%). In addition, most respondents gave birth to babies with hyperbilirubinemia (43 respondents / 51.8%). Chi-square test results indicated a correlation between the type of labor (p = 0.008), birth weight (p = 0.019), gestational age (p = 0.000), and asphyxia (p = 0.013) with the incidence of hyperbilirubinemia. While the variable of gender (p = 0.106) had no correlation. The most influential factor was gestational age (p = 0.027) with an odds ratio of 4.011. In conclusion: The types of labor, birth weight, gestational age, and asphyxia have a correlation with the occurrence of hyperbilirubinemia.

Effects of Umbilical Cord Milking on Term Infants Delivered by Cesarean Section.

Umbilical cord milking (UCM) is an efficient way to achieve optimal placental transfusion in term infants born by cesarean section (CS). However, it is not frequently performed due to concern for short-term adverse effects of increased blood volume, such as polycythemia and hyperbilirubinemia. The aim of this study is to evaluate the short-term effects of UCM on term infants delivered by CS. We conducted a pre- and postimplementation cohort study comparing term infants delivered by CS who received UCM five times (141 infants, UCM group) during a 6-month period (August 1, 2017 to January 31, 2018) to those who received immediate cord clamping (ICC) during the same time period (105 infants, postimplementation ICC) and during a 3-month period (October1, 2016 to December 31, 2016) prior to the implementation of UCM (141 infants, preimplementation ICC). Mothers were older in UCM group compared with both ICC groups. There were no significant differences in other maternal or neonatal characteristics. Although this study was not powered to detect differences in outcomes, the occurrence of hyperbilirubinemia needing phototherapy, symptomatic polycythemia, NICU admissions, or readmissions for phototherapy was similar between the groups. UCM intervention was not associated with increased incidence of phototherapy or symptomatic polycythemia in term infants delivered by CS.

Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: Diagnosis and Therapeutic Management and Considerations for Timing of Surgery and Duration of Follow-up After Initial Endoscopic Retrograde Cholangiopancreatography.

Ectopic opening of the common bile duct (EO-CBD) is a rare pathology, and its management is important. To date, only a few studies have been conducted for EO-CBD due to its low incidence. A retrospective review was conducted on 54 patients with available prospective data. Among them, 30 patients (group 1) underwent choledochoduodenostomy for reasons other than anomalous opening, and 24 patients (group 2) had an EO-CBD. Endoscopic retrograde cholangiopancreatography (ERCP) was performed for 24 patients with duodenal deformity and apical stenosis. EO-CBD was detected in 2.72% of all patients who underwent ERCP (24/880 ERCPs). The occurrence of hyperbilirubinemia (total bilirubin >1.2 mg/dL) was not significantly different between groups: 3.83±4.57 mg/dL for group 1 and 2.26±2.17 mg/dL for group 2. Failed ERCP, giant stones, and recurrent episodes (>2) of cholangitis requiring ERCP constitute indications for surgical treatment in cases of EO-CBD into the duodenum.

Prediction of neonatal hyperbilirubinemia using umbilical cord blood bilirubin

Background: Neonatal hyperbilirubinemia is a common problem among newborns. Neonatal hyperbilirubinemia has a potential complication of kernicterus which is still seen in many newborns. In present study authors used umbilical cord blood bilirubin to predict the development of significant hyperbilirubinemia in the early neonatal period. The objective of this study is to evaluate the correlation between concentration of bilirubin in the cord blood and occurrence of hyperbilirubinemia in term newborns.Methods: In this prospective study authors included 500 term healthy consecutively born babies whose umbilical cord blood was collected and were followed up for first 7 days for the appearance of jaundice. The clinical assessment of jaundice was done by Kramer rule. The data was analyzed by using SPSS 17 statistical software.Results: Study found that umbilical cord blood bilirubin was 90% sensitive and 87% specific with a PPV of 75% and NPV of 92% in predicting significant neonatal hyperbilirubinemia.Conclusions: The study conducted clearly points that the use of cord blood bilirubin for identifying newborns at risk of hyperbilirubinemia helps in early detection and treatment of jaundice. There by preventing the potential complication kernicterus. This method is economical and socially acceptable. Hence cord blood bilirubin should be done on all healthy term newborns.

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

Risk of BIND and kernicterus in late preterm

Severe hyperbilirubinemia can induce devastating and permanent neurodevelopmental handicaps in infants. The occurrence of hyperbilirubinemia is higher in late preterm than in term infants, ranging from 8 to 40% of the formers according to different definitions of hyperbilirubinemia. The mechanisms by which this occurs is not completely understood, however an increased bilirubin load on hepatocyte, as result of decreased erythrocyte survival and increased erythrocyte volume, increased enterohepatic circulation of bilirubin, decreased hepatic uptake of bilirubin from plasma, defective bilirubin conjugation, and diminished serum bilirubin binding capacity play a relevant role. Hyperbilirubinemia in late preterm infants is not only more prevalent than in term neonates, but also it occurs later and is more severe and protracted. In fact, Maisels et al. (Pediatrics 2006;117:1169) demonstrated that at 72 hours of life the value of 50° percentile of trans-cutaneous bilirubin (TcB) is 9 mg/dl in 35-37 wks infants, while is 40 wks infants. Late preterm infants are at higher risk of bilirubin induced neurological dysfunction (BIND) and kernicterus than term infants. The mechanisms that potentially could explain the high susceptibility of central nervous system to bilirubin-induced damage in late preterm neonates have not been well defined. However, some of the factors that can potentially contribute are the diminished serum bilirubin binding capacity due to the lower serum albumin levels, an enhanced permeability of the blood–brain barrier to unconjugated bilirubin influx, and an immaturity of neuronal protective mechanisms. This is probably the reason why late preterm neonates are at an increased risk to develop acute bilirubin encephalopathy and or kernicterus as demonstrated in the USA pilot kernicterus registry (Semin Perinatol 2006;30:89) in which this category of infants is over-represented compared to term neonates. Thus, clinicians need to be more concerned and conscientious to identify late preterm’s risk for severe hyperbilirubinemia in view of their increased susceptibility to BIND. This can allow of planning a prevention program including nursing and parental education, screening for jaundice in the nursery, the provision of lactation support, timely post discharge follow-up, and appropriate treatment when clinically indicated.

Incidence of Hyperbilirubinemia and Jaundice Due to Atazanavir in a Cohort of Hispanic Patients

Incidence of Hyperbilirubinemia and Jaundice Due to Atazanavir in a Cohort of Hispanic Patients

Effects of early nursing intervention on neonatal jaundice and weight

Objective To study the effects of early intervention on neonatal jaundice and body weight, thereby preventing the occurrence of hyperbilirubinemia in newborns. Methods 320 healthy newborns were randomly divided into the two groups of the intervention group and the control group, with 160 cases in each group. All neonates of the intervention group were given the early intervention, including early breast-feeding, formula milk before the adequate breast-feeding, swimming and massaging. There was no nursing intervention for the control group, only the general nursing. The first defecation time, the first yellow defecation time, body weight in everyday, bilirubin value per cutem were measured and recorded. Results The bilirnbin value of the intervention group was much lower than that of the control group. The difference had statistical meaning (P < 0. 01). The body weight of newborns in the intervention group was much higher than that of the control group 5 days after born. There was statistical difference between the two groups (P < 0. 01). Conclusions Early nursing intervention can mitigate the bilirubin value effectively, reduce the incidence rate of hyperbilirnbinemia in newborns, reduce the decrease of body weight in newborns, and raise the body weight on discharge. Key words: Neonatal jaundice; Body weight; Nursing intervention

Effect of fasting on the uptake of bilirubin and sulfobromophthalein by the isolated perfused rat liver

BACKGROUND & AIMS: Occurrence of hyperbilirubinemia after fasting has been recognized for many years. The pathogenesis of this syndrome is unclear. Although recent studies suggest that increased intestinal deconjugation and reabsorption of bilirubin may play a major role in establishment of hyperbilirubinemia during fasting, other studies have suggested that fasting down-regulates intrinsic hepatocyte transport of bilirubin. The present study was designed to examine this possibility in the isolated perfused rat liver.METHODS: Transport of 3H-bilirubin and 35S-sulfobromophthalein (BSP) was examined in isolated perfused livers from 48-hour fasted or control rats using a multiple indicator dilution technique. Data were analyzed to quantify single-pass extraction (model-independent analysis) and were also fit by computer to the model of Goresky to quantify unidirectional fluxes.RESULTS: Fasting for 48 hours resulted in an approximately 40% reduction in liver weight but had no effect on model-dependent or model-independent parameters of transport. Despite the fact that the liver was smaller, single-pass extraction of bilirubin and BSP by livers from fasted animals did not differ from control, indicating a greater efficiency at uptake of bilirubin and BSP.CONCLUSIONS: Enhanced enterohepatic circulation of bilirubin, not altered hepatic transport, is a major factor in the pathogenesis of fasting-induced hyperbilirubinemia.(Gastroenterology 1997 Nov;113(5):1707-13)

Occurrence of Hyperbilirubinemia in Cultured Red Sea Bream.

Occurrence of Hyperbilirubinemia in Cultured Red Sea Bream.

Anamnestische Faktoren bei SIDS-Risikokindern mit auffälligem Atemmuster

436 out of about 9000 infants who were born between April 1987 and November 1990 in Jena were selected by means of a risk score for a polygraphy monitoring. This score contains anamnestic factors of the mother and the infant which are characteristic of an enhanced risk for the sudden infant death syndrome (SIDS). We performed a day-time polysomnography (ECG, heart rate, respiration, EEG, EOG, EMG) with a sleep duration of at least one hour. 23 of the infants investigated demonstrated abnormal breathing patterns (increased mean apnea duration, apneas longer than 15 s, apneas with bradycardia) and were treated with aminophylline to prevent a possible SIDS event. Now we investigated the statistical relation between 26 anamnestic factors of our risk score and the need for treatment. In univariate statistical comparisons treated infants differed from untreated infants concerning the occurrence of intraventricular haemorrhages (IVH), the gestational age (GA) (preterm of fullterm) and the occurrence of hyperbilirubinemia (HB) in their anamnesis. In a multivariate analysis with all 26 factors the birth weight was the third important factor beside IVH and GA, but only factor IVH was statistically significant. A cluster analysis of the variables with respect to the separation of the two groups of infants indicates that the variables IVH, GA and HB strongly correlate. In the light of these results we can underline that abnormal breathing patterns can be expected especially in infants with IVH, short GA and low birth weight.

Studies on bilirubin metabolism. V. On the correlation between the decreased excretion of bilirubin conjugate "C" into the bile and the occurrence of hyperbilirubinemia.

Studies on bilirubin metabolism. V. On the correlation between the decreased excretion of bilirubin conjugate "C" into the bile and the occurrence of hyperbilirubinemia.

Studies in Hyperbilirubinemia

The preceding paper dealt with the occurrence of hyperbilirubinemia with levels comparable to those encountered in hemolytic disease of the newborn, in full-term and premature infants exhibiting no evidence of either hemolytic or hepatic disease. The serum bilirubin in some of the patients in this group of 46 infants was of a magnitude which in hemolytic disease would be associated with a high incidence of kernicterus and is therefore generally regarded as an indication for exchange transfusion. The rationale of an exchange transfusion in the treatment of hemolytic disease may not be generally agreed upon, but it would seem that most investigators perform the procedure with the chief aim of removing vulnerable sensitized red cells, thereby decreasing the potential for bilirubin formation resulting from the accelerated breakdown of hemoglobin. Secondarily an exchange transfusion can be expected to remove a certain amount of bilirubin directly by the exchange of plasma involved