Factors identifying babies at risk for significant hyperbilirubinemia: a prospective study conducted at a tertiary care center
Keywords:AAP, Newborns, Phototherapy, Significant hyperbilirubinemia, Serum bilirubin
Background: Hyperbilirubinemia is universally present in the newborn period and is recognized as clinical jaundice in approximately 50% infants. The aim was to determine the risk factors and treatment modalities of newborns with significant hyperbilirubinemia admitted from September 2011 to August 2013.
Methods: One hundred and fifty newborns with significant hyperbilirubinemia, both inborn and outborn were included in the study. Relevent information during hospitalisation was taken. American Academy of Pediatrics (AAP) guidelines were followed to determine the treatment modality. Treatment in the form of either phototherapy or exchange transfusion was given.
Results:Out of 150 patients 90 were males and 60 females. Higher values of serum bilirubin were found in the female babies and this difference was statistically significant. One hundred and thirty four babies had a birth weight of more than 2 kgs and 16 less than 2 kgs. The serum bilirubin levels were more in babies more than 2 kgs and this was statistically significant. Ninety one babies were delivered vaginally and 59 by LSCS. Higher serum bilirubin levels were found in those delivered vaginally with the difference being statistically significant .ABO blood group incompatibility was seen in 70 babies, 6 babies with Rh incompatibility. ABO incompatibility resulted in higher serum bilirubin levels with the difference being statistically significant. Ninety six babies had a gestation of more than 37weeks and higher bilirubin levels were found in this group as compared to lesser gestational age baby, the difference was statistically significant. Eighty five patients were admitted before 72 hours of life and 65 after that. Higher serum bilirubin levels were found in those admitted later with a statistically significant difference. The presence of antenatal risk factors (P = 0.4), parity of the mother (P = 0.178) were not found to play a major role in development of significant hyperbilirubinemia. Phototherapy was used as treatment modality in 137 patients, whereas 13 required exchange transfusion.
Conclusions:Significant hyperbilirubinemia was found to be more common in female babies, more than 37weeks of gestation, delivered vaginally, with birth weight of more than 2kgs, with ABO blood group incompatibility, admitted after 72hrs of life and with no identified antenatal risk factors. Most commonly used treatment modality found in these cases was phototherapy.
Stoll BJ, Kliegman RM. Jaundice and hyperbilirubinemia in the Newborn. In: Behrman RE, Kliegman RM, Jenson HB, Eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: WB Saunders Co; 2012:603-605.
American academy of pediatrics, provisional committee for quality improvement and subcommittee on hyperbilirubinemia. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics. 1994;94(4):558-65.
Davidson LT, Merritt KK, Weech AA. Hyperbilirubinemia in the newborn. Am J Dis Child. 1941;61:958-80.
Knudsen A. Prediction and non-invasive assessment of neonatal jaundice in the term healthy newborn infant. Acta Paediatr. 1996;85:393-7.
Maisels MJ, Newman TB. Predicting hyperbilirubinemia in newborns: the importance of timing: Commentaries. Pediatrics. 1999;103(2):493-5.
Maisels MJ, Kring EA. Length of stay, jaundice and hospital readmission. Pediatrics. 1998;101:995-8.
Pathak U, Chawla D, Kaur S, Jain S. Bilirubin nomogram for prediction of significant hyperbilirubinemia in north Indian neonates. Indian Pediatr. 2013;50(4):383-9.
Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999;103(1):6-14.
Romagnoli C, Catenazzi P, Barone G, Giordano L, Riccardi R, Zuppa AA, et al. Bili Check vs JM-103 in identifying neonates not at risk of hyperbilirubinaemia. Ital J Pediatr. 2013;23:39-46.
Najib K, Saki F, Hemmati F, Inaloo S. Incidence, risk factors and causes of severe neonatal hyperbilirubinemia in South of Iran (Fars Province). Iran Red Cres Med J. 2013;15(3): DOI: 10.5812/ ircmj.3337.
Kalakheti BK, Singh R, Bhatta NK, Karki A, Baral N. Risk of neonatal hyperbilirubinemia in babies born to 'O' positive mothers: a prospective cohort study. Kathmandu Univ Med J. 2009;7(25):11-5.
Watchko JF, Lin Z, Clark RH, Kelleher AS, Walker W, Spitzer AR. Complex multifactorial nature of significant hyperbilirubinemia in neonates. Pediatrics. 2009;124:868.
Stevenson DK, Fanaroff AA, Maisels MJ, Betty WY, Wong RJ, Vreman HJ. Prediction of hyperbilirubinemia in near-term and term infants. Pediatrics. 2001;108(1):31-9.
Keren R, Bhutani VK, Luan X, Nihtianova S, Cnaan A, Schwartz JS. Identifying newborns at risk of significant hyperbilirubinaemia: a comparison of two recommended approaches. Arch Dis Child. 2005;90(4):415-21.
Sarici SU, Yurdakok M, Serdar MA, Oran O, Erdem G, Tekinalp G, Yigit S. An early (sixth-hour) serum bilirubin measurement is useful in predicting the development of significant hyperbilirubinemia and severe ABO hemolytic disease in a selective high-risk population of newborns with ABO incompatibility. Pediatrics. 2002;109(4):53.
Joshi BD, Singh R, Mahato D, Prasad R. A clinico-laboratory profile of neonatal hyper-bilirubinemia in term babies at B.P. Koirala Institute of health sciences (BPKIHS), Dharan, Nepal. J Nepal Health Res. 2004.
Maisles MJ, Gifford K, Antle CE, Leib GR. Jaundice in the healthy newborn infant: a new approach to an old problem. Pediatrics. 1988;81(4):505-11.
Bhutani VK, Johnson LH. Kernicterus: a preventable neonatal brain injury. J Arab Neonatal Forum. 2005;2:13-24.
Narang A, Gathwala G, Kumar P. Neonatal Jaundice: An analysis of 551 cases. Indian Pediatr. 1997;34:429-32.
Singhal PK, Singh M, Paul VK, Deorari AK, Ghorpade MG. Spectrum of neonatal hyperbilirubinemia: an analysis of 454 cases. Indian Pediatr. 1992;29:319-25.
Michael S, Douglas C, Vibhuti S. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. 2006;6:175.
Varvarigou A, Fouzas S, Skylogianni E, Mantagou L, Bougioukou D, Mantagos S. Transcutaneous bilirubin nomogram for prediction of significant neonatal hyperbilirubinemia. Pediatrics. 2009;124(4):1052-9.
Sarici SU, Alpay F, Unay B, Ozcan O, Gokçay E. Double versus single phototherapy in term newborns with significant hyperbilirubinemia. J Trop Pediatr. 2000;46(1):36-9.
Awasthi S, Rehman H. Early prediction of neonatal hyperbilirubinemia. Indian J Pediatr. 1998;65:131-9.
Nahar Z, Shahidullah MD, Mannan A, Dey SK, Mitra U, Selimuzzaman SM. The value of umbilical cord blood bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy newborn. Bangladesh J Child Health. 2009;33(2):50-4.
Harry C, Trotman H. Epidemiology of neonatal jaundice at the University hospital of the west Indies. West Indian Med J. 2012;61(1):37-42.
Vos GH, Adhikari M, Coovadia HM. A study of ABO incompatibility and neonatal jaundice in black South African newborn infants. Transfusion. 1981;21(6):744-9.
Bhutani VK, Gourley GR, Adler S, Kreamer B, Dalin C, Johnson LH. Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics. 2000;106(2):17.