Subsequent Hyperbilirubinemia Research Articles

Umbilical Cord Blood Bilirubin, Albumin, Reticulocyte Count, and Nucleated Red Blood Cells to Predict Subsequent Hyperbilirubinemia in Term Neonates: A Prospective Observational Study.

Hyperbilirubinaemia is one of the most important causes of re-admission in the early neonatal period. The socioeconomic factors are one of the most common reasons for early discharge in a developing country like India. This study aims to evaluate and analyze the statistical correlation of umbilical cord blood bilirubin, albumin, nucleated red blood cells (nRBC), and reticulocyte count as early predictors of neonatal hyperbilirubinemia. A prospective observational study was conducted from November 2015 to April 2017 in a tertiary care hospital in North Karnataka, India. Umbilical cord blood was collected at birth for analysis of bilirubin, albumin, reticulocyte count, and nRBC in term neonates. Total serum bilirubin (TSB) levels were estimated using the VITROS BuBc Slide method at 72 hours of life. Data were analyzed using SPSS version 23 (IBM Corp., Armonk, NY). A total of 200 term neonates were enrolled in the study, out of which 123 completed follow-ups. Of the 66 newborns who had cord bilirubin levels ≥1.75 mg/dl, 23 (34.8%) developed hyperbilirubinemia after 72 hours of life, whereas 10 of the 57 newborns (17.5%) whose cord bilirubin levels <1.75 mg/dl developed hyperbilirubinemia after 72 hours of life. Cord blood albumin of ≥3.75 g/dl was seen in 93 neonates, of which 18 (19.4%) developed hyperbilirubinemia after 72 hours of life and 15 (50%) with <3.75 g/dl developed hyperbilirubinemia after 72 hours of life. Cord reticulocyte count ≥4.95% was seen in 54 neonates; 20 (37.03%) developed hyperbilirubinemia, whereas in 69 neonates with <4.95%, 13 (18.84%) developed hyperbilirubinemia after 72 hours of life. Of the 62 neonates who had cord nRBC ≥3.5%, 28 (45.2%) neonates developed hyperbilirubinemia after 72 hours of life, whereas 5 of the 61 neonates (8.19%) with cord nRBC <3.5% developed hyperbilirubinemia after 72 hours of life. Cord blood bilirubin, albumin, reticulocyte counts, and nucleated RBC can be used as predictors of subsequent neonatal hyperbilirubinemia.

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

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

The Predictive Value of Day one Serum Bilirubin Extent for Subsequent Increase Substantial Hyperbilirubinemia in Well Full Term Neonate in Mukalla Maternity and Child Hospital, Hadhramout,Yemen

Background: Significant neonatal hyperbilirubinemia is a common cause of readmission following initial sending home from hospitals in healthy mature neonates. Objective: To determine the predictive ability of first 24th hr entire serum bilirubin (TSB) levels for later development of important hyperbilirubinemia in well mature neonates at Mukalla Maternity and Child Hospital (MMCH) in Mukalla city, Hadhramaut Governorate, Yemen. Patients and Methods: A cross sectional study of 150 well mature newborns was tracked with everyday serum total bilirubin detections for five days of life at Mukalla Maternity &amp; Child Hospital between March 2019 and February 2020. Results: It was observed that 10%, 10%, 13.3% and 66.7%% of newborns were corresponding to high, high intermediate, low intermediate, and low risk zones respectively, while7.3% of newborns had developed significant hyperbilirubinemia and needed phototherapy. The day one bilirubin value of 5mg/dl had a sensitivity of 100% and specificity of 72%, the positive predictive value of 22%, and a negative predictive value of 100% in forecasting the risk of developing significant jaundice. Conclusion: A total serum bilirubin measurement may be applied as a useful screening test for each neonate at the first week of life, to foresee those at risk for later development of significant neonatal hyperbilirubinemia and permit for a harmless discharge from the hospital.

To Study the Predictive Value of Umbilical Cord Blood Bilirubin Levels Term Neonates as Marker of Neonatal Hyperbilirubinemia

Background: Infants who are clinically jaundiced in the first few days are more likely to develop hyperbilirubinemia. Hyperbilirubinemia is the most common medical problem in newborn infants. It is the most important cause for hospital readmissions during the early neonatal period and also the cause for neonatal morbidity. Objective: In this prospective study we are going to evaluate the predictive value of cord bilirubin level for identifying term neonates for subsequent hyperbilirubinemia. Materials and Methods: Cord bilirubin levels at birth and subsequently serum bilirubin levels at 72 h were assessed in 291 neonates. The cutoff value was estimated beyond which there was significant hyperbilirubinemia. Statistics employed include quantitative data which is expressed in terms of mean and SD and qualitative in terms of proportions and receiver operator characteristic curve used to find cut-off value and to find sensitivity and specificity. Results: The cutoff value of cord bilirubin &gt;2 mg/dl had sensitivity and specificity of 77.97 and 56.90%, respectively, with positive predictive value of 31.51 and negative predictive value of 91.03% for subsequent hyperbilirubinemia. Conclusion: To decreases the significant burden of untreated severe neonatal jaundice, cord serum bilirubin can be used as a screening tool to identify the neonatal jaundice in term and this prediction of neonatal hyperbilirubinemia has widespread implication especially in our country where there are limited resources. Keywords: Hyperbilirubinemia, Neonatal morbidity, cord serum bilirubin.

Effect of Early Supplemental Formula Intervention on Body Weight and Hyperbilirubinemia in Neonates During 72 h After Birth.

Background: The full breastfeeding may lead to insufficient milk intake of newborns and increase the rate of body weight loss (BWL). Severe BWL was generally believed as a cause of significant hyperbilirubinemia in newborn babies. The study aimed to investigate the effect if early supplemental feeding in newborns with birth weight loss at the first 3 days after birth could decrease the rate of hyperbilirubinemia 72 h of birth.Methods: A total of 395 neonates with gestational age >37 weeks and birth body weight >2500g were prospectively collected between 2016 and 2018. We analyzed 280 neonates with BWL rate reaching the predictive value (4.5%, 7.5%, and 8% on the first, second, third day after birth, respectively) for subsequent hyperbilirubinemia after 72 hours after birth. The enrolled cases were divided into four subgroups as interventional consecutive milk supplement for 0, 1, 2, and 3 days after birth for further analysisResults: For newborns with BWL reaching the predictive value on the first day after birth, the serum bilirubin levels were lower in the experimental group than those in the non-involved control group (p < 0.05). For newborns with three consecutive days of interventional milk supplementation, the serum bilirubin levels at the 72 h after birth showed the lowest levels compared with the other sub-groups with two consecutive days and one consecutive day of interventional milk supplementation (p < 0.05). Moreover, there was a significantly decreasing trend in the consecutive days of interventional milk supplementation (p < 0.05).Conclusion: Newborns with BWL over 4.5% on the first day after birth receiving early intervention milk supplementation could significantly reduce serum bilirubin levels at the72 h after birth. The more days of consecutive milk supplementation after birth may lead to the lower the 72 h serum bilirubin levels. It is recommended to early and consecutive milk supplementation after birth to be an effective way in reducing serum bilirubin levels.

Comparison of Umbilical Cord blood Bilirubin (UCB) and Bilirubin Albumin Ratio (BAR) in Predicting Neonatal Hyperbilirubinemia: A Prospective Observational Study

Introduction: Hyperbilirubinemia is a commonly encountered medical condition in neonates. It becomes problematic when the levels of bilirubin raises to abnormally high values leading on to neurological problems. Bilirubin Albumin Ratio (BAR) can be used as a prediction tool for subsequent hyperbilirubinemia in neonates thereby helping in early institution of therapy. Aim: To compare Umbilical Cord blood Bilirubin (UCB) and the BAR in predicting neonatal hyperbilirubinemia. Materials and Methods: This prospective observational study was conducted in the neonates born at Al-Azhar Medical College, Thodupuzha, Kerala, India, from April 2020 to February 2021. After obtaining clearance from Institute Research Committee and Institute Ethical Committee, 1025 healthy term babies were included in the study. After an informed consent from either of the parent, cord blood was sent for bilirubin, albumin and the blood group estimation. Babies were examined daily for any development of jaundice for five days or till discharge. Venous blood was sent for bilirubin estimation if clinical icterus was noted by Kramer’s rule any time after birth or at 72 hours. If hyperbilirubinemia was detected, treatment was instituted. Two cut-offs for UCB-2 and 2.5 mg/dL and two cut-offs for BAR 0.59 and 0.69 were correlated with the neonatal hyperbilirubinemia using Pearson correlation and Chi-square test. The p-value &lt;0.05 was taken as statistically significant. The cut-off values for cord bilirubin and BAR that could predict hyperbilirubinemia was also obtained from Receiver Operating Curve (ROC). Results: Of the 1025 babies studied, hyperbilirubinemia was detected in 246 babies (24%). Babies with higher UCB and BAR had statistically significant risk of neonatal hyperbilirubinemia. UCB &gt;2 mg/dL and 2.5 mg/dL and BAR 0.59 and 0.69 were found to strongly correlate with the risk of hyperbilirubinemia. Higher the UCB and BAR, higher the risk. On ROC analysis, cut-off points for UCB and BAR were 2 mg/dL and BAR &gt;0.59 respectively. A highly significant correlation was found between UCB and hyperbilirubinemia as well as between BAR and hyperbilirubinemia with a p-value &lt;0.001. Among UCB and BAR, UCB is found to have better sensitivity and specificity than BAR with cut-off 2 mg/dL with better sensitivity of 75.2% and cut-off 2.5 mg/dL with a better specificity of 89.6%. Conclusion: UCB and BAR are strong predictors of neonatal hyperbilirubinemia with UCB a better predictor than BAR.

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.

Predictive value of cord blood bilirubin in neonatal hyperbilirubinemia: A prospective study

Background: As there is a tendency for early discharge from a hospital, some babies may develop significant neonatal jaundice at home, which may go unrecognized and cause subclinical damage to the growing brain. If such babies could be identified early, their discharge can be postponed for timely and better management. Objectives: The objectives of the study were to evaluate the umbilical cord bilirubin (UCB) levels as a predictor for hyperbilirubinemia in full-term and near-term newborns up to the 3rd day of life. Materials and Methods: A prospective cohort study was carried out in a tertiary care hospital in South India. Data were collected from the enrolled cases by a pre-designed proforma. Statistical analysis was carried out with the help of statistical measures, such as percentages and proportions and the sensitivity, specificity, and negative and positive predictive values (NPV and PPV). Results: A total of 301 newborns were enrolled. A cutoff UCB 2 mg/dl had 94% sensitivity, 93% specificity, 61% PPV, and 99% NPV. A total of 61% of neonates who had UCB levels ?2 mg/dL required phototherapy by the 3rd day of life. However, 99% of neonates who had UCB &lt;2 mg/dL did not require phototherapy, and these infants with low risk of hyperbilirubinemia could be discharged early from the hospital. Conclusion: The cutoff value of 2 mg/dL of UCB with 94% sensitivity and 93% specificity canbe used as a predictor for developing subsequent hyperbilirubinemia.

Predictive value of serum bilirubin level for identifying term neonates at risk for subsequent hyperbilirubinemia

Background: Infants who are clinically jaundiced in the first few days are more likely to develop hyperbilirubinemia. The present study was made attempt to evaluate the predictive value of serum bilirubin level on day one postnatal age for identifying term neonates at risk for subsequent hyperbilirubinemia.Method: The present hospital based prospective study involving neonate’s ≥37 weeks of gestational age included 200 healthy term newborn babies (≥37weeks GA) born at GSL medical college and hospital at Rajahmundry during study period. The purpose of this study was explained to the parents/ guardian and written consent was taken prior to the study. Data collected was kept securely. Permission was obtained from the Ethical Committee of GSL medical College before starting the study.Result: Newborns who developed significant hyperbilirubinemia male: female ratio was 1.07:1. 9(33%) newborns with significant hyperbilirubinemia had jaundice in previous siblings. In the present study, the value of 4.9 mg/dl was determined to have the best combination of sensitivity and specificity to predict neonates at risk of hyper birubinemia subsequently. At this value of 4.9 mg/dl there is high sensitivity and a very high negative predictive value, although a low positive predictive value for predicting neonates likely to develop significant hyperbilirubinemia.Conclusion: Early screening and appropriate management of hyperbilirubinemia is needed for prevention of complications in the newborn. This decreases the significant burden of untreated severe neonatal jaundice, causing potential neurological sequelae. Prediction of neonatal hyperbilirubinemia has widespread implication especially in our country where there are limited resources.

Are Cord Blood Bilirubin Values Trustable to Predict the Forthcoming Significant Hyperbilirubinemia Requiring Treatment in Healthy Term Newborns?

Background: Jaundice is a clinical condition that is often observed in pediatric practice and constitutes one of the major issues within the neonatal period. As severe jaundice causes neurotoxicity(kernicterus), the diagnosis and treatment of severe hyperbilirubinemia is very important. Early prediction will help in early discharge and will prevent hospitalization of babies and mothers. On the other hand, predicting outcome in high risk neonates for subsequent hyperbilirubinemia is required.Objectives: This study investigates the predictive value of umbilical cord serum bilirubin (UCSB) for subsequent hyperbilirubinemia which is a required treatment in healthy term newborns.Methods: In this prospective study, 238 healthy term newborns were inducted into the study. Soon after delivery, the cord blood was sent for serum bilirubin analysis. Newborns were followed up by TCB (transcutaneous bilirubinometry) until the third day post birth and those who showed significantly high TCB values, according to the hour-specific normogram, received the appropriate intervention and treatment. The data were analyzed using t-Test, ROC (receiver operating characteristic) curve, and chi-square tests.Results: Of 238 newborns, 27 (11.4%) cases developed hyperbilirubinemia (bilirubin >= 15 mg/dL), which required phototherapy. There were no significant differences between the cases who did and who did not develop hyperbilirubinemia (bilirubin = 2.25 mg/dl had high sensitivity (92.6%), good positive and negative predictive value (66% and 69% respectively).Conclusions: UCSB level >= 2.25 mg/dL can be a useful predictor of hyperbilirubinemia in healthy term newborns on the third day. Therefore, infants with UCSB level >= 2.25 mg/dL should be followed up strictly either in a hospital or in an outpatient department on the third day, whereas neonates with cord bilirubin level < 2.25 mg/dL are probably safe for early discharge.

Prediction of neonatal hyperbilirubinemia by cord blood analysis to diagnose subsequent hyperbilirubinemia

Background: the study was aimed to determine the predictive value of cord bilirubin and 24th hour serum bilirubin levels in identifying newborn babies at risk of developing significant hyperbilirubinemia.Methods: A total 300 term neonates with a mean birth weight of 2.58±0.23 kg ranging from 1.92 kg-4.1kg were included in this study. Under strict aseptic precautions cord blood sample were collected from all newborns for analysis of serum bilirubin levels, and haemoglobin levels.Results: The incidence of significant hyperbilirubinemia in this study was 14%. Among jaundiced newborns sex ratio M/F:1.6:1(male female ratio 1.1:1). Mean Cord bilirubin levels in babies who subsequently developed hyperbilirubinemia was 2.798±0.5559 mg/dl and in others were 1.511±0.3260 mg/dl and the difference was statistically significant. There was a statistically significant correlation between cord bilirubin and neonatal jaundice. Cord bilirubin ≥2 mg/dl had good predictive value in identifying newborns who are likely to develop significant hyperbilirubinemia later.Conclusions: Babies with cord blood bilirubin ≥2 mg/dl can be followed up in the hospital for 5 days, the time of peak neonatal hyperbilirubinemia to prevent the babies discharged early and later readmission for neonatal hyperbilirubinemia.

A typical Presentation of Acute Infectious Mononucleosis (AIM) with Isolated Hyperbilirubinemia

Epstein - Barr virus (EBV) induced hepatitis and subsequent hyperbilirubinemia is a strikingly rare cause of jaundice. Lack of other common infectious mononucleosis symptoms makes the diagnosis difficult with history and physical exam alone. With differential diagnoses more commonly including HAV, HCV, and HBV hepatitis infections; alcoholic hepatitis; autoimmune hepatitis; and hepatocellular carcinoma, suspicion for EBV induced hepatitis is often low. We present a noteworthy case of isolated hyperbilirubinemia due to EBV virus confirmed with biopsy, without other infectious mononucleosis symptoms such as fever, sore throat, or splenomegaly. Furthermore, we review the pathophysiology, diagnosis, treatment, and prognosis of EBV-induced hepatitis.

Utility of Cord Blood Albumin as a Predictors of Significant Neonatal Hyperbilirubinemia in Healthy Term Neonate.

Background: Approximately 60% of term and 80% of preterm neonates develop jaundice in first week of life and significant neonatal hyperbilirubinemia occurs in 3-5% of healthy term neonates. Objective: To assess the cord blood albumin level as a tool to screen the risk of development of subsequent significant neonatal hyperbilirubinemia in term neonate. Subjects and Methods: A prospective observational study was conducted over a period of 2 years on 1040 healthy term neonates. Demographic profile, relevant maternal and neonatal information were recorded. Measurement of cord blood albumin, blood group/Rh typing and serum bilirubin at the end of 24 & 72 hours was done to predict significant hyperbilirubinemia. Results: A total of 1040 healthy term neonates were enrolled with male to female ratio of 1.4:1. 120 neonates had developed significant hyperbilirubinemia and required phototherapy while 2 of them did not respond to phototherapy and needed exchange transfusion. Out of 245(23.55%) neonates with low cord albumin level (<2.8gm/dl), 104(42.44%) neonates had significant hyperbilirubinemia at the end of 24 hours with sensitivity 86.67%, specificity 84.67%, positive predictive value 42.45% and negative predictive value 97.66%. While 105 (42.85%) neonates had significant jaundice at the end of 72 hours with cord blood albumin <2.8 gm/dl with sensitivity 87.50%, specificity 84.78% positive predictive value-42.86% and negative predictive value-98.11%. Conclusion: Neonates with cord blood albumin level more than 2.8gm/dl can be safely discharged early whereas neonates with albumin levels <2.8g/dl will need close follow up to check for development of significant jaundice. Hence cord blood albumin levels help to determine and predict the possibility of significant jaundice among healthy term neonates.

Cord blood albumin–bilirubin as a predictor for neonatal hyperbilirubinemia

Objective The aim was to evaluate the predictive value of cord blood albumin and bilirubin in identifying infants greater than or equal to 35 weeks for subsequent hyperbilirubinemia. Background Hyperbilirubinemia is the most common cause for readmission during the early neonatal period. Early discharge of healthy term newborns after delivery has become a common practice for socioeconomic reasons. Patients and methods A prospective cohort study was carried out on 75 neonates, greater than or equal to 35 weeks, with 34 female and 41 male neonates, delivered in Menoufia University hospital during the period from June 2016 to December 2017. Full history taking, clinical examination immediately after birth, and laboratory investigations were recorded. Results With cord albumin less than 2.8 g/dl, 81.8% of cases developed significant hyperbilirubinemia, whereas levels greater than 3.3 mg/dl were considered safe with no incidence of hyperbilirubinemia. Moreover, in the total group, the highest sensitivity (83.3%) was for cut-off value of cord bilirubin (CB) at 1.88 mg/dl, with positive predictive value of 72.9%, whereas the highest specificity (84.8%) was for cut-off value of CB–cord albumin at −0.6, with negative predictive value of 74.1. In high-risk group, the highest sensitivity (88.9%), highest positive predictive value (94.1%), highest specificity (85.7%), and negative predictive value (75%), were for cut-off value of CB–cord albumin at − 0.82. Conclusion Cord blood albumin and bilirubin examination can be used as an early useful indicator to predict significantly hyperbilirubinemia in neonates. Researches on large scale should be done for more clarification on the predictive value of cord blood albumin and bilirubin for early prediction of significant hyperbilirubinemia.

PREDICTIVE VALUE OF CORD BLOOD BILIRUBIN IN DEVELOPMENT OF NEONATAL HYPERBILIRUBINEMIA

Introduction: The early detection of neonatal hyperbilirubinemia (NNH) can be done by various methods; however, the most reliable is cord blood bilirubin (CBB). Objective: The objective of this study is to evaluate the predictive value of the CBB levels for the subsequent hyperbilirubinemia in healthy term newborns and its association with various maternal and neonatal factors. Materials and Methods: Two hundred healthy term-neonates between 37 and 42 weeks of gestation were included in the study. A thorough antenatal, perinatal, and natal history was obtained. Cord blood was collected from all newborns, and the samples were sent for the estimation of serum bilirubin, blood grouping, and Rh typing. Results: Various risk factors such as gender difference (p 2.5 mg/dl. At a cutoff of 2.5 mg/dl, sensitivity and specificity came out to be 33.33% and 96.25%, respectively. Conclusion: NNH and CBB level were found to be associated with several maternal and neonatal risk factors. Hence, total serum bilirubin in cord blood was indicative of the jaundice severity among neonates.

First day serum bilirubin level, as predictor of significant hyperbilirubinemia in neonates

Background: Age-specific (24 ± 6 h) predictive value of total serum bilirubin (TSB) ≤6 mg/dl in developing significant hyperbilirubinemia in infants. Materials and Methods: A prospective observational study on 200 term neonates having birth weight ≥2500 g and gestational age ≥37 weeks. Blood was collected from the venous site. The blood sample of all infants was sent for grouping and TSB estimation. Babies were clinically examined every day for jaundice. Whenever jaundice was clinically noticed to be >10 mg/dl, bilirubin estimation was repeated immediately and then every day until 5 days of age, and the highest reading was recorded as the peak TSB. Results: Significant hyperbilirubinemia (>17 mg/dl) was present in 13% of cases. At 24 ± 6 h, TSB >6 mg/dl was present in 47 cases and 26 of these developed hyperbilirubinemia (≥17 mg/dl), and TSB ≤6 mg/dl was present in 153 cases and two of them developed significant hyperbilirubinemia. The incidence of hyperbilirubinemia in babies whose mothers received oxytocin and those whose mothers did not receive oxytocin was 19.6% and 8.2%, respectively. The difference was highly significant. The mean values of TSB at 24 ± 6 h in oxytocin used and oxytocin not used groups were 3.94 ± 2.15 mg/dl and 3.36 ± 1.91 mg/dl, respectively, the difference was statistically significant; however, the mean values of peak TSB in oxytocin used and not used groups were 12.78 ± 4.28 mg/dl and 12.03 ± 3.42 mg/dl, respectively, which were statistically not significant. Conclusion: The incidence of significant hyperbilirubinemia in healthy babies is 13%. The use of oxytocin increased its incidence. TSB at 24 ± 6 h ≤6 mg/dl has a high predictive value in identifying those infants who are unlikely to develop subsequent hyperbilirubinemia. This study, thus, will help to discharge healthy term infants with TSB on 2nd day ≤6 mg/dl.

CORD BILIRUBIN LEVELS AS A PREDICTIVE MARKER FOR NEONATAL HYPERBILIRUBINEMIA: A PROSPECTIVE STUDY

Background: Hyperbilirubinemia is the most common medical problem in newborn infants. Early discharge is recommended but hospital readmission is a cause of concern among clinicians. This in turn carries a risk of delayed recognition of significant hyperbilirubinemia. Objective: A cross-sectional analytical study was done to evaluate the predictive value of cord bilirubin level for identifying term and near-term neonates for subsequent hyperbilirubinemia. Materials and Methods: Cord bilirubin levels at birth and subsequently serum bilirubin levels at 72 h were assessed in 100 neonates. The cutoff value was estimated beyond which there was significant hyperbilirubinemia. Results: The cutoff value of cord bilirubin >2.02 mg/dl had sensitivity and specificity of 87.5-70.8%, respectively, with positive predictive value of 0.39 and negative predictive value of 0.965 for subsequent hyperbilirubinemia. Conclusion: The cutoff value of cord bilirubin level estimated is 2.02 mg/dl can be used to predict significant neonatal hyperbilirubinemia.

Role of cord blood bilirubin and albumin levels as predictors of subsequent hyperbilirubinemia in newborns

Introduction: Neonatal hyperbilirubinemia is one of the most common problems in term and preterm babies. Development of hyperbilirubinemia in neonates is fretful for the parents and a concern for the pediatrician too. Healthy babies born through normal vaginal delivery who are getting discharged early are being readmitted for the treatment of hyperbilirubinemia. Aim sand Objectives: The present study is done to determine the correlation of cord blood bilirubin, albumin and neonatal hyperbilirubinemia in identifying newborn babies at risk of developing significant hyperbilirubinemia and to establish the cutoff values of cord blood bilirubin and cord blood albumin levels to identify such high-risk neonates. Materials and Methods: In present study, 303 term neonates who are delivered in ASRAM, Eluru from January 2012-January 2013, were included after parental consent. Cord blood bilirubin, Blood grouping and typing, Cord blood albumin and serum bilirubin levels were done in all babies. Results: The incidence of significant hyperbilirubinemia in this study was 23.7%. Cord serum unconjugated bilirubin level ≥2.0 mg/dl and total cordserum bilirubin level ≥ 2.5mg/dl as high risk indicator towards predicting neonatal hyperbilirubinemia in first week of life. 58.53% babies had cord serum albumin level &lt; 2.8gm/dl. Conclusion: Cord serum unconjugated bilirubin level ≥2mg/dl and total cord serum bilirubin level ≥2.5mg/dl, cord blood albumin &lt;2.8g/dl is a high-risk indicator towards predicting neonatal hyperbilirubinemia in the first week of life.

Transcutaneous bilirubin nomograms in African neonates.

BackgroundThe use of transcutaneous bilirubin (TcB) as a screening tool, based on relevant population-specific nomogram, or proxy for total serum bilirubin (TSB) levels in assessing the risk of subsequent hyperbilirubinemia is supported by several clinical guidelines on the management of neonatal hyperbilirubinemia. However, while TcB has been found to significantly over-estimate TSB in neonates of African-American ancestry, with variations across TcB devices, no nomogram has been specifically reported for this racial group. This study therefore set out to develop TcB nomograms for healthy late pre-term and term black African neonates derived from two widely used bilirubinometers.MethodsA retrospective analysis of 12,377 TcB measurements obtained from 6,373 neonates in the first postnatal week, over a period of 48 months using Bilichek and JM-103 bilirubinometers. TcB percentiles were computed from hour-specific TcB values and nomograms developed for each of the screening devices. Predictive ability of the 75th and 95th percentiles to detect significant hyperbilirubinemia was evaluated between 24–96 hours of age. The 95th percentile curve was compared with those from other populations.ResultsThe velocity of TcB rise at 75th and 95th percentiles was generally higher with JM-103 than Bilichek. Both percentiles also peaked at higher TcB levels with JM-103. The 95th percentile for both instruments showed a downward trend as from approximately 114 hours. Both instruments had high negative predictive values across the selected time-epochs and lower discriminatory ability than reported in non-black populations.ConclusionsThe predictive utility of TcB as a potential screening tool varies across devices in black African neonates with or without risk of significant hyperbilirubinemia, and lower than levels reported in non-black populations. Equipment-specific nomograms should be considered for TcB monitoring in this racial population where TSB is not routinely available.

Prediction of significant hyperbilirubinemia in term neonates by early non-invasive bilirubin measurement.

Neonatal jaundice is a common problem. We evaluated the utility and best cut-off values of 24-and 48-hour transcutaneous bilirubin indices (TcBI) in predicting subsequent significant hyperbilirubinemia and evaluated various associated maternal and fetal risk factors. TcBI at 24 and 48 hours and serum bilirubin levels at 72 hours of age were obtained for healthy, term, appropriate for gestational age neonates. Neonates with prematurity, birth weight <2500 g, ABO or Rh incompatibility, onset of clinical jaundice <24 hours, clinical suspicion of septicemia, positive pressure ventilation at birth, admission in neonatal intensive care unit and contraindications for BiliChek were excluded. Twently-four and 48-hour TcB indices were assessed as predictors of subsequent hyperbilirubinemia, defined as serum bilirubin >17 mg/dL after 72 hours of life and various cut-offs, and were evaluated by calculating sensitivity, specificity and predictive values. Of 500 newborns, 4.6% had significant hyperbilirubinemia, 27% had TcBI (mg/dL) <5 at 24 hours, and 27.4% had TcBI <8 at 48 hours. None of them had subsequent hyperbilirubinemia (100% negative predictive value). The percentage of newborns with subsequent hyperbilirubinemia increased from 3.4% to 13.2% as their 24-hour TcBI increased from 6 to above 9 mg/dL and from 4.2% to 7.4% as their 48-hour TcBI increased from 8 to above 11 mg/dL. The best cut-off value was TcBI (mg/dL) 7 (odd ratio=4.86, 95% confidence interval: 1.66-15.22) at 24 hours and 10 (odd ratio=2.87, 95% confidence interval: 1.04-8.29) at 48 hours. Area under the receiver operating characteristic curve for 24- and 48-hour measurements was 0.750 and 0.715, respectively. Maternal premature rupture of membranes, deep transverse arrest, post-date pregnancy, and fetal distress were significant risk factors for hyperbilirubinemia. Twenty-four and 48-hour TcB indices are good predictors of subsequent hyperbilirubinemia. Twenty-four-hour TcBI had better predictive ability than 48-hour TcBI.