scholarly journals A STUDY OF UMBILICAL CORD BILIRUBIN AS A PREDICTOR OF SIGNIFICANT NEONATAL JAUNDICE IN A TERTIARY RURAL CARE HOSPITAL

2020 ◽  
pp. 83-86
Author(s):  
Rohan Yadav ◽  
P. Sunil Kumar ◽  
Mahendrappa K.B. ◽  
G.M. Kumar ◽  
Channabasavanna N.
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Predictive Value ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Total Serum ◽  
Care Hospital ◽  
Term Infants ◽  
Increased Risk

Introduction. Around 80 percent of preterm infants and 60 percent of term infants are affected by neonatal jaundice in the first week of life. Early discharge of healthy term infants is a common practice because of economic constraints and social reasons. Which new-borns are at increased risk for developing significant hyperbilirubinemia (Total serum bilirubin ≥ 15mg/dl) is difficult to predict. This study was taken up to evaluate the predictive value of cord blood bilirubin level for identifying term infants for subsequent hyperbilirubinemia. Material and methods. This prospective observational study was conducted in Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka from 1st of April 2020 to 30th September 2020. 100 healthy term babies satisfying the eligibility criteria and born in the study period were included in the study. Umbilical cord blood was collected and was correlated with serum bilirubin levels at 48hours of life. Significant hyperbilirubinemia was taken as ≥ 15mg/dl at 48 hrs of life. Results. The incidence of neonatal hyperbilirubinemia was 14%. By using umbilical cord blood bilirubin ≥ 3mg/dl, significant hyperbilirubinemia can be predicted with Sensitivity of 92.9%, Specificity of 96.5%, Positive Predictive Value of 81.3% and Negative Predictive Value of 98.8%. Conclusion. Umbilical cord blood bilirubin ≥ 3mg/dl in healthy term babies can help in prediction of significant jaundice and thus can help in identifying high risk new-borns so that these neonates can be followed up more closely, it can also help in identifying neonates who are not at increased risk of developing significant jaundice, hence can prevent unnecessary hospital stay.

scholarly journals The Value of Umbilical Cord Blood Bilirubin Measurement in Predicting the Development of Significant Hyperbilirubinemia in Healthy Newborn

1970 ◽  
Vol 33 (2) ◽  
pp. 50-54 ◽  
Author(s):  
Zakia Nahar ◽  
Md Shahidullah ◽  
Abdul Mannan ◽  
Sanjoy Kumar Dey ◽  
Ujjal Mitra ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Predictive Value ◽  
Newborn Infants ◽  
Subsequent Development ◽  
Total Serum ◽  
Characteristic Analysis ◽  
Healthy Newborn ◽  
Group I

The present study was conducted to investigate the predictability of early serumbilirubin levels on the subsequent development of neonatal hyperbilirubinemia. Forthis purpose 84 healthy newborn infants were enrolled and followed up for first 5 daysof life. Study subjects were divided into two groups. Group-I consisted of 71 subjects,who did not develop significant hyperbilirubinemia (bilirubin <17mg/dl); Group-IIconsisted of 13 newborns, who developed significant hyperbilirubinemia (bilirubin >17mg/dl) during the follow up. Of the enrolled subjects, 46 (55%) were male and rest 38(45%) were female; 64 (76%) were term babies and 20 (24%) were pre-term babies.Significantly higher percentage of pre-term babies developed hyperbilirubinemia. ROC(receiver operating characteristic) analysis demonstrates that the critical value ofcord blood bilirubin >2.5mg/dl had the high sensitivity (77%) and specificity (98.6%)to predict the newborn who would develop significant hyperbilirubinemia. At this levelthe negative predictive value was 96% and positive predictive value 91%. In oursetting infants having umbilical cord blood total serum bilirubin (TSB) >2.5 mg/dlshould be followed up strictly either in hospital or as an outpatient department on day5 if practicable. Infants having TSB <2.5mg/dl in cord blood can be discharged early.Key words: Umbilical cord bilirubin; neonatal jaundice; healthy newborn.DOI: 10.3329/bjch.v33i2.5677Bangladesh Journal of Child Health 2009; Vol.33(2): 50-54

Transcutaneous Bilirubin Measurements in Full-Term Infants

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 464-467 ◽  
Author(s):  
M. Jeffrey Maisels ◽  
Sarah Conrad
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
False Positive ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
False Negative ◽  
Full Term ◽  
Bilirubin Concentration ◽  
Term Infants ◽  
Transcutaneous Bilirubin

A total of 292 transcutaneous bilirubin (TcB) measurements were performed in 157 white full-term infants: 157 were obtained from the forehead and 135 from the midsternum. TcB measurements correlated well with serum bilirubin determinations (r = .93, P &lt; .0001). The sensitivity of the test was 100% and the specificity 97%. It was possible to establish guidelines for the TcB measurement which identified all infants whose serum bilirubin concentrations exceeded 12.9 mg/100 ml (221 µmoles/liter) with no false-negative and only five false-positive determinations (3%). The positive predictive value for the TcB measurements was 58%. This implies that, in our population, an infant with a TcB index ≥24 has a 58% chance of having a serum bilirubin concentration &gt;12.9 mg/100 ml. The negative predictive value was 100%. Thus, a negative test will correctly predict the absence of hyperbilirubinemia in all cases. As these measurements were obtained prospectively in a well-baby population with a prevalence of hyperbilirubinemia (&gt;12.9 mg/100 ml) of 4.5%, the positive predictive value should be applicable to other similar populations and will, in fact, increase in populations with a higher prevalence of hyperbilirubinemia. TcB measurements can be recommended for the identification of significant neonatal jaundice in full-term infants. It is important to recognize, however, that because of potential variations in TcB meters as well as serum bilirubin measurements in different laboratories, each institution should establish its own criteria for the use of this instrument.

scholarly journals FREE RADICAL-RELATED DISEASES: THE PREDICTIVE VALUE OF BIOMARKERS IN THE UMBILICAL CORD BLOOD

2013 ◽  
Vol 5 (1) ◽  
pp. 49
Author(s):  
S. Perrone ◽  
M.G. Alagna ◽  
M.S. Cori ◽  
A. Santacroce ◽  
S. Negro ◽  
...  
Keyword(s):  
Free Radical ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Predictive Value

scholarly journals The Effect of Platelets on Thrombin Generation in Cord Blood and Peripheral Neonatal Blood in the Premature Infant; The Event Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3188-3188
Author(s):  
Claire Anne Murphy ◽  
Elaine Neary ◽  
Barry Kevane ◽  
Daniel O'Reilly ◽  
John O'Loughlin ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Extracellular Vesicles ◽  
Umbilical Cord Blood ◽  
Research Funding ◽  
Thrombin Generation ◽  
Phospholipid Content ◽  
Term Infants ◽  
Time To Peak ◽  
Neonatal Blood

Abstract Introduction Infants born very preterm (&lt;32 weeks) are at increased risk of haemorrhage, particularly intraventricular haemorrhage which can result in short and long term morbidity. Routine clinical laboratory tests such as the prothrombin time and activated partial thromboplastin time are frequently abnormal in this patient group but do not appear to correlate with clinical outcomes. Moreover, while reduced levels of circulating coagulation factors and platelet hypo-reactivity have been reported, plasma thrombin generation (TG), has been reported to be similar or even enhanced in very preterm infants when compared to term infants. Extracellular vesicles, comprising of lipid-bound nanoparticles released from cells (including platelets), may potentially play a role in modulating neonatal haemostasis. We aimed to characterize phospholipid (PL)-dependent plasma thrombin generation in platelet-rich (PRP) and platelet-poor plasma (PPP) in premature infants in both umbilical cord blood & peripheral neonatal blood using calibrated automated thrombography (CAT). Methods In this prospective observational study, PRP and PPP was prepared by centrifugation from citrated umbilical cord blood and peripheral neonatal blood collected from premature infants (24 - 31 weeks) and healthy term controls (&gt;37 weeks). No samples were collected from heparinised lines. Parameters of plasma thrombin generation in PRP were assessed using CAT, with thrombin generation stimulated by tissue factor only (TF; final concentration 1pM). CAT was also repeated in PPP using only TF and no exogenous PL (rendering the assay dependent upon the endogenous PL content of plasma). Results In the analysis of umbilical cord blood PRP, plasma thrombin generation was accelerated in the preterm infant group with a significantly shorter time to peak TG observed. The other parameters of TG were similar in both groups (Table 1). In the subset of infants from whom peripheral blood samples were available, there was further evidence of enhanced plasma TG in preterm PRP relative to term infants (Table 2). In this subgroup, the lag time and time to peak thrombin were significantly shorter in the preterm group and peak thrombin was significantly higher. TG was also assessed in both PPP and PRP prepared from umbilical cord blood samples in a subgroup of infants (n=10 term, n=6 preterm) using 1pM TF only, rendering the assay dependent on the phospholipid content of plasma. No difference was observed in any CAT parameters, suggesting that neonatal PPP phospholipid content (potentially from circulating extracellular vesicles) is sufficient to support thrombin generation in the absence of exogenous phospholipid. Conclusion These preliminary data suggest that neonatal PRP, measured in both umbilical cord blood and peripheral neonatal blood, has similar thrombin generation or may even be hypercoagulable, compared with healthy term controls. Moreover, neonatal plasma phospholipid appears to support thrombin generation in the absence of exogenous phospholipid. This ongoing prospective study aims to further characterize the platelet-dependency of neonatal thrombin generation and evaluate the potential role of extracellular vesicles in neonatal haemostasis. Figure 1 Figure 1. Disclosures Maguire: Actelion: Research Funding; Bayer Pharma: Research Funding. Ni Ainle: Leo Pharma: Research Funding; Actelion: Research Funding; Daiichi-Sankyo: Research Funding; Bayer Pharma: Research Funding.

scholarly journals Infectious Complications After Umbilical Cord Blood Transplantation for Hematological Malignancy

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Kathleen A Linder ◽  
Philip J McDonald ◽  
Carol A Kauffman ◽  
Sanjay G Revankar ◽  
Pranatharthi H Chandrasekar ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Viral Infections ◽  
Fungal Infections ◽  
Cord Blood Transplantation ◽  
Human Herpesvirus ◽  
Infectious Complications ◽  
Blood Transplantation ◽  
Increased Risk

Abstract Background Umbilical cord blood transplant (UCBT) is used for patients who do not have a matched donor, but engraftment often takes longer than with a standard allogeneic transplant, likely increasing the risk for infection. We characterized specific infections and outcomes in adults undergoing UCBT at our 2 centers. Methods All adults who underwent UCBT between January 1, 2006 and December 31, 2015 were included. Infectious episodes from 6 months before to 2 years after UCBT were reviewed. Results Fifty-seven patients underwent UCBT; 47 had neutrophil engraftment. A total of 179 infectious episodes occurred in 55 patients, 73 (41%) within 30 days post-UCBT. Viruses caused 85 (47%) infections. Cytomegalovirus caused 32 infectious episodes and was most common from day 30 to 100. Human herpesvirus 6 occurred in 28 episodes, was most common within 30 days, and caused 1 death. Bacteria were responsible for 82 (46%) infections, most commonly bacteremias due to Staphylococcus spp, Enterococcus spp, and Enterobacteriaceae. Of 11 invasive fungal infections, 9 were aspergillosis, 4 of which were fatal. Overall mortality was 56% in the first year. Thirteen deaths were from infection; 11 occurred in the first 100 days and 7 in the first 30 days post-UCBT. Of 10 patients who never engrafted, 9 died, 6 from infection, within 100 days post-UCBT. Conclusions Infectious complications were common after UCBT, especially in the first 30 days. Deaths from viral infections were fewer than expected. Delayed engraftment and nonengraftment continue to convey increased risk for fatal bacterial and fungal infections post-UCBT.

scholarly journals A Comparison of the Percentage of Fetal Hemoglobin in Human Umbilical Cord Blood as Determined by Chromatography and by Alkali Denaturation

Blood ◽  
1963 ◽  
Vol 22 (5) ◽  
pp. 554-565 ◽  
Author(s):  
DAVID H. ARMSTRONG ◽  
W. A. SCHROEDER ◽  
WILLIAM D. FENNINGER
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Fetal Hemoglobin ◽  
Full Term ◽  
Human Umbilical Cord Blood ◽  
Human Umbilical Cord ◽  
Careful Study ◽  
Term Infants ◽  
Accuracy And Precision

Abstract A comparison has been made of the determination of fetal hemoglobin in human umbilical cord blood by column chromatography and alkali denaturation. A careful study has also been made of the variables that control the accuracy and precision of the methods. Minor modification has led to much improved control of the 1-minute alkali denaturation procedure. The percentage of fetal hemoglobin in the umiblical cord blood of full term infants has been found to cover a far narrower range than is commonly reported. By chromatography, the average is 85.5 per cent with a range from 79 to 91 per cent that includes more than 95 per cent of normal full term infants. By alkali denaturation, the average is 74.0 per cent with a range from 63 to 87 per cent. Possible correlations with several clinical parameters have been examined. The highest correlation by both methods of determination occurred in the group of 12 samples from infants with a duration of gestation less than 37 weeks. In this group the linear correlation with weight was greater than 0.6. The precision and accuracy of the chromatographic method recommend it in the study of such subjects as prematurity, twinning, dysmaturity, intrauterine growth retardation, and infants of diabetic mothers.

Negative Effect of KIR Alloreactivity in Recipients of Umbilical Cord Blood Transplantation Depends on Transplantation Conditioning Intensity

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 152-152
Author(s):  
Claudio Brunstein ◽  
John E. Wagner ◽  
Daniel Weisdorf ◽  
Sarah Cooley ◽  
Harriet Noreen ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Acute Gvhd ◽  
Nk Cell ◽  
Cord Blood Transplantation ◽  
Hematopoietic Stem ◽  
Risk Of Death ◽  
Increased Risk ◽  
Reduced Intensity

Abstract Transplant strategies involving natural killer (NK) cell alloreactivity (KIR-ligand mismatch [KIR-L mismatch]) have demonstrated superior outcomes for patients receiving T cell depleted HLA haploidentical hematopoietic stem cell allografts. It is unknown whether KIR-L mismatch has a similar effect in recipients of partially HLA-matched umbilical cord blood (UCB) grafts which contain comparatively few T-cells. We examined the clinical impact of KIR-L mismatch in 257 UCB recipients treated with either a myeloablative (n=155) or reduced intensity (n=102) regimen. After myeloablative conditioning, KIR-L mismatch had no demonstrable effect on grades III–IV acute GVHD (17% [CI, 6–28%] vs. 17% [CI, 10–24], p=.97), transplant-related mortality (TRM) (27% [CI, 14–40%] vs. 18% [CI, 11–25%], p=.19), relapse at 2 yrs (18% [95%CI, 6–30%] vs. 28% [95%CI, 19–27%], p=.37) and survival at 3 yrs (50% [CI, 32–68%] vs. 57% [CI, 47–67%], p=.46). In contrast, following reduced intensity conditioning when the engrafting unit was KIR-L mismatched there was a significantly higher incidence of grades III–IV acute GVHD (42% [CI, 27–59) vs. 13% [CI, 5–21], p &lt; .01). Multivariate analysis confirmed NK cell alloreactivity as the only predictive factor associated with severe acute GVHD was (RR 1.8, CI [1.1–2.9]; p=.02). TRM was higher (27% [CI, 12–42%] vs. 12% [CI, 5–19%], p=.03) and three year survival was poorer (32% [CI, 15–59%] vs. 52% [CI, 47–67%], p=.03) when the engrafting unit was KIR-L mismatched, but relapse was unaffected (39% [95%CI, 21–57%] vs. 47% [95%CI, 34–60%], p=.72). KIR-L mismatch in recipients of a RIC UCB transplant was associated with a significant increased risk of death (RR 1.8, 95%CI, 1.0–3.1, p=.05). This data identify divergent effects of NK cell alloreactivity which are unmasked when comparing myeloablative versus RIC transplant platforms. We conclude that KIR-L mismatch should be avoided in recipients of a reduced intensity UCB transplant.

The Predictive Value of the Hematopoietic Cell Transplantation (HCT)-Specific Comorbidity Index (CI) in Recipients of Umbilical Cord Blood (UCB) Transplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5065-5065
Author(s):  
Claudio G. Brunstein ◽  
Navneet Majhail ◽  
Daniela C. Setubal ◽  
Todd E. DeFor ◽  
Jeffrey S. Miller ◽  
...  
Keyword(s):  
Cord Blood ◽  
Cell Transplantation ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Predictive Value ◽  
Acute Gvhd ◽  
Hematopoietic Cell Transplantation ◽  
Disease Risk ◽  
Conditioning Regimens ◽  
Comorbidity Index

Abstract The hematopoietic cell transplantation (HCT)-specific comorbidity index (CI) has been shown to predict nonrelapse mortality (NRM) and overall survival (OS) after sibling and unrelated adult volunteer donor transplantation (Sorror Blood 2005, 106:2912). We retrospectively studied the predictive value of the HCT-CI in a cohort of 182 patients who underwent an umbilical cord blood (UCB) transplant for advanced or high risk malignancy at the University of Minnesota, between August 2001 and May 2006. Patients receive either a myeloablative (MA, n=54) or nonmyeloablative (NST, n=128) conditioning regimens followed by cyclosporine and mycophenolate mofetil in both groups. Patients received single (n=27) or double (n=155) UCB grafts that were HLA-matched 4–6/6 matched to the recipient, and for double UCB grafts 4–6/6 matched each other as well. All received G-CSF from day 0 to ANC > 2500 for three days. Antibiotic prophylaxis, blood products, and growth factor administration followed the same institutional guidelines. Patients’ median age was 47 (range: 18–69), median weight 78 kg (r: 45–149), and 51% were CMV seropositive. Thirty patients, all in the NST group, had prior autologous transplant. HCT-CI scores were assigned retrospectively; scores were zero (n=18%), 1–2 (n=33%), or >2 (n=49%) and were comparable between the MA and NST groups. The median nucleated cell dose (NCD) was 3.5 X 107/kg (range: 1.1–6.8) and CD34+ cell dose was 4.7 X 105/kg (range: 0.7–18.8) with no difference in recipients of singles and double UCB grafts or MA and NST conditioning regimens. The NRM at 1-year was 13% (95%CI, 2–24) for patients with HCT-CI score of zero, 20% (95%CI, 10–30) for scores 1–2, and 22% (95%CI, 14–30) for score > 2 (p=.46). In multivariate regression model, HCT-CI score was not an independent predictor of NRM [HCT-CI score Zero RR 1(ref), 1–2 RR 1.5 (95%CI, 0.5–4.5, p=.5; >2 RR 1.8 (95%CI, 0.6–5.3), p=.27], whereas patients who received a NST conditioning had significantly lower relative risk (RR) of NRM (RR 0.5, 95%CI, 0.2–1.0, p=.05). The 1-yr OS was 72% (95%CI, 53–84) for patients with score zero, 65% (95%CI, 52–76) for scores 1–2, and 56% (95%CI, 29–65) for scores >2. In Cox regression analysis the HCT-CI was not associated with the risk of death, in contrast to disease risk group, development of grades II–IV acute GVHD, and interval between diagnosis and transplantation (Table). While the HCT-CI was not predictive of either NRM nor OS in recipients of UCBT, high OS for the group as whole, patient numbers and selection procedures may explain, at least in part, these results. However, it is also possible that the HCT-CI scoring system may not yet be optimized and some medical conditions may have greater impact on HSC transplantation outcome as compared to others. Factors RR of Death (95% C.I.) P-value * reference group HCT-Co-Morbidity Score 0* 1.0 1–2 1.4 (0.6–3.1) .40 >2 1.9 (0.9–3.9) .09 Conditioning Myeloablative* 1.0 Nonmyeloablative 0.9 (0.6–1.6) .83 Disease Risk Standard* 1.0 High 3.1 (1.5–6.5) <.01 Acute GVHD Grades 0–I 1.0 Grades II–IV 0.5 (0.3–0.9) <.01 Years from Dx to TX < 1* 1.0 1–2 0.8 (0.4–1.5) .50 >2 0.5 (0.3–0.9) .02

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