Significant Hyperbilirubinemia Research Articles

Predictive Value of Cord Blood Bilirubin for Hyperbilirubinemia in Term Neonates with ABO Incompatibility

Introduction: Jaundice affects 60% of full-term and 80% of preterm neonates. Feto-maternal ABO incompatibilities occur in 20-25% of pregnancies, but severe haemolytic disease develops in only 10%. ABO-incompatible babies have doubled the risk of jaundice requiring treatment and a 5-10 times increased risk of exchange transfusions. Objective: Aim of this study was to determine if cord blood bilirubin (CBB) can predict hyperbilirubinemia in term babies with ABO setup prior to discharge that would help to decrease readmission and subsequently complications due to jaundice. Methods: A hospital-based prospective observational study was conducted at Patan Hospital. Cord blood group and bilirubin levels were collected from newborns of O positive mothers. Babies with A positive and B positive blood groups had their CBB levels measured and were followed daily for 72 hours. Serum bilirubin was tested based on clinical judgment to detect hyperbilirubinemia and treated per NICE guidelines. Data were analysed using SPSS v21.0, Mann-Whitney test, ANOVA, and ROC analysis. Results: Among 66 cases, significant hyperbilirubinemia was seen in 7 neonates (10.6%). It was more common in B positive babies (12.2%) compared to A positive (8%). Mean CBB was 3.45 ± 0.57 in those developing significant hyperbilirubinemia. A CBB of 2.95 mg/dL had the highest sensitivity (86%), specificity (94%), and negative predictive value (98%) for predicting hyperbilirubinemia in ABO setup babies. Conclusion: Term babies with ABO incompatibility and CBB<2.95 mg /dL are unlikely to need further evaluation, while those with cord bilirubin level ≥2.95 mg/dL should have frequent early follow-ups.

Management and Treatment Outcomes of Hemolytic Disease of the Fetus and Newborn (HDFN)-A Retrospective Cohort Study.

Background: Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal antibodies attacking fetal blood cell antigens. Despite routine antenatal anti-D prophylaxis, intrauterine transfusions (IUTs) are still needed in some HDFN cases. Methods: We conducted a retrospective cohort study on newborns with HDFN born in the 1st Department of Obstetrics and Gynecology of the Medical University of Warsaw. We analyzed 274 neonates with HDFN, identifying 46 who required IUT due to fetal anemia and 228 who did not. The laboratory results, management, and outcomes were compared between these groups. Results: Comparative analysis showed that newborns treated with IUT were more likely to have significant anemia, hyperbilirubinemia, and iron overload, indicated by a high ferritin concentration. These neonates more often required top-up transfusions, phototherapy, intravenous immunoglobulin infusions, and exchange transfusions. The length of stay was longer for newborns who received IUT. Conclusions: HDFN requiring IUT is associated with a greater number of complications in the neonatal period and more often requires additional treatment compared to HDFN not requiring IUT.

Incidence, aetiology and short term outcomes of extreme hyperbilirubinaemia, in term infants born in the Western health subdistrict of Cape Town, South Africa between 2019 and 2020.

Extreme levels of bilirubin in newborn is a major cause of lifelong neurodevelopmental impairment, which places a financial burden on healthcare resources and caregivers. To determine the incidence, aetiology and short-term outcomes of extreme hyperbilirubinaemia in term infants born in a resource-limited setting. This is a retrospective observational study looking at term neonates with a birth weight ≥2500 g, born in the Western health subdistrict of Cape Town, South Africa, between 1 January 2019 and 31 December 2020, who were exposed to a serum bilirubin level of ≥430 μmol/L in the first week of life and received care in the public health system. Extreme hyperbilirubinaemia occurred in 59 term infants. The incidence was 74 cases per 100 000 (<0.01%) live births equating to 1 case in every 1345 live births. The cause of hyperbilirubinaemia was identified in 51 of the cases (86%), the most common being ABO incompatibility (31/51, 61%), followed by glucose-6-phosphate dehydrogenase deficiency (11/51, 22%). Twelve infants (20 %) underwent an exchange transfusion. Six infants were encephalopathic. Forty-seven infants (80%) were readmitted after initial post-natal discharge, with a mean age of readmission of 113 h old (SD 31 h). The incidence of extreme hyperbilirubinaemia in the Western health subdistrict of Cape Town is higher than in high-income settings. Further work should focus on training of healthcare workers and education of caregivers, for the early detection of significant hyperbilirubinaemia to prevent neurological complications caused by bilirubin toxicity.

Serum bilirubin at 24 h of life birth as a predictor of significant hyperbilirubinemia in preterm neonates

Background: As hyperbilirubinemia is one of the key contributors to brain damage and is crucial to identify those instances that are at risk as it is more prevalent and severe among the preterms. Many studies are available in the literature for terms babies but there is paucity of data for pre terms. Aims and Objectives: The aim of this study was to assess serum bilirubin at 24 h of live birth as a indicator of significant hyperbilirubinemia in preterm neonates. Materials and Methods: It was a prospective observational study conducted in the department of pediatrics of tertiary care center, Jodhpur on 150 preterms born within 33–36 weeks 6 days after considering the exclusion criteria in the study. Area under the receiver operating characteristic (ROC) curve was used to identify significant hyperbilirubinemia within 1 week of life, along with it the cutoff value of total serum bilirubin (TSB) at 24 h of life was calculated. Results: A total of 150 enrolled preterm newborns were followed up. TSB at 24 h of life was proved to be significant using the ROC curve, where area under the curve is 0.96 which was statistically significant. Among 150 preterms, 70 newborns with TSB &gt;4.2 mg/dL developed jaundice, and 65 babies (98.48%) required phototherapy. Hence, preterms with TSB &gt;4.2 mg/dL have a significant risk of developing hyperbilirubinemia. (Sensitivity: 98.48%, specificity: 94.05%, negative predictive value: 98.75%, and positive predictive value: 92.86%). Conclusion: TSB for preterms at 24 h of life can support to predict the significant hyperbilirubinemia successfully. Preterms with cutoff value of serum bilirubin level &gt;4.2 mg/dL are observed to be more prone to develop significant hyperbilirubinemia requiring appropriate intervention at the earliest.

Exploring bilirubin/albumin ratio as predictor of significant hyperbilirubinemia among neonate in Southwest Nigeria

Exploring bilirubin/albumin ratio as predictor of significant hyperbilirubinemia among neonate in Southwest Nigeria

Bilirubin Measurement and Phototherapy Use After the AAP 2022 Newborn Hyperbilirubinemia Guideline.

Guidelines for the management of neonatal hyperbilirubinemia have helped to reduce rates of significant hyperbilirubinemia. However, recent evidence suggesting overtreatment and potential harms of phototherapy have informed the American Academy of Pediatrics clinical practice guideline revision and the accompanying increase in phototherapy thresholds. These changes are predicted to safely reduce overuse; however, to date, the exact effect of these guidelines has not been established. We conducted a retrospective study of newborns born at ≥35 weeks' gestation across a network of 8 hospitals between January 2022 and June 2023. Outcomes included rates of phototherapy and total serum bilirubin (TSB) measurements before and after guideline publication, as well as clinical outcomes, including length of stay, readmissions, and duration of phototherapy. In our cohort of >22 000 newborns, we observed a 47% decrease in phototherapy utilization, from 3.9% to 2.1% (P < .001). TSB measurements were reduced by 23%, from 712 to 551 measurements per 1000 newborns (P < .001), without an increase in outpatient TSB measurements. We did not observe an increase in readmissions receiving phototherapy, and length of stay increased by only 1 hour (P < .001). Our study reveals that the publication of the updated American Academy of Pediatrics 2022 hyperbilirubinemia guidelines has likely yielded a significant reduction in phototherapy use and serum bilirubin measurement. Dedicated quality improvement initiatives may help determine which implementation strategies are most effective. Further population-level studies are needed to confirm safety with ongoing guideline uptake.

Predictability of Umbilical Cord Serum Bilirubin in Estimating the Risk of Hyperbilirubinemia in Term Neonates with ABO Incompatibility- A Prospective Cohort Study

Introduction: Neonatal hyperbilirubinemia is a significant cause of morbidity among term neonates. Delayed follow- up of newborns may lead to considerable morbidity and encephalopathy. High bilirubin levels may necessitate exchange transfusion, especially in infants with ABO or Rh blood incompatibility. Measurement of Umbilical Cord Bilirubin (UCB) is an easily available, inexpensive and non invasive method to predict the development of hyperbilirubinemia in newborns. Aim: To determine the predictive value of UCB in estimating the risk of subsequent hyperbilirubinemia in term neonates with ABO incompatibility and to establish a UCB cut-off associated with the risk of hyperbilirubinemia development. Materials and Methods: This prospective cohort study was conducted at the Punjab Institute of Medical Sciences (PIMS) in Jalandhar, Punjab, India, from June 2022 to March 2023. A total of 113 term babies born to O+ mothers were included in the study. At the time of delivery, cord blood was drawn from the placental side of the cord for blood group, Direct Coomb’s Test (DCT), and serum bilirubin analysis. Infants were followed-up every 12 hours while inpatient and every 48 hours after discharge until day 5 for assessment of clinical jaundice. Significant hyperbilirubinemia was managed with phototherapy according to American Academy of Paediatrics (AAP) guidelines. The data was collected and subjected to statistical analysis using IBM Statistical Package for Social Sciences (SPSS) 20.0 software, with a significance level set at p-value &lt;0.05, utilising Receiver Operating Characteristic (ROC) curve analysis. Results: A total of 113 term neonates were enrolled in the study, of which 57 (50.4%) were females. The mean cord bilirubin level was 2.6±1.06 mg/dL. A total of 40 (35.3%) babies developed significant jaundice requiring phototherapy, with a mean highest bilirubin level of 15±3.2 mg/dL. Using a cord bilirubin level of ≥2.0 mg/dL, significant hyperbilirubinemia could be predicted with a sensitivity of 80%, specificity of 54%, positive predictive value of 57.97%, and negative predictive value of 75%. There was a positive correlation between cord bilirubin and postnatal serum bilirubin in the present study, as determined by ROC analysis {Area Under Curve (AUC) &gt;0.5}. Conclusion: The present study concluded that UCB is an important predictor of significant hyperbilirubinemia occurrence in newborns with ABO incompatibility.

Unbound Bilirubin and Acute Bilirubin Encephalopathy in Infants Born Late Preterm and Term with Significant Hyperbilirubinemia

To compare the association of unbound bilirubin (UB), total serum bilirubin (TSB), and bilirubin:albumin molar ratio (BAMR) with acute bilirubin encephalopathy (ABE), as assessed by bilirubin-induced neurologic dysfunction (BIND) score, in infants with significant hyperbilirubinemia (TSB ≥20mg/dL or underwent exchange transfusion). In this prospective cohort study, infants ≥34weeks of gestational age with significant hyperbilirubinemia during the first 2 postnatal weeks were eligible, unless they had craniofacial malformations, chromosomal disorders, TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus and herpes simplex) infections, surgery, or a family history of congenital deafness. TSB, serum albumin, and UB were measured at hospital admission using the colorimetric, bromocresol green, and modified peroxidase method, respectively. Infants were evaluated on admission for ABE using a standardized neurologic examination and assigned a BIND score by trained physicians. Infants with a total BIND score of 0 were deemed to not have ABE, whereas those with a score ≥1 were deemed to have ABE. A total of 151 infants were studied, among whom 37 (24.5%) had ABE. Of these, 19 had mild ABE (BIND score 1-3) and 18 had moderate-to-severe ABE (BIND score 4-9). On logistic regression, UB, but not TSB or BAMR, was associated with ABE (aOR 1.64; 95% CI 1.17-2.3). On ordered logistic regression, UB, but not TSB or BAMR, was associated with severity of ABE (aOR 1.76; 95% CI 1.28-2.4). Our findings of the association between UB and ABE indicate that BIND scoring may be useful for evaluation of ABE in infants ≥34weeksof gestational age.

Clinical study to determine the predictability of significant rebound hyperbilirubinemia in neonates after phototherapy and conditions likely to be associated with it: Prospective observational study in a teaching hospital in Eastern India.

Neonatal hyperbilirubinemia is defined as yellowish discoloration of the skin, conjunctive, and sclera from the elevated serum or plasma bilirubin in the newborn. The standard of care for the management of neonatal hyperbilirubinemia is phototherapy to prevent long-term neurological sequelae. The aim of this study was to ascertain the predictability of significant rebound hyperbilirubinemia (SRH) in neonates after phototherapy and the factors associated with it. Neonates ≥ 35 weeks of gestation, who received treatment for hyperbilirubinemia and admitted in our hospital from 15th of March 2019 to 15th of September 2020 were enrolled after taking parental consent. SRH was defined as bilirubin levels crossing the treatment threshold within 72 hours of phototherapy termination. Logistic regression analysis was used to identify the predictability of SRH. Out of 400 neonates treated with phototherapy, 10% developed SRH. Prematurity (Gestational age < 37 weeks), low birth weight (Birth weight < 2000 gram), ABO and Rh incompatibility, Glucose-6-phophate dehydrogenase deficiency (G6PD) deficiency, sepsis, and longer duration of primary phototherapy were found to be significantly associated with rebound hyperbilirubinemia. The probability of SRH increases for all American Academy of Paediatrics (AAP) risk categories as the gestational age decreases and total serum bilirubin at the stoppage of phototherapy increases. The presence of risk factors should be taken into account while planning discharge and follow-up of neonates admitted for neonatal hyperbilirubinemia to prevent long-term complication of bilirubin neurotoxicity.

Do Gene Polymorphisms Play a Role in Newborn Hyperbilirubinemia?

Polymorphisms of the uridine-diphospho-glucuronosyltransferase 1A1 (UGT1A1) gene, hepatic solute carrier organic anion transporter 1B1/B3 (SLCO1B1/3) gene, and glutathione S-transferase (GST) gene have been associated with significant hyperbilirubinemia in some populations. This study aims to determine whether the variation of UGT1A1, SLCO1B1/3 and GST genes play an important role in neonatal hyperbilirubinemia in Turkish newborn infants. The study included 61 idiopathic hyperbilirubinemia cases, 28 prolonged jaundice cases, and 41 controls. Ten common polymorphisms in four genes involved in bilirubin metabolism were examined. Polymerase chain reaction-restriction fragment length polymorphism method was used to detect variants of those genes. No association was found between the variants of UGT1A1 at nt 211, the SLCO1B1 gene at nt 388, 463, 521, 1463, the SLCO1B3 gene at nt 334, 727+118, 1865+19721, and the GST gene at nt 313, 341, and neonatal hyperbilirubinemia. There was no difference between the case and control groups in terms of allele frequencies of these genes (except SLCO1B3 at nt 334) (p>0.05 in all comparisons). The presence of the G allele of the SLCO1B3 at nt 334 variant gene seemed to protect from jaundice in infants with idiopathic hyperbilirubinemia. These gene polymorphisms currently studied do not seem to modulate the risk of hyperbilirubinemia in Turkish newborn infants.

Uncovering a Rarely Diagnosed Disease: Severe Leptospirosis with Multiorgan Failure in Slovakia

Leptospirosis is a zoonotic disease caused by bacteria from the genus Leptospira. The infection occurs mainly in developing countries in the tropical zone and countries with lower hygiene standards. The highest incidence is observed especially in environments associated with the presence of rodents, mainly rats, which are a potential source of infection. The clinical manifestations and severity of leptospirosis are highly variable. This case report describes the a 53-year-old patient (male) without comorbidities, who was admitted to an infectious disease department in the east of Slovakia for jaundice, general fatigue, weakness, and fever (health difficulties for approximately 7 days at home). The clinical laboratory picture of the patient was dominated by significant hyperbilirubinemia, acute renal failure, hepatopathy, severe thrombocytopenia, and involvement of the lung parenchyma in the sense of bilateral interstitial pneumonia on chest X-ray. A double combination of antibiotics (ceftriaxone and clarithromycin) were added to the treatment. During hospitalization, a diagnosis of leptospirosis was suspected based on medical history and the results of laboratory tests and was subsequently confirmed serologically. The antibiotic regimen was de-escalated to cephalosporin (ceftriaxone) monotherapy with adequate laboratory and clinical effects (on the 4th day). The patient was discharged after a total of 18 days in good clinical condition.

Intravenous immunoglobulin G therapy for neonatal hyperbilirubinemia

BackgroundNeonatal hyperbilirubinemia (NHb) results from increased total serum bilirubin and is a common reason for admission and readmission amongst newborn infants born in North America. The use of intravenous immunoglobulin (IVIG) therapy for treating NHb has been widely debated, and the current incidence of NHb and its therapies remain unknown.MethodsUsing national and provincial databases, a population-based retrospective cohort study of infants born in Ontario from April 2014 to March 2018 was conducted.ResultsOf the 533,084 infants born in Ontario at ≥35 weeks gestation, 29,756 (5.6%) presented with NHb. Among these infants, 80.1–88.2% received phototherapy, 1.1–2.0% received IVIG therapy and 0.1–0.2% received exchange transfusion (ET) over the study period. Although phototherapy was administered (83.0%) for NHb, its use decreased from 2014 to 2018 (88.2–80.1%) (P < 0.01). Similarly, the incidence of IVIG therapy increased from 71 to 156 infants (1.1–2.0%) (P < 0.01) and a small change in the incidence of ET (0.2–0.1%) was noted.ConclusionIVIG therapy is increasingly being used in Ontario despite limited studies evaluating its use. The results of this study could inform treatment and management protocols for NHb.ImpactsClinically significant neonatal hyperbilirubinemia still occurs in Ontario, with an increasing number of infants receiving Intravenous Immunoglobulin G (IVIG) therapy.IVIG continues to be used at increasing rates despite inconclusive evidence to recommend its use.This study highlights the necessity of a future prospective study to better determine the effectiveness of IVIG use in treating neonatal hyperbilirubinemia, especially given the recent shortage in IVIG supply in Ontario.The results of this study could inform treatment and management protocols for neonatal hyperbilirubinemia.

A "Gold Standard" Test for Diagnosing and Quantifying Hemolysis in Neonates and Infants.

Identifying "gold standard" diagnostic tests can promote evidence-based neonatology practice. Hemolysis is a pathological shortening of the erythrocyte lifespan, differing from erythrocyte senescence in responsible mechanisms and clinical implications. Diagnosing hemolysis goes beyond a binary (yes vs. no) determination. It is characterized according to magnitude, and as acute vs. chronic, and genetically based vs. not. For neonates with significant hyperbilirubinemia or anemia, detecting hemolysis and quantifying its magnitude provides diagnostic clarity. The 2022 American Academy of Pediatrics (AAP) Clinical Practice Guideline on management of hyperbilirubinemia in the newborn states that hemolysis is a risk factor for developing significant hyperbilirubinemia and neurotoxicity. The guideline recommends identifying hemolysis from any cause, but specific guidance is not provided. A spectrum of laboratory tests has been endorsed as diagnostic methods for hemolysis. Herein we examine these laboratory tests and recommend one as the "gold standard" for diagnosing and quantifying hemolysis in neonates and infants.

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.&#x0D; Study Design: Prospective study.&#x0D; Place and Duration of Study: Department of Paediatrics, MMCH &amp; RC, Kozhikode, Kerala from March 2021 to July 2022.&#x0D; Methodology: The prospective study enrolled 162 appropriate for gestational age term newborns, delivered at MMCH &amp; 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.&#x0D; 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&lt;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.&#x0D; 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.

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

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

Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns.

Jaundice is a very common condition in newborns, affecting up to 60% of term newborns and 80% of preterm newborns in the first week of life. Jaundice is caused by increased bilirubin in the blood from the breakdown of red blood cells. The gold standard for measuring bilirubin levels is obtaining a blood sample and processing it in a laboratory. However, noninvasive transcutaneous bilirubin (TcB) measurement devices are widely available and used in many settings to estimate total serum bilirubin (TSB) levels. To determine the diagnostic accuracy of transcutaneous bilirubin measurementfor detecting hyperbilirubinaemia in newborns. We searched CENTRAL, MEDLINE, Embase, CINAHL and trial registries up to 18 August 2022. We also checked the reference lists of all included studies and relevant systematic reviews for other potentially eligible studies. We included cross-sectional and prospective cohort studies that evaluated the accuracy of any TcB device compared to TSB measurement in term or preterm newborn infants (0 to 28 days postnatal age). All included studies provided sufficient data and information to create a 2 × 2 table for the calculation of measures of diagnostic accuracy, including sensitivities and specificities. We excluded studies that only reported correlation coefficients. Two review authors independently applied the eligibility criteria to all citations from the search and extracted data from the included studies using a standard data extraction form. We summarised the available results narratively and, where possible, we combined study data in a meta-analysis. We included 23 studies, involving 5058 participants. All studies had low risk of bias as measured by the QUADAS 2 tool. The studies were conducted in different countries and settings, included newborns of different gestational and postnatal ages, compared various TcB devices (including the JM 101, JM 102, JM 103, BiliChek, Bilitest and JH20-1C) and used different cutoff values for a positive result. In most studies, the TcB measurement was taken from the forehead, sternum, or both. The sensitivity of various TcB cutoff values to detect significant hyperbilirubinaemia ranged from 74% to 100%, and specificity ranged from 18% to 89%. The high sensitivity of TcB to detect hyperbilirubinaemia suggests that TcB devices are reliable screening tests for ruling out hyperbilirubinaemia in newborn infants. Positive test results would require confirmation through serum bilirubin measurement.

Higher ETCOc predicts longer phototherapy treatment in neonatal hyperbilirubinemia.

This study aimed to evaluate the predictive performance of end-tidal carbon monoxide corrected to ambient carbon monoxide (ETCOc) values phototherapy in neonates with significant hyperbilirubinemia. A prospective study was conducted on neonates with significant hyperbilirubinemia who received phototherapy between 3 and 7 days of life. The breath ETCOc and serum total bilirubin of the recruited infants were measured on admission. The mean ETCOc at admission in 103 neonates with significant hyperbilirubinemia was 1.70 ppm. The neonates were categorized into two groups: phototherapy duration ≤72 h (n = 87) and >72 h (n = 16) groups. Infants who received phototherapy for >72 h had significantly higher ETCOc (2.45 vs. 1.60, P = 0.001). The cutoff value of ETCOc on admission for predicting longer phototherapy duration was 2.4 ppm, with a sensitivity of 62.5% and specificity of 88.5%, yielding a 50% positive predictive value and a 92.7% negative predictive value. ETCOc on admission can help predict the duration of phototherapy in neonates with hyperbilirubinemia, facilitate clinicians to judge disease severity, and make clinical communication easier and more efficient.

A prospective study on correlation of cord blood bilirubin with occurrence of neonatal hyperbilirubinemia

Background: Neonatal hyperbilirubinemia is one of the most common problems that can occur in a healthy new-born. This physiological rise in indirect component of bilirubin resolves gradually without any intervention in majority of cases. But few babies require intervention in the form of phototherapy and exchange transfusion when the bilirubin levels exceed the normal physiological range for gestational age. The study was aimed to evaluate the predictive value of cord blood bilirubin level for identifying newborn for development of significant hyperbilirubinemia. Methods: It was a prospective observational study carried out in Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Karnataka. The cord blood bilirubin at birth and 48 hrs serum bilirubin levels were measured. Also, blood group, Rh status and DCT (direct coomb’s test) were tested to estimate the risk in development of hyperbilirubinemia. Results: A total of 210 were included in the study, out of which 52 babies required phototherapy, with a sensitivity of 94.23% and specificity of 3.97%, with the mean cord blood bilirubin level of 2.6mg/dl, having sensitivity of 63.46% and specificity of 90.50%. The multivariate analysis showed ABO and Rh incompatibility, cord blood bilirubin level and lower gestational age had an increased the risk of hyperbilirubinemia requiring phototherapy. Conclusions: Cord blood bilirubin may be used as a potential tool to determine hyperbilirubinemia in newborns. And initiation of phototherapy early in at-risk neonates may decrease the hyperbilirubinemia related morbidity and mortality. Keywords: hyperbilirubinemia; cord blood bilirubin; phototherapy; newborn

Cord Blood Albumin and Bilirubin as Predictor of Neonatal Jaundice

Background: Jaundice in newborn is quite common affecting nearly 60% of term and 80% of preterm neonates during the first 7 days of life. It is the most common cause of readmission in the hospital during early neonatal period. Aims: To find out the sensitivity of cord blood bilirubin and albumin level in predicting neonatal hyperbilirubinemia in healthy newborn. Material and Methods: The study was conducted on 200 full term healthy babies delivered by LSCS and were followed up till day 3 of life. 2ml of blood was drawn for estimating albumin and bilirubin in a sterile manner from the umbilical cord &amp; then veni puncture at 72 hrs of life from those neonates for estimation of bilirubin. All these samples were taken to the laboratory immediately. Results: from 200 babies, 53 babies developed significant hyperbilirubinemia (&gt;15mg/dl) with incidence of 26.5%. The mean weight of these babies was 2.47±0.38kg, mean cord blood bilirubin was 2.83±0.44mg/dl, mean cord albumin was 2.64±0.3 gm/dl and mean total serum bilirubin after 72 hrs of life was 17.31±2.09mg/dl. Cord blood bilirubin &gt;2.5mg/dl had a sensitivity of 90.5% and specificity 90.4% in the development of hyperbilirubinemia and had a direct correlation, wherever cord blood albumin &lt;2.8gm/dl has sensitivity 86.0% and specificity of 93% and showing an inverse correlation. Conclusion: Neonates with cord blood bilirubin &lt;2. 5mg.dl and cord blood albumin &gt;2.8 can be safely discharged early whereas neonates with bilirubin &gt;2.5gm/dl and cord blood albumin &lt;2.8g/dl will need close follow up for development of significant hyperbilirubinemia. Keywords: Hyperbilirubinemia, cord blood, bilirubin, albumin

Umbilical Cord Blood Bilirubin and Determination of Neonatal Hyperbilirubinemia

Objective: To determine accuracy of cord blood bilirubin in identifying significant neonatal hyperbilirubinemia. Methodology: A Cross sectional study was conducted in Pediatric department of Fauji Foundation Hospital Rawalpindi from Jan.2019 to June 2019. Cord blood samples were sent for the blood group and bilirubin levels. Neonates with cord bilirubin level &gt; 2mg/dl and &lt; 5 mg/dl were enrolled and admitted for 3 days and serum bilirubin level were done on 3rd day. Those developing significant hyperbilirubinemia were further investigated for hemoglobin, reticulocyte count, Coomb’s test and other causes. Results: Total 74 newborns at &gt;35 weeks of gestation were included in the study of which 35 (47.3%) were male and 39 (52.7%) were female (male: female: 1:1.1). The data was analyzed using SPSS 17. At 3rd day of life mean ± SD cord blood bilirubin was 8.4 ± 2.7 mg/dl, mean direct bilirubin was 1.6 ± 0.9 mg/dl and mean indirect bilirubin was 6.8 ± 2.3mg/dl. Significant hyperbilirubinemia developed in 16 (21.6%) newborns at &gt;35 weeks of gestation, who had a cord blood bilirubin level of &gt; 2 mg/dl, so that the accuracy of cord blood bilirubin level (true positives) in determining significant hyperbilirubinemia was 21.6%. Conclusion: Cord blood bilirubin level &gt;2mg/dl in all healthy term newborns predicts significant hyperbilirubinemia.