Bilirubin dosage in cord blood
could it predict neonatal hyperbilirubinemia?
Keywords:
Newborn, Hyperbilirubinemia, Umbilical cordAbstract
CONTEXT: With early discharge, many newborns have to be readmitted to hospital for hyperbilirubinemia to be treated, and this has been held responsible for the reappearance of kernicterus. OBJECTIVE: To evaluate whether bilirubin levels in cord blood could predict neonatal hyperbilirubinemia that would require treatment, in full-term newborns up to their third day of life. TYPE OF STUDY: Prospective study. SETTING: Neonatal Unit of Hospital Israelita Albert Einstein, São Paulo, Brazil. PARTICIPANTS: 380 full-term newborns considered normal: with or without ABO/Rh blood group incompatibility and without other complications. PROCEDURES: Blood was taken from the umbilical cord for analysis of conjugated, unconjugated and total bilirubin serum levels. The newborns were followed up until discharge, and unconjugated bilirubin that required phototherapy was compared to the cord bilirubin assay. Discriminant analysis was used to classify newborns: with or without risk of needing phototherapy by the third day of life. MAIN MEASUREMENTS: Bilirubin assay in cord blood; mother’s and newborn’s blood groups; phototherapy indication. RESULTS: The mean value for unconjugated bilirubin in cord blood was significantly higher in newborns whose unconjugated bilirubin required phototherapy. The presence of ABO blood group incompatibility was a significant variable in relation to unconjugated bilirubin that required phototherapy. The most useful cutoff point for unconjugated bilirubin in cord blood was 2.0 mg/100 ml. DISCUSSION: Cord blood could be collected, stored and used for further analysis of unconjugated bilirubin levels as a means for considering whether or not to discharge a moderately jaundiced child from hospital, in association with other resources. CONCLUSIONS: Blood incompatibility between mother and child was a predictor for the appearance of hyperbilirubinemia that required treatment. Considering a cutoff point of 2.0 mg/100 ml, it could be concluded that 53% of the newborns who had greater unconjugated bilirubin levels in cord blood would reach levels requiring phototherapy by the third day.
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References
Maisels MJ. Jaundice. In: Avery GB, Fletcher MA, MacDonald MG, editors. Neonatology. Pathophysiology and management of the newborn. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 1999. p.765-819.
Lasker MR, Holzman IR. Neonatal jaundice: when to treat, when to watch and wait. Postgrad Med. 1996;99(3):187-93, 197-8.
Johnson L, Buthani VK. Guidelines for management of the jaundiced term and near-term infant. Clin Perinatol. 1998;25(3):555-74.
Halameck LP, Stevenson DK. Neonatal jaundice and liver dis- ease. In: Fanaroff AA, Martin RJ, editors. Neonatal perinatal medicine. Diseases of the fetus and infant. 6th ed. St Louis: Mosby; 1997. p.1345-89.
Practice parameter: management of hyperbilirubinemia in the healthy term newborn. American Academy of Pediatrics. Provi- sional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia. Pediatrics. 1994;94(4 Pt 1):558-65.
Segre CAM. Informações perinatais. Relatório de atividades. São Paulo: Hospital Israelita Albert Einstein; 1999.
Kiely M, Drum MA, Kessel W. Early discharge. Risks, benefits, and who decides. Clin Perinatol. 1998;25(3):539-53.
Oshiro CGS, Gallaci CB. Alta hospitalar precoce em RN a termo: existe alguma vantagem? Atualizando. 1996;2:1-2.
Hansen TW. Kernicterus: an international perspective. Semin Neonatol. 2002;7(2):103-9.
Brown AK, Johnson L. Loss of concern about jaundice and the reemergence of kernicterus in full-term infants in the era of managed care. In: Fanaroff AA, Klaus MH, editors. Yearbook of neonatal and perinatal medicine. St. Louis: Mosby Yearbook; 1996. p.17-28.
Catz C, Hanson JW, Simpson L, Yaffe SJ. Summary of work- shop: early discharge and neonatal hyperbilirubinemia. Pediatrics. 1995;96(4 Pt 1):743-5.
Silverman JA. Early discharge causes “jaundice problem”. Pediatrics. 1988;81(1):174-5.
Wennberg RP, Ahlfors CE. Discharging the jaundiced infant from the hospital: risky for the infant or physician? Pediatrics. 1988;81(1):175.
Roberts J. US warns against early discharge of babies. BMJ. 1995;311(7012):1041-2.
Maisels MJ, Newman TB. Jaundice in full-term and near-term babies who leave the hospital within 36 hours. The pediatrician’s nemesis. Clin Perinatol. 1998;25(2):295-302.
Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent sig- nificant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999;103(1):6-14.
Capurro H, Konichezky S, Fonseca D, Caldeyro-Barcia R. A simplified method for diagnosis of gestational age in the new- born infant. J Pediatr. 1978;93(1):120-2.
Kramer LI. Advancement of dermal icterus in the jaundiced newborn. Am J Dis Child. 1969;118(3):454-8.
Gomella TL, Cunningham MD, Eyal FG. Phototherapy table. In: Gomella TL, Cunningham MD, Eyal FG, editors. Neonatology. Management, procedures, on-call problems, diseases and drugs. 3rd ed. Norwalk: Appleton and Lange; 1994. p.564.
Thilo EH, Townsend SF, Merenstein GB. The history of policy and practice related to the perinatal hospital stay. Clin Perinatol. 1998;25(2):257-70.
Radmacher P, Massey C, Adamkin D. Hidden morbidity with “successful” early discharge. J Perinatol. 2002;22(1):15-20.
Risemberg HM, Mazzi E, MacDonald MG, Peralta M, Heldrich F. Correlation of cord bilirubin levels with hyperbilirubinaemia in ABO incompatibility. Arch Dis Child. 1977;52(3):219-22.
Rosenfeld J. Umbilical cord bilirubin levels as a predictor of sub- sequent hyperbilirubinemia. J Fam Pract. 1986;23(6):556-8.
Knudsen A. Prediction of the development of neonatal jaun- dice by increased umbilical cord blood bilirubin. Acta Paediatr Scand. 1989;78(2):217-21.
