Hour-Specific Total Serum Bilirubin Percentiles for Infants Born at 29–35 Weeks’ Gestation

<b><i>Introduction:</i></b> As preterm infants are susceptible to hyperbilirubinemia, they require frequent close monitoring. Prior to initiation of phototherapy, hour-specific total serum bilirubin (TSB) percentile cut-points are lacking in these infants, which led to the current study. <b><i>Methods:</i></b> A multi-site retrospective cohort study of preterm infants born between January 2013 and June 2017 was completed at 3 NICUs in Ontario, Canada. A total of 2,549 infants born at 29^0/7–35^6/7 weeks’ gestation contributed 6,143 pre-treatment TSB levels. Hour-specific TSB percentiles were generated using quantile regression, further described by degree of prematurity, and among those who subsequently received phototherapy. <b><i>Results:</i></b> Among all infants, at birth, hour-specific pre-treatment, TSB percentiles were 36.1 µmol/L (95% confidence interval [CI]: 34.3–39.3) at the 40th, 52.3 µmol/L (49.4–55.1) at the 75th, and 79.5 µmol/L (72.1–89.6) at the 95th percentiles. The corresponding percentiles were 39.3 μmol/L (35.9–43.2), 55.4 μmol/L (52.1–60.2), and 87.1 μmol/L (CI 70.5–102.4) prior to initiating phototherapy and 24.4 μmol/L (20.4–28.8), 35.3 μmol/L (31.1–41.5), and 52.0 μmol/L (46.1–62.4) among those who did not receive phototherapy. Among infants born at 29–32 weeks, pre-treatment TSB percentiles were 53.9 µmol/L (49.4–61.0) and 95.5 µmol/L (77.5–105.0) at the 75th and 95th percentiles, with respective values of 48.7 µmol/L (43.0–52.3), and 74.1 µmol/L (64.8–83.2) for those born at 33–35 weeks’ gestation. <b><i>Conclusion:</i></b> Hour-specific TSB percentiles, derived from a novel nomogram, may inform how bilirubin is described in preterm newborns. Further research of pre-treatment TSB levels is required before clinical consideration.

Evaluation Of Some Blood Biomarkers As Predictors Of Neonatal Necrotizing Enterocolitis

Background Necrotizing enterocolitis is a leading cause of mortality and morbidity in preterm neonates; however the lack of a reliable biomarker makes definite diagnosis difficult. Therefore, its early suspicion and proper management are important. Objective To evaluate the value of NLR, serum levels GGT, total serum bilirubin and serum Ca2+ concentrations for early diagnosis and prediction of NEC severity; and to make a predictive score for early diagnosis of NEC. Patients and methods A case control study which was conducted on neonates admitted to NICU, Children Hospital, Ain Shams University over a period of 6 months, fifty neonates were classified into two groups: the patients group included 25 neonates with NEC with a gestational age 28-36 weeks regardless of birth weight matched with control group which included 25 healthy preterm neonates, however we excluded neonates with congenital infectious diseases, perinatal asphyxia, severe birth defects, congenital digestive tract malformations, inherited metabolic diseases or parental refusal of enrollment. Results ROC curve of NEC diagnosis by NLR, serum GGT, total serum bilirubin and serum Ca2+ showed cut off: &gt; 1.13, &gt; 40 U/L, &gt; 0.95 mg/dl, &lt; 8.85 mg/dl respectively, Sensitivity 84, 92%, 84%, 84% respectively and Specificity 80%, 92%, 92%, 84% respectively; also beta-weighted score for prediction of NEC disease showed that NLR (Best cut off &gt; 1.13) or GGT (Best cut off &gt; 40 U/L could be helpful with sensitivity 92% and specificity 92%. Conclusion NLR, GGT, T.Bil and calcium levels could be good non-invasive markers for NEC disease prediction and also for its diagnosis.

ROLE OF HYPERBILIRUBINEMIA IN PREDICTON OF GANGRENOUS/PERFORATED APPENDICITIS

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

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.

The Determination of Total Serum Bilirubin Concentration in Type 2 Diabetes patients

Bilirubin represent a natural end-product of heme metabolism and is used as as a marker in diagnosis off hepatobiliary diseases. Recent studies demonstrated that serum bilirubin levels are related to the risk of Type 2 diabetes mellitus (T2D) development and subsequent complications. The aim of this study was to analyzed serum total bilirubin concentrations and its relationship with biochemical and clinical characteristics in T2D patients. Total of 109 participants were included in this study, 54 controls and 55 diabetic patients, both gender, while ages ranged from 35 to 70 years. Biochemical parameters were analyzed by standard IFCC methods while serum total bilirubin concentrations was determined by the method of Jendrassik/Gróf. All analyses and measurements were provided by using the chemical analyzer VITROS 350. Results showed a significant difference in concentrations of glucose, glycated hemoglobin (HbA1c), lipid profile (total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol) and bilirubin between T2D patients and controls (p<0.05). Also, significant association was found between bilirubin and glucose concentrations in two investigated populations (p<0.05). It appears that elevated concentration of bilirubin and biochemical characteristics are associated with the progression development of Type 2 diabetes and its related vascular complications. Therefore, total serum bilirubin concentrations could be used as potential T2D biomarker and therefore, as new therapeutic target.

Transcutaneous versus Total Serum Bilirubin Measurements in Preterm Infants

<b><i>Introduction:</i></b> Transcutaneous bilirubin (TcB) measurement offers a noninvasive approach for bilirubin screening; however, its accuracy in preterm infants is unclear. This study determined the agreement between TcB and total serum bilirubin (TSB) among preterm infants. <b><i>Methods:</i></b> A multisite prospective cohort study was conducted at 3 NICUs in Ontario, Canada, September 2016 to June 2018. Among 296 preterm infants born at 24^0/7 to 35^6/7 weeks, 856 TcB levels were taken at the forehead, sternum, and before and after the initiation of phototherapy with TSB measurements. Bland-Altman plots and 95% limits of agreement (LOA) expressed agreement between TcB and TSB. <b><i>Results:</i></b> The overall mean TcB-TSB difference was −24.5 μmol/L (95% LOA −103.3 to 54.3), 1.6 μmol/L (95% LOA −73.4 to 76.5) before phototherapy, and −31.1 μmol/L (95% LOA −105.5 to 43.4) after the initiation of phototherapy. The overall mean TcB-TSB difference was −15.2 μmol/L (95% LOA −86.8 to 56.3) at the forehead and −24.4 μmol/L (95% LOA −112.9 to 64.0) at the sternum. The mean TcB-TSB difference was −31.4 μmol/L (95% LOA −95.3 to 32.4) among infants born 24–28 weeks, −25.5 μmol/L (95% LOA −102.7 to 51.8) at 29–32 weeks, and −15.9 μmol/L (95% LOA −107.4 to 75.6) at 33–35 weeks. Measures did not differ by maternal ethnicity. <b><i>Conclusion:</i></b> Among preterm infants, TcB may offer a noninvasive, immediate approach to screening for hyperbilirubinemia with more careful use in preterm infants born at &#x3c;33 weeks’ gestation, as TcB approaches treatment thresholds. Its underestimation of TSB after the initiation of phototherapy warrants the use of TSB for clinical decision-making after the initiation of phototherapy.

Efektifitas Fototerapi Pada Bayi Baru Lahir dengan Hiperbilirubinemia Berdasarkan Jenis Lampu dan Panjang Gelombang Fototerapi

Hiperbilirubinemia adalah terjadinya peningkatan kadar bilirubin dalam darah, baik oleh faktor fisiologis maupun non fisiologis yang secara klinis menimbulkan gejala yang disebut ikterus (kuning). Pada neonatus, kadar serum bilirubin indirek yang tinggi dapat menyebabkan kerusakan otak yang parah dan tidak dapat disembuhkan. Fototerapi dan transfusi tukar adalah dua strategi terapeutik utama untuk mencegah kerusakan otak akibat bilirubin pada neonatus. Bilirubin, yang merupakan target fototerapi ini menyerap sinar secara maksimal pada rentang spektrum biru (460-490 nm). Namun, literatur lain mengatakan spektrum panjang gelombang yang berbeda, yaitu pirus (497 nm) juga sama efektifnya dalam menurunkan kadar bilirubin. Eligibilitas dari metode penelitian ini berdasarkan Participant, Intervention, Comparison, and Outcomes (PICO) dan penggunaan Boolean Operator. Berdasarkan seleksi studi dan penilaian kualitas, didapatkan 9 artikel yang dapat dianalisa. Pada bagian pembahasan didapatkan fototerapi lampu hijau dengan panjang gelombang (500nm) memiliki efektifitas yang sama dengan fototerapi gelombang biru dalam penurunan total serum bilirubin, sehingga dapat digunakan sebagai fototerapi alternatif. Fototerapi LED tidak lebih unggul dalam efektifitas penurunan total serum bilirubin jika dibandingkan dengan fototerapi konvensional. Hal ini dikarenakan iradiasi dalam keadaan normal fototerapi LED lebih tinggi dibandingkan dengan fototerapi konvensional sehinnga meningkatkan efektifitas dari fototerapi LED.

Correlation of transcutaneous bilirubin with total serum bilirubin in neonates with hyperbilirubinemia

Background: For determining hyperbilirubinemia in a neonate, clinical evaluation, serum bilirubin estimation and trans cutaneous bilirubin estimation are the modalities available. Transcutaneous bilirubinometry (TcB) is routinely used to monitor jaundice in term and near-term infants. Literature shows a positive correlation observed between TcB and total serum bilirubin (TSB). The present study was conducted determine the correlation of TcB with TSB in neonates with hyperbilirubinemia admitted at a tertiary care hospital, ChennaiMethods: A cross sectional study was conducted at a tertiary care hospital, Chennai where 350 neonates who have clinical jaundice and require estimation of serum bilirubin who are admitted to the tertiary care centre, Chennai during December 2020-March 2021 were included in the study. The ROCHE INTEGRA-e 411+ autoanalyzer was used to estimate TSB (mg/dl) using a modified diazo method. The Jaundice Meter JM-103 to measure TcB, (Manufactured by Draeger medical systems, Germany). Pearson corelation coefficient was used to find the correlation between the two variables. P<0.05 was considered to be statistically significant.Results: Out of 350 neonates admitted to the tertiary care centre, term deliveries were 57.1% and pre term were 42.9%. 83.1% were in the age group of 3-7 days. The mean weight of the study population was 2.16±0.60 kg. In term babies, Pearson corelation between TSB and TcB shows a statistically significant positive correlation, r=0.90 with p≤0.0001. Among pre term babies, Pearson corelation between TSB and TcB shows a statistically significant positive correlation, r=0.96 with p≤0.0001.Conclusions: This study's findings support the use of a TcB metre as a screening tool for clinically significant hyperbilirubinemia.

Effect of Oral Fenofibrate on Serum Bilirubin Level in Term Neonates with Unconjugated Hyperbilirubinaemia: A Randomized Control Trial

Introduction: Hyperbilirubinemia is a common problem in the neonatal period. Phototherapy is the most important proposed treatments for hyperbilirubinemia, but several drugs along with phototherapy are used with recent advances. Aim: To see the effect of oral fenofibrate on serum bilirubin level in term neonates with unconjugated hyperbilirubinaemia. Methods: This prospective study was carried out in Combined Military Hospital Cumilla from July 2018 to June 2019. Total 60 term and normal birth weight neonates with neonatal jaundice were enrolled in this study. Jaundiced newborns presenting with infection, G6PD deficiency, conjugated bilirubin >2 mg/dl or >15% of total serum bilirubin (TSB) and congenital anomalies were excluded from this study. These neonates were randomly allocated to the Fenofibrate group (30 cases) and Control group (30 cases). Total serum bilirubin was measured every 24 hours till the end of phototherapy and at the time of discharge. Statistical analysis was done using SPSS 22.0 and p<0.05 was considered significant. Results: There were no significant differences in gender, age, weight, gestational age and type of delivery between two groups. Mean duration of hospital stay were 4.0±0.7 and 5.5±1.4 days in Fenofibrate group and Control group respectively (p<0.001). In Fenofibrate group, TSB was decreased from 17.2 mg/dl to 15.2 mg/dl after 24 hours, to 13.6 mg/dl after 48 hours, and to 10.1 mg/dl at the time of discharge. In control group, TSB was decreased from 17.0 mg/dl to 16.3 mg/dl after 24 hours, to 15.9 mg/dl after 48 hours, and to 10.3 mg/dl at the time of discharge. Conclusion: Treatment of neonatal unconjugated hyper- bilirubinemia with fenofibrate reduces neonatal bilirubin levels and decreases the need for phototherapy and hospitalization. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 35-38