Neonatal Serum Bilirubin Research Articles

Correlation of Clinical Assessment of Jaundice with Total Serum Bilirubin in Neonates: Hospital-Based Cross-Sectional Study

Introduction: Neonatal jaundice is a common cause of admission in the neonatal period. Early diagnosis and treatment of neonatal jaundice prevent the bilirubin encephalopathy. There are various methods for the estimation of neonatal jaundice. Clinical assessment of neonatal jaundice can aid in the diagnosis of neonatal jaundice in low-resource settings and refer to the higher center for those who require treatment. This study aims to understand the relation between clinical assessment of jaundice and total serum bilirubin in neonates and to know the risk factors of neonatal jaundice.  Methods: The Clinical assessment of jaundice by Kramers scale can be used to assess the level of jaundice and know the progression of jaundice.  Results: This shows a significant positive relation between clinical assessment of jaundice and serum bilirubin level.  Conclusions: The study findings showed that clinical assessment of jaundice was comparable with the serum bilirubin. Clinical assessment of jaundice by Kramer‟ 's scale can be used to assess the level of jaundice and know the progression of jaundice.

Therapeutic Effects of Probiotics In The Reduction of Neonatal Hyperbilirubinemia

Objective: To evaluate probiotics' effects in reducing hyperbilirubinemia in late preterm and term neonates. Study Design: Quasi-experimental study Place and Duration of Study: Department of Neonatology, Pakistan Institute of Medical Sciences (PIMS), Islamabad Pakistan, from Oct 2018 to Mar 2019. Methodology: The quasi-experimental study was conducted on 60 neonates with hyperbilirubinemia. They were randomlydivided into two Groups. Group-A (n=30) received phototherapy. Group-B (n=30) received probiotics containing Lactobacillus reuteri at a dose of 5 drops daily for three days, in addition to phototherapy. Total serum bilirubin was calculated at 0, 24 and 72 hours for both Groups. Results: In Group-A, the mean total bilirubin in mg/dl at 0, 24 and 72 hours were 18.14±2.35, 15.28±2.93 and 12.31±2.29, respectively. Similarly, in Group-B, it was 19.86±5.85, 16.23±4.01 and 10.75±2.23 at 0, 24 and 72 hours, respectively. There was an insignificant statistical difference in mean total bilirubin between Groups A and B at 0 and 24 hours (p<0.001). However, when comparison was made at 72 hours, a significant statistical difference was observed in Group-B (Intervention Group) (p=0.005) Conclusion: Probiotics significantly lowered total serum bilirubin in neonates with hyperbilirubinemia. Further studies are required to evaluate its role in physiological and pathological jaundice.

Design and field evaluation of a lateral flow cassette device for point-of-care bilirubin measurement.

Neonatal jaundice is an important cause of morbidity and mortality worldwide, and neonates born in low and middle-income countries bear a disproportionate burden. We previously developed a low-cost, point-of-care system to measure total serum bilirubin (TSB) in neonates. This device was effective at detecting and monitoring jaundice; however, the disposable strips were difficult to produce at scale. Here, we report a new lateral flow cassette design, called BiliDx, that was produced at scale using traditional manufacturing techniques. We evaluated the performance of BiliDx at sites in Nigeria and Malawi. The lateral flow strip consists of plasma separation membranes, nitrocellulose, and a plastic cassette. We evaluated the performance of the strips and reader at two hospitals located in Nigeria and Malawi compared to reference standard TSB. We also assessed performance for samples with high direct bilirubin (DB) and high hematocrit (HCT). We collected 1,144 samples from 758 neonates (TSB ranged from 0.2 to 45.9 mg/dL). The mean bias of BiliDx measurements in the validation set was +0.75 mg/dL, and 95% limits of agreement were -2.57 to 4.07 mg/dL. The mean bias and limits of agreement were comparable for samples with HCT < 60% and HCT ≥ 60%, and for samples with low and intermediate DB levels; the samples with high DB levels had wider 95% limits of agreement (-4.50 to +3.03 mg/dL). Error grid analysis shows that 96.9% of samples measured with BiliDx would have resulted in the same clinical decision as the reference standard. This performance is comparable to previous results that used a handmade two-dimensional strip. Additionally, error grid analysis shows that all 20 samples with high DB levels would have resulted in the same clinical decision as the reference standard. This evaluation supports the use of BiliDx lateral flow cassettes to provide accurate point-of-care measurements in low-resource settings.

Correlation between transcutaneous bilirubin levels and total serum bilirubin levels in postnatal period in a tertiary care center

Background: Neonatal jaundice is generally a benign condition seen during the postnatal period. The non-invasive methods including transcutaneous bilirubinometry have been developed for assessment of neonatal jaundice, transcutaneous bilirubin TcB) meters noninvasively estimate the bilirubin levels by measuring light transmission through the skin of neonates this value is then to be plotted against a chart in order to look for hyperbilirubinemia. Aim was to determine the efficacy of measuring the transcutaneous bilirubin as a screening tool for clinically significant hyperbilirubinemia. Methods: Study was a cross sectional study conducted under pediatric department of SMBT IMS and RC at tertiary care center after taking the approval from the ethical committee. Total of 110 neonates that appear to be clinically suffering from neonatal jaundice were considered for study after consent from respective parent/ guardian. Neonatal TCB levels and serum bilirubin levels were done. If bilirubin levels lie in phototherapy range, then baby was shifted to NICU and phototherapy treatment was given, and once levels came within normal range after the phototherapy treatment, again serum bilirubin levels were measured in order to compare pre-and post-treatment levels. Results: Present study showed male preponderance. 64 were male and 46 were female. Majority 61% were full term normal delivery and 39% were LSCS. Mean TCB level was 8.5±2.8. Statistical significance was seen for TCB and sever hyperbilirubinemia. Conclusions: Present study concluded that hyperbilirubinemia is commonly seen among males. Newborn delivered had hyperbilirubinemia. Statistical significance was seen between TCB level and severity of the disease. Thus, neonatal TCB levels can be used as a screening test for detecting hyperbilirubinemia in neonates. As TCB is a noninvasive and cost effective it can be used widely as predictor of the disease.

Oral fenofibrate for hyperbilirubinemia in term neonates: A single-blind randomized controlled trial

Hyperbilirubinemia is common in the neonatal period; however, delayed diagnosis or inadequate treatment can cause irreparable damage to the neonates. We aimed to evaluate the efficacy of oral fenofibrate for hyperbilirubinemia in term neonates. This single-blind randomized controlled trial included 86 term neonates aged 3-7 days, with birth weight ≥2500 g, admitted to Bandar Abbas Children's Hospital, Bandar Abbas Iran, from July 23, 2019, to July 22, 2020. The fenofibrate group received 10 mg/kg oral fenofibrate and phototherapy, while controls only received phototherapy. Serum total bilirubin was measured at 24 and 48 h and at the time of discharge. Hospital length of stay was also noted. The two study groups were comparable regarding age, gender, gestational age, birth weight, and baseline total serum bilirubin levels. Serum total bilirubin levels at 48 h (P < 0.001) and at discharge (P < 0.001) were significantly lower in the fenofibrate group compared to controls. Although hospital length of stay was lower in the fenofibrate group compared to controls, the difference was not statistically significant (P = 0.612). Fenofibrate was more effective on the reduction of serum bilirubin in neonates aged 3-4.5 days starting at the 24th hour. Moreover, it was more effective in female neonates compared to males starting at the 48th hour. A single dose of oral fenofibrate reduced total serum bilirubin in term neonates with hyperbilirubinemia without any side effects; however, this effect was more prominent after 48 h.

How accurate is transcutaneous bilirubin testing in newborns with darker skin tones?

Fairly accurate. Photometric transcutaneous bilirubin (TcB) testing may overestimate total serum bilirubin (TSB) in neonates with darker skin tones by a mean of 0.68 to > 2 mg/dL (strength of recommendation [SOR]: C, diagnostic cohort studies with differing reference standards).Overall, TcB meters retain accept able accuracy in infants of all skin tones across a range of bilirubin levels, despite being more likely to underestimate lighter skin tones and overestimate darker ones (SOR: C, diagnostic cohort studies with differing reference standards). It is unclear if the higher readings prompt an increase in blood draws or otherwise alter care.

Frequency of Neonatal Hyperbilirubinemia in Maternal Hyperglycemia

Objective: To evaluate the occurrence of newborn hyperbilirubinemia among women who were diagnosed as maternal hyperglycemia. Subject and Method: The present cross-sectional study was conducted in the OBS and Gynecology department of PNS Shifa Karachi. The study was done over the time period of six months. All pregnant women who visit antenatal clinics at PNS Shifa Hospital with a gestational age of 24 and 32 weeks undergoing a 75 gm 2 h glucose tolerance test and fulfilling criteria of IFG, IGT, or GIGT were included. After delivery, a 2 ml blood sample was drawn from each newborn and sent to the hospital diagnostic laboratory to evaluate the neonatal bilirubin level and serum bilirubin &gt;300µmol/L after 96 hrs was considered as neonatal hyperbilirubinemia. All of the data was obtained using a study proforma. For the analysis of the data, SPSS software version 20 was utilized. Results: A total of 157 hyperglycemic mothers were studied; their average age was 28.20±4.67years and gestational ag was 37.11±3.22 weeks. Out of all, most of the women 100(63.7%) were multiparous. Caesarean section was done in 98(62.4%) cases. New born Neonatal hyperbilirubinemia was noted in 10.2% of the cases. The frequency of the neonatal hyperbilirubinemia was higher in the age groups of 19–30 years and &gt;30 years, while findings were non-significant statistically according to maternal age and gestational age (p = &gt;0.05). Conclusion: The study's findings showed that 10.2% of women with diabetes were found to have newborns with hyperbilirubinemia. It was proven to be statistically insignificant based on maternal age and gestational age. Keywords: Maternal, hyperglycemia, hyperbilirubinemia

The spectrum of ABO haemolytic disease of the fetus and newborn in neonates born to group O mothers.

ABO haemolytic disease of the fetus and newborn (HDFN) is a lesser recognized entity; however, the severity may vary in neonates. This prospective observational study was performed to determine the severity and risk of ABO-HDFN in neonates born to O group mothers. A total of 260 neonates born to non-alloimmunized blood group O mothers were recruited. Blood group O neonates were excluded from the study. Neonatal direct antiglobulin test (DAT) was performed using the column agglutination technique. They were monitored for clinical and laboratory parameters and followed up at 6-8 weeks. The maternal anti-A and anti-B titres (IgM and IgG) were also done. A total of 176 neonates with blood group A (77/260; 29.6%) and B (99/260; 38.1%) were finally included in the study, and 15 (8.5%) of them were DAT positive. Overall, 26.7% (47/176) neonates received phototherapy, 172 (97.7%) survived and none required readmission. The median (inter-quartile range [IQR]) maternal IgG anti-B titre (32 [32-64]) was significantly higher (p < 0.001) than the IgG anti-A titre (16 [8-64]). The maximum total serum bilirubin in neonates had a significant positive association with neonatal birth weight (p=0.045), positive DAT (p=0.006) and requirement of phototherapy (p < 0.001). The relative risk (95% CI) of a DAT-positive neonate requiring phototherapy was 4.55 (3.12-6.33). The frequency of ABO incompatibility in neonates born to group O mothers was 67.69% (176/260). The maternal IgG titre of ≥64 could be a good predictor for identifying the neonates at risk of developing hyperbilirubinaemia requiring phototherapy.

Association between umbilical cord clamping time, hemoglobin and total serum bilirubin in term neonates admitted for phototherapy

BackgroundThe aim of the study was to investigate relationship between cord clamping status, total hemoglobin (THb) and total bilirubin (TBil) in term infants requiring phototherapy for neonatal jaundice. MethodsThis retrospective study included term infants admitted at the study hospital for management of physiological neonatal jaundice between 2013 and 2019. Associations between THb, TBil, cord clamping status and Direct Coombs Test (DCT) status, as well as correlation between laboratory and blood gas analyzer (BGA) methods were investigated. Results258 term infants were included. 147 infants had cord clamping status documented; 111 had unknown cord clamping status. Delayed cord clamping (DCC) was associated with significantly higher mean THb in DCT negative infants only. Negative DCT was associated with higher THb and TBil regardless of cord clamping status. Mean TBil concentration did not change with increasing THb or cord clamping status. The incidence of term infants admitted for phototherapy increased over the study period. There was strong positive correlation between BGA and laboratory assays. ConclusionsDCC was associated with a higher THb in DCT negative infants only. There was no correlation between THb and TBil. There was strong positive correlation of TBil between BGA and laboratory assays thus supporting BGA use in ambulatory care settings.

COMPARISON OF TOTAL SERUM BILIRUBIN AND TRANSCUTANEOUS BILIRUBIN IN NEONATES WITH HYPERBILIRUBINAEMIA

Background: Jaundice is considered as one of the most prevalent and common clinical problems during neonatal period which may require interventional treatment. Transcutaneous bilirubinometry is a simple method for estimating bilirubin levels and diagnosing jaundice in neonates. This study was done to compare transcutaneous bilirubin and total serum bilirubin in jaundiced neonates. Methods: A hospital based prospective cross-sectional study of neonates from Out Patient Department, Emergency Ward, and Neonatal Intensive Care Unit with clinical jaundice was conducted between January 2016 and December 2016, at Kanti Children’s Hospital, Maharajgunj, Nepal. A total of 162 neonates were interviewed using preformed questionnaires. Then the correlation between the transcutaneous bilirubin and plasma bilirubin level was assessed by linear regression analysis. It was then analyzed with the help of SPSS Version 20. p-value &lt;0.05 was considered statistically significant. Results: Out of 162 cases, 61.7% were males and 38.3% were females. There was a high correlation between TcB and TSB level in neonates (r = 0.981) and this finding was statistically significant (p-value&lt;0.001). Correlation coefficient of 0.98 and 0.97 were found in term and preterm neonates respectively, which suggested strong correlation between TcB and TSB in both groups of neonates. Conclusions: Transcutaneous bilirubin measurement can be considered as a suitable tool for predicting neonatal bilirubinemia as it has high sensitivity.

Review on Different Methods of Serum Bilirubin Estimation

It is quite essential to estimate serum bilirubin in neonates with jaundice. The early prediction of jaundice is usually by observing the yellowish colour of the skin. Various methods of estimation of bilirubin have been developed and used for assessing the risk of jaundice.&#x0D; Jaundice is the common neonatal problem, that with the timely diagnosis, effective treatment and proper counselling to the mother can decrease the neonatal morbidity. Proper neonatal examination, breastfeeding advice to the mother, identifying the high risk groups, proper history elicitation, quick diagnosis and early intervention can reduce the incidence of jaundice and also prevent long term complications. The main goal is to prevent the risk of severe hyperbilirubinemia and for prevention of kernicterus. Hence there is a need for a sensitive, rapid and a reliable method for the assessment of serum bilirubin. These methods include both invasive and non-invasive analysis. Invasive methods involve estimation of serum bilirubin by obtaining a plasma or serum sample and non-invasive include the assessment of bilirubin using various instruments without the requirement of blood sample from the neonate.&#x0D; As the invasive method of bilirubin estimation needs more time for analysis to yield a result, many non invasive methods are being studied to find an effective tool which can give fast and accurate results ,thus making it an effective screening tool. This review article throws light on the different methods of estimating bilirubin levels in a neonate.

Is perinatal asphyxia associated with an increase in serum bilirubin in neonates? A case-control study.

Perinatal asphyxia affects different organs of body depending upon the severity of hypoxemia and ischemia. This study was carried out to evaluate severity of hyperbilirubinemia in relation to severity of asphyxia. A case-control study. Asphyxiated newborns with Apgar score ≤7 at 1 min. and categorized as severe birth asphyxia according to the WHO classification of diseases (ICD10) were matched with controls without birth asphyxia. All babies were examined twice daily for dermal icterus until start of phototherapy. Babies with congenital heart disease, sepsis, cephalohematoma, blood group incompatibility were excluded. Arterial blood gas analysis was done along with serial TSB measurement as per standard guidelines. 50 cases and 50 matched controls were enrolled. The average birth weight and gestation in cases was 2427 ± 30.05 g and 35.9 ± 2.5 weeks and among control it was 2633 ± 378.62 g and 37.76 ± 0.116 weeks. Among cases, onset of jaundice was 56.64 ± 20.43 h compared to 63.36 ± 23 h in control group. In the cases, the average pH was 7.31 ± 0.06, CO2 was 41.52 ± 84, O2 was 94.98 ± 14.83, and HCO3 was 18.56 ± 2.04. The rise and peak of serum bilirubin differed between the case and control groups; in the cases, the peak occurred at the 22nd h of life, then plateaued from the 40th to the 78th hour of life, and ultimately fell at the 96th hour of life. In comparison, the rise and peak of serum bilirubin occurred comparatively late in the control group. The rise and peak in the control group occurred at the 80th and 96th h of life, respectively. The multiple linear regression analysis showed CRP, Apgar at 5 min. below 7 and male gender significantly affects the rise of serum bilirubin (P < 0.05). The peak serum bilirubin in asphyxiated newborns occurs earlier, and plateau for longer duration compared to normal newborns. Low Apgar at 5 min. has significant correlation to earlier rise of bilirubin.

Effect of Intravenous Fluid Adjuvant Therapy on Decreasing Serum Bilirubin during Intensive Phototherapy in Healthy Term Neonate with Severe Nonhemolytic Hyperbilirubinemia.

Phototherapy is the most common form of treatment and prevention of neonatal nonconjugated hyperbilirubinemia. It seems that intravenous fluid therapy as a complementary method of phototherapy can accelerate the healing process in affected infants. This study aimed at investigating intravenous fluid therapy's effect in decreasing serum bilirubin in healthy term neonates with nonhemolytic hyperbilirubinemia under intensive phototherapy. As many as 160 healthy term infants with severe nonhemolytic hyperbilirubinemia and without exclusion criteria were enrolled. Infants were randomized to the two treatment groups (phototherapy alone and combination with intravenous fluid therapy). Serum bilirubin at admission time, 6, 12, 24, and 48 h later were measured. We evaluated decreasing serum bilirubin levels and duration of hospitalization in both groups. In this study, the mean levels of serum bilirubin on admission time, 6, 12, 24, and 48 h after treatment gradually reduced in both groups; still, the decrease was not statistically significant between the two groups. Intravenous fluids therapy does not have a significant advantage in the process of phototherapy in healthy term neonates with severe nonhemolytic hyperbilirubinemia.

ACCURACY OF TRANSCUTANEOUS BILIRUBIN MEASUREMENTS DURING PHOTOTHERAPY IN JAUNDICED PRETERM NEONATES

Aim: It is very difcult to nd veins and also seems unethical to withdraw blood daily in a preterm baby for the monitoring of jaundice during the course of phototherapy. So it becomes essential that we nd out a method which is non-invasive and at the same time accurate to assess jaundice. Jaundice is the most common morbidity in the rst week of life, reported in 60% of term, 80% of preterm (1, 2) &amp; also being the commonest cause of readmission. Materials and Method: Study was planned to assess the accuracy of transcutaneous bilirubin in comparison to total serum bilirubin in premature jaundiced neonates of gestational age (28-32 weeks v/s 32-37 weeks) during phototherapy. Result: Study has demonstrated reliability of TCB measurements in preterm infants during phototherapy. Gestational age, comorbidities and risk factors for jaundice did not inuence the correlation. Summary: This study reveals that Transcutaneous Bilirubin Estimation by bilirubin meter can be used as a non-invasive method for monitoring of jaundice treatment during phototherapy in preterm neonates.

Effects of delayed cord clamping on neonatal hyperbilirubinemia in pre-gestational diabetes at term

Objective To evaluate the effects of delayed cord clamping on neonatal hyperbilirubinemia in infants born to patients diagnosed with pre-gestational diabetes (type I or type II). Methods In January 2016, our institution implemented an organization-wide thirty-second delayed cord clamping protocol. This retrospective cross-sectional study represents infants of mothers diagnosed with pre-gestational diabetes who delivered before and after protocol implementation. The study period was from October 2014 to August 2017. The primary outcome was peak neonatal transcutaneous bilirubin (mg/dL) level during neonatal hospital stay. The secondary outcomes included neonatal serum bilirubin (mg/dL), jaundice requiring phototherapy, hypoglycemia, polycythemia, respiratory distress, and neonatal intensive care unit (NICU) admission. A subgroup analysis for outcomes stratified by type of pre-gestational diabetes was also performed. Results 145 patients were included in the final analysis. The mean peak neonatal transcutaneous bilirubin level was 10.1 mg/dL ± 3.4 mg/dL for immediate cord clamping and 9.5 mg/dL ± 3.4 mg/dL for delayed cord clamping (p = .25). There were no significant differences between groups for neonatal jaundice requiring phototherapy, hypoglycemia, polycythemia, respiratory distress, or NICU admission. No differences were observed in neonatal outcome by subgroup analysis of pre-gestational diabetes type. Conclusion In our study, there was no significant increase in peak neonatal transcutaneous bilirubin in term (≥37 week) infants of mothers with pre-gestational diabetes after undergoing thirty-seconds of delayed cord clamping. In the absence of contraindications, we advocate for continued use of delayed cord clamping for these infants.

Correlation of transcutaneous bilirubin with total serum bilirubin in neonates with hyperbilirubinemia

Background: For determining hyperbilirubinemia in a neonate, clinical evaluation, serum bilirubin estimation and trans cutaneous bilirubin estimation are the modalities available. Transcutaneous bilirubinometry (TcB) is routinely used to monitor jaundice in term and near-term infants. Literature shows a positive correlation observed between TcB and total serum bilirubin (TSB). The present study was conducted determine the correlation of TcB with TSB in neonates with hyperbilirubinemia admitted at a tertiary care hospital, ChennaiMethods: A cross sectional study was conducted at a tertiary care hospital, Chennai where 350 neonates who have clinical jaundice and require estimation of serum bilirubin who are admitted to the tertiary care centre, Chennai during December 2020-March 2021 were included in the study. The ROCHE INTEGRA-e 411+ autoanalyzer was used to estimate TSB (mg/dl) using a modified diazo method. The Jaundice Meter JM-103 to measure TcB, (Manufactured by Draeger medical systems, Germany). Pearson corelation coefficient was used to find the correlation between the two variables. P&lt;0.05 was considered to be statistically significant.Results: Out of 350 neonates admitted to the tertiary care centre, term deliveries were 57.1% and pre term were 42.9%. 83.1% were in the age group of 3-7 days. The mean weight of the study population was 2.16±0.60 kg. In term babies, Pearson corelation between TSB and TcB shows a statistically significant positive correlation, r=0.90 with p≤0.0001. Among pre term babies, Pearson corelation between TSB and TcB shows a statistically significant positive correlation, r=0.96 with p≤0.0001.Conclusions: This study's findings support the use of a TcB metre as a screening tool for clinically significant hyperbilirubinemia.

Comparison of the Predictive Accuracy of Stool Color for Triage of Infants for Phototherapy (STrIP) Score With Transcutaneous Bilirubinometer in Predicting Serum Bilirubin in Neonates

To compare the agreement of stool color for triage of infants for phototherapy (STrIP) score and transcutaneous bilirubinometer values with measured serum bilirubin in neonatal hyperbilirubinemia. Babies more than 35 weeks of gestation, with clinical jaundice, and on exclusive breastfeeding were included in the study. Babies with who were clinically unstable or who had received phototherapy based on clinical assessment were excluded. The agreement was analyzed using Bland-Altman charts. Results of three non-invasive methods were further compared with the measured serum bilirubin levels. There was a mean difference of 4 mg/dL of bilirubin between transcutaneous bilirubin and serum bilirubin levels, whereas the agreement between the STrIP score and Serum bilirubin shows a difference of only 2 mg/dL. On further analysis of Kramer, transcutaneous and STrIP score, method of bilirubin estimation against serum bilirubin, there was a mean difference 6 mg/dL, 4 mg/dL and 2 mg/dL, respectively. STrIP score has the best agreement with serum bilirubin in neonates compared to other non-invasive techniques such as transcutaneous bilirubinometry and clinical assessment using Kramer scale.

Association between the inter-aural latency difference of brainstem auditory evoked potential wave V and neonatal hyperbilirubinemia

OBJECTIVE To study brainstem auditory evoked potential (BAEP) in neonates with hyperbilirubinemia using short auditory stimuli (60 dBnHL), and to investigate the differences in the inter-aural latency difference (ILD) of wave V between neonates with different total serum bilirubin (TSB) levels. METHODS A prospective study was conducted in neonates with hyperbilirubinemia who were admitted to the Department of Neonatology, Yuhuan People's Hospital of Zhejiang Province, from May 2019 to October 2020. The neonates were divided into a severe group (n=50) and a mild group (n=50) according to their TSB levels. The mild group was divided into two subgroups: 7-10 days (n=20) and 11-14 days (n=20) according to their age. ILD was compared between the neonates with different TSB levels, and its diagnostic value was analyzed. RESULTS Compared with the mild group, the severe group had significantly higher proportions of neonates with abnormal hearing threshold and abnormal ILD (P 0.05). The receiver operating characteristic (ROC) analysis showed that ILD had predictive value for hearing impairment caused by neonatal hyperbilirubinemia (P < 0.05), with an area under the ROC curve of 0.727 as well as a sensitivity of 52.4% and a specificity of 90.9% at the optimal cut-off value of 0.365 ms. CONCLUSIONS Serum bilirubin in neonates affects the ILD of BAEP wave V, especially in those with severe hyperbilirubinemia. ILD at the optimal cut-off value of ≥0.4 ms shows potential value in the diagnosis of hearing impairment caused by neonatal hyperbilirubinemia.

Amplitude of low-frequency fluctuation may be an early predictor of delayed motor development due to neonatal hyperbilirubinemia: a fMRI study.

BackgroundAcute bilirubin encephalopathy or kernicterus is the worst consequence of brain damage caused by the elevation of total unbound serum bilirubin (TSB) in neonates. The present study aimed to visualize the characteristic brain regions of neonates with hyperbilirubinemia (HB) using functional magnetic resonance imaging (fMRI) and to measure the amplitude of low-frequency fluctuation (ALFF) values.MethodsThis was a prospective cohort study, which included newborns with HB who were hospitalized at the Children’s Hospital of Fudan University. The control group included neonates admitted with neonatal simple wet lung or pneumonia without neurological disease or brain injury. Newborns were divided into a severe hyperbilirubinemia group (SHB), moderate HB group, and control group based on TSB levels. The newborns completed routine MRI combined with fMRI scans and brainstem auditory evoked potentials (BAEPs) during their hospitalization.ResultsA total of 251 newborns were included in this study. There were 45 patients in the SHB group, 65 in the HB group, and 141 in the control group. The average ALFF value in the basal ganglia region in the SHB group was the highest, which was greater than that in the HB and control groups (P<0.001). The ALFF increased with an increase in TSB concentration. Based on the results of the Bayley Scales of infant development assessment, we further found that the most significant difference in ALFF remained in the basal ganglia region between newborns with motor development scores above 70 (including 70) and below 70. Correlation analysis revealed a strong negative correlation between motor development scores and ALFF (r=−0.691, P<0.001). When ALFF alone was used to predict motor development, the sensitivity was 89%. When ALFF was combined with TSB and BEAP results, the area under the ROC curve was the largest (AUC =0.85). The sensitivity and specificity of the model were 67.86% and 90.77%, respectively.ConclusionsThe ALFF value may be able to serve as an early imaging biomarker and has a greater sensitivity than TSB or BAEP results in predicting long-term motor development (18 m) in HB.

Effectiveness of Transcutaneous Bilirubin Measurement in High-Risk Neonates and to Evaluate Validity of Transcutaneous Bilirubin With Total Serum Bilirubin Levels in Both Low and High-Risk Neonates at a Tertiary Care Center in a Developing Country.

ObjectivesTo evaluate the usefulness of transcutaneous bilirubin (TcBR) nomogram in high-risk neonates and to identify the validity of TcBR and total serum bilirubin (TsBR) in both low and high-risk neonates to guide management in under-resourced settings.MethodologyA cross-sectional study was conducted at the well-baby nursery of a tertiary care center in Karachi, Pakistan. All neonates admitted in the well-baby nursery with jaundice were stratified into high and low-risk groups. Eighty-seven neonates were included in the low-risk group and 121 neonates in the high-risk group. The usefulness of the TcBR nomogram in high-risk neonates and the validity of TcBR and TsBR in both low and high-risk neonates were determined through sensitivity and specificity analysis.ResultsThe correlation coefficients (r) were found to be comparable in the high-risk group (r = 0.82, p < 0.001) and the low-risk group (r = 0.87, p < 0.001). The specificity of cutaneous bilirubin measurement based on bilirubin levels in the high-risk group was higher (93.0%) than that of the low-risk group (90.1%). However, the sensitivity was found to be lower (60.0%) in the high-risk group compared to the low-risk group (68.8%). The mean value of TsBR was equal in both groups. The mean TcBR in the high-risk group was 10 ± 2.3 compared to 11 ± 2.1 in the low-risk group. Phototherapy was given in 67.0% of the high-risk cases and 41.4% of the low-risk cases. Bland Altman analysis was also performed to depict the relationship between TcBR and TsBR measurements.ConclusionThe TcBR nomogram was effective in high-risk neonates and also had validity in both high and low-risk neonates. A phototherapy-driven protocol based on TcBR would be a cost-effective and useful tool in the identification and management of neonatal jaundice in both high and low-risk groups in developing countries like Pakistan.