Pathological Hyperbilirubinemia Research Articles

Bilirubin in wound healing: A double-edged sword.

The impact of bilirubin levels on wound healing remains a topic of controversy. The present study is a literature review that examines the impact of increased levels of bilirubin in the bloodstream on the process of wound healing. The physiological pathways and their interrelationships, as well as the relevant research publications, were comprehensively addressed in our discussion. The present study undertook a comprehensive review of the extant literature pertaining to the impact of bilirubin concentration on the process of wound healing, with particular emphasis on its association with reactive oxygen species. This scholarly article provides an overview of several studies that elucidate the mechanisms and correlation between bilirubin and the process of wound healing. The impact of bilirubin on wound healing has been observed, and it appears to function as a modulator. This review demonstrates that there exists a spectrum of bilirubin concentrations that can function as precise regulators, although this range falls under pathological hyperbilirubinemia. Further research is required to determine the precise boundary of this range. Within a certain range, bilirubin serves as a positive regulator in the process of wound healing. Beyond this range, it has the potential to function as a negative regulator.

Feasibility analysis of TCB, hs-CRP, and UCB/ALB as outcome measures for dynamic assessment during phototherapy of neonates with Hyperbilirubinemia

ABSTRACT Hyperbilirubinemia (HY) is a common condition in neonates that requires phototherapy treatment. This study aimed to evaluate the effectiveness of transcutaneous bilirubin measurements (TCB), hypersensitive C-reactive protein (hs-CRP), and unconjugated bilirubin (UCB)/albumin (ALB) as indicators of HY during neonatal phototherapy. A research group of 67 neonates with pathological HY and a control group of 55 healthy neonates were selected from a hospital between June 2020 and May 2021. TCB, hs-CRP, and UCB/ALB tests were performed before, during (at 3 days of treatment), and after (at 6 days of treatment) phototherapy in the research group and at admission in the control group. The study also included a 1-year prognostic follow-up on the research group. The study observed the difference in TCB, hs-CRP, and UCB/ALB test results between both groups and their assessment effect on adverse reactions, treatment effects, and poor prognosis in phototherapy. TCB, hs-CRP, and UCB/ALB levels were higher in the research group than in the control group and gradually decreased during phototherapy (P < 0.05). The combined TCB, hs-CRP, and UCB/ALB assay had 100.0% sensitivity and 64.58% specificity (P < 0.001) for predicting adverse reactions, 88.24% sensitivity and 80.00% specificity (P < 0.001) for predicting the effect of phototherapy, and 90.91% sensitivity and 88.89% specificity (P < 0.001) for predicting poor prognosis. The combined TCB, hs-CRP, and UCB/ALB assay showed superior assessment of adverse effects, clinical outcomes, and poor prognosis in HY neonates treated with phototherapy. TCB, hs-CRP, and UCB/ALB could be used as dynamic disease assessment indicators for HY to better prevent and treat the occurrence of HY.

Value of cord blood albumin and bilirubin in the prediction of pathological hyperbilirubinemia in preterm neonates

Background: Preterm infants have a higher incidence of indirect hyperbilirubinemia than term infants in about 80% of cases. Approach to initial screening for hyperbilirubinemia in preterm infants by cord blood is practical, cheap and noninvasive. Objectives: To determine the value of cord blood albumin, bilirubin and bilirubin/albumin ratio to predict pathological hyperbilirubinemia in preterm infants. Materials and method: A prospective cohort study was carried out all preterm infants &lt; 37 weeks, were born at Hospital of University of Medicine and Pharmacy, Hue, Viet Nam from 4/2018 to 8/2020. Cord blood albumin and bilirubin was collected after birth. Neonates were followed up daily for hyperbilirubinemia. Check serum bilirubin levels on the second day after birth and whenever an infant has significant hyperbilirubinemia. Results: We studied 176 preterm infants with jaundice, 88/176 (50%) infants had pathological hyperbilirubinemia. At the cut-off point for total cord bilirubin &gt; 1.818 mg/dl and bilirubin/albumin ratio &gt; 0.518 had a good predictive in detecting pathological hyperbilirubin in preterm infants with an AUC 0.854 and 0.842 respectively. However, cord blood albumin had no predictive value with an AUC of 0.524. Conclusion: Cord blood bilirubin and bilirubin/albumin ratio have a good discrimination in predicting pathological hyperbilirubinemia in preterm infants Key words: neonate, preterm, hyperbilirubinemia, cord blood albumin, cord blood bilirubin, bilirubin/albumin ratio.

Cord blood bilirubin level as a predictor of development of pathological hyperbilirubinemia in newborns

Background: Early discharge of healthy term newborns after delivery has become a common practice because of medical and social reasons and economic constraints. Thus, the recognition, follow-up, and early treatment of jaundice has become more difficult as a result of earlier discharge. This study is done to know the cut-off value of cord blood bilirubin and establish correlation between cord blood bilirubin level and development of significant neonatal hyperbilirubinemia without having significant risk factors and its treatment modality and outcome. Methods: This prospective study performed on 150 eligible term newborns born to mothers with ‘A’ Positive, ‘B’ Positive and ‘AB’ Positive blood group. Cord blood was collected from healthy term newborns delivered by caesarean section for total serum bilirubin and blood group. Serum bilirubin estimation was repeated at 72 hrs after birth by peripheral venous blood Results: Subjects were categorized into hyperbilirubinemia and non-hyperbilirubinemia newborns. Babies with serum bilirubin level of ≥17mg/dl after 72 hrs of life were considered for phototherapy and it is taken as significant hyperbilirubinemia in the present study.

Carboxyhemoglobin as an early predictor for pathological hyperbilirubinemia in preterm neonates

Carboxyhemoglobin as an early predictor for pathological hyperbilirubinemia in preterm neonates

Cord Bilirubin Value as a Predictor of Significant Hyperbilirubinemia in Abo Incompatiblity

Background: Hyperbilirubinemia is a condition in which the blood contains too much bilirubin and producing jaundice (yellow coloring of the eyes and skin). Low bilirubin levels in newborns are common and do not pose any problems; they will resolve on their own within the first week of life. Studying the cord bilirubin levels in new born babies is significant to predict the risk of abo incompatiblity.&#x0D; Methods: A total of 129 babies born to O blood group mother were included in the study. Out of which 111 babies were with risk of ABO incompatibility. Among them 17 babies developed pathological hyperbilirubinemia. None of the 0 positive babies developed pathological hyperbilirubinemia.&#x0D; Results: The peak bilirubin level was attained on 3rd and 4th day for all the babies and was taken as the outcome measure and cord serum bilirubin was taken as the predictive factor. The incidence of pathological hyperbilirubinemia is 13.2%. The mode of delivery had no positive association with the development of pathological hyperbilirubinemia. Male babies had positive ociation for pathological hyperbilirubinemia without any statistical significance. Incidence of pathological hyperbilirubinemia is higher in babies with a birth weight of &lt;3 kg.&#x0D; Conclusion: A cord bilirubin value of 2.65 mg/dL can be used as a cut off for predicting pathological hyperbilirubinemia. Infants with bilirubin level more than the cutoff values were subjected to early intervention with complete recovery. None of the babies had developed encephalopathy and its sequelae.

ROLE OF CORD BLOOD BILIRUBIN IN THE PREDICTION OF PATHOLOGICAL HYPERBILIRUBINEMIA IN PRETERM INFANTS

Background: Neonatal hyperbilirubinemia is a common clinical problem. Approximately 60% term babies and 80% preterm babies will develop clinically apparent jaundice encountered during the first week of life. Excessive indirect bilirubin concentration can cross the blood-brain barrier and result in death or other severe neurological sequelae. Objectives: To determine the value of cord blood bilirubin to predict pathological hyperbilirubinemia in preterm. Materials and method: A prospective cohort study was carried out on 122 neonates under 37 week at Hue University of Medicine and Pharmacy Hospital, Hue, Vietnam from 4/2018 to 8/2020. Cord blood bilirubin was estimated after birth. Neonates were followed up daily for 7 days for hyperbilirubinemia. Serum bilirubin levels in peripheral blood were estimated from 24 to 36 hours after birth and when the baby developed clinical jaundice. Results: Cord blood bilirubin is a fairly predictor of pathological hyperbilirubinemia in preterm with AUC (95%CI) 0.752 (0.667-0.837). When level of total cord bilirubin is higher than 35.6 μmol/L, preterm babies developed pathological hyperbilirubinemia with a 43,3% sensitivity and 96.4% specfically and +LR 11.9. Conclusion: Cord blood bilirubin may help predict pathological hyperbilirubinemia in preterm Key words: Neonate, preterm, hyperbilirubinemia, cord blood bilirubin.

Correlation between Non-invasive Measurement of Carboxyhemoglobin and Bilirubin Level Measurement in Near- Term and Term Neonates as a Predictor of Neonatal Hemolysis

Abstract Background Neonatal hyperbilirubinemia is common in the neonatal period. Yet, serious pathological hyperbilirubinemia may cause kernicterus with detrimental neurologic sequalae. Carbon monoxide (CO) is the byproduct of the breakdown of heme, it is transported as carboxyhemoglobin to the lungs to be exhaled. Thus, carboxyhemoglobin levels increase as a result of hemolysis, and is therefore considered a sensitive index for the degree and severity of the subsequent hyperbilirubinemia. Objectives To correlate between non-invasive carboxyhemoglobin levels and bilirubin levels in near-term and tem neonates starting hour I of life. Subjects and methods A total of 100 near-term and term neonates were studied, by measuring carboxyhemoglobin by a Pulse CO-oximetry and serum bilirubin level (hour l) and transcutaneous bilirubin (TcB) hourly since birth for the I st 6 hours then every 6 hours till the time of discharge in a cross sectional case-control study. Results A cut off value of 4 for non-invasive carboxyhemoglobin with sensitivity of 81.25%, specificity of 95.24% was found to the earliest non-invasive predictor for subsequent jaundice. In patients with proven hemolysis, carboxyhemoglobin when compared to TcB was found to increase significantly in the first 3 hours of life more than TcB, stalting hour 4 till time of discharge it was increased yet statistically insignificant Conclusion We found that non-invasive carboxyhemoglobin is an effective early predictor for subsequent jaundice starting first hour of life. It can be used as a screening tool for hemolytic jaundice especially in hospitals with early discharge policy.

Outcome of Neonatal Hyperbilirubinemia from a Tertiary Care Hospital in Eastern Nepal: A Cross-sectional Study

Background: Timely detection and treatment of pathological hyperbilirubinemia in newbornscan prevent acute bilirubin encephalopathy and its consequences. We aimed to identifyitsoccurrence, presentationtime, phototherapyduration, need for exchange transfusion,and outcome.&#x0D; Methods: In this cross-sectional study, we enrolled all the babies admitted for pathological neonatal hyperbilirubinemia in the university hospital ofBPKIHSin a one-yearduration. Babies with life-threatening congenital malformations or conjugated bilirubin &gt;20% of total serum bilirubin or &gt;2 mg/dl were excluded. Obstetric profile of mothers, clinical and laboratory parameters of babies, onset time of pathological jaundice, duration of phototherapy, need for exchange transfusion or intravenous immunoglobulin were recorded. Neonatal outcome was classified as good and poor and its association with potential predictors analyzed. &#x0D; Results: One-hundred and fifty babiesdeveloped neonatal jaundice requiring treatment. The most common causes includedABO and Rh setting. No cause was found in 26 (18%) babies. One-hundred and eight babies (72%) were only managed withphototherapy whereas 42 (28%) required both phototherapy and double volume exchange therapy. The majority (84.5%) had good outcome without any residual neurological deficit at discharge.Babies with total serum bilirubin &gt;20 mg/dl at presentation, duration of phototherapy &gt;44.8 h, ABO setting, hemolysis, and out born statussignificantly developed poor outcome (p &lt; 0.05).&#x0D; Conclusion: About 15% of the babies with hyperbilirubinemia had acute bilirubin encephalopathy at discharge suggestive of poor outcome. Babies with high bilirubin at presentation, longer duration of phototherapy, ABO settings, hemolysis, and out born statusdeveloped poor outcome.

Study of Cord Blood Levels of Erythropoietin, Bilirubin and Reticulocyte Count as Early Predictors of Neonatal Hyperbilirubinemia.

Neonatal hyperbilirubinemia is a serious neonatal problem which has hazardous effects on the neonates when the level of indirect bilirubin is increased to the levels that could cause kernicterus. The aim of this research is to study the cord blood levels of erythropoietin (EPO), bilirubin and reticulocyte count (RC) as early predictors of neonatal hyperbilirubinemia. This is a case-control study, which was conducted at Tanta University Hospital (TUH) from July 2016 to March 2018 on 90 neonates. The studied neonates were divided into 2 groups: Group 1 (45 neonates) who developed pathological hyperbilirubinemia and required treatment and group 2(45 neonates) who did not develop pathological hyperbilirubinemia and did not require treatment. Cord blood levels of EPO, bilirubin and RC were measured in all the studied neonates in both groups. There was a significant difference between both groups with regard to cord blood bilirubin (CBB), hemoglobin, EPO and RC levels where the P. value is 0.001*,0.027, *0.001*&0.001*respectively. There was a significant positive correlation between cord blood EPO levels and both CBB and cord blood RC with r=0.610 and 0.579, respectively and P. value is 0.001* & 0.001* respectively. With regard to ROC curve, there were high cord blood EPO levels where the cut off value was 22.5 mIU/ml while the sensitivity and specificity were 96 and89, respectively. In the cord blood RC, the cut off value was 5.7% while the sensitivity and specificity were 93 and 85, respectively, and lastly, CBB where the cut off value was 1.8 mg/dl while the sensitivity and specificity were 89 and 78 respectively. Cord blood levels of EPO, bilirubin and RC were increased in cases of pathological neonatal hyperbilirubinemia. Cord blood levels of EPO, bilirubin and RC could be used for early prediction of pathological neonatal hyperbilirubinemia.

Can Phototherapy Requirements Be Predicted through Cord Blood Test Results in Newborns?

Objective: Hyperbilirubinemia is one of the common problems in newborns. If not diagnosed and treated in time, high bilirubin levels can cause kernicterus and permanent brain damage. Therefore, early detection of hyperbilirubinemia development risk in newborns is important. Our aim is to determine whether the cord blood bilirubin level and the direct coombs test can be used as determinant parameters in order to predict babies with a high risk of developing hyperbilirubinemia requiring treatment. Material and Method: During the process of creating a hyperbilirubinemia follow-up protocol at Ordu University Training and Research Hospital, 300 babies born between January -June 2014with a birth weight ≥ 2500 g and gestational week ≥ 37 weeks were included in the study. The results of the cord blood bilirubin in of these babies, direct coombs test, maternal and infant blood groups and serum bilirubin levels of those who were hospitalized for phototherapy treatment within the first 24 hours were analyzed retrospectively. Results: Phototherapy was given to 35 of 300 (11.7%) newborns included in the study within the first 24 hours after birth. Direct coombs test was positive in 25 of them (8.3%). Phototherapy was given to 80% (n: 20) of the cases whose direct coombs test was positive. ABO incompatibility was found in the etiology of 51.5% of the cases with hyperbilirubinemia. It has been observed that patients with positive direct coombs test have a high rate of hospitalization (p&lt;0.001). Cord blood bilirubin levels were found to be statistically higher in cases who received phototherapy (2.7±1.0 and 1.8±0.6, respectively, p&lt;0.01). In determining the need for phototherapy, sensitivity was 77.1%, specificity was 77.0%, and negative predictive value was 96% for the cut off value of 2.0 mg/dl of cord blood bilirubin. Conclusion: Cord blood bilirubin level and direct coombs test are useful in predicting the possibility of pathological hyperbilirubinemia and hospitalization in newborns. Thus, detection of risky newborns with a noninvasive method within a few hours after birth will prevent early discharge and provide close follow-up and early treatment.

Evaluation of cord blood alkaline phosphatase as a predictor of hyperbilirubinemia in Egyptian neonates

Background/aim Hyperbilirubinemia is a major cause of neonatal morbidity. It affects nearly 60% of term and 80% of preterm neonates during the first week of life. Early prediction of hyperbilirubinemia will help in early discharge and prevent hospitalization of babies and mothers for longer periods. The aim of this study was to verify whether the cord alkaline phosphatase (ALP) levels can predict the development of neonatal hyperbilirubinemia. Participants and methods This prospective study was conducted at Alglaa Teaching Hospital from June 2016 to May 2018. A total of 200 healthy term and late preterm neonates meeting the inclusion criteria were enrolled in this study (gestational age >35 weeks of either sex, from any mode of delivery, and Apgar score ≥7 at first and fifth minutes of life). After birth, cord blood was collected for the estimation of cord blood ALP and serum total bilirubin. Results The incidence of clinical jaundice in our study was 50.54% (94 cases). Only 28.72% (27 cases) of them required treatment. There is a significant association between cord blood ALP levels and the development of hyperbilirubinemia requiring treatment. Receiver operating characteristic curve analysis demonstrates that ALP level of the cord blood greater than 342 IU/l was the most appropriate cutoff value for predicting significant jaundice (that needs treatment). It was associated with 91.07% sensitivity and specificity 61.54%. The area under the curve was 0.791, indicating the high significance and the usefulness of this assay in predicting significant jaundice requiring medication. Conclusion This study concludes that cord blood ALP levels reliably predict the occurrence of pathological hyperbilirubinemia requiring therapy as defined by the current operational guidelines.

Study of auditory brain stem response in newborns treated from unconjugated hyperbilirubinemia started in the first day of life

Background Neonatal jaundice remains a very common presentation in newborn babies, especially during the first week of life. Serious morbidities and long-term sequelae are seen in babies with delayed diagnosis and intervention. A timely and early decision-making workout would make the outcome better. First-hour-of-life presenting icterus is a worrisome sign, and hence, a swift intervention is much needed. Aim To compare the auditory brain stem response results between healthy newborns and newborns managed from pathological unconjugated hyperbilirubinemia started in the first day of life. Patients and methods A case–control study was conducted at the neonatal intensive care unit of Alexandria University Maternity Hospital on 55 full-term newborns; 30 were cases who had pathological unconjugated hyperbilirubinemia in the first day of life using Queensland Clinical Guideline: neonatal jaundice 2017, and 25 were controls who had no pathological jaundice and were healthy. The exclusion criteria were considered. Diagnostic auditory brain stem response tests were done at the Audiology Unit in Outpatient clinics at Alexandria Main University Hospital by an audiologist for each ear of the case group within 7 days of complete management and were made for each ear of the controls group from 7 to 15 days of age. Results The study found no significant difference between both studied groups regarding latency, amplitude of waves I, III, and V, V/I amplitude ratio, and interpeak interval between waves I–III, III–V, and I–V at intensity of 70 dBnHL on both right and left ears. Conclusions Early identification and management of newborns with early-onset pathological hyperbilirubinemia using Queensland Clinical Guidelines: Neonatal jaundice 2017 can protect them from the acute bilirubin encephalopathy and auditory neuropathy spectrum disorder.

Predictability of transcutaneous bilirubinometry in late preterm and term infants at risk for pathological hyperbilirubinemia

The aim was to assess the predictability of transcutaneous bilirubinometry in late preterm and term neonates at risk for pathological hyperbilirubinemia, and to identify the neonatal population in which transcutaneous bilirubin most accurately predicts serum bilirubin level (SB, mg/dl). The correlations between transcutaneous bilirubin (TCB, mg/dl) and SB in different neonatal population subsets; and between ΔTSB (TCB-SB) and relevant neonatal variables and clinical groups were analyzed. TCB correlated with SB (r = 0.82, p < 0.05) in the cohort (n = 350) and in population subsets (r = 0.81-0.9, p < 0.001). Black infants with gestational age (GA) >35 weeks and chronological age (CA) >3 days recorded strongest correlation (r = 0.9, p < 0.001) followed by Blacks, and non-Black infants with CA >3 days and GA >35 weeks. ΔTSB was positive in Blacks, and in infants with CA <3 days, or with no phototherapy. ΔTSB was negative in non-Blacks, in infants with positive direct Coombs test (DC+) or those receiving phototherapy. Black race [beta (SE) = 1.3(0.33), p < 0.001] had positive, while CA [beta (SE) =-1.74 (0.36), p < 0.001], DC + status [beta (SE) =-0.72 (0.25), p = 0.004] and receipt of phototherapy [beta (SE) =-0.84 (0.21), p < 0.001] each had negative correlation with ΔTSB. ΔTSB for Blacks was >Whites, Hispanics and Asians. SB is best predicted by TCB in Black infants with CA over 3 days and GA over 35 weeks. Variability in SB estimation by TCB is race, CA and immune mediated hemolysis specific.

Risk Factors of Pathological Unconjugated Hyperbilirubinemia among Yemeni Newborn

Abstract Background: Jaundice is a clinical condition that is often present in pediatric practice and constitutes one of the major issues within the neonatal period and it is either physiological or pathological. Although most newborn who have jaundice are otherwise healthy, they need close monitoring for serum bilirubin level as bilirubin is potentially toxic to the central nervous system. Risk factors may be maternal or neonatal in origin. This preliminary study focuses on the detection of the risk factors of pathological unconjugated hyperbilirubinemia due to lack of information on this topic in Yemen. Aim of Study: To determine the most common aetiology and risk factors of pathological unconjugated hyperbilirubine-mia and their relation to serum bilirubin. Patients and Methods: The study was prospective cross-sectional descriptive study of newborns with pathological unconjugated hyperbilirubinemia admitted to neonatal intensive care unit (NICU) at Al-Thawra General Modern Teaching Hospital and Al-Sabeen Maternity and Childhood Teaching Hospital during a period of 12 months starting on June 2012 to end of May 2013.Of the total admitted cases, two hundred cases were selected according to the inclusion and exclusion criteria. Data was collected, tabulated and analyzed by using Statistical Package for the Social Sciences (SPSS) version 20. Results: The risk factors of pathological hyperbilirubine-mia were Neonatal sepsis which was the most common aeti-ology and associated risk factor and was present in 70% of the cases, ABO incompatibility was present in 14% of the cases, Rh incompatibility was present in 8% of the cases, Cephalohaematoma (excessive bruising) was present in 6% of the cases, and G6PD deficiency was present in 2% of the cases. Conclusion: Pathological unconjugated hyperbilirubinemia is one of the major problems in neonatal morbidity and mortality in Yemen. Neonatal sepsis was the commonest aetiology and associated risk factor of pathological hyperbi-lirubinemia and the major cause of death in this study. We need to do early screening for detecting hyperbilirubinemia and we need to adopt early essential newborn care and resus-citation guideline on a national level to conduct appropriate management.

IMPACT OF PROBIOTICS ON NEONATAL HYPERBILIRUBINEMIA

Background: Jaundice is one of the most common conditions requires medical care in neonates. The yellow colour of the skin and the sclera in neonates is the result of the accumulation of bilirubin, the most common natural consequence of the first week of life as indicated by Bhutani Hour-specific bilirubin nomogram, Bilirubin encephalopathy is a devastating brain injury, which can cause permanent neurodevelopmental handicaps, so prevention& treatment of neonatal hyperbilirubinemia is very important . Objectives: The aim of this study was to evaluate the efficacy and safety of probiotics on neonatal hyper bilirubinemia. Methods: It is randomized controlled clinical trial; it included 100Full term neonates who were admitted immediately or shortly after birth due to pathological Hyperbilirubinemia as indicated by Bhutani Hour-specific bilirubin nomogram. To NICU of Al-AZHAR university hospitals the cases dived into Group (A) 50 cases treated by phototherapy in combination with probiotics and group (B) 50 as control treated by Phototherapy only. The serum bilirubin levels were done before and the1st, 4th, 7th days after treatment with probiotics (lactobacillus 5 billion/ sachets) divided into 3 doses daily for 7 days). The time when therapy showed effects and jaundice faded, Clinical outcomes as well as adverse reactions were recorded. Results: Serum bilirubin levels of the two groups were similar before treatment. The levels significantly decreased at the 4th and 7th days after treatment of probiotics in group(A )(P 0.05) between the two groups, In group (A) the therapy exerted effects after (2.7±0.8) day and jaundice faded after (4.8±0.9) day) while in group (B)) the therapy exerted effects after (3.9±1.7) day and jaundice faded after (5.9±1.8) day, the effective rate of decrease in group (A) significantly exceeded that in group (B), (P=0.007, 0.002). Conclusion: The use of probiotics is an important adjuvant to phototherapy during management of neonatal hyper bilirubinemia this combination reduce the side effects of phototherapy and the duration of hospital stay for cases of neonatal hyper bilirubinemia.

ANALYSIS OF HEMOGLOBIN LEVELS AND LEUKOCYTE COUNT IN NEONATES WITH HYPERBILIRUBINEMIA

Hyperbilirubinemia is one of the most common clinical phenomena in neonatal patient. Etiology is generally physiological, only about 10% being pathological. It is important for clinicians to distinguish between physiological and pathological hyperbilirubinemia, because uncontrolled pathological conditions can cause severe complications of kern icterus, one ofthe causes of death in infants.This study was retrospective study by obtaining data of all neonatal patients with diagnosis of hyperbilirubinemia, who undergone hemoglobin and leukocyte count test. The data were classified into two groups: physiological and pathological hyperbilirubinemia. Statistical tests were performed to assess the association of hemoglobin levels and leukocytes count between the two groups. A total of 144 data were collected, 54 physiological and 90 pathological hyperbilirubinemia. In physiological hyperbilirubinemia, hemoglobin levels and leukocyte counts were found to be normal, whereas in pathological anemia and leukocytosis developed and the difference between the two groups was statistically significant (p&lt;0,001). Anemia was found in neonates with pathological hyperbilirubinemia caused by RDN, LBW, sepsis, hemolytic, and hemorrhagic. Leukocytosis was found in pathological hyperbilirubinemia caused by sepsis.There was a significant difference between the incidence of anemia and leukocytosis in physiological and pathological hyperbilirubinemia. It can be concluded that routine blood tests can be used to distinguish whether hyperbilirubinemia experienced by neonatel patient is a physiological or pathological condition, so it can be one of the tests suggested when the neonate is hyperbilirubinemia.

Correlation of cord blood bilirubin values with neonatal jaundice in healthy newborns: A prospective observational study

Background and Objective: Hyperbilirubinemia is the most common clinical condition requiring evaluation and treatment in the newborn and a frequent reason for hospital readmission during the 1st week of life. Although generally a benign, postnatal, transitional phenomenon, a few neonates develop marked potentially hazardous bilirubin levels that can pose a direct threat of serious brain injury. The present study was conducted to investigate the predictability of pathological jaundice on cord blood bilirubin (CBB) values. Materials and Methods: This was a prospective observational study conducted on 289 healthy newborns. Babies were divided into two groups: Group A who developed physiological jaundice and Group B who developed pathological jaundice. CBB was estimated in all newborns who were then followed up to the 5th day of life. Babies who developed jaundice requiring treatment were admitted in neonatal intensive care unit for phototherapy. Other neonates were checked regularly up to the 5th day of life and values were recorded on the 5th day by estimation of serum bilirubin. Results: Incidence of pathological hyperbilirubinemia in our study was 11.2%. A statistically significant correlation between CBB and development of pathological jaundice was observed. Gender, age, mode of delivery, and birth weight has no correlation with cord bilirubin and the subsequent development of jaundice. CBB 3.5 mg/dl has high sensitivity (97.06%), specificity (99.22%), positive predictive value (94.29%), and negative predictive value (99.61%) in predicting future development of future pathological jaundice. Conclusion: The present study suggests that in healthy term babies (CBB ≤2.5 mg/dl), cord serum bilirubin can help to identify those newborns who are unlikely to require further evaluation and intervention. These newborns can be discharged with assurance to parents. Babies with CBB level ≥3 mg/dl should be followed more frequently. Thus, this study concludes that cord blood total bilirubin levels reliably predict the occurrence of pathological hyperbilirubinemia.

Cord blood bilirubin level as a predictor of development of pathological hyperbilirubinemia in new-borns

Background: There may be a delay in recognition of pathological hyperbilirubinemia which may lead to serious consequences in the new born. The purpose of this study was to verify whether the cord bilirubin levels predicted the development of pathological hyperbilirubinemia.Methods: In this hospital based prospective cross-sectional study conducted at Central Referral Hospital, Gangtok from December 2014 to November 2015, 202 live new born meeting the inclusion criteria were enrolled. After birth, cord blood was collected for the estimation of cord blood bilirubin and the babies were followed up daily for the development of clinical jaundice. Peripheral venous blood was collected for the estimation of serum bilirubin levels in those who developed clinical jaundice.Results: The incidence of pathological hyperbilirubinemia in our study is 12.87%. The mean gestational age is 38.3 weeks. There is a significant association between cord blood total bilirubin levels and the development of pathological hyperbilirubinemia in newborns with a P-value of 0.000. A critical cord bilirubin level ≥ 2.50mg/dl has sensitivity of 84.1%, specificity of 88.5%, positive predictive value of 98% and negative predictive value of 45.1% for predicting the risk of developing pathological jaundice.Conclusions: This study concludes that cord blood total bilirubin levels reliably predict the occurrence of pathological hyperbilirubinemia as defined by current operational guidelines.

Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia and Neurotoxicity in Neonates from Hilly Terrain of India.

Background and Aim:Neonatal hyperbilirubinemia continues to be the most common cause of hospital admissions and readmissions in the neonatal population worldwide and this pattern continues despite attempts to identify neonates at risk of pathological hyperbilirubinemia. Therefore, this study aimed to study the risk factors for severe hyperbilirubinemia in neonates.Materials and Methods:An observational prospective study was undertaken for 1 year in neonates with hyperbilirubinemia requiring double volume exchange transfusion in neonatology unit of a tertiary rural health care hospital.Results:Risk factors included ABO incompatibility in 14 (28.5%), Rh incompatibility in 14 (28%). Other risk factors for hyperbilirubinemia were, jaundice in elder sibling, oxytocin use, birth asphyxia, hypothyroidism, ABO along with Rh incompatibility, Glucose-6 phosphate Dehydrogenase deficiency, cephalhematoma, and sepsis in neonates. Ten (20%) neonates were neurologically abnormal with signs of encephalopathy. Significant association of risk factors with neurotoxicity were also found. All neurologically abnormal neonates were small for date and none was appropriate for date (P = 0.05). There were no neurologically abnormal neonates with A+ and O− mothers (P = 0.04).Conclusion:The high rate of exchange transfusion warrants aggressive management of neonatal hyperbilirubinemia by health-care providers by adequate dissemination of information, strict following of hour-based normograms, performing total serum bilirubin assessment in all icteric neonates, and stratification into risk groups thereafter.