scholarly journals ROLE OF HYPERBILIRUBINEMIA IN PREDICTON OF GANGRENOUS/PERFORATED APPENDICITIS

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Irfan Hussain Khan ◽  
Arun Bhargava
Keyword(s):  
Acute Appendicitis ◽  
Prospective Study ◽  
Bilirubin Level ◽  
Diagnostic Tool ◽  
Liver Enzymes ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Total Serum Bilirubin ◽  
Total Serum

Introduction: The aim of this study was to determine the role of hyperbilirubinemia as a new diagnostic tool for predictor of gangrenous / perforated appendicitis. Methods: Hospital based prospective study was conducted on 100 patients with perforated/gangrenous appendix Results: In acute appendicitis case out of 84 cases 26 cases bilirubin level was more than 1mg/dl, in gangrenous appendicitis out of 3 cases all cases bilirubin level was more than 1mg/dl and in perforated appendicitis out of 13 cases 12 cases bilirubin level was more than 1mg/dl Conclusion: It is concluded from present study that elevated total serum bilirubin without elevation of liver enzymes is a good indicator of appendicular perforation. Keywords: Perforation, Appendicitis, Bilirubin

scholarly journals Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

2021 ◽  
Author(s):  
Sabyasachi Bakshi ◽  
Nilay Mandal
Keyword(s):  
Acute Appendicitis ◽  
Likelihood Ratio ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Total Bilirubin Level ◽  
Complicated Appendicitis ◽  
Total Serum

Abstract BACKGROUND:In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied.METHODS:After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination.RESULTS:Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was Mixed Type Of Hyperbilirubinemia in gangrenous/perforated appendicitis.The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively.Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of Complicated appendicitis be 31.80%.ROC (Receiver Operating Characteristic) curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence.CONCLUSIONS:This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications.Trial Registration: Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019.This was a prospective trial. Trial URL:http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27

scholarly journals Evaluation of role of hyperbilirubinemia as a new diagnostic marker of complicated appendicitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sabyasachi Bakshi ◽  
Nilay Mandal
Keyword(s):  
Acute Appendicitis ◽  
Likelihood Ratio ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Total Bilirubin Level ◽  
Complicated Appendicitis

Abstract Background In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi. In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied. Methods After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination. Results Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03 (8.58%) had normal levels. Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels. It was Mixed Type of Hyperbilirubinemia in gangrenous/perforated appendicitis. The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively. Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of complicated appendicitis be 31.80%. Receiver Operating Characteristic curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence. Conclusions This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial registration Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. This was a prospective trial. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27.

scholarly journals Role of Hyperbilirubinemia as a Diagnostic Tool to Predict Gangrenous/Perforated Appendicitis: An Observational Study

2020 ◽  
Vol 3 (1) ◽  
pp. 52-55
Author(s):  
Mohak Mankad ◽  
Pranjal Sangole ◽  
Gyaneshwar Rao
Keyword(s):  
Observational Study ◽  
Acute Appendicitis ◽  
Diagnostic Tool ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Medical Science ◽  
Elevated Serum ◽  
Perforated Appendicitis ◽  
Serum Total Bilirubin

Background: Elevation in serum bilirubin was reported recently, but the importance of the raised total bilirubin has not been stressed in acute appendicitis and appendicular perforation. The aim of the study was to establish the role of hyperbilirubinemia as a new diagnostic tool to predict gangrenous/perforated appendicitis. Subjects and Methods: This was a prospective observational study, which was conducted at the Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. A total of 100 patients clinically diagnosed as appendicitis from August 2018 to August 2019 at Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. Patients were clinically evaluated by detailed history, routine examination on initial contact with patients and the routine investigations as per surgery and anesthesia requirements with inclusion of serum total bilirubin. Based on histopathological examination patients will be categorized as positive (acute appendicitis with perforation and/or gangrene) and negative (acute appendicitis without perforation or gangrene). Results: Out of 100 patients, 20 were managed conservatively (mass formation) and was called for interval appendectomy after 6 weeks. In acute catarrhal appendicitis group 47 patients showed normal total bilirubin levels, whereas 8 patients showed increase in levels of total bilirubin.  In gangrenous appendicitis group all 10 patients showed elevated serum total bilirubin levels  In perforated appendicitis group consisted of 15, 11 patients showed elevated serum bilirubin levels and 4 patients showed normal total bilirubin levels. Conclusion: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations.

scholarly journals Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

2020 ◽  
Author(s):  
Sabyasachi Bakshi ◽  
Nilay Mandal
Keyword(s):  
Acute Appendicitis ◽  
Likelihood Ratio ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Total Bilirubin Level ◽  
Complicated Appendicitis ◽  
Total Serum

Abstract BACKGROUND:In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied.METHODS:After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination.RESULTS:Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was Mixed Type Of Hyperbilirubinemia in gangrenous/perforated appendicitis.The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively.Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of Complicated appendicitis be 31.80%.ROC (Receiver Operating Characteristic) curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence.CONCLUSIONS:This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications.Trial Registration: Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27

scholarly journals Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

2020 ◽  
Author(s):  
Sabyasachi Bakshi ◽  
Nilay Mandal
Keyword(s):  
Acute Appendicitis ◽  
Likelihood Ratio ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Total Bilirubin Level ◽  
Complicated Appendicitis

Abstract BACKGROUND: In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied. METHODS: After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination. RESULTS: Out of 110 subjects with acute appendicitis, 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects, diagnosed as complicated appendicitis, 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was MIXED TYPE OF HYPERBILIRUBINEMIA in gangrenous/perforated appendicitis. The SENSITIVITY of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the SPECIFICITY of this test was 88.00% (78.439% to 94.363%). POSITIVE PREDICTIVE VALUE and NEGATIVE PREDICTIVE VALUE were 78.03% and 95.65% respectively. POSITIVE LIKELIHOOD RATIO and NEGATIVE LIKELIHOOD RATIO were found to be 7.619 and 0.097 respectively taking PREVALENCE of Complicated appendicitis be 31.80%. ROC (Receiver Operating Characteristic) curve was obtained which shows OPTIMAL CRITERION at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence. CONCLUSIONS: Serum Bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial Registration:Trial URL: http://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=33113&EncHid=2976.35990&modid=1&compid=19

scholarly journals Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

2020 ◽  
Author(s):  
Sabyasachi Bakshi ◽  
Nilay Mandal
Keyword(s):  
Acute Appendicitis ◽  
Likelihood Ratio ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Total Bilirubin Level ◽  
Complicated Appendicitis ◽  
Total Serum

Abstract BACKGROUND:In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied.METHODS:After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination.RESULTS:Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was Mixed Type Of Hyperbilirubinemia in gangrenous/perforated appendicitis.The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively.Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of Complicated appendicitis be 31.80%.ROC (Receiver Operating Characteristic) curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence.CONCLUSIONS:This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial Registration: Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27

scholarly journals Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

2020 ◽  
Author(s):  
Sabyasachi Bakshi ◽  
Nilay Mandal
Keyword(s):  
Acute Appendicitis ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Total Bilirubin Level ◽  
Complicated Appendicitis ◽  
Direct Invasion

Abstract BACKGROUND: Hyperbilirubinemia has also been found in infective diseases involving organs other than liver. The bacteremia/endotoxemia resulting in impaired hepatocyte function and bile secretion along with increased acute phase reactants contribute to the pathogenesis. In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene/perforation. This is accompanied by bacterial cytotoxin facilitated progressive bacterial invasion. This elevated load of bacteria causes direct invasion or translocation into the portal system. Direct invasion of bacteria into the hepatic parenchyma interferes with the bilirubin excretion into the bile canaliculi biochemically rather than by any obstructive pathway. In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied. METHODS: After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination. RESULTS: Out of 110 patients of acute appendicitis 41 patients (37.27%) had hyperbilirubinemia. Out of 35 patients diagnosed as complicated appendicitis 32 patients (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 patients diagnosed as acute simple appendicitis 09 patients (12%) had raised total bilirubin level, while the remaining 66 patients (88%) had normal levels .It was MIXED TYPE OF HYPERBILIRUBINEMIA in gangrenous/perforated appendicitis. The SENSITIVITY of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the SPECIFICITY of this test was 88.00% (78.439% to 94.363%). POSITIVE PREDICTIVE VALUE and NEGATIVE PREDICTIVE VALUE were 78.03% and 95.65% respectively. POSITIVE LIKELIHOOD RATIO and NEGATIVE LIKELIHOOD RATIO were found to be 7.619 and 0.097 respectively taking PREVALENCE of Complicated appendicitis be 31.80%. ROC (Receiver Operating Characteristic) curve was obtained which shows OPTIMAL CRITERION at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence. CONCLUSIONS: Serum Bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial Registration:Trial URL: http://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=33113&EncHid=2976.35990&modid=1&compid=19

scholarly journals C-reactive protein and total serum bilirubin as a predictor of perforated appendicitis: a cross sectional study

2018 ◽  
Vol 5 (7) ◽  
pp. 2574
Author(s):  
Anil Reddy Pinate ◽  
Shivakumar C. R. ◽  
Mohammad Fazelul Rahman Shoeb ◽  
Sharangouda Patil
Keyword(s):  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Diagnostic Value ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Perforated Appendix

Background: C-reactive protein (CRP) and bilirubin have been used as adjuncts for diagnosis of appendicitis. This study assessed the diagnostic value of these markers in patients with suspected acute appendicitis.Methods: CRP values and total serum bilirubin among the patients who presented with acute appendicitis were compared among patients who had perforated appendix and non- perforated appendix. The diagnostic value of CRP and TSB markers as a predictor for perforation were compared in terms of Sensitivity, specificity, PPVs and NPV and the diagnostic accuracy assessed by AUC using receiver operating characteristic (ROC) curve analysis.Results: This study showed sensitivity is 72.50%, specificity of 92.23%, positive predictive value of 78.38% for a raised CRP. The sensitivity of TSB for predicting perforation is 77.50 and the values of specificity, PPV and NPV of the same are 87.38 %, 70.45% and 90.91% respectively. The area under curve was more for CRP than TSB indicating that CRP is better predictor for perforation in appendicitis as compared to the TSB.Conclusions: Thus, serum CRP and total serum bilirubin (TSB) can be used as useful markers for early diagnosis and prediction of perforation in cases of acute appendicitis.

scholarly journals Hyperbilirubinemia: a new diagnostic marker for perpendicular perforation

2017 ◽  
Vol 4 (9) ◽  
pp. 3024
Author(s):  
Ramaswami Y. B. ◽  
Prakash H. S. ◽  
Raghavendra Prabhu T. C. ◽  
Faiyaz Abdul Jabbar
Keyword(s):  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
Diagnostic Marker ◽  
Clinical Signs ◽  
Perforated Appendicitis ◽  
Signs And Symptoms ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Delay In Diagnosis ◽  
Clinical Signs And Symptoms

Background: Appendicitis is one of the commonest causes of abdominal pain requiring emergency surgery. Diagnosing acute appendicitis clinically still remains a common surgical problem as the clinical signs and symptoms of other abdominal pathologic conditions mimic the diagnosis of acute appendicitis. Delay in diagnosis and surgery for this condition may lead to various complications like perforation, abdominal abscess etc. By knowing perforation prior to the exploration, we can manage the condition very effectively in terms explaining the prognosis of disease, morbidity of surgery, wound infection, and requirement of emergent nature of surgery. Aim of the study is to determine of role of hyperbilirubinemia as a new diagnostic marker to predict gangrenous/perforated appendicitis.Methods: It’s a retrospective study was conducted in the department of surgery, MMCRI, Mysore during the period of January 2015 to December 2015 total of 100 patients with clinical as well as ultrasonographic diagnosis of acute appendicitis or appendiceal perforation were made. The serum bilirubin test was carried out in all the patients pre-operatively.Results: In the study, the total 100 patients enrolled for the study, hyperbilirubinemia (> 1.2 mg/dL) in present study was found in 47 patients with 19 acute and 28 patients perforated appendicitis of all the 100 patients while 53 patients had normal bilirubin levels (≤ 1.2 mg/dL) 51 patients acute and 2 patients perforated appendix.Conclusions: Total serum bilirubin appears to be a new promising laboratory marker for diagnosing appendicular perforation. The patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia without elevation of liver enzymes should be identified as having a higher probability of appendicular perforation, suggesting total serum bilirubin levels have a predictive potential for the diagnosis of appendicular perforation.

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.

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