Significant Hyperbilirubinemia Research Articles

Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia in Neonates from Eastern Part of Nepal


 
 
 
 Introduction: Neonatal hyperbilirubinemia continues to be the commonest cause of nursery and NICU admissions and readmissions in the neonatal period worldwide. Although most cases are physiological, toxic levels of un-conjugated bilirubin can lead to acute and chronic bilirubin encephalopathy. Hence, this study aimed to study the risk factors for exchange range hyperbilirubinemia in neonates.
 Methods: This was a hospital-based prospective observational study conducted in a teaching and referral NICU over a period of one year from July 2019 to August 2020. All neonates with diagnosis of hyperbilirubinemia requiring double volume exchange transfusion were included in the study. Risk factors for significant hyperbilirubinemia were analysed with descriptive statistics. P-value of < 0.05 was considered significant wherever applicable.
 Results: The mean gestational age and birth weight were 38.06 ± 2.13wks and 2611.72 ± 389.39 gm respectively. Fifteen percent of the babies (162) developed hyperbilirubinemia and 28 (17.3%) required double volume exchange transfusion. Among neonates requiring exchange transfusion, 17 were females and 11 were males. Among 28 babies who required DVET, 20 (71.4%) were SGA. ABO incompatibility was present in 14 (50.0%) neonates and Rh incompatibility in 13 (46.4%) neonates. ABO along with Rh incompatibility was present in eight (28.6%) neonates. DCT was positive in six neonates with ABO incompatibility and nine neonates in Rh incompatibility. G6PD deficiency was present in four (14.3%) neonates.
 Conclusions: The most important risk factors identified were small for gestational age, ABO and Rh incompatibility followed by oxytocin use and sibling treated for jaundice.
 
 
 

Profil kadar Bilirubin pada bayi baru lahir sehat dengan Ikterus di Rumah Sakit DR. Sardjito Yogyakarta

Jaundice is yellow color in the baby¢s skin caused by an excess amount of bilirubin. This condition can be physiologic or pathologic. Jaundice may appear in increased bilirubin levels and it is a serious condition. The aim of this study was to determine the profile of bilirubin levels in healthy newborn babies with jaundice, to detect hyperbilirubinemia in healthy newborn babies. An observasional retrospective study was used in this study. Data ware collected from the subsection of Clinical Chemistry, the Clinical Pathology Department and Medical Record of DR Sardjito Hospital Yogyakarta, from January 1999 to May 2003. The inclusion criterian were as follows: healthy newborn babies and had jaundice clinically. The exclusion criterian were babies with sepsis, ABO incompatibility and without examination of serum bilirubin level. Statistical analysis was performed using Pearson and Spearman correlation. The results showed that a total of 32 babies were observed and jaundice appeared on third day of birth in 17 babies (53.10%) and significant hyperbilirubinemia was observed on the third day in 14 babies (43.80%) correlation was observed between hemoglobin and total serum bilirubin (r=0.280; p=0.121) non between haematocrit and total serum bilirubin (r=0.277; p=0.125). Weak correlation was observed between jaundice reference of Kramer and serum of unconjugated bilirubin (r=0.439; p=0.012). It was concluded that the most common hyperbilirubinemia in healthy newborn appeared on third day of birth and had no correlation with haemoglobin levels, haematocrit and had weak correlation with jaundice reference of Kramer

Prediction of Neonatal hyperbilirubinemia by The Cord Blood Alkaline ‎Phosphatase

Background: Owing to early discharge of neonates from the hospital, the readmission rate has been increased. Therefore, early detection of jaundice and prompt measures are important. Measurements of bilirubin and alkaline phosphatase levels in cord blood have been used for this function. The aim of the work: To assess the cord blood alkaline phosphatase value in predicting neonatal jaundice. Patients and Methods: This study carried out during the period from August 2019 to January 2020 in pediatric department [Al-Azher University Hospital in Damietta]. This study included a total of 101 term infants with gestational age between 37 and 42 weeks, weighing more than 2500g born to healthy mothers. We performed an assessment of the complete medical history [maternal history and neonatal history]. Cord blood samples were collected for measurement of alkaline phosphatase. Neonates were followed-up for the emergence of jaundice. Infants with clinical jaundice were recalled and serum bilirubin level was measured. Significant indirect neonatal hyperbilirubinemia was considered. Results: The study showed that patients with neonatal jaundice had statistically significant higher reticulocyte count, alkaline phosphate level and total bilirubin than patients without neonatal jaundice. However, the study shows the best cut-off points of regarding ALP to predict neonatal jaundice in neonates. A value of 200 or more IU/L was the best cut-off point to predict occurrence with a sensitivity of 98.3%, a specificity of 97.6%. Conclusion: Increased alkaline phosphatase level in cord blood act as an indicator to neonatal jaundice, and may be used as a marker for early diagnosis.

Genetic Association of UGT1A1 Promoter Variants (c.-3279T>G and c.-3156G>A) with Neonatal Hyperbili-rubinemia in an Iranian Population

Background: Several studies have reported that two promoter variants (c.-3279T>G and c.-3156G>A) in UDP-glucuronosyltransferase (UGT1A1) gene may contribute to neonatal hyperbilirubinemia. However, these variants have not been investigated in Iranian neonates. This cross-sectional study aimed to determine if the UGT1A1 promoter variants are significant risk factors associated with neonatal hyperbilirubinemia. Methods: A total of 178 unrelated neonates, including newborns with neonatal jaundice (n=95) and healthy controls (n=83), were included in this study. Each individual was genotyped by the PCR-RFLP and COP-PCR at nucleotides -3279 and -3156, respectively, using fresh blood DNA. Logistic regression analyses were performed to assess the association of UGT1A1 promoter variants with the presence of significant hyperbilirubinemia. Anthropometric indices and clinical variables were also compared between the different genotype groups. Results: Allele and genotype analysis of the c.-3279T>G and c.-3156G>A variants showed no significant association with the risk of neonatal hyperbilirubinemia neither in the crude nor after adjustment for gestational age, gender, and birth weight in different genetic models (P>0.05). However, in haplotype-association analysis, only one haplotype (A-T) was found to be associated with the risk of neonatal hyperbilirubinemia (OR=0.19, 95% CI; [0.18–0.20], P=0.001). Conclusion: This study failed to demonstrate that c.-3279T>G and c.-3156G>A variants alone might contribute to the risk of neonatal hyperbilirubinemia in Iranian neonates. However, the A-T haplotype may play a significant role in increasing the risk of hyperbilirubinemia.

Transcutaneous Bilirubin Levels and Risk of Significant Hyperbilirubinemia in Early-Term and Term Newborns

ObjectiveTo compare the course of the transcutaneous bilirubin (TcB) values of early-term newborns with those of term newborns in the first month of life and to investigate whether early-term newborns have an increased risk of significant hyperbilirubinemia requiring treatment. DesignA prospective, controlled cohort analysis. SettingA tertiary level mother–child birth and health care center. ParticipantsFour hundred early-term (37 0/7 to 38 6/7 weeks) and 320 term (39 0/7 to 41 6/7 weeks) newborns born during a 27-month period. MethodsA total of six TcB measurements in a longitudinal manner were made in early-term and term newborns: the first two at 6 and 48 hours after birth and the next four on routine examination days (Days 4, 7, 15, and 30). Demographic characteristics, values of daily TcB measurements, number of newborns with significant hyperbilirubinemia, and risk of jaundice requiring treatment were compared between the two groups. ResultsAll six TcB values were significantly greater in the early-term group than in the term group (p < .001 for each). Early-term newborns had a statistically significant increased risk of jaundice requiring treatment compared to term newborns (risk ratio = 1.91; 95% confidence interval [1.23–2.96]; p = .0046). Results of the repeated-measures analysis of variance and post hoc adjusted multiple comparison analysis showed that TcB levels increased to and peaked at 96 hours after birth and then gradually decreased to baseline (first measurement) levels at 30 days after birth in each group. ConclusionsEarly-term newborns should not be treated as full-term newborns because they have significantly higher TcB levels. These newborns should be closely monitored for pathologic jaundice because they have increased risk for significant hyperbilirubinemia requiring phototherapy.

Incidence of urinary tract infection in neonates with significant indirect Hyperbilirubinemia of unknown etiology: case-control study

BackgroundIndirect hyperbilirubinemia is frequently encountered during neonatal period. Although it has different causes, in some cases it can’t be explained. Previous studies have illustrated that jaundice could be a major sign of urinary tract infection (UTI) in neonates.Aim of the workWe aimed to determine the association between UTI and significant unexplained neonatal indirect hyperbilirubinemia.MethodsThis prospective controlled study was performed on 150 neonates divided in two groups (100 as cases and 50 as controls) to investigate the incidence of UTI in neonates with significant unexplained hyperbilirubinemia. Urine sample was obtained using urine catheterization technique from neonates and full urine analysis was done and cases with pyuria had urine culture to confirm UTI. Immediate renal ultrasonography (USG) was performed for neonates with UTI.ResultsUTI incidence was 11% in cases while none of neonates in control group had UTI with statistical significance between cases and controls (P value < 0.05). The most common (36.4%) pathogen was Escherichia coli. Posterior urethral valve with mild hydronephrosis was diagnosed in 18.2% of UTI positive patients by renal ultrasonography.ConclusionIn neonates with unexplained indirect hyperbilirubinemia, UTI should be considered as a pathological cause.

Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting

BackgroundAnesthesia in lactating women is frequently indicated for time-sensitive procedures such as postpartum tubal ligation. Ketamine and diazepam are two of the most commonly used anesthetic agents in low resource settings, but their safety profile in lactating women has not been established.MethodsMedical records of post-partum tubal ligations between 2013 and 2018 at clinics of the Shoklo Malaria Research Unit were reviewed for completeness of key outcome variables. Logistic regression identified presence or absence of associations between drug doses and adverse neonatal outcomes: clinically significant weight loss (≥95th percentile) and neonatal hyperbilirubinemia requiring phototherapy.ResultsOf 358 records reviewed, 298 were lactating women with singleton, term neonates. There were no severe outcomes in mothers or neonates. On the first postoperative day 98.0% (290/296) of neonates were reported to be breastfeeding well and 6.4% (19/298) had clinically significant weight loss. Phototherapy was required for 13.8% (41/298) of neonates. There was no association between either of the outcomes and increasing ketamine doses (up to 3.8 mg/kg), preoperative oral diazepam (5 mg), or increasing lidocaine doses (up to 200 mg). Preoperative oral diazepam resulted in lower doses of intraoperative anesthetics. Doses of intravenous diazepam above 0.1 mg/kg were associated with increased risk (adjusted odds ratio per 0.1 mg/kg increase, 95%CI) of weight loss (1.95, 95%CI 1.13–3.35, p = 0.016) and jaundice requiring phototherapy (1.87, 95%CI 1.11–3.13, p = 0.017).ConclusionsIn resource-limited settings ketamine use appears safe in lactating women and uninterrupted breastfeeding should be encouraged and supported. Preoperative oral diazepam may help reduce intraoperative anesthetic doses, but intravenous diazepam should be used with caution and avoided in high doses in lactating women.

Effects of delayed cord clamping in intrauterine growth-restricted neonates: a randomized controlled trial.

The time of cord clamping in intrauterine growth-restricted (IUGR) neonates remains an area of uncertainty. This assessor-blinded randomized controlled trial compared the effects of delayed cord clamping (DCC) with early cord clamping (ECC) on the systemic blood flow (SBF) and cerebral hemodynamics in IUGR neonates of gestational age ≥28 weeks, not requiring resuscitation. Eligible newborns were randomized to DCC (cord clamping after 60 s; n=55) or ECC (cord clamping within 30 s; n=55) group immediately after delivery. The primary outcome variable was superior vena cava (SVC) blood flow at 24±2 h. The secondary outcome variables were right ventricular output (RVO), anterior cerebral artery (ACA) blood flow velocity (BFV), superior mesenteric artery (SMA)-BFV and venous hematocrit at 24±2 h, peak total serum bilirubin (TSB), incidences of polycythemia, intraventricular hemorrhage, respiratory distress, feeding intolerance, and necrotizing enterocolitis, outcome, duration of hospital stay, screening audiometry, and serum ferritin levels at the postnatal age of 3 months. Compared to ECC, DCC was associated with significantly higher SVC flow (101.22±21.02 and 81.27±19.12 mL/kg/min, in DCC and ECC groups, respectively; p<0.0001), and significantly increased RVO, SMA-BFV, venous hematocrit, and serum ferritin levels. Though peak TSB was significantly higher with DCC, duration of phototherapy was comparable. ACA-BFV, incidence of polycythemia, and other outcomes were comparable between the groups.Conclusions: DCC was a safe and beneficial intervention in IUGR infants with an improved SBF and SMA-BFV and an increased hematocrit and serum ferritin levels without higher incidences of polycythemia and requirement of phototherapy for significant hyperbilirubinemia.Trial registration: Clinical Trials Registry of India (CTRI/2019/05/018904) What is Known: • Delayed cord clamping (DCC) increases superior vena cava (SVC) blood flow in preterm neonates. • DCC increases hematocrit and serum ferritin in intrauterine growth-restricted (IUGR) neonates, but there may be an associated risk of polycythemia and neonatal hyperbilirubinemia. What is New: • DCC increases SVC blood flow, right ventricular output, superior mesenteric artery blood flow velocity, venous hematocrit, and serum ferritin in IUGR neonates. • Incidences of polycythemia and duration of phototherapy for significant neonatal hyperbilirubinemia do not increase with DCC.

Role of Cord Blood Carboxyhemoglobin in Detecting Significant Hyperbilirubinemia in Term Neonates with ABO Alloimmunization.

This study aimed to assess whether cord blood carboxyhemoglobin (COHb) levels in jaundiced term neonates with and without a positive direct Coombs test (DCT) and in healthy controls could be used as a predictor of severe hyperbilirubinemia. The percentage of cord blood COHb should be higher among neonates with Coombs-positive ABO hemolytic disease than among those with Coombs-negative ABO incompatibility and higher than that of ABO-compatible control neonates. This cross-sectional descriptive study of 198 term neonates comprised three subgroups: group I featured 68 DCT-positive ABO-incompatible neonates (ABO + DCT), group II featured 60 DCT-negative ABO-incompatible neonates with hyperbilirubinemia (ABO-DCT), and group III featured 70 healthy controls. COHb was determined by an OSM3 hemoximeter. Group I differed from groups II and III for cord blood bilirubin, cord blood hemoglobin, and cord blood hematocrit. Groups I and II had higher mean total serum bilirubin (TSB) levels than group III, while there was no difference in the mean TSB levels between groups I and II. There was no significant difference between the COHb group means for groups I, II, and III (p = 0.98). The area under the receiver operating characteristic curve calculated for group I/group III and group II/group III were found to be 0.62 and 0.54, respectively. COHb levels did not prove to be superior to the DCT for predicting the risk of developing severe hyperbilirubinemia in term neonates. · COHb levels do not predict the risk of developing severe hyperbilirubinemia in term neonates.. · COHb levels may predict that ABO incompatibility in early life.. · COHb levels did not prove to be superior to the direct coombs test..

Umbilical cord bilirubin level used as a predictor of significant hyperbilirubinemia in newborns: An observational study

Umbilical cord bilirubin level used as a predictor of significant hyperbilirubinemia in newborns: An observational study

Maternal and Neonatal Risk Factors for Neonatal Jaundice and Readmission – An Indian Perspective

Introduction: Neonatal hyperbilirubinemia is a common neonatal ailment and is mostly benign except in few cases where it might progress to kernicterus. Neonatal jaundice is preventable and treatable if detected in time, and therefore, it is crucial to identify risk factors for developing severe hyperbilirubinemia. Materials and Methods: A prospective observational study was conducted with the aim to examine the risk factors for significant jaundice and also for readmission to the hospital. Results: A total of 1159 neonates were enrolled, of which 11.2% (n = 134) developed significant neonatal jaundice prior to discharge and 2.1% (n = 25) were readmitted with significant jaundice. The maternal risk factors for significant jaundice were primigravida with age range between 23 and 27 years, "O" blood group, conception by in vitro fertilization and embryo transfer (IVF-ET), antenatal oxytocin use, and lower segment cesarean section delivery. The neonatal risk factors for significant jaundice were late preterm male neonates born with birth weight between 2 and 2.5 kg and delayed cord clamping (DCC). The maternal risk factors for readmisssion jaundice were young primigravida with "O" blood group hailing from North India with antenatal use of oxytocin and gestational diabetes mellitus. The neonatal risk factors for readmission jaundice were low birth weight, DCC, twin pregnancies, neonates discharged between 48 and 72 h after birth. Conclusion: The statistically significant factors (P &lt; 0.05) associated with an increased risk of developing significant hyperbilirubinemia requiring readmission included low birth weight, gestational age 35–36 weeks and 6 days, DCC, and IVF-ET conception.

Noninvasive methods for bilirubin measurements in newborns: A report

New technologies have become available for noninvasive assessments of neonatal hyperbilirubinemia. Our objective is to review the noninvasive methods for measuring bilirubin in the newborn. We searched relevant literature from 1966 to January 1, 2020, which included cross-sectional studies to define the accuracy of any noninvasive methods for measuring or estimating total serum/plasma bilirubin (TB) levels in newborns. We identified and included 83 relevant studies of direct visual assessment, icterometry, mobile phone applications, and transcutaneous bilirubinometry (TcB). Compared with laboratory TB measurements, visual assessment was the least accurate and least reliable (r: 0.37 to 074), while TcB was the most accurate, but not always near-equivalent (r: 0.45 to 0.99). The sensitivity and specificity of TcB cut-off values to detect significant hyperbilirubinemia (TB>95th percentile for age in hours) ranged from 74% to 100% and 18% to 89%, respectively.

A STUDY OF UMBILICAL CORD BILIRUBIN AS A PREDICTOR OF SIGNIFICANT NEONATAL JAUNDICE IN A TERTIARY RURAL CARE HOSPITAL

Introduction. Around 80 percent of preterm infants and 60 percent of term infants are affected by neonatal jaundice in the first week of life. Early discharge of healthy term infants is a common practice because of economic constraints and social reasons. Which new-borns are at increased risk for developing significant hyperbilirubinemia (Total serum bilirubin ≥ 15mg/dl) is difficult to predict. This study was taken up to evaluate the predictive value of cord blood bilirubin level for identifying term infants for subsequent hyperbilirubinemia. Material and methods. This prospective observational study was conducted in Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka from 1st of April 2020 to 30th September 2020. 100 healthy term babies satisfying the eligibility criteria and born in the study period were included in the study. Umbilical cord blood was collected and was correlated with serum bilirubin levels at 48hours of life. Significant hyperbilirubinemia was taken as ≥ 15mg/dl at 48 hrs of life. Results. The incidence of neonatal hyperbilirubinemia was 14%. By using umbilical cord blood bilirubin ≥ 3mg/dl, significant hyperbilirubinemia can be predicted with Sensitivity of 92.9%, Specificity of 96.5%, Positive Predictive Value of 81.3% and Negative Predictive Value of 98.8%. Conclusion. Umbilical cord blood bilirubin ≥ 3mg/dl in healthy term babies can help in prediction of significant jaundice and thus can help in identifying high risk new-borns so that these neonates can be followed up more closely, it can also help in identifying neonates who are not at increased risk of developing significant jaundice, hence can prevent unnecessary hospital stay.

Impact of Phototherapy on Oxidative Stress Indices in Preterm Neonates with Unconjugated Hyperbilirubinemia

Background: Neonatal jaundice is one of the most common neonatal problems especially in preterm ones. Preterm babies are treated with different types of phototherapy. Preterm neonates have a weak antioxidant defense mechanism. Both the hyperbilirubinemia and phototherapy have an impact on this antioxidant defense system. Objective: In the current study we aimed to assess the effect of hyperbilirubinemia and phototherapy in the oxidant/antioxidant status of preterm newborns. Subjects and Methods: Thirty late preterm (≥35 weeks) neonates with non-hemolytic neonatal jaundice in the 3-9 days of life were involved in the preset study, and received phototherapy. 15 healthy neonates of the same gestational and postnatal age without jaundice were included as a control. We assessed the total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI). Results: TOS and OSI were significantly higher (P<0.01); TAC level was significantly lower (P<0. 01); in jaundiced preterm neonates than in control group. Following phototherapy there were significant increase in TOS and OSI (P<0. 01) and decrease in TAC (P<0.001). Conclusions: Both hyperbilirubinemia and phototherapy induce oxidative stress in preterm neonates. Recommendations: preterm neonates with significant hyperbilirubinemia benefits of phototherapy overwhelm the risks.

Impact of Phototherapy on Oxidative Stress Indices in Preterm Neonates with Unconjugated Hyperbilirubinemia

Background: Neonatal jaundice is one of the most common neonatal problems especially in preterm ones. Preterm babies are treated with different types of phototherapy. Preterm neonates have a weak antioxidant defense mechanism. Both the hyperbilirubinemia and phototherapy have an impact on this antioxidant defense system. Objective: In the current study we aimed to assess the effect of hyperbilirubinemia and phototherapy in the oxidant/antioxidant status of preterm newborns. Subjects and Methods: Thirty late preterm (≥35 weeks) neonates with non-hemolytic neonatal jaundice in the 3-9 days of life were involved in the preset study, and received phototherapy. 15 healthy neonates of the same gestational and postnatal age without jaundice were included as a control. We assessed the total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI). Results: TOS and OSI were significantly higher (P<0.01); TAC level was significantly lower (P<0. 01); in jaundiced preterm neonates than in control group. Following phototherapy there were significant increase in TOS and OSI (P<0. 01) and decrease in TAC (P<0.001). Conclusions: Both hyperbilirubinemia and phototherapy induce oxidative stress in preterm neonates. Recommendations: preterm neonates with significant hyperbilirubinemia benefits of phototherapy overwhelm the risks.

Validity of maternal visual assessment of neonatal jaundice: a hospital-based study in Thailand

ABSTRACT Background Hyperbilirubinaemia is a common cause of hospital admission of newborn infants; however, maternal visual assessment of jaundice may reduce unnecessary hospital visits. Aims To investigate the validity of maternal visual assessment of neonatal jaundice to identify infants with hyperbilirubinaemia requiring phototherapy or who have significant hyperbilirubinaemia ≥239.4 µmol/L (14 mg/dL). Methods A prospective study of the diagnostic accuracy of maternal visual assessment of jaundice was conducted at a university hospital in Bangkok. Mothers were trained to assess for neonatal jaundice using their infant’s palms as a skin colour reference. Trained mothers who were blinded to transcutaneous bilirubin or serum bilirubin values assessed their infants and reported ‘jaundice’ or ‘no jaundice’, and determined jaundice severity using dermal icterus zones. Sensitivity and negative predictive values were used to assess the validity of visual assessment for neonatal jaundice. Results In 180 mothers, the median (min/max) transcutaneous or serum bilirubin value in their infants was 177.8 µmol/L (119.7–309.5). The sensitivity and negative predictive values (95% CI) of maternal assessment for detecting hyperbilirubinaemia requiring phototherapy were 91.7% (73.0–99.0) and 96.6% (87.9–99.1), respectively, and for identifying significant hyperbilirubinaemia were 92.9% (76.5–99.1) and 96.6% (87.9–99.1), respectively. The accuracy of maternal report of dermal zones for serum bilirubin levels was only 44.5%. In 56 infants who received a second jaundice assessment, the sensitivity of maternal assessment for detecting increased transcutaneous or serum bilirubin was 93.9% (83.1–98.7). Conclusion Teaching mothers to visually assess their infants for neonatal jaundice was demonstrated to be feasible. Abbreviations CI, confidence interval; MB, microbilirubin; min/max, minimum/maximum; NPV, negative predictive value; OPD, outpatient department; PPV, positive predictive value; SD, standard deviation; TcB, transcutaneous bilirubin

Neonatal Hyperbilirubinemia: An Updated Appraisal of National Guidelines.

Recent reports from several developed countries have documented a resurgence of bilirubin encephalopathy causing both healthcare and forensic issues. For these reasons, many national pediatric societies have issued recommendations on the diagnosis and the treatment of clinically significant neonatal hyperbilirubinemia. The differences among individual national documents may have an impact on neonatal healthcare. This paper shortly reviews the advantages and the shortcomings of the main international guidelines with a focus on the available evidence.

Clinical Implication of Immunohaematological Tests in ABO haemolytic disease of newborn: Revisiting an old disease.

We aimed to assess the frequency distribution of of ABO haemolytic disease of newborn (ABO-HDN) and to know the predictive value of immunohaematological tests in identifying at risk neonates. ABO incompatibility, although a common cause of haemolytic disease of newborn, has several unaddressed issues related to it. A prospective study over 20 months was carried out in a tertiary care centre in South India. Blood grouping, Direct Antiglobulin test (DAT) and elution studies were performed on neonatal samples, whereas blood grouping, antibody screening and antibody titration were performed on maternal samples. In suspected cases, ABO-HDN was diagnosed after excluding other possible causes for haemolysis. The laboratory results were correlated with the clinical details to assess the predictive value of the tests. Of the total 2856 pregnancies, 34% had ABO incompatibility. On testing with columnagglutination test (CAT), the overall DAT positivity and that among ABO-incompatible cases were 3.8% and 11.2%, respectively,) whereas by conventinal tube technique (CTT) it was 0.6% and 2.4% respectively. CAT was found to have higher sensitivity, and the predictive value was higher for CTT. Maternal IgG titre showed a positive linear relationship with the DAT strength and the rise in indirect bilirubin levels. The positive predictive value of combination of tests such as DAT, elution and titation was 94.12%, which was much higher than that of the individual tests. DAT positivity is a predictor of early rise in serum bilirubin level, and a combination of tests has a better predictive value than individual tests towards development of clinically significant hyperbilirubinemia in ABO-HDN.

Neurodevelopmental Evaluation of Term Newborns with Significant Hyperbilirubinemia

Neurodevelopmental Evaluation of Term Newborns with Significant Hyperbilirubinemia

Noninvasive Detection of Hemolysis with ETCOc Measurement in Neonates at Risk for Significant Hyperbilirubinemia

Background: Hemolytic hyperbilirubinemia due to blood group incompatibility or glucose-6-phosphate dehydrogenase deficiency (G6PD) is a common cause of significant hyperbilirubinemia. Hemolysis in a hyperbilirubinemic infant increases the risk of bilirubin neurotoxicity. A new portable device (CoSense) can rapidly detect breath end-tidal carbon monoxide corrected to ambient carbon monoxide (ETCOc). ETCOc levels are surrogate markers of hemoglobin breakdown and bilirubin production. Objective: The aim was to evaluate the association between ETCOc values and hemolysis and its relevance in neonates at risk for significant hyperbilirubinemia. Methods: A prospective study was conducted among newborn infants born at more than 35 weeks and with a birth weight greater than 2,000 g with a G6PD deficiency, blood group incompatibility, or clinical jaundice needing phototherapy during the first 7 days of life. The recruited infants had their breath ETCOc measured twice, first on the day of recruitment and then again on the following day. Results: Fifty infants completed this study. Their mean ETCOc was 1.61 (±0.56) ppm. There was a linear correlation (r = 0.89) between increasing ETCOc values and reticulocyte counts (RC). Sixteen newborns with ABO incompatibility had a significantly higher mean ETCOc of 1.98 ppm (±0.71) as compared to 1.43 (±0.38) ppm in the nonhemolytic hyperbilirubinemia (NHH) group (n = 25) (p = 0.002). This was suggestive of hemolysis as shown by the significantly higher RC of 6.90% (±3.38) compared to 4.68 (±1.26) in the NHH group (p <0.005). Neonates with an ETCOc level ≥1.8 ppm had a higher RC, a lower hemoglobin level, higher serum bilirubin levels, and a rapid rise in serum bilirubin and needed a longer duration of phototherapy. ETCOc values ≥1.8 ppm were suggestive of hemolysis (RC ≥6%), with a sensitivity of 90% and a specificity of 83%. Conclusion: Higher ETCOc values ≥1.8 ppm are suggestive of hemolysis and they are associated with significant hyperbilirubinemia.