scholarly journals Cord Bilirubin Value as a Predictor of Significant Hyperbilirubinemia in Abo Incompatiblity

2021 ◽  
pp. 256-262
Author(s):  
C. Shanmuga Sundaram
Keyword(s):  
Birth Weight ◽  
Bilirubin Level ◽  
Predictive Factor ◽  
Outcome Measure ◽  
Serum Bilirubin ◽  
Statistical Significance ◽  
Mode Of Delivery ◽  
Positive Association ◽  
Complete Recovery ◽  
Abo Incompatibility

Background: Hyperbilirubinemia is a condition in which the blood contains too much bilirubin and producing jaundice (yellow coloring of the eyes and skin). Low bilirubin levels in newborns are common and do not pose any problems; they will resolve on their own within the first week of life. Studying the cord bilirubin levels in new born babies is significant to predict the risk of abo incompatiblity. Methods: A total of 129 babies born to O blood group mother were included in the study. Out of which 111 babies were with risk of ABO incompatibility. Among them 17 babies developed pathological hyperbilirubinemia. None of the 0 positive babies developed pathological hyperbilirubinemia. Results: The peak bilirubin level was attained on 3rd and 4th day for all the babies and was taken as the outcome measure and cord serum bilirubin was taken as the predictive factor. The incidence of pathological hyperbilirubinemia is 13.2%. The mode of delivery had no positive association with the development of pathological hyperbilirubinemia. Male babies had positive ociation for pathological hyperbilirubinemia without any statistical significance. Incidence of pathological hyperbilirubinemia is higher in babies with a birth weight of <3 kg. Conclusion: A cord bilirubin value of 2.65 mg/dL can be used as a cut off for predicting pathological hyperbilirubinemia. Infants with bilirubin level more than the cutoff values were subjected to early intervention with complete recovery. None of the babies had developed encephalopathy and its sequelae.

scholarly journals Utility of Transcutaneous Bilirubinometer in Tertiary Care Hospital

2017 ◽  
Vol 37 (1) ◽  
pp. 72-78
Author(s):  
Vijay Kumar ◽  
Pardeep Singh Kahlon ◽  
Palwinder Singh ◽  
Kamail Singh ◽  
Anubha Sharma
Keyword(s):  
Birth Weight ◽  
Correlation Coefficient ◽  
Bilirubin Level ◽  
Gestational Age ◽  
Serum Bilirubin ◽  
Mean Value ◽  
Pearson’S Correlation Coefficient ◽  
Pearson's Correlation ◽  
Pearson's Correlation Coefficient ◽  
Transcutaneous Bilirubinometer

Introduction: Hyperbilirubinemia is one of the most vexing problems that may occur in 60% of term and 80% of preterm neonates. In order to reduce the risk of developing serious hyperbilirubinemia, it is vital to identify jaundiced infants who are in need of treatment as soon as possible. The objectives of this study were to find whether transcutaneous bilirubin (TcB) measurement correlates with total serum bilirubin (TSB) levels, measured with standard laboratory method and to analyse the effect of gestational age, birth weight and postnatal life on TcB and TSB.Material and Methods: A prospective study was conducted in the Department of Paediatrics, Government Medical College, Amritsar on 300 neonates with visible jaundice. These neonates were divided into various groups depending upon gestational age, birth weight and day of life. TcB readings were recorded at forehead and sternum and serum bilirubin level was measured within 30 minutes. Test of significance applied was unpaired T-test; mean value, p-value, standard deviation and Pearson's correlation coefficient 'r' were calculated.Results: Overall Mean value TcB at forehead was 15.32 with SD ± 2.75, mean TcB at sternum was 14.94 with SD ±2.51, mean value of TSB was 13.80 with SD ±2.15. Pearson’s correlation coefficient r was 0.895 for TcB forehead vs TSB, 0.903 for TcB sternum vs TSB and 0.966 between TcB forehead vs TcB sternum.Conclusion: TcB levels correlates well with the gold standard measurement of TSB. Gestational age, birth weight and day of life had no effect on TcB and TSB correlation. Transcutaneous bilirubinometer can thus be used to measure bilirubin level as a screening method for neonatal hyperbilirubinemia.

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 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 Utility of cord blood bilirubin as a predictors of significant neonatal Hyperbilirubinemia in healthy term neonate

2019 ◽  
Vol 6 (5) ◽  
pp. 2058
Author(s):  
Rajkumar M. Meshram ◽  
Saira Merchant ◽  
Swapnil D. Bhongade ◽  
Sartajbegam N. Pathan
Keyword(s):  
Positive Predictive Value ◽  
Cord Blood ◽  
Negative Predictive Value ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Serum Bilirubin ◽  
Mode Of Delivery ◽  
Neonatal Hyperbilirubinemia ◽  
Term Neonates

Background: Clinical jaundice is evident in more than two-third neonates in their early neonatal life. Early identification of neonates at risk might allow early intervention and prevent complication. Objective of the study was to assess the cord blood bilirubin level as a tool to screen the risk of development of subsequent significant neonatal hyperbilirubinemia in term neonates.Methods: A prospective observational study was conducted over a period of 2 years on 1040 healthy term neonates. Demographic profile, relevant maternal and neonatal information were recorded. Measurement of cord blood bilirubin, blood group/Rh typing and serum bilirubin at the end of 24 & 72 hours was done to predict significant hyperbilirubinemia.Results: Incidence of significant hyperbilirubinemia was 11.53%. Gender, gestational age, mode of delivery and birth weight had no correlation with development of significant jaundice. 800 (76.93%) neonates had cord blood bilirubin level ≤3.0mg/dl and 240 (23.07%) neonate had cord blood bilirubin level >3.0mg/dl. Out of 240 (23.07%) neonates with higher cord bilirubin (>3.0 mg/dl), 108 (45%) had significant hyperbilirubinemia at the end of 24 hours with sensitivity 90.00%, specificity 85.65%, positive predictive value 45.00% and negative predictive value 98.50% while 110 (45.83%) neonates were observed with serum bilirubin >17mg/dl at the end of 72 hours with cord blood bilirubin >3mg/dl with sensitivity 91.67%, specificity 84.52% positive predictive value 45.83% and negative predictive value-98.61% and this difference was statistically significant.Conclusions: Neonates with cord blood bilirubin level ≤3mg/dl can be safely discharged early whereas neonates with bilirubin >3mg/dl will need close follow up to check for development of subsequent significant jaundice. Hence cord blood bilirubin levels help to determine and predict the possibility of significant jaundice among healthy term neonates.

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.

Relationship of Serum Bilirubin Levels to Ototoxicity and Deafness in High-Risk Low-Birth-Weight Infants

PEDIATRICS ◽  
1985 ◽  
Vol 76 (3) ◽  
pp. 351-354
Author(s):  
L. S. de Vries ◽  
S. Lary ◽  
L. M.S. Dubowitz
Keyword(s):  
Birth Weight ◽  
High Risk ◽  
Preterm Infants ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Sensorineural Deafness ◽  
Serum Bilirubin Level ◽  
Low Birth Weight Infants ◽  
High Risk Infants ◽  
L 14

During a 4-year period, 12 premature infants, all less than 34 weeks of gestation and all with a bilirubin level above 240 µmol/L (14 mg/dL) were determined to have bilateral sensorineural deafness. In order to investigate how far the hyperbilirubinemia or any associated factor might have been a causative factor, all infants of 34 weeks of gestation or less who had a serum bilirubin level above 240 µmol/L were investigated. For a period of 4 years, 99 infants meeting these criteria were classified as high risk or low risk on the basis of perinatal risk factors. Eight of the 22 high-risk infants with birth weight less than 1,500 g, but only two of 43 high-risk infants with birth weight greater than 1,500 g were deaf (P &lt; .05). The deaf infants were also matched with infants of normal hearing who had similar bilirubin levels and the same number of adverse perinatal factors. The mean duration of hyperbilirubinemia was significantly longer in the deaf infants (P &lt; .02), and they appeared to have a greater number of acidotic episodes while they were hyperbilirubinemic. These findings suggest that in healthy preterm infants with birth weight greater than 1,500 g, high bilirubin levels carry little risk, whereas a serum bilirubin level greater than 240 µmol/L in highrisk preterm infants with birth weight of 1,500 g or less is associated with a high risk of deafness.

Risk Factors for Serum Bilirubin Rebound After Stopping Phototherapy in Neonatal Hyperbilirubinemia

2021 ◽  
pp. 097321792110483
Author(s):  
Abhishek Yadav ◽  
Baljeet Maini ◽  
Bablu Kumar Gaur ◽  
Rupa R Singh
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Sepsis ◽  
G6pd Deficiency ◽  
Serum Bilirubin ◽  
Neonatal Hyperbilirubinemia ◽  
P Value ◽  
Inclusion Criteria ◽  
Abo Incompatibility

Objective: To identify the factors affecting rebound increase in bilirubin levels after stopping phototherapy in neonatal hyperbilirubinemia. Setting: Tertiary-level neonatal unit. Patients: This was a hospital-based cross-sectional observational study. The study was conducted in neonatal division of rural tertiary care hospital. All neonates who were admitted for hyperbilirubinemia treatment and fulfilled the inclusion criteria were included in the study. Inclusion Criteria: All neonates 1.5 kg and above and treated in newborn intensive care unit for hyperbilirubinemia. Exclusion Criteria: (a) Critically ill patients requiring respiratory support any time after delivery, (b) neonates presenting with life-threatening surgical conditions, (c) patient with congenital malformation, (d) conjugated bilirubin elevation, (e) patients with birth asphyxia. Statistical Analysis: All the data were entered into a Microsoft Excel sheet. Appropriate tests of significance were applied. The various variables were sorted and presented as a number or percentage. The categorical variables used in the analysis were evaluated using the chi-square test (Yates’s correction and Fischer exact test were employed where applicable). The continuous data were analyzed by “t” test. The P value of less than 0.05 was taken to be level of statistical significance. Results: One hundred and fifty patients of neonatal hyperbilirubinemia were included in this study. In this study, 81 newborns (54.0%) were male and 78 (52%) of them were born by normal vaginal delivery. One hundred and nine babies (72.6%) were term babies. Fifty babies (33.3%) were low birth weight. Out of 150 neonates, 18(12%) had ABO incompatibility, 13(8.7%) Rh incompatibility, 23(15.7%) neonatal sepsis, and 4 (2.6%) had polycythemia. Out of 150 patients, 15(10%) babies had rebound hyperbilirubinemia at 24 h of life requiring phototherapy prematurity (particularly <34 weeks) ( P value: .03), low birth weight (particularly <2.0 kg) ( P value:.009), onset of jaundice requiring phototherapy before 72 h of life ( P value .04), blood group (both Rh and ABO) incompatibility ( P values: .001 and .002), neonatal sepsis ( P value: .004) were significantly associated with rebound hyperbilirubinemia. Glucose 6 phosphate dehydrogenase (G6PD) deficiency, polycythemia, maturity, mode of feeding, and gender did not show any statistical significant relationship with rebound hyperbilirubinemia. Conclusions: Rebound level of bilirubin need not be checked in all babies. Babies with risk factors like born preterm, low birth weight, having sepsis, requirement of phototherapy before 72 h of life, Rh and ABO group incompatibility, only need to be checked for serum bilirubin rebound. We recommend more studies with larger sample size to evaluate all these factors including polycythemia and G6PD deficiency.

Phototherapy for Hyperbilirubinemia of Hemolytic Disease of the Newborn

PEDIATRICS ◽  
1985 ◽  
Vol 75 (2) ◽  
pp. 407-441
Author(s):  
Harold M. Maurer ◽  
Barry V. Kirkpatrick ◽  
Nancy B. McWilliams ◽  
David A. Draper ◽  
Dolores A. Bryla
Keyword(s):  
Birth Weight ◽  
Serum Bilirubin ◽  
Hemolytic Disease ◽  
Bilirubin Concentration ◽  
Term Infants ◽  
Abo Incompatibility ◽  
Rh Incompatibility ◽  
Infant Birth ◽  
Positive Results ◽  
Serum Bilirubin Concentration

Although phototherapy has proven effective in lowering the serum bilirubin concentration of fullterm and premature infants with physiologic or idiopathic hyperbilirubinemia, its effect on serum bilirubin concentration in hemolytic disease due to ABO blood group incompatibility remains uncertain. Sisson and associates91 have reported a marked effect of phototherapy on serum bilirubin levels and exchange transfusion rates in premature and full-term infants with ABO incompatibility. Others have reported similar findings, but studies were retrospective49 or uncontrolled.80 On the other hand, Patel and associates79 found no significant clinical response to phototherapy in five infants (four with birth weight &gt;2,500 g) with ABO and one infant (birth weight 2,660 g) with Rh incompatibility. A total of 1,339 infants were randomly selected for study between May 1974 and June 1976. Of the 1,339 infants, 79.4% weighed less than 2,500 g and 276 (20.6%) were 2,500 g or more at birth. Of the 1,063 infants who weighed less than 2,500 g, 17 had positive findings on Coombs tests, 14 due to ABO incompatibility and three due to Rh incompatibility. As phototherapy was administered early and prophylactically in infants weighing less than 2,000 g and late and therapeutically in infants weighing between 2,000 and 2,499 g, a combined analysis of the infants weighing less than 2,500 g and who had positive results on Coombs test was not possible. Of the 276 infants whose birth weight was 2,500 g or more, 64 (23.1%) had positive findings on Coombs tests, 58 due to ABO incompatibility and six to Rh incompatibility.

Is Cord Blood Bilirubin Level a Reliable Predictor for Developing Significant Hyperbilirubinemia?

2018 ◽  
Vol 36 (03) ◽  
pp. 317-321
Author(s):  
Caner Dogan ◽  
Zeynep Okmen ◽  
Seda Gulec ◽  
Selma Aktas
Keyword(s):  
Cord Blood ◽  
Blood Group ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Mode Of Delivery ◽  
Blood Groups ◽  
Serum Bilirubin Level ◽  
Delay In Diagnosis ◽  
Rh Incompatibility ◽  
The Mean

Objective We aimed to investigate whether cord blood bilirubin (CBB) level could be used to identify the newborns at a high risk of developing hyperbilirubinemia. Study Design Total and direct serum bilirubin level were evaluated from umbilical cord blood of newborns. We checked blood groups and Rh status of all mothers and determined blood groups and direct Coombs test (DC) of newborns born to mothers whose blood group was O type or Rh negative to determine the maternal–fetal blood group or Rh incompatibility. Results A total of 418 newborns were included, and phototherapy (PT) was required in 17 newborns. The cutoff value of CBB for predicting the occurrence of significant hyperbilirubinemia requiring PT was 1.67 mg/dL, with a sensitivity of 82% and specificity of 99%. The mean CBB level in babies receiving PT was 2.4 ± 0.9 mg/dL. When blood group, CBB level, DC, gender, and mode of delivery were assigned as possible risk factors, multıvariate analysis showed ABO, Rh incompatibility, and CBB level increased the risk of PT requirement. Conclusion CBB could be useful to determine newborns at a risk of developing hyperbilirubinemia and prevent developing severe complications due to delay in diagnosis.

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