scholarly journals Hour-Specific Total Serum Bilirubin Percentiles for Infants Born at 29–35 Weeks’ Gestation

Neonatology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Thivia Jegathesan ◽  
Joel G. Ray ◽  
Vinod K. Bhutani ◽  
Charles Donald George Keown-Stoneman ◽  
Douglas M. Campbell ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Retrospective Cohort ◽  
Serum Bilirubin ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Close Monitoring ◽  
Clinical Consideration ◽  
Cut Points ◽  
Pre Treatment ◽  
Preterm Newborns

<b><i>Introduction:</i></b> As preterm infants are susceptible to hyperbilirubinemia, they require frequent close monitoring. Prior to initiation of phototherapy, hour-specific total serum bilirubin (TSB) percentile cut-points are lacking in these infants, which led to the current study. <b><i>Methods:</i></b> A multi-site retrospective cohort study of preterm infants born between January 2013 and June 2017 was completed at 3 NICUs in Ontario, Canada. A total of 2,549 infants born at 29<sup>0/7</sup>–35<sup>6/7</sup> weeks’ gestation contributed 6,143 pre-treatment TSB levels. Hour-specific TSB percentiles were generated using quantile regression, further described by degree of prematurity, and among those who subsequently received phototherapy. <b><i>Results:</i></b> Among all infants, at birth, hour-specific pre-treatment, TSB percentiles were 36.1 µmol/L (95% confidence interval [CI]: 34.3–39.3) at the 40th, 52.3 µmol/L (49.4–55.1) at the 75th, and 79.5 µmol/L (72.1–89.6) at the 95th percentiles. The corresponding percentiles were 39.3 μmol/L (35.9–43.2), 55.4 μmol/L (52.1–60.2), and 87.1 μmol/L (CI 70.5–102.4) prior to initiating phototherapy and 24.4 μmol/L (20.4–28.8), 35.3 μmol/L (31.1–41.5), and 52.0 μmol/L (46.1–62.4) among those who did not receive phototherapy. Among infants born at 29–32 weeks, pre-treatment TSB percentiles were 53.9 µmol/L (49.4–61.0) and 95.5 µmol/L (77.5–105.0) at the 75th and 95th percentiles, with respective values of 48.7 µmol/L (43.0–52.3), and 74.1 µmol/L (64.8–83.2) for those born at 33–35 weeks’ gestation. <b><i>Conclusion:</i></b> Hour-specific TSB percentiles, derived from a novel nomogram, may inform how bilirubin is described in preterm newborns. Further research of pre-treatment TSB levels is required before clinical consideration.

scholarly journals Cognitive Oucome of Preterm Infants is Related to Maximal Total Serum Bilirubin

2011 ◽  
Vol 70 ◽  
pp. 348-348
Author(s):  
A B Schreuder ◽  
D E Van Imhoff ◽  
P H Dijk ◽  
M Schaaf ◽  
A F Bos ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Serum Bilirubin ◽  
Total Serum Bilirubin ◽  
Total Serum

scholarly journals Transcutaneous versus Total Serum Bilirubin Measurements in Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-11
Author(s):  
Thivia Jegathesan ◽  
Douglas M. Campbell ◽  
Joel G. Ray ◽  
Vibhuti Shah ◽  
Howard Berger ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Clinical Decision Making ◽  
Serum Bilirubin ◽  
Clinical Decision ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Transcutaneous Bilirubin ◽  
Treatment Thresholds ◽  
Before And After ◽  
The Mean

<b><i>Introduction:</i></b> Transcutaneous bilirubin (TcB) measurement offers a noninvasive approach for bilirubin screening; however, its accuracy in preterm infants is unclear. This study determined the agreement between TcB and total serum bilirubin (TSB) among preterm infants. <b><i>Methods:</i></b> A multisite prospective cohort study was conducted at 3 NICUs in Ontario, Canada, September 2016 to June 2018. Among 296 preterm infants born at 24<sup>0/7</sup> to 35<sup>6/7</sup> weeks, 856 TcB levels were taken at the forehead, sternum, and before and after the initiation of phototherapy with TSB measurements. Bland-Altman plots and 95% limits of agreement (LOA) expressed agreement between TcB and TSB. <b><i>Results:</i></b> The overall mean TcB-TSB difference was −24.5 μmol/L (95% LOA −103.3 to 54.3), 1.6 μmol/L (95% LOA −73.4 to 76.5) before phototherapy, and −31.1 μmol/L (95% LOA −105.5 to 43.4) after the initiation of phototherapy. The overall mean TcB-TSB difference was −15.2 μmol/L (95% LOA −86.8 to 56.3) at the forehead and −24.4 μmol/L (95% LOA −112.9 to 64.0) at the sternum. The mean TcB-TSB difference was −31.4 μmol/L (95% LOA −95.3 to 32.4) among infants born 24–28 weeks, −25.5 μmol/L (95% LOA −102.7 to 51.8) at 29–32 weeks, and −15.9 μmol/L (95% LOA −107.4 to 75.6) at 33–35 weeks. Measures did not differ by maternal ethnicity. <b><i>Conclusion:</i></b> Among preterm infants, TcB may offer a noninvasive, immediate approach to screening for hyperbilirubinemia with more careful use in preterm infants born at &#x3c;33 weeks’ gestation, as TcB approaches treatment thresholds. Its underestimation of TSB after the initiation of phototherapy warrants the use of TSB for clinical decision-making after the initiation of phototherapy.

scholarly journals Insights Image for “Rate of rise of total serum bilirubin in very low birth weight preterm infants”

2019 ◽  
Vol 87 (6) ◽  
pp. 1135-1135
Author(s):  
Sigrid Hahn ◽  
Christoph Bührer ◽  
Gerd Schmalisch ◽  
Boris Metze ◽  
Monika Berns
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Serum Bilirubin ◽  
Very Low Birth Weight ◽  
Total Serum Bilirubin ◽  
Total Serum

Rate of rise of total serum bilirubin in very low birth weight preterm infants

2019 ◽  
Vol 87 (6) ◽  
pp. 1039-1044 ◽  
Author(s):  
Sigrid Hahn ◽  
Christoph Bührer ◽  
Gerd Schmalisch ◽  
Boris Metze ◽  
Monika Berns
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Serum Bilirubin ◽  
Very Low Birth Weight ◽  
Total Serum Bilirubin ◽  
Total Serum

Two Different UGT1A1 Mutations causing Crigler–Najjar Syndrome types I and II in an Iranian Family

2015 ◽  
Vol 24 (4) ◽  
pp. 523-526 ◽  
Author(s):  
Yoshihiro Maruo ◽  
Mahdiyeh Behnam ◽  
Shinichi Ikushiro ◽  
Sayuri Nakahara ◽  
Narges Nouri ◽  
...  
Keyword(s):  
Serum Bilirubin ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Compound Heterozygous ◽  
Type I ◽  
Syndrome Type ◽  
Type Ii ◽  
Wild Type ◽  
Iranian Family ◽  
Udp Glucuronosyltransferase

Background: Crigler–Najjar syndrome type I (CN-1) and type II (CN-2) are rare hereditary unconjugated hyperbilirubinemia disorders. However, there have been no reports regarding the co-existence of CN-1 and CN-2 in one family. We experienced a case of an Iranian family that included members with either CN-1 or CN-2. Genetic analysis revealed a mutation in the bilirubin UDP-glucuronosyltransferase (UGT1A1) gene that resulted in residual enzymatic activity.Case report: The female proband developed severe hyperbilirubinemia [total serum bilirubin concentration (TB) = 34.8 mg/dL] with bilirubin encephalopathy (kernicterus) and died after liver transplantation. Her family history included a cousin with kernicterus (TB = 30.0 mg/dL) diagnosed as CN-1. Her great grandfather (TB unknown) and uncle (TB = 23.0 mg/dL) developed jaundice, but without any treatment, they remained healthy as CN-2. Results: The affected cousin was homozygous for a novel frameshift mutation (c.381insGG, p.C127WfsX23). The affected uncle was compound heterozygous for p.C127WfsX23 and p.V225G linked with A(TA)7TAA. p.V225G-UGT1A1 reduced glucuronidation activity to 60% of wild-type. Thus, linkage of A(TA)7TAA and p.V225G might reduce UGT1A1 activity to 18%–36 % of the wild-type. Conclusion: Genetic and in vitro expression analyses are useful for accurate genetic counseling for a family with a history of both CN-1 and CN-2. Abbreviations: CN-1: Crigler–Najjar syndrome type I; CN-2: Crigler–Najjar syndrome type II; GS: Gilbert syndrome; UGT1A1: bilirubin UDP-glucuronosyltransferase; WT: Wild type; TB: total serum bilirubin.

scholarly journals Transcutaneous billirubinometry to estimate total serum bilirubin in neonatal jaundice

2017 ◽  
Vol 57 (1) ◽  
pp. 8 ◽  
Author(s):  
Andra Kurnianto ◽  
Herman Bermawi ◽  
Afifa Darmawanti ◽  
Erial Bahar
Keyword(s):  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Subcutaneous Tissue ◽  
Correlation Coefficients ◽  
Total Serum Bilirubin ◽  
Blood Sampling ◽  
Total Serum ◽  
Transcutaneous Bilirubin ◽  
Non Invasive ◽  
Transcutaneous Bilirubinometry

Background The gold standard for diagnosis of neonatal jaundice is total serum bilirubin (TSB) measurement. This method, however, is invasive, painful, and costly in terms of workload, time, and money. Moreover, repeated blood sampling may lead to significant blood loss, which is of particular concern in preterm infants. To overcome these drawbacks, non-invasive methods of bilirubin measurement have been proposed. Transcutaneous bilirubinometry (TcB) determines the yellowness of the subcutaneous tissue of a newborn infant by measuring the difference between optical densities for light in the blue and green wavelength regions.Objective To evaluate the accuracy of transcutaneous bilirubinometry for estimating TSB levels in neonatal jaundice.Methods Subjects were infants aged < 28 days with jaundice who had never been treated with phototherapy or exchange transfusion. The study was done from February to July 2016 in Mohammad Hoesin Hospital. Subjects underwent transcutaneous bilirubin (TcB) and TSB assays, with a maximum interval of 15 minutes between tests.Results One hundred fifty patients were included in this study. The TcB values > 5 mg/dL were correlated to TSB > 5 mg/dL, with 100% sensitivity and 83.3% specificity. This cut-off point was obtained from a receiver-operator characteristic (ROC) curve with AUC 99.3% (95%CI 97.9 to 100%; P< 0.001).The correlation coefficients (r) for TSB and TcB measurements on the forehead were 0.897 (P<0.001).Conclusion Transcutaneous bilirubinometry can be used to accurately estimate TSB levels in neonatal jaundice, and may be useful in clinical practice as a non-invasive method to reduce blood sampling.

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