Outcome of Neonatal Hyperbilirubinemia from a Tertiary Care Hospital in Eastern Nepal: A Cross-sectional Study

Background: Timely detection and treatment of pathological hyperbilirubinemia in newbornscan prevent acute bilirubin encephalopathy and its consequences. We aimed to identifyitsoccurrence, presentationtime, phototherapyduration, need for exchange transfusion,and outcome. Methods: In this cross-sectional study, we enrolled all the babies admitted for pathological neonatal hyperbilirubinemia in the university hospital ofBPKIHSin a one-yearduration. Babies with life-threatening congenital malformations or conjugated bilirubin >20% of total serum bilirubin or >2 mg/dl were excluded. Obstetric profile of mothers, clinical and laboratory parameters of babies, onset time of pathological jaundice, duration of phototherapy, need for exchange transfusion or intravenous immunoglobulin were recorded. Neonatal outcome was classified as good and poor and its association with potential predictors analyzed. Results: One-hundred and fifty babiesdeveloped neonatal jaundice requiring treatment. The most common causes includedABO and Rh setting. No cause was found in 26 (18%) babies. One-hundred and eight babies (72%) were only managed withphototherapy whereas 42 (28%) required both phototherapy and double volume exchange therapy. The majority (84.5%) had good outcome without any residual neurological deficit at discharge.Babies with total serum bilirubin >20 mg/dl at presentation, duration of phototherapy >44.8 h, ABO setting, hemolysis, and out born statussignificantly developed poor outcome (p < 0.05). Conclusion: About 15% of the babies with hyperbilirubinemia had acute bilirubin encephalopathy at discharge suggestive of poor outcome. Babies with high bilirubin at presentation, longer duration of phototherapy, ABO settings, hemolysis, and out born statusdeveloped poor outcome.

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Adverse Events of Exchange Transfusion in Neonatal Hyperbilirubinemia

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v34i1.9030 ◽

2014 ◽

Vol 34 (1) ◽

pp. 7-13 ◽

Cited By ~ 1

Author(s):

M Chitlangia ◽

GS Shah ◽

P Poudel ◽

OP Mishra

Keyword(s):

Adverse Events ◽

Respiratory Distress ◽

Exchange Transfusion ◽

Serum Bilirubin ◽

Tertiary Care ◽

Neonatal Hyperbilirubinemia ◽

Total Serum Bilirubin ◽

Total Serum ◽

Bilirubin Encephalopathy ◽

The Common

Introduction: Jaundice is an important problem during neonatal period. When total serum bilirubin (TSB) level exceeds a critical limit, it crosses the blood brain barrier and results into bilirubin encephalopathy. The main aim of therapy for neonatal hyperbilirubinemia is prevention of bilirubin encephalopathy by phototherapy and/or exchange transfusion. The aims of this study were to evaluate the efficacy of exchange transfusion (ET) and observe the adverse events during and following three days of ET in neonates with hyperbilirubinemia. Materials and Method: Hospital based cross-sectional descriptive study. All neonates admitted to neonatal intensive care unit and /or paediatric wards of a tertiary- care centre between September 2010 to March 2012, requiring ET were enrolled. Results: A total of 139 ETs were performed in 120 neonates. The common causes were ABO incompatibility (30.8%), prematurity (30.8%), idiopathic (27.5%), Rh isoimmunization (6.7%) and cephalhematoma (4.2%). Mean pre- ET total serum bilirubin (TSB) was 24.2 mg% dL. There was 58% reduction in TSB in post ET and 31% net reduction in 6 hr post ET. Term and preterm neonates showed equal percentage of TSB reduction. Respiratory distress (10.8%) and bradycardia (6.7%) were the common adverse events during, and hypocalcemia (98.3%) and thrombocytopenia (34.2%) in 3 days following ET. The sick neonates had significantly higher incidence of thrombocytopenia (p= 0.031), respiratory distress (p=0.009), apnea (p<0.001) and cardiorespiratory arrest (p<0.001). Overall mortality was 4.2%, and non-survivors were mostly low birth weight, born outside the present hospital and had higher incidence of adverse events. Conclusion: Exchange transfusion is an effective intervention in reducing the serum bilirubin level. However, these neonates require monitoring of ionised calcium and thrombocytopenia. Sick neonates had higher incidence of adverse events than healthy and close clinical monitoring is needed to improve the outcome. DOI: http://dx.doi.org/10.3126/jnps.v34i1.9030 J Nepal Paediatr Soc 2014;34(1):7-13

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Frequency of Hypocalcemia with Exchange Transfusion in Neonatal Jaundice

10.53350/pjmhs211581849 ◽

2021 ◽

Vol 15 (8) ◽

pp. 1849-1851

Author(s):

Ambreen Ali ◽

Ashfaq Ahmad Shah Bukhari ◽

Shameela Majeed ◽

Saira Gul ◽

Nomana Khalil ◽

...

Keyword(s):

Serum Level ◽

Study Design ◽

Selection Criteria ◽

Exchange Transfusion ◽

Neonatal Jaundice ◽

Serum Bilirubin ◽

Cross Sectional Study ◽

Total Serum ◽

Sectional Study ◽

Cross Sectional

Aim: To determine the frequency of hypocalcemia with exchange transfusion in neonatal jaundice. Study design: Descriptive cross-sectional study Place and duration of study: Departments of Pediatrics and Pathology, Naseer Teaching Hospital Peshawar from 1stJanuary 2018 to 31st December 2018. Methodology: One hundred and sixty twopatients of jaundiced neonates having total serum bilirubin >20mg/dl, both gender and patients having age up to 14 days were included. Patients fulfilling the selection criteria had undergone exchange transfusion. Hypocalcaemia was evaluated and considered positive if calcium serum level is <8 mg/dl or <2 mmol/L. Results: 50% of neonates were between 1-5 days, 45% of neonates were between 5-10 days, and 3% of neonates were in age 10-14 days. One hundred and ten (68%) of neonates were males and 52 (32%) of neonates were females. 30% neonates had hypocalcemia while 70% were without hypocalcemia. Conclusion: The incidence of hypocalcemia was found to be 30% with exchange transfusion in neonatal jaundice. Keywords: Hypocalcemia, Exchange transfusion, Neonatal jaundice

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Unconjugated Neonatal Hyperbilirubinemia: Evaluation and Treatment

Diyala Journal of Medicine ◽

10.26505/djm.19025330426 ◽

2020 ◽

Vol 19 (2) ◽

pp. 31-40

Author(s):

Zaid T Yaseen ◽

◽

Jalil I Alezzi ◽

Suad M Khaleel

Keyword(s):

Exchange Transfusion ◽

Serum Bilirubin ◽

Daily Practice ◽

Cross Sectional Study ◽

Total Serum Bilirubin ◽

Total Serum ◽

Term Infants ◽

Cross Sectional ◽

Unconjugated Hyperbilirubinemia ◽

Abo Incompatibility

Background: Neonatal jaundice is a common problem with a lot of faults that may happen during its management. Objective:To study the epidemiological features of the unconjugated hyperbilirubinemia(UHB)in Diyala Governorate and discuss the proper lines of therapy, as well as to discuss the daily practice adopted in our hospital, and its complications. Patients and Methods: A cross-sectional study included 100 neonates (term and preterm babies) with unconjugated hyperbilirubinemia aged 0-7 days who were admitted to the Al-Batool Teaching Hospital in Baqubah, Iraq, from 1st February 2018 to the 1st November 2018. Term infants with total serum bilirubin (TSB) ≥ 22mg/dL were treated with exchange transfusion and phototherapy (Group A, 44 neonates). Those with total serum bilirubin levels from 13-<22mg/dL were treated with phototherapy only (Group B, 56 neonates). These decisions were made according to the TSB level and risk factors. Results: Forty-eight percent of neonates had hemolytic causes (Rh-isoimmunization 13%; ABO-incompatibility 10%; G6PD-deficiency 25%). Other include: sepsis 8%; prematurity 33%; congenital CMV infection 1%; and there were 10% had no evidence of hemolysis or other serious problems. The mortality rate was 3.8% of those who had an exchange transfusion. Conclusion: The decision of kind of treatment is dependent on the underlying etiology of unconjugated hyperbilirubinemia. Keywords: Unconjugated hyperbilirubinemia, Neonates, complications

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STUDY OF CLINICAL AND SUBCLINICAL CHARACTERISTICS IN NEONATAL HYPERBILIRUBINEMIA

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.1.13 ◽

2017 ◽

pp. 84-89

Author(s):

Thi Thanh Binh Nguyen ◽

Thi Phuong Thao Tran ◽

Hung Viet Phan

Keyword(s):

Serum Bilirubin ◽

Clinical Problem ◽

The Body ◽

Neonatal Hyperbilirubinemia ◽

Total Serum Bilirubin ◽

High Rate ◽

Total Serum ◽

Term Infants ◽

Cross Sectional ◽

Hands And Feet

Background: Neonatal hyperbilirubinemia is a common clinical problem encountered during the neonatal period, especially in the first week of life. It is a multifactorial disorder with many symptoms. Most of these cases are benign but it is important to identify those babies at risk of acute bilirubin encephalopathy and kernicteurs or chronic encephalopathy. Jaundice may also be a sign of a serious underlying illness. Objectives: Describe and examine the relationship between clinical characteristics with laboratory tests of indirect hyperbilirubinemia in neonatal. Methods: A cross-sectional descriptive. A convenient sample includes 124 patients under 28 days old had jaundice and were treated at Neonatal room, Hospital of Hue University of Medicine and Pharmacy from 05/2015 to 06/2016. Results: The proportion of male/female is 1.3/1. 66.9% is in term infants. 73.4% onset of jaundice in 24 - 72 hours of age. 67.7% had jaundice all the body before were taken to neonatal room. 47.6% cases were caused by neonatal infection. 93.5% cases had total serum bilirubin < 340 µmol/L. It has a weak positive correlation between the degree of clinical jaundice with level of total serum bilirubin. 31/124 cases suspected ABO incompatibility but Coombs test were negative, however they had high rate of anemia than the others is 13.2 times (p<0.01). Conclusions: Indirect hyperbilirubinemia in neonatal is usually detected when the baby had jaundice to hands and feet. Therefore precautionary measure should be adopted by both parents and clinicians to diagnose and treat the disease properly. Key words: jaundice, hyperbilirubinemia, neonatal

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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

Diyala Journal of Medicine ◽

10.26505/djm.20025741020 ◽

2021 ◽

Vol 20 (2) ◽

pp. 1-13

Author(s):

Saleh Awad Bahwal ◽

◽

Mazin Ahmed Jawass ◽

Faiza Salmeen Naji

Keyword(s):

Predictive Value ◽

Serum Bilirubin ◽

Predictive Ability ◽

Cross Sectional Study ◽

Neonatal Hyperbilirubinemia ◽

Total Serum ◽

Serum Total Bilirubin ◽

Subsequent Increase ◽

Cross Sectional ◽

Child Hospital

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 & 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.

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Race specific nomograms: time for change?

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20180528 ◽

2018 ◽

Vol 5 (2) ◽

pp. 420

Author(s):

Pearl Mary Varughese ◽

Nishanth Rajan ◽

Manikandan Mani ◽

Lalitha Krishnan

Keyword(s):

Serum Bilirubin ◽

Geographical Location ◽

Predictive Ability ◽

Cross Sectional Study ◽

Total Serum Bilirubin ◽

Total Serum ◽

Cross Sectional ◽

South Indian ◽

Bilirubin Metabolism ◽

Severe Hyperbilirubinemia

Background: Hyperbilirubinemia is a common problem in neonates. Because of the genetic differences in bilirubin metabolism, an hour specific nomogram is better in each geographical location. No studies in South India for creation and validation of a nomogram for significant hyperbilirubinemia. The aim of this study was to create and validate a bilirubin nomogram in South Indian infants.Methods: A prospective cross-sectional study. The data was collected in 2 parts, over 18 months (264 infants) and 20 months (450 infants) respectively. Babies with established direct hyperbilirubinemia, polycythemia, hypothyroidism, culture proven sepsis, major congenital anomalies and jaundice on day 1 of life were excluded. For all babies, cord bilirubin (for first set of infants), total serum bilirubin values were sent at 24 hours of life and at the time of discharge. An hour specific nomogram was created with 834 bilirubin values (first set of data). The predictive ability of this nomogram and Bhutani nomogram were tested and compared using 972 total serum bilirubin values (second set of data)Results: A nomogram was created with serum bilirubin values from the first set of infants and validated it with the serum bilirubin values from the second set of infants. Bhutani nomogram was also validated. Comparing with Bhutani nomogram, our nomogram was better in predicting significant hyperbilirubinemia in our population.Conclusions: Discharging neonates without risk assessment for severe hyperbilirubinemia may be dangerous. A nomogram generated and validated with our data is an accurate tool for predicting significant hyperbilirubinemia in our population.

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Association of Serum Bilirubin Level with Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study of 1672 Obese Children

Journal of Clinical Medicine ◽

10.3390/jcm10132812 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2812

Author(s):

Cristina Bellarosa ◽

Giorgio Bedogni ◽

Annalisa Bianco ◽

Sabrina Cicolini ◽

Diana Caroli ◽

...

Keyword(s):

Metabolic Syndrome ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Serum Bilirubin ◽

Cross Sectional Study ◽

Sectional Study ◽

Obese Children ◽

Cross Sectional ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

As in adults, obesity also plays a central role in the development of metabolic syndrome (MS) in children. Non-alcoholic fatty liver disease (NAFLD) is considered a manifestation of MS. Not only MS but also NAFLD seem to be inversely associated with serum bilirubin concentrations, an important endogenous tissue protector when only mild elevated. The aim of the study was to evaluate the association between serum bilirubin levels and the prevalence of MS and NAFLD in Italian obese children and adolescents. A retrospective cross-sectional study was performed in 1672 patients aged from 5 to 18 years. Clinical and laboratory parameters were assessed. NAFLD was measured by liver ultrasonography. The study was approved by the Ethical Committee of the Istituto Auxologico Italiano (research project code 1C021_2020, acronym BILOB). MS was present in 24% and fatty liver (FL) in 38% of this population. Bilirubin was not associated with FL and MS as a whole, but it was inversely associated only with selected components of MS, i.e., large WC, high blood pressure and high triglycerides. Our data suggest that bilirubin is not protective against MS and NAFLD in the presence of severe obesity.

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