The predictive value of first day bilirubin levels for early discharged newborns.

Document Type : Original Article

Authors

1 KAYSERÄ° ASKER HASTANESÄ°

2 ERCÄ°YES UNIVERSITY

3 Ä°STANBUL BÄ°LÄ°M UNIVERSITY

4 Ä°STANBUL MEDÄ°POL UNIVERSITY

5 Zeynep Kamil Maternity and Childrens Disease Education and Research Hospital

Abstract

Objective: Early discharge of newborns is essential because of social, economic an medical reasons in our area, but it increases readmission rates especially for hyperbilirubinemia. Hence, predicting the high risk neonates for subsequent hyperbilirubinemia is required. This study was designed to investigate which level of total serum bilirubin (TSB) at the first day could be used to predict hyperbilirubinemia .
Methods: The venous blood samples obtained from 300 newborns at post-partum 24±6 hours for blood group, direct coomb’s, TSB and direct bilirubin level (DBL). These newborns were followed up during 5- day and TSB and DBLwere detected in 90 newborns with jaundice again according to Kramer dermal zones at 120±6 hours of age.
Results: In 23.3% of 90 newborns phototherapy was needed. The cut off value of TSB at the first day to define newborns at high risk for subsequent hyperbilirubinemia was 6.50 mg/dl with positive predictive value 19.75%, negative predictive value 97.72%. At that point sensitivity was 76.19%, specificity was 76.70%.
Conclusion: The cut-off point of 6.5 mg/dl of TSB at the first day might be used to predict subsequent hyperbilirubinemia risk at healthy, full-term early discharged newborns as the test is economic and available in all healthcare units.

Keywords

References

  1. Bhutani VK, Stark AR, Lazzeroni C, Poland R, Gourley GR, Kazmierczak S, et al. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr. 2013; 162(3):477-82.
  2. Alpay F, Sarıcı U, Tosuncuk D, Serdar MA, Inanç N, Gökçay E. The value of first-day bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy term newborns. Pediatrics. 2000; 106(2):1-6.
  3. Romagnoli C, Tiberi E, Barone G, Curtis MD, Regoli D, Paolillo P, et al. Development and validation of serum bilirubin nomogram to predict the absence of risk for severe hyperbilirubinaemia before discharge: a prospective, multicenter study. Ital J Pediatr. 2012; 38:6.
  4. Ipek IO, Bozaykut A, ÇaÄŸrıl SC, Sezar RG. Does cord blood bilirubin level help the physician in the decision of early postnatal discharge? J Matern Fetal Neonatal Med. 2012; 25(8):1375-8.
  5. Bulbul A, Okan F, Uslu S, Isci E, Nuhoglu A. Clinical characteristics of term newborns with hiperbilirubinemia and identification of the risk factors for hiperbilirubinemia. Turk Arch Ped. 2005; 40:204-10.
  6. Kramer LI. Advancement of dermal icterus in the jaundiced newborn. Am J Dis Child. 1969; 118(3):454-8.
  7. American Academy of Pediatrics. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004; 114(1):297-316.
  8.  Maisels MJ. Screening and early postnatal management strategies to prevent hazardous hyperbilirubinemia in newborns of 35 or more weeks of gestation. Seminars in Fetal & Neonatal Medicine. 2010; 15(3):129-35.
  9. Johnson L, Bhutani VK, Karp K, Sivieri EM, Shapiro SM. Clinical report from the pilot USA Kernicterus Registry (1992 to 2004). J Perinatol. 2009; 29(Suppl 1):S25-45.

10. Sgro M, Campbell DM, Fallah S, Shah V. Kernicterus-January 2007 to December 2009. Canadian Paediatric Surveillance Program 2009.

11. Manning D, Todd P, Maxwell M, Platt MJ. Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland. Arch Dis Child Fetal Neonatol Ed. 2007; 92(5):F342-6.

12. McGillivray A, Evans N.Severe neonatal jaundice: is it a rare event in Australia? J Paediatr Child Health. 2012; 48(9):801-7.

13. Randev S, Grover N. Predicting neonatal hyperbilirubinemia using first day serum bilirubin levels. Indian J Pediatr. 2010; 77(2):147-50.

14. Pratesi S, Dani C. [The jaundiced newborn: which early monitoring for a safe discharge?]. Pediatr Med Chir. 2013; 35(4):161-5.

15. Ip S, Chung M, Kulig J, O'Brien R, Sege R, Glicken S, et al. An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics. 2004; 114(1):e130-53.

16. Stevenson DK, Fanaroff AA, Maisels MJ, Young BW, Wong RJ, Vreman HJ, et al. Prediction of hyperbilirubinemia in near-term and term infants. Pediatrics. 2001; 108(1):31-9.

17. Knudsen A. Prediction and non-invasive assessment of neonatal jaundice in the term healthy newborn infant. Acta Paediatr. 1996; 85(4):393-7.

18. Carbonell X, Botet F, Figueras J, Riu-Godo A. Prediction of hyperbilirubinaemia in the healthy term newborn. Acta Paediatr. 2001; 90(2):166-70.

19. Knüpfer M, Pulzer F, Gebauer C, Robel-Tillig E, Vogtmann C. Predictive value of umbilical cord blood bilirubin for postnatal hyperbilirubinaemia. Acta Paediatr. 2005; 94(5):581-7.

20. Knudsen A. Prediction of the development of neonatal jaundice by increased umbilical cord blood bilirubin. Acta Paediatr Scand. 1989; 78(2):217–

21.Sarıcı SU, Yurdakok M, Serdar AM. : An Early (Sixth-Hour) Serum Bilirubin Measurement Is Useful in Predicting the Disease in a Selective High-Risk Population of Newborns With ABO Development of Significant Hyperbilirubinemia and Severe ABO Hemolytic Incompatibility: Pediatrics 2002;109.

22. Smith DW, Inguillo D, Martin D, Vreman HJ, Cohen RS, Stevenson DK. Use of noninvasive tests to predict significant jaundice in full-term infants: preliminary studies. Pediatrics. 1985; 75(2):278 - 80.

23. Onks D, Silverman L, Robertson A. Effect of melanin, oxyhemoglobin and bilirubin on transcutaneous bilirubinometry. Acta Paediatr. 1993; 82(1):19-21.

24. Rodríguez-Capote K, Kim K, Paes B, Turner D, Grey V. Clinical implication of the difference between transcutaneous bilirubinometry and total serum bilirubin for the classification of newborns at risk of hyperbilirubinemia. Clin Biochem. 2009; 42(3):176-9.

25. Keren R, Luan X, Friedman S, Saddlemire S, Cnaan A., Bhutani V. A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics. 2008; 121(1):e170-9.

26. Newman TB, Liljestrand P, Escobar GJ. Combining clinical risk factors with bilirubin levels to predict hyperbilirubinemia in newborns. Arch Pediatr Adolesc Med. 2005; 159(2):113-9

27. Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999; 103(1):6-14.

28. Agarwal R, Kaushal M, Aggarwal R, Paul VK, Deorari AK. Early neonatal hyperbilirubinemia using first day serum bilirubin level. Indian Pediatr. 2002; 39(8):724-30.

29. Farhat R, Rajab M. Length of postnatal hospital stay in healthy newborns and re-hospitalization following early discharge. N Am J Med Sci. 2011; 3(3):146

Iranian Journal of Neonatology
Volume 6, Issue 3 - Serial Number 3
September 2015
Pages 1-5

Files

Share

How to cite

Statistics