scholarly journals Hyperbilirubinemia in Preterm Infants Admitted to Neonatal Intensive Care Units in Ethiopia

2020 ◽  
Vol 7 ◽  
pp. 2333794X2098580
Author(s):  
Sara Aynalem ◽  
Mahlet Abayneh ◽  
Gesit Metaferia ◽  
Abayneh G. Demissie ◽  
Netsanet Workneh Gidi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Preterm Infants ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Total Serum ◽  
P Value ◽  
Abo Incompatibility ◽  
Preterm Babies

Background. Hyperbilirubinemia is prevalent and protracted in preterm infants. This study assessed the pattern of hyperbilirubinemia in preterm infants in Ethiopia. Methods. This study was part of multi-centered prospective, cross-sectional, observational study that determined causes of death among preterm infants. Jaundice was first identified based on clinical visual assessment. Venous blood was then sent for total and direct serum bilirubin level measurements. For this study, a total serum bilirubin level ≥5 mg/dL was taken as the cutoff point to diagnose hyperbilirubinemia. Based on the bilirubin level and clinical findings, the final diagnoses of hyperbilirubinemia and associated complications were made by the physician. Result. A total of 4919 preterm infants were enrolled into the overall study, and 3852 were admitted to one of the study’s newborn intensive care units. Of these, 1779 (46.2%) infants were diagnosed with hyperbilirubinemia. Ten of these (0.6%) developed acute bilirubin encephalopathy. The prevalence of hyperbilirubinemia was 66.7% among the infants who were less than 28 weeks of gestation who survived. Rh incompatibility ( P = .002), ABO incompatibility ( P = .0001), and sepsis ( P = .0001) were significantly associated with hyperbilirubinemia. Perinatal asphyxia ( P-value = 0.0001) was negatively associated with hyperbilirubinemia. Conclusion. The prevalence of hyperbilirubinemia in preterm babies admitted to neonatal care units in Ethiopia was high. The major risk factors associated with hyperbilirubinemia in preterm babies in this study were found to be ABO incompatibility, sepsis, and Rh isoimmunization.

scholarly journals Cord Serum Bilirubin Level in Predicting the Development of Significant Hyperbilirubinemia in Newborns with ABO Incompatibility

2016 ◽  
Vol 35 (3) ◽  
pp. 231-236
Author(s):  
Sunita Arora ◽  
Shifali
Keyword(s):  
Blood Group ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Tertiary Care ◽  
Serum Bilirubin Level ◽  
Total Serum ◽  
Care Hospital ◽  
Hemolytic Disease ◽  
Cord Serum ◽  
Abo Incompatibility

Introduction: Neonatal hyperbilirubinaemia is common problem which is benign in majority of neonates. Rh iso immune hemolytic disease as a cause of hyperbilirubinemia is becoming nearly nonexistent due to the use of prophylactic anti D. Hence Isoimmune hemolytic disease due to ABO incompatibility assumes significance as a cause of significant hyperbilirubinaemia. This study was conducted to determine the incidence of ABO incompatibility, ABO iso immune disease in new born, to determine critical cord serum bilirubin level to predict subsequent significant hyperbilirubinemia.Material and Methods: The study was done in neonatal ICU of a tertiary care hospital where 100 full term healthy newborns with B.W≥2500gm and gestational age ≥37 wk with blood group A, B, AB, born to mothers with O blood group without simultaneous Rh incompatibility at SGRDIMSR were included. Serum bilirubin was measured approximately at 12-24hrs, 36-48hrs, 60-72hrs. Results: Out 100 ABO incompatible newborns 33(33%) developed ABO isoimmune disease manifesting as significant hyperbilirubinaemia with any of the four total serum bilirubin levels exceeding threshold levels defined for phototherapy. TSB of ≥ 2.16mg/d1 from cord blood has a sensitivity of 100% specificity of 89.55%, NPV 100% and PPV of 82.50% to predict significant hyperbilirubinaemia. Conclusion: A critical cord S.bilirubin between 2.16 mg/d1 and 4.09mg/d1 will predict all newborns who will have significant hyperbilirubinaemia and can be used as a safe demarcator to decide time of discharge. Any therapeutic intervention if necessary can be started as early as possible.J Nepal Paediatr Soc 2015; 35(3): 231-236 

scholarly journals Glucose-6-Phosphate Dehydrogenase (G6PD) Status in Neonatal Jaundice and its Relationship with Severity of Hyperbilirubinemia

1970 ◽  
Vol 4 (2) ◽  
pp. 71-76
Author(s):  
Nilufa Akhter ◽  
Noorzahan Begum ◽  
Waqar Ahmed Khan
Keyword(s):  
Bilirubin Level ◽  
G6pd Deficiency ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Total Serum ◽  
Control Group ◽  
Term Neonates ◽  
Group A ◽  
The Difference ◽  
Enzyme Deficient

Background: G6PD deficiency is one of the common inherited enzymatic disorder associated with high incidence of severe neonatal hyperbilirubinemia. Objectives: To observe G6PD status in male, term neonates with jaundice and its correlation with serum level of bilirubin. Methods: This cross sectional study was conducted on 90 male, term neonates with jaundice, age ranged from 3 to 12 days (Group B) in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU) between July 2007 to June 2008. On the basis of total serum bilirubin (TSB) level, study group was further divided into B1(TSB <15mg/dl), B2(TSB 15-20mg/dl) and B3 (TSB>20mg/dl). For comparison age and sex matched 30 apparently healthy neonates (Group A) were also included in the study. Erythrocyte G6PD level was measured by Spectrophotometric method by using kit of Randox. Serum bilirubin level was measured by standard laboratory technique. For statistical analysis ANOVA, independent sample "t" test and Pearson's correlation coefficient test were performed as applicable by using SPSS windows version-12. Results: In this study, erythrocyte G6PD levels were significantly lower in moderate (p<0.01) and severe (p<0.001) hyperbilirubinemic group in comparison to that of control group . However, this enzyme level was lower in mild group compared to that of control but the difference was statistically non significant. Again, this enzyme levels were significantly lower in moderate (p<0.05) and severe (p<0.01) group than that of mild group and also between severe and moderate hyperbilirubinemic group (p<0.05). In this study, G6PD enzyme deficient were found in 1(3.33%) and 6(20%) subjects of group B2 and B3 respectively. Though, percentage of the subjects with enzyme deficiency were higher in severe group ( B3 ) compared to that of moderate group( B2 ) but the difference was statistically not significant. However, no enzyme deficient patient were found in control group (A) and mild hyperbilirubinemic group (B1). Serum bilirubin level showed significant (p<0.05) positive (r=+.429) correlation with erythrocyte G6PD level in control group (A). On the other hand, this level was negatively correlated with G6PD enzyme in groups B1 (r= -.127), B2 (r=-.120) and B3 ( r= -.671) but significant negative correlation in group B3 (p<0.01). Conclusion: The results of the study revealed that severity of hyperbilirubinemia depends on degree of G6PD deficiency. Therefore, early detection of this enzymopathy and close surveillance of the affected neonates may be important in reducing the complications of severe hyperbilirubinemia. Key words: Glucose-6-PD, Hyperbilirubinemia, Neonates DOI: 10.3329/jbsp.v4i2.4176 J Bangladesh Soc Physiol. 2009 Dec;4(2): 71-76  

scholarly journals Effect of Time of Cord Clamping on Serum Bilirubin Level among Full Term Babies Born at Tikur Anbessa Specialized Hospital: A Three Arm Randomized Control Trial.

2021 ◽  
Author(s):  
Biruk Hailu Tesfaye ◽  
Mulugeta Betre Gebremariam ◽  
Abiy Seifu Estifanos ◽  
Asrat D. Gebremedhin
Keyword(s):  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Tertiary Care ◽  
Serum Bilirubin Level ◽  
Full Term ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Care Hospital ◽  
Delayed Cord Clamping ◽  
Cord Clamping

Abstract Background: Delayed cord clamping (DCC) above one minute is associated with nutritional and developmental benefits newborns. DCC could also lead to elevated serum bilirubin, leading to jaundice that require phototherapy at the early ages of life. However, evidence on the relationship between DCC and outcomes is limited in resource-limited settings.Objective: To evaluate the effect of the time of cord clamping on serum bilirubin level at 24 hours post-birth in an Ethiopian Tertiary Care hospital.Methods: A three-arm, single-blind, randomized controlled trial was conducted between October 2019-January 2020 targeting healthy, full-term neonates. Study participants were randomly assigned into one of the following interventions depending on the timing of cord clamping: immediate cord clamping (<30 seconds), intermediate cord clamping (60 sec), and delayed cord clamping (180 seconds). The primary outcome is serum bilirubin level in the newborns, which was assessed at 24-hour after birth and before they were discharged home. Descriptive analysis was applied to assess differences between groups in terms of demographic, obstetric, and social characteristics of participants, while linear regression model was employed to examine the association between cord clamping time and serum bilirubin level. STATA version 14 was used for statistical analyses.Result: A total of 141 term newborns were included and randomized into the three categories. Demographic, social and obstetrics factors of the women were not different across groups except labor duration that had a P-value < 0.05. Time of cord clamping was not a significant predictor of total serum bilirubin levels at 24 hours post-birth, whereas cord blood total serum bilirubin (coef. 0.24; p<0.05) and bilirubin nomogram high-risk zone (Coef. 6.25; p<0.001) were significant predictors.Conclusion: Time of umbilical cord clamping has no effect on the total serum bilirubin level of neonates at least within 24 hours of birth.

STUDIES ON ERYTHROBLASTOSIS DUE TO ABO INCOMPATIBILITY

PEDIATRICS ◽  
1954 ◽  
Vol 13 (6) ◽  
pp. 503-510
Author(s):  
DAVID YI-YUNG HSIA ◽  
SYDNEY S. GELLIS
Keyword(s):  
Blood Group ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Laboratory Data ◽  
Serum Bilirubin Level ◽  
Present Knowledge ◽  
Coombs Test ◽  
Abo Incompatibility ◽  
Rh Incompatibility

Detailed clinical and laboratory data have been presented on 21 infants with erythroblastosis due to ABO incompatibility. A careful survey in one newborn service over a six-month period showed that there were 11 cases of erythroblastosis due to ABO incompatibility as compared to 7 cases of erythroblastosis due to Rh incompatibility, suggesting that the disease occurs with greater frequency than has been hitherto reported. No one test is available which can in every case be absolutely diagnostic of the disease. The criteria useful in suggesting the diagnosis are listed. Practically, the presence of a major blood group incompatibility between infant and mother with a negative Coombs' test, clinical jaundice in the first 24 hours, and a serum bilirubin level of more than 10 mg./100 cc. at 24 hours or less is sufficient to make the diagnosis in the absence of manifest infection. The same criteria for treatment as applied to Rh erythroblastosis should be applied to erythroblastosis due to ABO incompatibility in the light of our present knowledge.

Double Versus Single Phototherapy in Low Birth Weight Newborns

PEDIATRICS ◽  
1992 ◽  
Vol 90 (5) ◽  
pp. 674-677
Author(s):  
Paul C. Holtrop ◽  
Kathleen Ruedisueli ◽  
M. Jeffrey Maisels
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Elevated Serum ◽  
Threshold Level ◽  
Serum Bilirubin Level ◽  
Total Serum ◽  
The Difference ◽  
To Receive

Conventional phototherapy systems that simultaneously irradiate the front and the back of the baby lower the serum bilirubin level more rapidly than one-sided systems, but they are impractical. Fiberoptic phototherapy makes it easy to administer conventional phototherapy from above while the infant lies on a fiberoptic phototherapy blanket. Newborns with birth weights less than 2500 g were randomly assigned to receive either single (n = 37) or double (n = 33) phototherapy. The groups were similar in clinical and laboratory characteristics. After 18 hours of therapy the serum bilirubin concentration declined by 31 ± 11% in the double and 16 ± 15% in the single phototherapy group (2.9 ± 1.1 vs 1.6 ± 1.4 mg/dL), and the difference in the total serum bilirubin levels after 18 hours of therapy was significant (double phototherapy group 7.1 ± 2.7 mg/dL vs single phototherapy group 8.2 ± 2.6 mg/dL). After 18 hours of treatment the serum bilirubin level was less than the phototherapy threshold level in 26 of 37 single phototherapy patients vs 32 of 33 double phototherapy patients. Double phototherapy was well tolerated. It is concluded that this type of double phototherapy is more effective than single phototherapy in low birth weight newborns. Double phototherapy may be useful when it is necessary to reduce an elevated serum bilirubin level as rapidly as possible or when the bilirubin level is rising with single phototherapy.

scholarly journals Efficacy of prophylactic phototherapy for prevention of hyperbilirubinemia in very low birth weight newborns

2016 ◽  
Vol 6 (2) ◽  
pp. 151
Author(s):  
M. A. Mannan ◽  
Ismat Jahan ◽  
Sadeka Choudhury Moni ◽  
Zahidul Hasan ◽  
Arjun Chandra Dey ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Birth Weight ◽  
Exchange Transfusion ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Control Group ◽  
P Value ◽  
Unconjugated Hyperbilirubinemia

<p><strong>Background:</strong> Jaundice is a common clinical condition in newborn occurring in approximately 60% of term and 80% of preterm infants. Unconjugated hyperbilirubinemia is universally common in all preterm infants especially in newborns with very low biLth weight. Low birth weight and premature infants are at major risk for exaggerated hyperbilirubinemia that can lead to bilirubin encephalopathy. Significant heterogeneity in the approach to the treatment of jaundiced neonates exists throughout the world. Phototherapy is the most common treatment for neonatal hyperbilirubinemia and could be most effective in preventing the sequelae of hyperbilirubinemia if initiated prophylactically. This randomized clinical trial has been proposed with the objective of assessing the efficacy of prophylactic photo therapy in preventing significant rise of unconjugated hyperbilirubinemia in premature neonates weighing less than 1500 gram and therefore to decrease the need for exchange transfusion and finally to reduce hospital stay due to hyperbilirubinemia. <strong></strong></p><p><strong>Methods:</strong> This randomized controlled clinical trial enrolled sixty newborns with birth weight less than 1500 gram. They were divided into two groups: 1) Prophylactic group, in whom phototherapy was started within 24 hours of birth and continued for 7 days and 2) Control group in whom therapeutic phototherapy was started considering serum bilirubin level and other clinical condi­tions as per institutional guidelines. Mean value of total serum bilirubin (TSB), duration of phototherapy, the need for exchange transfusion and duration of hospital stay in both groups were analyzed.</p><p><strong>Results:</strong> The maximum mean TSB level in prophylactic group was observed on 7th day and in control group it was observed on 3rd day of life. The total serum bilirubin levels were significantly lower in the 3rd and 5th days of life in the prophylactic group in comparison to control group (P value 0.001). Total serum bilirubin level exceeded therapeutic range in 6 (21 %) and 14 (50 %) newborns of the prophylactic group and control groups respectively (P value 0.026). No documented side effects of prophylactic photo­therapy was observed.<strong> </strong></p><p><strong>Conclusion:</strong> The use of prophylactic photo therapy for infants weighing less than 1500 grn is effec­tive and sate when compared to the control group, considering satisfactory maintenance of low total serum bilimbin levels during first 7 days of life.</p>

scholarly journals Risk of neonatal hyperbilirubinemia in babies born to ‘O’ positive mothers: A prospective cohort study

1970 ◽  
Vol 7 (1) ◽  
pp. 11-15 ◽  
Author(s):  
BK Kalakheti ◽  
R Singh ◽  
NK Bhatta ◽  
A Karki ◽  
N Baral
Keyword(s):  
Cohort Study ◽  
Blood Group ◽  
Prospective Cohort Study ◽  
Bilirubin Level ◽  
Prospective Cohort ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Health Science ◽  
Abo Incompatibility ◽  
Laboratory Services

Introduction: Hyperbilirubinemia in a neonate is one of the most common problems that may occur in 60-70 % of term and 80% of preterm babies. It is known to be associated with significant morbidity like neonatal bilirubin encephalopathy and even death. Clinically, and almost exclusively ABO incompatibility occur in ‘A' and ‘B' blood group babies of O ‘+ve' mothers. These babies are reported to be at high risk of severe hyperbilirubinemia (serum bilirubin level more than 16 mg/dl). Objectives: To find out the incidence of hyperbilirubinemia in babies born to ‘O' positive mothers. To estimate the risk of ABO incompatibility in babies born to ‘O' positive mothers. Materials and methods: A prospective cohort study conducted in B. P. Koirala institute of Health Science (Department of Pediatrics and Dept. of Gynae and Obstetric) from July 2002 to June 2003. A total of 199 women having ‘O' positive blood group admitted to the Department of Gynae and Obstetric were included in the study. A piloted proforma was used to collect information. The blood group of neonates was tested by tile and slide method and serum bilirubin was estimated by diazo method in the Central Laboratory Services and Emergency laboratory of BPKIHS. The data was observed and analysis was carried out using statistical software SPSS-10. Results: Total 37 (18.5%) babies had developed hyperbilirubinemia and among them 14 (38%) were from group of babies having ‘O' Positive blood group and 23 (62%) were from group of babies having other than ‘O' Positive blood group. There was 2.6 times higher chance of having hyperbilirubinemia in the babies with ABO incompatibility than ‘O' Positive babies after adjusting other significant variables. Conclusion: Among different significantly associated variables, ABO incompatibility was found to be a major risk factor for neonatal hyperbilirubinemia.It was seen that neonate with ABO incompatibility had two times higher chances of having hyperbilirubinemia than those babies with O ‘+ve' blood group. This finding in BPKIHS suggests that there is a need of screening cord blood bilirubin and continuous monitoring of bilirubin level in the hospital especially among ABO incompatible neonates. Key words: Hyperbilirubinemia, Neonatal Jaundice, ABO-incompatibility doi: 10.3126/kumj.v7i1.1758       Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 11-15  

scholarly journals Learning from claims: hyperbilirubinaemia and kernicterus

2018 ◽  
Vol 104 (2) ◽  
pp. F202-F204 ◽  
Author(s):  
Janet M Rennie ◽  
Jeanette Beer ◽  
Michele Upton
Keyword(s):  
Cerebral Palsy ◽  
Bilirubin Level ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Sufficient Information ◽  
Haemolytic Disease ◽  
Total Cost ◽  
Abo Incompatibility ◽  
Extremely Preterm

We examined claims made against the National Health Service (NHS) involving neonatal jaundice in order to determine whether there were lessons that could be learnt from common themes.This was a retrospective anonymised study using information from the NHS Resolution database for 2001–2011.Twenty cases (16 males) had sufficient information for analysis. Fifteen had confirmed cerebral palsy and two young children had damage to the globus pallidus without confirmed CP. In three cases, the outcome was uncertain. Two were extremely preterm, five were born at 34–36 weeks’ gestation. Jaundice was typically present very early in life; in four cases, it was noted at less than 24hours of age, and in 14 cases, it was first noted on the second to third day. There was a lag between recognition and readmission, with a range of 26–102 hours. The peak serum bilirubin level was over 600 µmol/L in all the babies born at term. An underlying diagnosis was found in all but two; six had glucose-6-phosphatase deficiency (one also had Gilbert’s syndrome); five were diagnosed with ABO incompatibility; three with Rh haemolytic disease; one with spherocytosis and three preterm. The total cost of these claims by August 2017 was almost £150.5 million. This figure is likely to rise.These data show that, in the group who litigate, babies who develop kernicterus generally have an underlying diagnosis. We recommend adherence to theNational Institute for Health and Care Excellence guideline that recommends measuring the bilirubin level within 6 hours in all babies who are visibly jaundiced.

scholarly journals Effect of intravenous fluid supplementation on drop in serum bilirubin levels in term babies with severe hyperbilirubinemia

2017 ◽  
Vol 5 (1) ◽  
pp. 106
Author(s):  
Priyanka Tank ◽  
Rakesh Tank ◽  
Abhishek Singh
Keyword(s):  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Intravenous Fluid ◽  
Total Serum ◽  
Control Group ◽  
Study Group ◽  
Breast Feed ◽  
Fluid Supplementation ◽  
Severe Hyperbilirubinemia

Background: Varied results emerging out of various studies have created a controversy about effect of intravenous fluid supplementation on drop in Serum Bilirubin levels in term babies with severe hyperbilirubinemia. Paucity of literature also warrants this study. The objective of this study is to evaluate the probable effect, if any, of intravenous fluid supplementation in decreasing the serum bilirubin level in healthy term babies with hyperbilirubinemia from Northern India.Methods: In this prospective study healthy term neonates (37-41 weeks gestation) with serum bilirubin (>18 mg/dl and <25 mg/dl) for treatment with phototherapy were randomly allocated to two groups, study group received intravenous fluid for total 16 hours along with breast feed and control group given only breast feeds. Results: Baseline variables like sex distribution, age at admission, gestation, birth weight, admission weight, number of babies, appropriate for gestational age, mode of delivery, oxytocin use, incidence of breast feeding and serum bilirubin level at the time of inclusion in study, were comparable in both control and study group. Drop of total serum Bilirubin (TSB) at 4 hours, 8 hours, 24 hours, 36 hours and 48 hours of study were also significantly higher in study group as compared to control group. Although the drop in TSB level at 60 hours between two groups was not significantly different. Conclusions: Based on our findings it can be concluded that additional intravenous fluid supplementation significantly reduced the serum bilirubin in study group as compared to control group.

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