Total Serum Bilirubin In Neonates Research Articles

Therapeutic Effects of Probiotics In The Reduction of Neonatal Hyperbilirubinemia

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

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

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

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

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

Serum 25-Hydroxyvitamin-D Level in Full-term Neonates with Indirect Hyperbilirubinemia at a Level Requiring Phototherapy

Background: Low antioxidant system may contribute to the severity of neonatal hyperbilirubinemia. Aim of the work: This study was performed to clarify the relationship between serum 25-hydroxyvitamin-D (25[OH] D) and the hyperbilirubinemia in full-term neonates. Methods: This is a cross sectional case control study performed with the aim of determining whether there is an association between serum indirect bilirubin and serum vitamin D levels in newborns with jaundice at a level necessitating phototherapy. The study was carried on 60 full term newborns admitted to the Neonatal Intensive Care Unit of Minia University Hospital, from April 2017 to December 2017. They were classified into 2 groups, Group I: (cases): Newborns with postnatal ages of 3-10 days and gestational ages of 37-40 weeks, with a bilirubin level above the pre-set threshold for phototherapy as recommended by the American Academy of Pediatrics (AAP). Group II :( controls) 30 matched apparently normal healthy newborns were enrolled in the study as a control group. The study included the mothers of case group. All laboratory investigations were done in clinical pathology department, Minia University hospital. Results: Serum Vitamin D levels were significantly lower in patients than controls (p < 0.01). There was a strong negative correlation between neonatal total serum bilirubin level and neonatal serum vitamin D in cases group. In addition, we observed that there was a highly statistically significant positive correlation between serum vitamin D level of neonates and their maternal serum level was present. Conclusions: Indirect hyperbilirubinemia in full-term neonates is associated with decreased serum levels of (25[OH] D)

Cotoneaster manna oral drop for the management of neonatal hyperbilirubinemia; a randomized, double-blinded and placebo controlled clinical trial

Introduction: Neonatal hyperbilirubinemia is a common physiologic condition, which is occurred in early days after birth with an estimated incidence of about 50% in term neonates. Objectives: The aim of this study was to evaluate the effect of Cotoneaster nummularioides manna on reducing neonatal total serum bilirubin (TSB) levels, and shortening hospitalization period. Patients and Methods: One hundred breast-fed term neonates with hyperbilirubinemia were randomly assigned to the intervention group or control group. The Newborns of the intervention group were received Cotoneaster manna drop in the dosage of 1 g/d divided into three doses every 8 hours for at least 3 days and the control group received placebo drops. Total serum bilirubin levels were measured at baseline, at 12, 24 hours and then daily through hospitalization days (day 9). Secondary outcome (discharge from hospital, TSB &lt;10 mg/dL) was also documented with risk ratio calculation. Results: TSB levels were declined in both groups; however, this was more prominent in the manna group than the placebo group. The greatest difference of mean TSB levels between the intervention and control groups was seen on days two (10.01 versus 13.04 mg/dL; mean difference [95% CI]: - 3.03 [-3.60 to -2.46]; P&lt;0.001). On day four, significantly more newborns in the intervention group versus the control group were discharged (70% versus 6.1%; risk ratio = 11.43, 95% CI= 3.76, 34.74). No major side effects were recorded in both groups. Conclusion:Cotoneaster nummularioides manna drop combined with phototherapy was superior to the control group in reducing TSB levels and reaching this observation more rapidly and shortening hospitalization period with no major side effects. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical trials (identifier: IRCT20160531028188N4; https://en.irct.ir/trial/27765, ethical code #IR.MAZUMS.REC.1394.1316).

The impact of COVID-19 on routine patient care from a laboratory perspective.

Globally, few studies have examined the effect of the COVID-19 pandemic on routine patient care and follow-up. To evaluate the effect of the COVID-19 response on biochemical test requests received from outpatient departments (OPDs) and peripheral clinics serviced by the National Health Laboratory Service Chemical Pathology Laboratory at Tygerberg Hospital, Cape Town, South Africa (SA). Request volumes were used as a measure of the routine care of patients, as clinical information was not readily available. A retrospective audit was conducted. The numbers of requests received from OPDs and peripheral clinics for creatinine, glycated haemoglobin (HbA1c), lipid profiles, thyroid-stimulating hormone (TSH), free thyroxine, free tri-iodothyronine (fT3), serum and urine protein electrophoresis, serum free light chains and neonatal total serum bilirubin were obtained from 1 March to 30 June for 2017, 2018, 2019 and 2020. The biggest impact was seen on lipids, creatinine, HbA1c, TSH and fT3. The percentage reduction between 1 March and 30 June 2019 and between 1 March and 30 June 2020 was 59% for lipids, 64% for creatinine and HbA1c, 80% for TSH and 81% for fT3. There was a noteworthy decrease in overall analyte testing from March to April 2020, coinciding with initiation of level 5 lockdown. Although an increase in testing was observed during June 2020, the number of requests was still lower than in June 2019. This study, focusing on the short-term consequences of the SA response to the COVID-19 pandemic, found that routine follow-up of patients with communicable and non-communicable diseases was affected. Future studies are necessary to evaluate the long-term consequences of the pandemic for these patient groups.

EXCLUSIVE BREAST MILK AND FORMULA MILK: HOW IS THE DIFFERENCE IN THE DECREASE IN BILIRUBIN AFTER ADMINISTRATION OF PHOTOTHERAPY TO NEONATES WITH HYPERBILIRUBINEMIA?

Increased hemolysis in neonates after birth increases the amount of unconjugated bilirubin. Low levels of glucoronyl transferase cause the baby cannot metabolize an increase in the load of unconjugated bilirubin resulting in hyperbilirubinemia. High levels of bilirubin can cause acute enchelopathy and in extreme conditions can cause Kern Jaundice. Hyperbilirubinemia in neonates requires medical treatment with phototherapy. This research aims to determine differences in bilirubin levels in neonates who received exclusive breastfeeding with neonates who received formula after phototherapy. This study used a retrospective study to look at changes in Total Serum Bilirubin (TSB) before and after phototherapy for 2 x 24 hours in neonates who exclusively breast milk and neonates with formula milk. Data was obtained from medical records during 2017. The number of samples was 23 neonates with ASI and 22 neonates with formula milk. The results showed that the average age of the neonate was 5.22 days, the average TSB in neonates with ASI 17.01 mg / dl, and neonates with formula milk 16.22 mg / dl. After phototherapy, the average TSB in neonates with breast milk was 10.19 mg / dl, while neonates with formula milk 5.19 mg / dl. There were differences in TSB in neonates with breast milk and formula milk who received phototherapy (p

Efficacy of oral agar in management of indirect hyperbilirubinemia in full-term neonates

Aim This prospective randomized case control study aimed to investigate effect of oral agar administration in reducing total serum bilirubin (TSB) levels in full-term neonates with jaundice in comparison with control. Materials and methods One hundred sixty full-term neonates were enrolled with TSB 10–19 mg/dl at first week of age from Assiut University Children’s Hospital. Neonates were divided according to TSB into outpatient group (n = 100) (TSB 10–15 mg/dl) and admitted group (n = 60) (TSB > 15–19 mg/dl). Outpatients group were subdivided into agar group received oral agar and control group received placebo. Admitted group were subdivided into agar group received oral agar plus phototherapy combination and control group received phototherapy alone. Neonates in the agar supplementation received oral agar 600 mg/kg/day dissolved in 10 ml distilled water twice daily till TSB decreased to 7 mg/dl. Daily weight, stool frequency and side effects of treatment were observed for each group. TSB was determined pretreatment then serially every 48 h until TSB level reaching ≤7 mg/dl. Results Agar fed was effective in lowering TSB in neonates with TSB 10–15 mg/dl. TSB percentage changes were not significantly lower in agar-fed newborn with TSB >15–19 mg/dl compared with control groups after 24 h and 7 days. Age fed shortened the time required to decrease TSB and increased stooling frequency. Conclusions Oral agar supplemented feeding at 600 mg/kg/day is safe for full-term neonates and useful in decreasing TSB and phototherapy duration. The efficacy of phototherapy in decreasing TSB level in neonatal hyperbilirubinemia can be augmented with oral agar usage.

Comparison of Transcutaneous Bilirubin Measurement with Total Serum Bilirubin Levels in Term Neonates with Hyperbilirubinemia: A Descriptive-Analytical Study

Background: A common procedure for the diagnosis of hyperbilirubinemia is the total investigation of total serum bilirubin (TSB); however, this procedure is invasive for neonates. For two decades, transcutaneous bilirubin (TCB) was used as a non-invasive and painless method to assess bilirubin. Objectives: This study aimed to compare the accuracy of TCB versus TSB before and after phototherapy. Methods: This descriptive-analytical study included 85 neonates. Neonates were selected by convenience sampling methods. Neonates had a normal birth weight and physiological jaundice; having no need for blood transfusions. Data were collected using a BiliChek device (APEL, Japan). The researcher, before phototherapy and simultaneously by checking the TSB, pressed the BiliChek three consecutive times in the middle of the neonate’s forehead and then, recorded the results. The correlation between TCB and TSB were determined before and after phototherapy. Pearson, t-test, and ROC were used by SPSS v.18 for analysis data. Results: There was a strong correlation between the TCB and the TSB in neonates weighing 3001 to 4000g before phototherapy (r = 0.74, P 0.05), the cut-off value of bilirubin was 6 - 8 mg/dL. The sensitivity was (100%) and specificity was 90% for bilirubin at the levels of 6.7 mg/dL. Conclusions: TCB procedure can be a reliable alternative to the TSB, especially in the initiation of phototherapy with bilirubin levels of 6 - 8 mg/dL. However, it is not a device with a high accuracy after phototherapy.

Reductive effect of ursodeoxycholic acid on bilirubin levels in neonates on phototherapy.

BackgroundPhototherapy is paramount in the management of high total serum bilirubin (TSB). Whether its effectiveness can be improved with ursodeoxycholic acid (UDCA) has not been evaluated among newborns of African descent.MethodsA double-blind-controlled study was used to evaluate the effect of UDCA on the management of high TSB in neonates. Recruited neonates were categorized into the experimental group (given UDCA plus phototherapy) and the control group (phototherapy and plain syrup), and their TSB and conjugated bilirubin levels were measured. The data were analyzed using SPSS version 20. Statistical significance was set at a p-value of <0.05.ResultsThe mean (SD) percentage reductions in TSB after 24 hrs were 40.73% (18.1) and 10.21% (7.1) in the experimental and control groups, respectively, and the difference was statistically significant (p=0.001). The mean (SD) durations on therapy were 3.0 days (0.58) in the experimental group and 5.5 days (1.35) in the control group (p=0.001).ConclusionsPhototherapy is still effective in the management of neonatal hyperbilirubinemia, but inclusion of UDCA accentuates the reductive effect of phototherapy on the TSB in neonates, reducing the duration of treatment and in-patient care.

Association between neonatal serum bilirubin and childhood obesity in preterm infants.

Serum bilirubin levels are inversely associated with obesity in adults. We are interested in whether neonatal jaundice is associated with childhood obesity in preterm infants. Data were obtained from the US Collaborative Perinatal Project. Neonatal bilirubin levels were used as exposure factors for obesity at age 7 years. Logistic regression models were used to control for potential confounders and calculate odds ratios (ORs). A generalized estimating equation (GEE) model was used to correct for intracluster correlation coefficient. SAS was used for all statistical analyses. In the study subjects, 865 of 5019 preterm infants were obese at age 7 years. While neonatal total serum bilirubin (TSB) rose 1 mg/dl, body mass index (BMI) increased 0.03 kg/m2 (95% confidence interval (CI) 0.02, 0.04). Compared with infants with TSB <3 mg/dl, the ORs (95% CIs) for obesity in infants with 3 mg/dl≤ TSB <6 mg/dl, 6 mg/dl≤ TSB <9 mg/dl, 9 mg/dl≤ TSB <12 mg/dl and TSB ≥12 mg/dl were, respectively, 1.18 (0.87, 1.59), 1.25 (0.93, 1.67), 1.52 (1.11, 2.09), and 1.67 (1.22, 2.07). By using subtypes of bilirubin as exposure factors and the GEE model to correct for intracluster correlation coefficient, similar trends of associations were observed. Neonatal bilirubin levels have positive trends of associations with childhood obesity in preterm infants.

Correlation Between Maternal and Neonatal Vitamin B12 Serum Levels in Full Term Neonates with Physiologic Jaundice

Introduction: Vitamin B12 (vitB12)deficiency causes failure of red blood cells (RBC) maturation leading to cell lysis causing excess heme production resulting in indirect hyperbilirubinemia. Purpose: We aimed toassess vitB12 serum levels in neonates with jaundice and compare these levels with that of apparently healthy neonates and detect the impact of the maternal vitB12 on both vitB12 and bilirubin of their neonates. Patients and methods: Complete blood count (CBC), C- reactive protein (CRP), and VitB12 were assessed in both groups; 60 full term neonates with jaundice (Group I) and 60 full term controls. VitB12 levels were assessed for the mothers of all included neonates. Results: VitB12 in jaundice neonates were significantly lower than that of controls. Maternal vitB12 was positively correlated with neonatal vitB12 and negatively correlated with neonatal total serum bilirubin levels (TSB). Conclusion: Low maternal vitB12 affects both vitB12 and bilirubin levels of their neonates.

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.

Auditory toxicity in late preterm and term neonates with severe jaundice.

Jaundice may cause auditory toxicity (auditory neuropathy and hearing loss). However, total serum bilirubin (TSB) does not discriminate neonates at risk for auditory toxicity. We compared TSB, bilirubin:albumin molar ratio (BAMR), and unbound bilirubin for their association with auditory toxicity in neonates with severe jaundice (TSB ≥342μmol/L, or that met exchange transfusion). Neonates greater or equal to 34 weeks gestational age with severe jaundice during the first 2 postnatal weeks were eligible for prospective cohort study, unless they had craniofacial malformations, chromosomal disorders, toxoplasmosis, other infections, rubella, cytomegalovirus, herpes simplex infections, surgery, or family history of congenital deafness. Twenty-eight out of 100 neonates (mean gestational age 37.4wks; 59 males, 41 females) had auditory toxicity. Peak unbound bilirubin, but not peak TSB and BAMR, was associated with auditory toxicity (p<0.05) in neonates with severe (TSB <427.5μmol/L) and extreme hyperbilirubinemia (TSB ≥427.5μmol/L). Area under the receiver operating characteristic curve for unbound bilirubin (0.78) was significantly greater (p=0.03) than TSB (0.54) among neonates with severe but not extreme hyperbilirubinemia. Unbound bilirubin is more strongly associated with auditory toxicity than TSB and/or BAMR in greater or equal to 34 weeks gestational age neonates with severe jaundice. Unbound bilirubin is a better predictor than TSB in neonates with severe hyperbilirubinemia.

Evaluation of the Effect of Oral Clofibrate Intake on Neonatal Total Serum Bilirubin: a Randomized Clinical Trial

Background: Clofibrate is a pharmacological agent, which affects the lipid metabolism. This compound could be involved in bilirubin accumulation and excretion process. Therefore, this study aimed to evaluate the effect of oral clofibrate intake on total serum bilirubin (TSB) of neonates hospitalized at Khatam Hospital. Methods: This clinical trial was conducted on 73 neonates with hyperbilirubinemia. Samples were divided into clofibrate (n=41) and control (n=32) groups. In the Clofibrate group, samples were given a single oral dose of 100 mg/kg clofibrate, whereas the control group received distilled water in an equal amount and color as placebo. Birth weight, type of delivery, gender, age and primary TSB level were recorded prior to the intervention and TSB was measured 24, 48 and 72 hours after the intervention. Results: In this study,no significant difference was observed between the groups on the first and third day of intervention in terms of mean TSB in neonates. However, a significant reduction was found on the second day in mean TSB of neonates, who received clofibrate (P=0.04). Conclusion: According to the results of this study, application of clofibrate was associated with faster alleviation of mean TSB and shorter duration of hospital stay without major side effects. Therefore, it is recommended that clofibrate be only used for clinical management of neonatal hyperbilirubinemia.

Invited Commentary: Does Neonatal Hyperbilirubinemia Cause Asthma?

In an analysis of data from the US Collaborative Perinatal Project, Huang et al. (Am J Epidemiol. 2013;178(12):1691-1697) report an association between neonatal total serum bilirubin levels and childhood asthma. To consider the implications of this finding, we need to evaluate whether the association is causal. The results do not appear to be due to chance or any obvious biases. It is likely that the observed association is the result of a common cause of both hyperbilirubinemia and asthma (confounding). Polymorphisms in the glutathione S-transferase gene are a potential genetic confounder. The glutathione S-transferase M1-null phenotype has been linked to both neonatal hyperbilirubinemia and asthma in several studies. Before making any changes in practice aimed at lowering peak bilirubin levels to reduce asthma risk, it is vital to determine not only whether the association between higher bilirubin levels and asthma risk is causal, but also whether interventions to reduce peak bilirubin levels (or their duration) are associated with decreased risk of asthma (without evidence of other adverse effects). The study by Huang et al. should encourage further investigation of these questions.

Outcomes among newborns with total serum Bilirubin levels of 25 mg per deciliter or more

. Newman, T.B., Liljestrand, P., Jeremy, R.J., Ferriero, D.M., Wu, Y.W., Hudes, E.S., Escobar, G.J. , ( 2006 ) , 354 , 1889 – 1900 . Background The neurodevelopmental risks associated with high total serum bilirubin levels in newborns are not well defined.Methods We identified 140 infants with neonatal total serum bilirubin levels of at least 25 mg per deciliter (428 µmol per litre) and 419 randomly selected controls from a cohort of 106 627 term and near‐term infants born from 1995 to 1998 in Kaiser Permanente hospitals in northern California. Data on outcomes were obtained from electronic records, interviews, responses to questionnaires and neurodevelopmental evaluations that had been performed in a blinded fashion.Results Peak bilirubin levels were between 25 and 29.9 mg per deciliter (511 µmol per litre) in 130 of the newborns with hyperbilirubinemia and 30 mg per deciliter (513 µmol per litre) or more in 10 newborns; treatment involved phototherapy in 136 cases and exchange transfusion in five. Follow‐up data to the age of at least 2 years were available for 132 of 140 children with a history of hyperbilirubinemia (94%) and 372 of 419 controls (89%) and included formal evaluation at a mean (±SD) age of 5.1 ± 0.12 years for 82 children (59%) and 168 children (40%) respectively. There were no cases of kernicterus. Neither crude nor adjusted scores on cognitive tests differed significantly between the two groups; on most tests, 95% confidence intervals excluded a 3‐point (0.2 SD) decrease in adjusted scores in the hyperbilirubinemia group. There was no significant difference between groups in the proportion of children with abnormal neurologic findings on physical examination or with documented diagnoses of neurologic abnormalities. Fourteen of the children with hyperbilirubinemia (17%) had ‘questionable’ or abnormal findings on neurologic examination, as compared with 48 controls (29%; P = 0.05; adjusted odds ratio, 0.47; 95% confidence interval, 0.23–0.98; P = 0.04). The frequencies of parental concern and reported behavioural problems also were not significantly different between the two groups. Within the hyperbilirubinemia group, those with positive direct antiglobulin tests had lower scores on cognitive testing but not more neurologic or behavioural problems.Conclusions When treated with phototherapy or exchange transfusion, total serum bilirubin levels in the range included in this study were not associated with adverse neurodevelopmental outcomes in infants born at or near term.

Serum Bilirubin Levels and Developmental Outcome

The neurodevlopmental risks associated with neonatal total serum bilirubin levels of 25 mg/dL or higher in 140 affected infants were compared with 419 randomly selected controls from a cohort of term-infants born 1995-1998 in Kaiser Permanente hospitals in northern California.

Neonatal jaundice--a comparison between intravenous oxytocin and oral prostaglandin E2.

The total serum bilirubin levels at two and occasionally five days after birth were studied in 162 infants whose mothers received either intravenous oxytocin or oral Prostaglandin te2 during labour, and the results were compared with those obtained in forty-two control patients. Following labour of spontaneous onset, whether the mother received intravenous oxytocin or oral Prostaglandin E2, neonatal total serum bilirubin levels were not different from those in controls. After induction by amniotomy and an active agent, higher mean total serum bilirubin levels were found in infants whose mothers received intravenous oxytocin than in those given oral prostaglandin E2; a significant rise in the total serum bilirubin level appeared to occur when mothers received a total of more than 12,000 milliunits of oxytocin or more than 4,000 milliunits per kg birthweight of the infant.