Pathological jaundice in late preterm neonates admitted in a tertiary hospital, Imphal: a prospective COHORT study
DOI:
https://doi.org/10.18203/2349-3291.ijcp20223062Keywords:
Late-preterm, Pathological jaundice, Total serum bilirubin, Exchange transfusionAbstract
Background: Approximately 85% of all term and most preterms develop clinical jaundice. Hyperbilirubinrmia is defined as a total bilirubin (TB) >95th percentile on the hour-specific Bhutani normogram. Pathological jaundice implies the onset of jaundice before 24 hours of age, rate of rise in TSB of >0.2 mg/dl/hour and jaundice persisting after 14 days in term and 21 days in late-preterms. The aim of this study was to determine the incidence, progression and the predictors of pathological jaundice among the late preterm infants admitted in Paediatrics ward of a tertiary care centre, Imphal.
Methods: A hospital based prospective cohort study was carried out in paediatrics department, RIMS during a period of 2 years (September 2019 to August 2022) with approval from research ethics board. Sample size was 100 based on consecutive sampling.
Results: Pathological jaundice developed among 65.0% (95% CI: 54.7-74.1%) neonates. The median duration of onset was 47.0 hours. The mean bilirubin at the time of diagnosis of jaundice was 15.5 mg/dl. Three neonates underwent exchange transfusion. Of these 3, one had pre-exchange bilirubin encephalopathy. Male gender, breast feeding, sepsis, infants blood group (B +ve), jaundice among the siblings and birth trauma (birth asphyxia/cephalhematoma) were significantly associated with the development of neonatal hyperbilirubinemia.
Conclusions: Jaundice is condition that is often present and constitutes one of the major risks for neurodevelopmental issues in later life and the risk is further compounded by prematurity. Hence further studies with a larger sample size on a multicentric level could add robustness to our study thereby helping in better understanding and management of the condition.
References
Dale P, Woolridge, Colletti JE. Hyperbilirubinemia in newborn. In: Sharieff LA, editor. Neonatal and infant emergencies. New York: Cambridge. 2010;234-40.
Hinkes MT, Cloherty JP. Neonatal hyperbilirubinemia. In: Coherty JC, editor. Manual of neonatal care. New York: Lippincott Raven. 1998;175-209.
Kliegman RM, St Geme J. Nelson textbook of pediatrics 21st edition. Elsevier. 2019.
Gleason CA, Juul SE. Avery's diseases of the newborn-Ed 10 e-book. Elsevier Health Sciences. 2017.
Gomella TL. Management of the Late Preterm Infants. In: Cunningham MD, Eyal FG, editors. Neonatology Management, procedures, on-call Problems, Diseases, and drugs. 7th ed. New York: McGraw Hill. 2015;169-70.
Maisels MJ. Jaundice. In: Avery Gb, Fletcher MA, Macdonald MG, editors. Neonatology. 4th ed. Philadelphia: JB Lippincott company. 1994;630-725.
Alpay F, Sarici SU, Tosuncuk HD, Serdar MA, Inanç N, Gökçay E. The value of first-day bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy term newborns. Pediatrics. 2000;106(2):E16.
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316.
Ballard JL, Khoury JC, Wediq K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard score expanded to include extremely premature infants. J Pediatr. 1991;119:417-23.
Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a pre-discharge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999;103:6-14.
Keren R, Luan X, Freidman S, Saddlemire S, Cnaan A, Bhutani V. A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics. 2008;12:170-9.
Lavanya KR, Jaiswal S, Reddy P, Murki S. Predictors of significant jaundice in late preterm infants. Indian Pediatrics. 2012;49(9):717-20.
Gupta A, Tripathi VN, Singh RD, Pandey K. Comparative Study on Prediction and Course of Significant Hyperbilirubinemia in Term and Late Preterm Babies. Astrocyte. 2017;4:139-43.
Bansal R, Agarwal AK, Sharma M. Predictive value of transcutaneous bilirubin levels in late preterm babies. IJCMR. 2016;3(6):1661-3.
Bhutani VK, Johnson L. Kernicterus in late preterm infants cared for as term healthy infants. Semin Perinatol. 2006;30(2):89-97.
Aynalem S, Abayneh M, Metaferia G, Demissie AG, Gidi NW, Demtse AG, et al. Hyperbilirubinemia in Preterm Infants Admitted to Neonatal Intensive Care Units in Ethiopia. Glob Pediatr Health. 2020;7:2333794X20985809.
Algameel A, Elhawary M, Amin S, Abd Elmenem M. Outcome of late preterm newborns in Upper Egypt. Egypt Pediatr Assoc Gaz. 2020;68(1):1-11.
Ozdemirci S, Kut A, Salgur F. Late Preterm and Term Birth: Neonatal Hyperbilirubinemia and Birth Model. Fetal Pediatr Pathol. 2016;35(4):213-9.
Aziz TA, Azab N, Odah M, El-deen IM. Factors and Assays Identifying Babies at Risk to Develop Significant Hyperbilirubinemia. IJIRSET. 2014;3:9804-9.
Kaplan M, Muraca M, Vreman HJ, Hammerman C, Vilei MT, Rubaltelli FF, et al. Neonatal bilirubin production-conjugation imbalance: effect of glucose-6-phosphate dehydrogenase deficiency and borderline prematurity. Arch Dis Child Fetal Neonatal Ed. 2005;90:123-7.
Gatea SK. Cord bilirubin level as predictor for Newborns at Risk for post natal Hyperbiliruinemia. Kuf Med J. 2009;2:109-17.
Maisels MJ, Kring E. Length of stay, jaundice and hospital readmission. Pediatrics. 1998;101:764-7.
Taskande A, Velhekar K, Jain M. Prediction of the development of neonatal hyperbilirubinemia by increased umbilical cord bilirubin. Ind Medica. 2004;1:5-9.
Knupfer M, Pulzer F, Gebauer C. Predictive value of umbilical cord blood bilirubin for postnatal hyperbilirubinaemia. Act Paediatr. 2005;5:581-7.
