THE PREVALENCE AND RISK FACTORS FOR HYPERBILIRUBINEMIA IN NEONATES

Background: Jaundice is very common in the neonatal period of life especially hyperbilirubinemia>12 mg/dl. Although it is not a major cause of mortality, it is an important cause of morbidity. So, assessment of the prevalence and risk factors of neonatal jaundice is very important. Objectives: The objectives of the study were to estimate the prevalence,to identify the risk factors and to findout the association between hyperbilirubinemia with selected neonatal,maternal,environmental and socio demographic variablesand to identify the risk factors. Methodology: This descriptive cross sectional survey study was conducted among 200 neonates of 37 completed weeks of gestation. Subjects were selected by using total enumerative sampling.Transcutaneous bilirubin was measured by bilirubinometer,clinical and demographic variables collected by using semi structured questionnaire and the risk factors were assessed by interview schedule. Results:Research showed that most of neonates (81.5%) had Transcutaneous bilirubin level more than 12mg/dl, out of that (15% )subjects had elevated level of bilirubin 15- 20mg/dl. It is concluded that there is high prevalence of hyperbilirubinemia among neonates . It is evident that neonates developed hyperbilirubinemia by 48 to 72 hours. It is inferred that prevalence of hyperbilirubinemia was high at 72 hours (56.5%) after birth compared to 48 hours of birth (38%). There was a significant association between level of hyperbilirubinemia and family history of genetic diseases (P=0.003),parity (p=0.03, χ2=4.37),mode of conception(p=0.012, χ2=6.37), and gestational age(P=0.04),gender of the neonate (p=0.004, χ2=8.1)and duration of second stage of labour (p=0.026, χ2=7.27). The study revealed that the family history of genetic diseases (p=0.004),(OR=0.09) at level of significance 0.05,is a risk factor leads to hyperbilirubinemia. Conclusion: Neonatal jaundice is a leading cause of hospitalisation in the first few weeks of life throughout the world.Though major complications may arise like kernicterus,encephalopathy and neural sequlae.Hence there is an exigent need for assessing the bilirubin value in the routine neonatal assessment.

Effects of a breastfeeding coaching program on growth and neonatal jaundice in late preterm infants in South Korea

Purpose: This study examined the effects of a breastfeeding coaching program for mothers on growth and neonatal jaundice in late preterm infants (LPIs).Methods: This was a quasi-experimental study (non-randomized intervention) with a time-series design. The study was conducted among 40 LPIs who were admitted to the neonatal intensive care unit of a university hospital in Daegu, South Korea. In the order of admission, the first 21 infants were assigned to the experimental group, and 19 were assigned to the control group. The intervention program consisted of home- based and web-based practical breastfeeding support education for mothers across a total of 5 sessions. Infant growth was measured using body weight, length, and head circumference, and neonatal jaundice was assessed using transcutaneous bilirubin levels.Results: The likelihood of breastfeeding for infants in the experimental group at 4 weeks after discharge was the same as on the day of discharge, whereas it steadily decreased in the control group. There were significant differences in head circumference between the groups. However, weight, length, and transcutaneous bilirubin levels did not show a significant group-time interaction.Conclusion: A formal breastfeeding coaching program should be considered in clinical settings and at home within the first few weeks postpartum.

Clinical utility of hand held, non invasive transcutaneous bilirubinometer in neonatal jaundice: a prospective observational study

Background: Neonatal Jaundice is the most common morbidity in the first week of life, occurring in 60% of term and 80% of preterm newborn. However, visual inspection, being subjective, usually inaccurate and unreliable and will result in a number of unnecessary blood sampling. Taking all these in to considerations, transcutaneous bilirubinometer (TCB) may provide a solution which is an objective, noninvasive, fast and painless method of bilirubin estimation.Methods: Transcutaneous bilirubinometer levels were measured at forehead and sternum and blood samples for TSB were collected by venepuncture within 30 minutes and sent to biochemistry lab. After getting serum bilirubin reports, TCB and TSB values were compared by using Bhutani’s hour specific nomogram. Results: The correlation between serum bilirubin and transcutaneous bilirubin measured at forehead and sternum is very good at serum bilirubin <15 mg/dl, r value (Karl Pearson’s Correlation co-efficient) is 0.93 and 0.94 respectively.Conclusions: The findings of the present study indicate that the TCB is a reliable screening tool for hyperbilirubinemia in newborns >35 weeks of gestation, especially with bilirubin levels ≤15 mg/dl in 2-7 days of life. TCB can be a viable option for universal screening. Incorporating the use of TCB devices in clinical practice, can reduce the need for blood sampling for the management of neonatal jaundice.

Correlation between Non-invasive Measurement of Carboxyhemoglobin and Bilirubin Level Measurement in Near- Term and Term Neonates as a Predictor of Neonatal Hemolysis

Background Neonatal hyperbilirubinemia is common in the neonatal period. Yet, serious pathological hyperbilirubinemia may cause kernicterus with detrimental neurologic sequalae. Carbon monoxide (CO) is the byproduct of the breakdown of heme, it is transported as carboxyhemoglobin to the lungs to be exhaled. Thus, carboxyhemoglobin levels increase as a result of hemolysis, and is therefore considered a sensitive index for the degree and severity of the subsequent hyperbilirubinemia. Objectives To correlate between non-invasive carboxyhemoglobin levels and bilirubin levels in near-term and tem neonates starting hour I of life. Subjects and methods A total of 100 near-term and term neonates were studied, by measuring carboxyhemoglobin by a Pulse CO-oximetry and serum bilirubin level (hour l) and transcutaneous bilirubin (TcB) hourly since birth for the I st 6 hours then every 6 hours till the time of discharge in a cross sectional case-control study. Results A cut off value of 4 for non-invasive carboxyhemoglobin with sensitivity of 81.25%, specificity of 95.24% was found to the earliest non-invasive predictor for subsequent jaundice. In patients with proven hemolysis, carboxyhemoglobin when compared to TcB was found to increase significantly in the first 3 hours of life more than TcB, stalting hour 4 till time of discharge it was increased yet statistically insignificant Conclusion We found that non-invasive carboxyhemoglobin is an effective early predictor for subsequent jaundice starting first hour of life. It can be used as a screening tool for hemolytic jaundice especially in hospitals with early discharge policy.

The Impact of Phototherapy on the Accuracy of Transcutaneous Bilirubin Measurements in Neonates: Optimal Measurement Site and Timing

Transcutaneous bilirubinometer devices are widely applied to assess neonatal hyperbilirubinemia. However, the optimal skin site and timing of transcutaneous bilirubin (TCB) measurements for the strongest correlation with total serum bilirubin (TSB) levels after phototherapy are still unclear. We conducted a retrospective observational study evaluating the correlation of TCB and TSB levels in neonates postphototherapy. The TCB measurements on the forehead and mid-sternum at 0 and 30 min postphototherapy were assessed by using a JM-103 bilirubinometer. Paired TCB and TSB measurements were assessed by Pearson correlation and Bland–Altman plots. We analyzed 40 neonates with 96 TSB and 384 TCB measurements. The TSB level correlated moderately with the forehead TCB level at 30 min postphototherapy (r = 0.65) and less strongly with the midsternum TCB level at 0 min postphototherapy (r = 0.52). The forehead at 30 min after cessation of phototherapy was the best time point and location of TCB measurement for the assessment of neonatal jaundice status. The reliability of TCB measurements varied across skin sites and durations after phototherapy. The effectiveness of TCB measurement to assess neonatal hyperbilirubinemia is much better on covered skin areas (foreheads) 30 min postphototherapy. The appropriate application of transcutaneous bilirubinometers could aid in clinical practice and avoid unnecessary management.

ACCURACY OF TRANSCUTANEOUS BILIRUBIN MEASUREMENTS DURING PHOTOTHERAPY IN JAUNDICED PRETERM NEONATES

Aim: It is very difcult to nd veins and also seems unethical to withdraw blood daily in a preterm baby for the monitoring of jaundice during the course of phototherapy. So it becomes essential that we nd out a method which is non-invasive and at the same time accurate to assess jaundice. Jaundice is the most common morbidity in the rst week of life, reported in 60% of term, 80% of preterm (1, 2) & also being the commonest cause of readmission. Materials and Method: Study was planned to assess the accuracy of transcutaneous bilirubin in comparison to total serum bilirubin in premature jaundiced neonates of gestational age (28-32 weeks v/s 32-37 weeks) during phototherapy. Result: Study has demonstrated reliability of TCB measurements in preterm infants during phototherapy. Gestational age, comorbidities and risk factors for jaundice did not inuence the correlation. Summary: This study reveals that Transcutaneous Bilirubin Estimation by bilirubin meter can be used as a non-invasive method for monitoring of jaundice treatment during phototherapy in preterm neonates.

Correlation of serum bilirubin and transcutaneous bilirubin in newborns

Background: Hyperbilirubinemia is a very common entity in newborns. Screening all the babies for hyperbilirubinemia is must. Serum bilirubin is the standard method of checking the bilirubin in newborns. This is very cumbersome, invasive and time consuming method. Hence many newborns will be discharged without screening. Transcutaneous bilirubinometry would help us in making this task easy and safe. Hence the present study was planned.Methods: This is an institutional cross sectional study conducted in a tertiary care hospital for a period of 6 months. After a written informed consent from parents/ guardians and considering selection criteria, 500 newborns with clinical jaundice were included in study. Each newborn was examined, transcutaneous bilirubin checked at forehead and sternum and serum bilirubin was done at the same time. Data was statistically analyzed to see the correlation between TcB and TSB.Results: Out of 500 newborns, 316 were males, 184 were females and 475 were term gestation and 25 were preterm. Coefficient of correlation was 0.73 and 0.72 for total serum bilirubin versus forehead and sternum respectively which were statistically significant.Conclusions: Transcutaneous bilirubinometer readings closely correlate with that of serum bilirubin. Hence TcB can be used as a safer, economical and effective tool in screening newborns for hyperbilirubinemia.

Uptodate about techniques for the neonatal screening values of bilirubin levels used for jaundice

Neonatal jaundice is one of the main factors responsible for maternal stress and the increasing length of hospitalization in the first days after birth. Therefore, accurately determining bilirubin values with low costs investment is essential to guide a quickly and effectively treated. This article aims to review the main techniques used in current practice to measure bilirubin levels in the newborn and establish the correlation between treatment and monitoring. Thus, we will present the working methods for transcutaneous bilirubin measurement, continuous transcutaneous bilirubin monitoring simultaneously with vital signs and serum bilirubin measurement. Furthermore, we will present the main differences in the evaluation in normal weight and premature newborns. In conclusion, the measurement of bilirubin in the newborn contributes to initiating the phototherapy and the decrease of kernicterus cases with significant neurological consequences.