Clinical predictive score of predischarge screening for severe hyperbilirubinemia in late preterm and term infants

Abstract

Available online ---Key Words clinical predictive score; hyperbilirubinemia; neonatal Background: Early identification and appropriate follow-up of infants at risk of severe hyperbilirubinemia are part of preventing complications. This study aims to develop the clinical predictive score to predict subsequent severe hyperbilirubinemia in healthy Thai infants. Methods: A case-control study was conducted using medical records of 147 hyperbilirubinemia cases and 147 age-matched controls among healthy late preterm and term Thai newborn infants during January 2015 and December 2016. The routinely measured TcB values at 48e54 hours of age and all predischarge clinical characteristics were collected. Multivariable logistic regression was used to find a clinical prediction model to predict subsequent severe hyperbilirubinemia within 7 days after birth which defined as a postdischarge bilirubin level exceeding the hour-specific recommended threshold for phototherapy by the American Academy of Pediatrics (AAP). Results: The best clinical predictors for subsequent severe hyperbilirubinemia were TcB values at 48e54 hours and gestational age of infants. Predischarge TcB at 48e54 hours of life was classified into 3 levels: < 10 mg/dL, 10e12 mg/dL and > 12 mg/dL. Gestational age was categorized into 5 groups. The risk score derived from these 2 significant factors predicted subsequent severe hyperbilirubinemia with an AuROC curve of 81.0% (95% CI: 76.2e85.9%) in 3 risk group, high, moderate and low. The positive likelihood ratio for subsequent severe hyperbilirubinemia of the high-risk group (score > 5) was 4.53 (95% CI: 2.91e7.04) with specificity of 87.1%. The negative predictive value of low-risk group (score < 3) was 81%. Conclusions: A simple predischarge prediction score using gestational age and TcB values at 48 e54 hours of life was developed. This score classified late preterm and term newborn infants into 3 distinct risk levels and may be useful to identify high-risk infants for outpatient followup of subsequent severe hyperbilirubinemia.

Como a hiperbilirrubinemia deve ser considerada na definição do protocolo da triagem auditiva para neonatos de risco?

“…Na análise das medidas de bilirrubina foi obtido diferença estatística para a mediana de BT1 (p<0,001) e BI1 (p<0,001), com maiores valores no G1 quando comparado ao G2, ao contrário do esperado, visto que o G2 é formado por neonatos prematuros, que a princípio apresentam uma maior imaturidade hepática e, portanto, uma produção relativamente maior da bilirrubina e menor capacidade de sua excreção (8,16) . Não foi observada diferença significativa ao considerar a PBT e PBI, com valores semelhantes em ambos os grupos.…”

Transcutaneous bilirubinometry in preterm infants: A literature review

“…Jaundice muncul pada bayi prematur lebih tinggi (80%) daripada bayi yang matur (50%) pada usia satu minggu pertama (Raba, O'Sullivan, & Miletin, 2020;Ng, Maul, Viswanathan, & Chua, 2023;Arman, Topcuoğlu, Gürsoy, Ovalı, & Karatekin, 2019). Jaundice apabila tidak diatasi sedari awal dapat menyebabkan resiko terjadinya kern ikterik dan Encephalopathy (Thanomsingh, 2020).…”

“…Screening hyperbilirubinemia dengan menggunakan transcutaneous bilirubin dalam berbagai penelitian menjadi alternatif non invasif dalam perawatan bayi prematur. Pengambilan sampel darah untuk mengetahui TSB yang terlalu sering akan menjadikan traumatis pada bayi dan bisa menyebabkan anemia, dan infeksi (Ng et al, 2023;Thanomsingh, 2020). AAP dan Canadian pediatric society merekomendasikan pengukuran TcB secara rutin pada bayi prematur dengan usia kehamilan >35 minggu sebelum keluar dari rumah sakit dan bayi prematur yang usia kehamilan 24-35 minggu menjadikan angka insiden encephalopati bilirubin akut dan kronis menurun di Kanada dan amerika serikat (Jegathesan et al, 2021).…”

The association of oxidative stress of neonatal hyperbilirubinemia and vitamin E supplementation

“…Between 8% and 11% of newborns experience hyperbilirubinemia. During the first week of life, when the total serum bilirubin (TSB) rises over the 95 th percentile for age (highrisk zone) it is considered hyperbilirubinemia [2]. It is typical for idiopathic neonatal jaundice to occur in 60% to 80% of healthy newborns.…”