Predischarge non-invasive risk assessment for prediction of significant hyperbilirubinemia in term and late preterm neonates

Abstract

Objective: To evaluate efficacy of predischarge transcutaneous bilirubin (TcB) measurement and clinical risk assessment in predicting hyperbilirubinemia needing treatment.Study Design: A diagnostic test was performed in a prospective cohort study conducted at a teaching hospital in North India. Subjects included healthy neonates with a gestation period of X35 weeks or birth weight X2000 g. Maternal, neonatal and delivery risk factors for hyperbilirubinemia were prospectively collected. TcB was measured in all enrolled neonates at 24±6, 72 to 96 and 96 to 144 h of postnatal age and when indicated clinically. Neonates were followed up during hospital stay and after discharge till completion of the 7th postnatal day. The key outcome was significant hyperbilirubinemia defined as need of phototherapy on the basis of modified American Academy of Pediatrics guidelines. In neonates born at X38 weeks of gestation and in neonates born at p37 completed weeks of gestation, middle line and lower line of phototherapy thresholds were used to initiate phototherapy, respectively. Variables observed to be significantly associated with significant hyperbilirubinemia on multivariate analysis were used for construction of a clinical risk assessment tool. Predictive ability of the risk assessment tool was assessed by calculating sensitivity, specificity, positive predictive value and negative predictive value, by plotting receiver-operating characteristics curve and calculating c-statistic.Result: A total of 997 neonates (birth weight: 2627 ± 536 g, gestation: 37.8 ± 1.5 weeks) were enrolled in the study, of which 931 completed follow-up. Among enrolled neonates, 344 (34.5%) were low birth weight. Overall, a total of 199 (20%) neonates developed significant hyperbilirubinemia. On stepwise logistic regression analysis, predischarge TcB percentile and gestation were significantly found to be associated with significant hyperbilirubinemia. A risk assessment graph was constructed to predict subsequent development of significant hyperbilirubinemia. Area under curve for this risk assessment strategy was 0.75. Conclusion:A risk assessment graphical tool consisting of TcB and gestation accurately predicted subsequent need of phototherapy. Further studies are needed to validate performance of this risk assessment tool.

Risk Factors for Severe Neonatal Hyperbilirubinemia in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis

“…There were wide variations in the primary outcomes, diagnostic criteria and putative risk factors explored across studies. In the three prospective cohort studies [ 25 , 30 , 31 ] included in the meta-analysis, follow-up was within 7 postnatal days and the reported attrition rate was less than the 20% general rule of thumb [Song & Chung, 2010].…”

“…The pooled data of the two studies from India [ 24 , 33 ] that explored the contribution of UGT1A1 polymorphisms to the risk of neonatal hyperbilirubinemia showed significant cumulative risk estimate (OR, 4.92; 95% CI, 1.30–18.62, p = 0.019), with high heterogeneity (I 2 = 74.0%). Gestational age in relation to the risk of severe hyperbilirubinemia in two studies from India [ 30 , 31 ] and the pooled data showed that infants with low gestational age (<37 weeks) were at increased risk of severe hyperbilirubinemia (OR, 1.71; 95% CI, 1.40–2.11, p<0.0001), with low heterogeneity (I 2 = 0.0%). Four studies from Nigeria [ 26 , 27 ], Egypt [ 28 ] and India [ 33 ] examined the role of infant weight on admission for severe jaundice.…”

Incidence of and risk factors for neonatal jaundice among newborns in southern Nepal

“…Transcutaneous bilirubinometers correlate well with serum bilirubin and to be valid indicators of hyperbilirubinemia in preterm and term neonates (Kaur et al . ). There are also relatively inexpensive instruments such as the icterometer and the jaundice meter that are non‐invasive diagnostic tools that have been used for many years to improve the visual assessment of jaundice in neonates and could be used in community‐based studies in low‐resource settings.…”

Early breastfeeding initiation and incidence of severe neonatal jaundice in Chipinge district Zimbabwe

“…There is need to assess neonatal jaundice objectively as clinical assessment through eye observation has limitation in picking at risk babies. 18,19 Early breastfeeding initiation still holds an upper hand in reducing incidence of neonatal jaundice in the first week of life.…”