Predictability of transcutaneous bilirubinometry in late preterm and term infants at risk for pathological hyperbilirubinemia

2020 ◽  
pp. 1-7
Author(s):  
E. Dianova ◽  
J. Fogel ◽  
R.P. Verma
Keyword(s):  
At Risk ◽  
Serum Bilirubin Level ◽  
Late Preterm ◽  
Term Infants ◽  
Term Neonates ◽  
Transcutaneous Bilirubin ◽  
Immune Mediated ◽  
Positive Direct ◽  
Neonatal Population ◽  
Transcutaneous Bilirubinometry

BACKGROUND: The aim was to assess the predictability of transcutaneous bilirubinometry in late preterm and term neonates at risk for pathological hyperbilirubinemia, and to identify the neonatal population in which transcutaneous bilirubin most accurately predicts serum bilirubin level (SB, mg/dl). METHODS: The correlations between transcutaneous bilirubin (TCB, mg/dl) and SB in different neonatal population subsets; and between ΔTSB (TCB-SB) and relevant neonatal variables and clinical groups were analyzed. RESULTS: TCB correlated with SB (r = 0.82, p <  0.05) in the cohort (n = 350) and in population subsets (r = 0.81–0.9, p <  0.001). Black infants with gestational age (GA) >35 weeks and chronological age (CA) >3 days recorded strongest correlation (r = 0.9, p <  0.001) followed by Blacks, and non-Black infants with CA >3 days and GA >35 weeks. ΔTSB was positive in Blacks, and in infants with CA <3 days, or with no phototherapy. ΔTSB was negative in non-Blacks, in infants with positive direct Coombs test (DC+) or those receiving phototherapy. Black race [beta (SE) = 1.3(0.33), p <  0.001] had positive, while CA [beta (SE) =−1.74 (0.36), p <  0.001], DC + status [beta (SE) =−0.72 (0.25), p = 0.004] and receipt of phototherapy [beta (SE) =−0.84 (0.21), p <  0.001] each had negative correlation with ΔTSB. ΔTSB for Blacks was >Whites, Hispanics and Asians. CONCLUSION: SB is best predicted by TCB in Black infants with CA over 3 days and GA over 35 weeks. Variability in SB estimation by TCB is race, CA and immune mediated hemolysis specific.

scholarly journals Morbidity profile and immediate outcome of late preterm neonates compared to term neonates in a rural tertiary care hospital of Gujarat

2017 ◽  
Vol 4 (4) ◽  
pp. 1329 ◽  
Author(s):  
Manish Rasania ◽  
Prasad Muley
Keyword(s):  
Preterm Infants ◽  
Tertiary Care ◽  
Preterm Births ◽  
Full Term ◽  
Late Preterm ◽  
Preterm Neonates ◽  
Care Hospital ◽  
Term Infants ◽  
Term Neonates ◽  
Late Preterm Infants

Background: Late premature infants are born near term, but are immature. As a consequence, late preterm infants are at higher risk than term infants to develop morbidities. Although late preterm infants are the largest subgroup of preterm infants, there is a very limited data available on problems regarding late preterm infants in rural India.Methods: This is a retrospective cohort study using previously collected data from neonates born at Dhiraj Hospital and neonates who were born outside but admitted at SNCU of Dhiraj Hospital, Piparia, Vadodara district, Gujarat, India between January 2015 to December 2015.Results: 168 late preterm infants and 1025 term infants were included in this study. The need for SNCU admission is significantly higher in late preterm compared to full term (41.07% vs 2.04%). Morbidities were higher in late preterm neonates compared to full term neonates. Sepsis (4.76% vs 1.07%), TTN (10.11% vs 2.04%), hyperbilirubinemia (19.04% vs 9.36%), RDS (1.78% vs 0.09%), hypoglycemia (1.78% vs 0.29%), PDA (1.78% vs 0.58%), risk of major congenital malformation (2.38% vs 0.58%). Need for respiratory support was 5.95% in late preterm vs 2.04% in full term neonates. Immediate neonatal outcome in terms of death and DAMA (non-salvageable) cases was poor in late preterm neonates compared to full term neonates (1.19% vs 0.78%).Conclusions: Late preterm neonates are at higher risk of morbidities and mortalities. They require special care. Judicious obstetric decisions are required to prevent late preterm births. 

scholarly journals Early neonatal morbidities in late preterm compared to term neonates born in a tertiary care private hospital

2020 ◽  
Vol 7 (3) ◽  
pp. 565
Author(s):  
Yogesh P. Mehta ◽  
Manjusha Bhicurao Naik ◽  
Kinnera Putrevu
Keyword(s):  
Preterm Infants ◽  
Tertiary Care ◽  
Full Term ◽  
Late Preterm ◽  
Term Infants ◽  
Term Neonates ◽  
Late Preterm Infants ◽  
Increased Risk ◽  
Preterm Babies ◽  
Term Newborns

Background: Late preterm babies, born between 34 completed weeks of gestation through 36 weeks 6/7 gestation, tend to be physiologically less mature than term infants, subjecting them to an increased risk of developing various morbidities. Limited information is available regarding the current scenario in India. Therefore, the objective of this study was to understand and compare the early morbidities in late preterm newborns with those in full term babies in a tertiary hospital in India.Methods: The current prospective, observational study consisted of total 150 babies divided into two groups equally; late preterm neonates born between 34 and 36 weeks of gestation and full-term neonates. Weight (at birth, at 72 hours), heart rate, temperature and respiratory parameters were noted of all babies. The newborns were examined for respiratory morbidities, ability to breastfeed, hypoglycemia, hypothermia, neonatal jaundice and signs of sepsis. The need for resuscitation, admission to neonatal intensive care unit (NICU) and parenteral nutrition was also assessed. Data was expressed as mean±SD and was analyzed using the Student ‘t’ and Mann Whitney U tests.Results: The mean length and weight at birth in late preterm babies was significantly lesser than term newborns. Late preterm babies were found to have significantly higher incidence of complications like hyperbilirubinemia (62.7% vs 13.3%), respiratory morbidities (16% vs 4%), poor feeding, hypothermia, hypoglycemia, and sepsis compared to term newborns (p<0.01).Conclusions: Late preterm infants are at a higher risk than term infants for a number of neonatal complications. Initiatives imparting special care to late preterm infants are required in order to lower the morbidities endured by this population.

scholarly journals Placental histopathology in late preterm infants: clinical implications

2020 ◽  
Vol 63 (2) ◽  
pp. 48-51
Author(s):  
Kristina Ericksen ◽  
Joshua Fogel ◽  
Rita P. Verma
Keyword(s):  
Magnesium Sulfate ◽  
Preterm Labor ◽  
Antibiotic Use ◽  
Late Preterm ◽  
Retrospective Case ◽  
Intrauterine Environment ◽  
Term Infants ◽  
Term Neonates ◽  
Maternal Hypertension ◽  
Control Study

Background: The etiopathogenesis of late preterm (LPT) birth is undetermined. Placental histopathology, which reflects an adverse intrauterine environment and is reportedly associated with preterm labor and neonatal morbidities, has not been studied in LPT infants.Purpose: We investigated placental pathological lesion as markers of an adverse intrauterine environment during LPT labor.Methods: This retrospective case-control study compared placental histopathological and clinical variables between LPT and term neonates. Placental variables included chorioamnionitis, funisitis, hemorrhage, abruption, infarction, calcification, and syncytial knots. Maternal variables included age, substance abuse, pregnancyassociated diabetes mellitus and hypertension, duration of rupture of membrane, antibiotic use, and magnesium sulfate, whereas, those of neonates included gestational age, birth weight, race, sex, and Apgar scores. Standard statistical proedures were applied to analyze the data.Results: Chorioamnionitis (50% vs. 17.8%, <i>P</i><0.001) and funisitis (20% vs. 4.4%, <i><i>P</i></i>=0.002) were more common in term infants. Placental infarction rate was insignificantly higher in LPT infants (25.6% vs. 14.3%, <i><i>P</i></i>=0.08). The mothers in the LPT group were older (30.4 years vs. 28.1 years, <i><i>P</i></i>=0.05; odds ratio [OR], 1.06; 95% confidence interval [CI], 0.998–1.12, <i><i>P</i></i>=0.056) and more often suffered from hypertension (28.9 vs. 12.9 %, <i><i>P</i></i>=0.02), and received magnesium sulfate (48.9 vs. 20%, <i>P</i>< 0.001; OR, 2.86; 95% CI, 1.12–7.29, <i>P</i><0.05). Duration of rupture of membrane was higher in term infants (13.6 hours vs. 9.1 hours, <i>P</i><0.001). Chorioamnionitis (OR, 0.33; 95% CI, 0.13–0.79; <i>P</i><0.05) was associated with a lower risk of LPT delivery.Conclusion: Placental infection is not a risk factor for LPT births. There is a nonsignificant predominance of vascular anomalies in LPT placentas. Higher maternal age, magnesium sulfate therapy, and maternal hypertension are clinical risk factors for LPT labor.

scholarly journals Effects of Skin-to-Skin Care on Late Preterm and Term Infants At-Risk for Neonatal Hypoglycemia

2017 ◽  
Vol 2 (4) ◽  
pp. e030 ◽  
Author(s):  
Arpitha Chiruvolu ◽  
Kimberly K. Miklis ◽  
Karen C. Stanzo ◽  
Barbara Petrey ◽  
Chelsey G. Groves ◽  
...  
Keyword(s):  
At Risk ◽  
Skin Care ◽  
Late Preterm ◽  
Neonatal Hypoglycemia ◽  
Term Infants ◽  
Skin To Skin

Accuracy of transcutaneous bilirubin measured by the BiliCare device in late preterm and term neonates

2016 ◽  
Vol 29 (22) ◽  
pp. 3641-3645 ◽  
Author(s):  
Ratchada Kitsommart ◽  
Buranee Yangthara ◽  
Punnanee Wutthigate ◽  
Bosco Paes
Keyword(s):  
Late Preterm ◽  
Term Neonates ◽  
Transcutaneous Bilirubin

scholarly journals Kramer’s scale or transcutaneous bilirubinometry: the ideal choice of a pediatrician? can we trust our eyes?

2019 ◽  
Vol 6 (5) ◽  
pp. 1794 ◽  
Author(s):  
Pearl Mary Varughese
Keyword(s):  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Roc Curves ◽  
Serum Bilirubin Level ◽  
Total Serum ◽  
Neonatal Septicemia ◽  
Transcutaneous Bilirubin ◽  
Non Invasive ◽  
Transcutaneous Bilirubinometer ◽  
Transcutaneous Bilirubinometry

Background: Neonatal hyperbilirubinemia, though benign in 80% cases, can lead to kernicterus if not diagnosed and treated early. The golden method of estimation is measuring serum bilirubin levels. Both Kramer’s scale and Transcutaneous bilirubinometer are non -invasive methods. Its high time the pediatricians choose an ideal non-invasive and reliable method to detect hyperbilirubinemia. Objective of this study is to find out which has a better correlation with serum bilirubin - transcutaneous bilirubinometer reading (TcB) or Kramer's scale.Methods: The study was conducted in a tertiary newborn center from November 2014 to June 2016. The inclusion criteria included all babies above 34 weeks gestation and exclusion criteria included babies with established direct hyperbilirubinemia, neonatal septicemia, major congenital/ gastrointestinal malformations and those on phototherapy. The sample size was 450 and the correlation was analyzed using ROC curves and plots of agreement was done using Bland Altman charts.Results: The incidence of significant Hyperbilirubinemia is 12%. Transcutaneous bilirubin level had a better correlation and prediction level compared to Kramer at both 24 hours and 48 hours. Bland Altman analysis showed that transcutaneous values were closer to the total serum bilirubin level compared to Kramer values.Conclusion: Transcutaneous bilirubinometry is a better and more ideal choice to replace serum bilirubin levels. In settings where TcB is not feasible, it’s always best to screen for jaundice using Kramer’s scale rather than estimating serum bilirubin values in all babies. In babies where TcB levels are above the cut off range, it’s better to do serum bilirubin levels.

scholarly journals Updates on an At-Risk Population: Late-Preterm and Early-Term Infants

PEDIATRICS ◽  
2019 ◽  
Vol 144 (5) ◽  
pp. e20192760 ◽  
Author(s):  
Dan L. Stewart ◽  
Wanda D. Barfield ◽  
Keyword(s):  
At Risk ◽  
Late Preterm ◽  
Term Infants ◽  
Risk Population ◽  
Early Term

Correlation between Non-invasive Measurement of Carboxyhemoglobin and Bilirubin Level Measurement in Near- Term and Term Neonates as a Predictor of Neonatal Hemolysis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hisham A Awad ◽  
Basma M Shehata ◽  
Marina A Fouad
Keyword(s):  
Bilirubin Level ◽  
Early Discharge ◽  
Serum Bilirubin Level ◽  
Cross Sectional ◽  
Term Neonates ◽  
Transcutaneous Bilirubin ◽  
Non Invasive ◽  
Level Measurement ◽  
Discharge Policy ◽  
Near Term

Abstract Background Neonatal hyperbilirubinemia is common in the neonatal period. Yet, serious pathological hyperbilirubinemia may cause kernicterus with detrimental neurologic sequalae. Carbon monoxide (CO) is the byproduct of the breakdown of heme, it is transported as carboxyhemoglobin to the lungs to be exhaled. Thus, carboxyhemoglobin levels increase as a result of hemolysis, and is therefore considered a sensitive index for the degree and severity of the subsequent hyperbilirubinemia. Objectives To correlate between non-invasive carboxyhemoglobin levels and bilirubin levels in near-term and tem neonates starting hour I of life. Subjects and methods A total of 100 near-term and term neonates were studied, by measuring carboxyhemoglobin by a Pulse CO-oximetry and serum bilirubin level (hour l) and transcutaneous bilirubin (TcB) hourly since birth for the I st 6 hours then every 6 hours till the time of discharge in a cross sectional case-control study. Results A cut off value of 4 for non-invasive carboxyhemoglobin with sensitivity of 81.25%, specificity of 95.24% was found to the earliest non-invasive predictor for subsequent jaundice. In patients with proven hemolysis, carboxyhemoglobin when compared to TcB was found to increase significantly in the first 3 hours of life more than TcB, stalting hour 4 till time of discharge it was increased yet statistically insignificant Conclusion We found that non-invasive carboxyhemoglobin is an effective early predictor for subsequent jaundice starting first hour of life. It can be used as a screening tool for hemolytic jaundice especially in hospitals with early discharge policy.

scholarly journals Non invasive trans-cutaneous bilirubin as a screening test to identify the need for serum bilirubin assessment in healthy term neonates

2014 ◽  
Vol 1 (4) ◽  
pp. 17-21 ◽  
Author(s):  
BK Gupta ◽  
N Chaudhary ◽  
BD Bhatia ◽  
Binod Gupta
Keyword(s):  
Bilirubin Level ◽  
Clinical Assessment ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Trained Observer ◽  
Term Neonates ◽  
Transcutaneous Bilirubin ◽  
Non Invasive

INTRODUCTION: Hyperbilirubinemia is a common problem in the neonates. It can progress to develop kernicterus unless intervention is initiated. Severity of jaundice and decision for management are usually based on total serum bilirubin (TsB) estimation which technique and results closely correlates with total serum bilirubin levels. OBJECTIVES: To compare the accuracy of visual assessment of jaundice by single trained observer based on Kramer's index with total serum bilirubin levels in healthy term neonates. To compare accuracy of non invasive bilirubin assessment with serum bilirubin levels, to compare trans-cutaneous bilirubin assessment on different sites (forehead and sternum) and to develop a cutoff point oftrans-cutaneous bilirubin level for serum bilirubin assessment. METHODS: This prospective study was conducted in the Neonatal unit of the department of Paediatrics at Kasturba Hospital ,Manipal. Study period was from October 2007 to June 2008. Clinical assessment of jaundice was done in healthy term neonates by observer (Trained Paediatric Post Graduate Resident) based on Kramer's index. Transcutaneous bilirubin assessment was done on the forhead and sternum of each baby using JM-103 Minolta. Air shields bilirubino meter. Serum bilirubin level was measured within 30 minutes of the clinical assessment for each baby. RESULTS: This study included 187 healthy term neonates. The mean birth weight was 2856.83gm ± 493.89gm and mean gestation was 38.25+ 1.030 SD. Clinical assessment and Transcutaneous bilirubin(TcB) significantly correlated with total serum bilirubin (TsB), with correlation co-efficient of 0.757 and 0.801 respectively (p 0.0001). Transcutaneous bilirubin assessment over forehead showed a tendency to under estimate total serum bilirubin, with mean difference of-0.31 mg/dl, SD 1.75 mg/dl with 95% confidence interval ofthe mean -0.60 and -0.02 mg/dl (p value 0.05).Transcutaneous bilirubin assessments between 10 mg/dl to 15 mg/dl correlated accurately with total serum bilirubin levels avoiding blood sampling. CONCLUSION: Trained observer clinical assessment of jaundice can be used for screening neonatal jaundice. Non invasive transcutaneous bilirubin assessment has demonstrated significant accuracy with serum bilirubin level estimates between 48 hours to 7 days on two different sites forehead and sternum. DOI: http://dx.doi.org/10.3126/jucms.v1i4.9567 Journal of Universal College of Medical Sciences (2013) Vol.1 No.04: 17-21

Sign in / Sign up

Export Citation Format

Share Document