Post-test probability for neonatal hyperbilirubinemia based on umbilical cord blood bilirubin, direct antiglobulin test, and ABO compatibility results

Peeters, Bart; Geerts, Inge; Mullem, Mia Van; Micalessi, Isabel; Saegeman, Veroniek; Moerman, Jan

doi:10.1007/s00431-016-2690-1

Cited by 13 publications

(10 citation statements)

References 23 publications

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“…However, our finding is higher than that found in a previous meta-analysis (21). In contrast, the prevalence of hyperbilirubinemia found in our study was substantially lower than that found in previous systematic reviews carried out in Pakistan (22), Myanmar (23) and global burden diseases GBD (24,25). These differences might be the result of different diagnostic standards for neonatal hyperbilirubinemia, early diagnosis and treatment in developed countries, and the early discharge of healthy late-preterm and full-term newborns.…”

Section: Discussioncontrasting

confidence: 96%

Prevalence of neonatal hyperbilirubinemia and its association with glucose-6-phosphate dehydrogenase deficiency and blood type incompatibility in sub-Saharan Africa: a systematic review and meta-analysis

Aynalem

Mulu

Akalu

et al. 2020

Preprint

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Background: Severe indirect hyperbilirubinemia is a silent cause of newborn disease and death worldwide. However, studies of the disease in sub-Saharan Africa are highly variable with respect to its prevalence. Hence, this study aimed to estimate the overall magnitude of neonatal hyperbilirubinemia and its association with glucose-6-phosphate dehydrogenase (GP6D) deficiency and blood type incompatibility in sub-Saharan Africa.Methods: PubMed, Scopus, Google Scholar, and the Cochrane Review were systematically searched online to retrieve hyperbilirubinemia-related articles. All observational studies reported the prevalence of hyperbilirubinemia in sub-Saharan Africa were included for analysis and excluded if the study failed to determine the desired outcome. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. Heterogeneity across the included studies was evaluated using the inconsistency index (I2). Publication bias was examined by funnel plot and the Egger’s regression test. The random-effect model was fitted to estimate the pooled prevalence of neonatal hyperbilirubinemia among patients in Sub Saharan Africa. The meta-analysis was performed using the STATA™ version 14 software.Results: A total of 30,486 studies were collected from the different databases and 10 articles were included for the final analysis. The overall magnitude of neonatal hyperbilirubinemia was 28.08 % (95% CI: (20.23, 35.94)) in sub-Saharan Africa. Neonates with G6PD deficiency were 2.42 times (95% CI: 1.64, 3.56) more likely to develop hyperbilirubinemia as compared to infants with normal G6PD levels. Moreover, the risk of developing hyperbilirubinemia was 3.3 times (95% CI: 1.96, 5.72) higher among neonates that had a blood type that was incompatible with their mother’s.Conclusion: The failure to prevent and screen G6PD deficiency and blood type incompatibility with their mother’s results in high burden of neonatal hyperbilirubinemia in sub-Saharan Africa. Therefore, early identification and care strategies should be developed to the affected neonates with G6PD deficiency and blood type incompatibility with their mother’s to address long-term medical and scholastic damages among those exposed to severe hyperbilirubinemia

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Section: Discussioncontrasting

confidence: 96%

Prevalence of neonatal hyperbilirubinemia and its association with glucose-6-phosphate dehydrogenase deficiency and blood type incompatibility in sub-Saharan Africa: a systematic review and meta-analysis

Aynalem

Mulu

Akalu

et al. 2020

Preprint

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“…CBBs are easily obtained from umbilical cord blood and have a short turnaround time. In a retrospective study of 12,993 Belgian neonates, a CBB of 1.98 mg/dL had a sensitivity at 71% with a specificity of 77% for a TSB concentration >95 th percentile [ 13 ]. In our study, a slightly lower CBB cut-off value of 1.85 mg/dL had a greater sensitivity at 79% and lower specificity at 72%.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, a slightly lower CBB cut-off value of 1.85 mg/dL had a greater sensitivity at 79% and lower specificity at 72%. The negative predictive values (98–99%) and AUCs (0.81–0.82) were similar, and both studies had low positive predictive values [ 13 ]. In subgroup analysis of subjects with a positive DAT in this study, the sensitivity and specificity improved to 92% and 70%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, all neonates in our study had a TSB. In contrast, in most studies, TSB concentrations were only measured in small sub-groups [ 6 , 8 , 10 , 13 ]. Last, we developed and validated multivariate predictive models that combined CBB with maternal Asian race and gestational age for the prediction of three clinically relevant outcomes (PT, and TSB concentration >95 th and >75 th percentile) [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

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Umbilical cord blood bilirubins, gestational age, and maternal race predict neonatal hyperbilirubinemia

et al. 2018

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ObjectiveNo validated biomarker at birth exists to predict which newborns will develop severe hyperbilirubinemia. This study’s primary aim was to build and validate a prediction model for severe hyperbilirubinemia using umbilical cord blood bilirubins (CBB) and risk factors at birth in neonates at risk for maternal-fetal blood group incompatibility. This study’s secondary aim was to compare the accuracy of CBB to the direct antigen titer.MethodsInclusion criteria for this prospective cohort study included: ≥35 weeks gestational age, mother with blood type O and/or Rh negative or positive antibody screen, and <24 hours of age. The primary outcome was severe hyperbilirubinemia, defined as phototherapy during the initial hospital stay. Secondary outcomes were a total serum bilirubin concentration >95th and >75th percentile during the initial hospital stay. The predictive performance and accuracy of the two tests (CBB and direct antigen titer) for each outcome was assessed using area under a receiver-operating characteristic curve (AUC), sensitivity, and specificity.ResultsWhen compared to neonates who did not receive phototherapy (n = 463), neonates who received phototherapy (n = 36) had a greater mean CBB ± standard deviation (2.5 ± 0.7 vs. 1.6 ± 0.4 mg/dL, p<0.001). For every 0.3 mg/dL increase in CBB, a neonate was 3.20 (95% confidence interval, 2.31–4.45), 2.10 (1.63–2.70), and 3.12 (2.44–3.99) times more likely to receive phototherapy or have a total serum bilirubin concentration >95th and >75th percentile, respectively. The AUC ± standard error (95% confidence interval) for CBB for phototherapy and a total serum bilirubin concentration >95th and >75th percentile was 0.89 ± 0.03 (0.82–0.95), 0.81 ± 0.04 (0.73–0.90), and 0.84 ± 0.02 (0.80–0.89), respectively. However, the AUC for gestational age and maternal Asian race for these outcomes was only 0.55 ± 0.05 (0.45–0.66), 0.66 ± 0.05 (0.56–0.76), and 0.57 ± 0.04 (0.05–0.64), respectively. When the CBB was combined with gestational age and maternal Asian race, the AUC for a total serum bilirubin concentration >95th percentile improved to 0.87 ± 0.03 (0.81–0.92) (p = 0.034 vs. the model with CBB only and p<0.001 vs. the model with clinical risk factors only). In a sub-group of subjects (n = 189), the AUC for the direct antigen titer for phototherapy was 0.64 ± 0.06 (0.52–0.77) with a 52% sensitivity and 77% specificity. In contrast, a CBB cut-point of 1.85 mg/dL was 92% sensitive and 70% specific for phototherapy with an AUC of 0.87 ± 0.04 (0.80–0.95).ConclusionCBB, in combination with gestational age and maternal race, may be a useful, non-invasive test to predict shortly after birth which neonates will develop severe hyperbilirubinemia.

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“…If there were no previous TSB measurements, ROR was calculated by using an estimated TSB at birth of 1.7 mg/dL. 16,17 Inpatient feeding was categorized as exclusive breast milk feeding, mixed breast milk and formula feeding, or exclusive formula feeding on the basis of nursing flowsheets documenting feeding. For comparison, we developed a model based on the Bhutani Nomogram by assigning each predischarge TSB a Bhutani risk zone (high, high-intermediate, low intermediate, or low).…”

Section: Predictors and Modelsmentioning

confidence: 99%

Predicting the Need for Phototherapy After Discharge

et al. 2021

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BACKGROUND AND OBJECTIVES: Bilirubin screening before discharge is performed to identify neonates at risk for future hyperbilirubinemia. The American Academy of Pediatrics recommends using a graph of bilirubin levels by age (the Bhutani Nomogram) to guide follow-up and a different graph to determine phototherapy recommendations. Our objective was to evaluate predictive models that incorporate the difference between the last total serum bilirubin (TSB) before discharge and the American Academy of Pediatrics phototherapy threshold (D-TSB) to predict a postdischarge TSB above the phototherapy threshold by using a single graph. METHODS:We studied 148 162 infants born at $35 weeks' gestation at 11 Kaiser Permanente Northern California facilities from 2012 to 2017 whose TSB did not exceed phototherapy levels and who did not receive phototherapy during the birth hospitalization. We compared 3 logistic models (D-TSB; D-TSB-Plus, which included additional variables; and the Bhutani Nomogram) by using the area under the receiver operating characteristic curve (AUC) in a 20% validation subset.RESULTS: A total of 2623 infants (1.8%) exceeded the phototherapy threshold postdischarge. The predicted probability of exceeding the phototherapy threshold after discharge ranged from 56% for a predischarge D-TSB 0 to 1 mg/dL below the threshold to 0.008% for D-TSB .7 mg/dL below the threshold. Discrimination was better for the D-TSB model (AUC 0.93) and the D-TSB-Plus model (AUC 0.95) than for the Bhutani Nomogram (AUC 0.88). CONCLUSIONS:The use of D-TSB models had excellent ability to predict postdischarge TSB above phototherapy thresholds and may be simpler to use than the Bhutani Nomogram.

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Post-test probability for neonatal hyperbilirubinemia based on umbilical cord blood bilirubin, direct antiglobulin test, and ABO compatibility results

Cited by 13 publications

References 23 publications

Prevalence of neonatal hyperbilirubinemia and its association with glucose-6-phosphate dehydrogenase deficiency and blood type incompatibility in sub-Saharan Africa: a systematic review and meta-analysis

Prevalence of neonatal hyperbilirubinemia and its association with glucose-6-phosphate dehydrogenase deficiency and blood type incompatibility in sub-Saharan Africa: a systematic review and meta-analysis

Umbilical cord blood bilirubins, gestational age, and maternal race predict neonatal hyperbilirubinemia

Predicting the Need for Phototherapy After Discharge

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