Study of cord blood albumin as a predictor of neonatal jaundice

Background: Neonatal jaundice is a commonly encountered condition in the neonates during first week of life. Early discharge of healthy term newborns is a common practice, because of the risk of nosocomial infections, social causes like in early naming ceremony, and also due to economical constrains. In significant number of newborns, neonatal hyperbilirubinemiais the most common cause for readmission. There is concern regarding early discharge of healthy term newborns due to reports of bilirubin induced brain damage resulting in sequel like kernicterus .There are reports of bilirubin induced brain damage which occurred in healthy term neonates even without hemolysis and the clinical outcome could be serious. The need for early detection of hyperbilirubinemia in the newborns is therefore important. Aims and Objective: The objective of the study was to find whether cord blood albumin can be considered as a predictor of neonatal jaundice. The study also explored for any possible associations of different factors like gender, birth weight and mode of delivery with the occurrence of neonatal jaundice. Materials and Methods: The hospital based cross sectional study enrolled 100 healthy term newborns from August 2016-July 2017. Cord blood was sent for albumin level and blood group estimation. All babies were assessed for clinical jaundice using Krammer criteria and confirmed by estimation of total serum bilirubin level on the fourth day of life. Results: Correlation of cord blood albumin with the fourth day bilirubin level revealed negative correlation (r value of - 0.455) with p value of 0.000 which was highly significant. However, there was no correlation between cord blood albumin level with total serum bilirubin level of more than 17mg/dl (neonatal hyperbilirubinemia) that required phototherapy or exchange transfusion (p value of >0.005). Similarly, the study found no statistically significant association of neonatal jaundice with gender, weight and mode of delivery of the neonates. Conclusion: Cord blood albumin can be a risk factor rather than a diagnostic tool which can give a clue to possibility of high bilirubin level during neonatal period. There was no statistical significance seen between cord blood albumin level with total serum bilirubin level of ≥ 17mg/dl (neonatal hyperbilirubinemia) that required phototherapy or exchange transfusion.

Severe hemolytic disease of the premature newborn due to RH1 incompatibility: a case report

We report a case of dramatic outcome of severe haemolytic disease in a newborn due to RH1 incompatibility. A newborn with A RH1 blood group was admitted in the Mohammed V Military Teaching Hospital for the problem of hydrops fetalis associated with RH1 incompatibility. The blood group of his mother, aged 31, was AB RH1-negative and that of his 37 year old father was A RH1.The mother had a history of 4 term deliveries, 3 abortions, and 1 living child. There was no prevention by anti-D immunoglobulin postpartum. The mother‘s irregular agglutinin test was positive and the pregnancy was poorly monitored. The laboratory tests of the newborn showed a high total serum bilirubin level (30 mg/L) and macrocytic regenerative anemia (Hemoglobin=4 g/dL, mean corpuscular volume = 183 fL, reticulocytes count =176600/m3). The blood smear showed 1256 erythroblasts per 100 leukocytes, Howell–Jolly bodies and many macrocytes. The direct antiglobulin test was positive. He was transfused with red blood cell concentrates and treated with conventional phototherapy. The evolution was unfavourable; he died three days after the death of his mother. The monitoring of these high-risk pregnancies requires specialized centers and a close collaboration between the gynaecologist and the blood transfusion specialist to strengthen the prevention, as well as clinico-biological monitoring in patients with a history of RH1 fetomaternal alloimunization.

Incidence of neonatal hyperbilirubinemia in low, intermediate-low, and intermediate-high risk group infants

Background Neonatal hyperbilirubinemia is commonly found in newborns. Assessment of the risk of hyperbilirubinemia and information on the average time of the occurrence of hyperbilirubinemia are important to prevent the development of severe hyperbilirubinemia.Objective To find out the incidence of and the time of the development of hyperbilirubinemia in healthy-term newborns.Method A cohort prospective study was done on healthy-term newborns born at Hasan Sadikin Hospital between November and December 2009. Subjects were divided into 4 groups of risk at discharged, based on Bhutani nonnogram. A serial bilirubin level measurement were perfonned within 6 days.Resu l ts One of 14 newborns at low risk group developed hyperbilirubinemia but did not need phototherapy. Six of 14 newborns at intermediate-low risk group developed hyperbilirubinemia, 2 of them needed phototherapy with total serum bilirubin level of 14.7 mg/dL at 57 hours and 19.8 mg/dL at111 hours. Nine of 15 newborns of intennediate-high risk group developed hyperbilirubinemia, 1 of them needed phototherapy with total serum bilirubin level of 16.6 mg/dL at 76 hours. There was no newborn cathegorized as high risk group in this study. The median time the occurrence of hyperbilirubinemia in intennediate-low and intennediate-high risk group was 140 hours and 82 hours, respectively. There was no significant difference in survival curve between intennediate-high and intennediate-low risk groups (95% CI 108.1 to 1 2 5.4).Conclusion The incidence of hyperbilirubinemia was not different between intennediate-low and intermediate-high risk babies.

Neonatal Jaundice—A Comparison between Intravenous Oxytocin and Oral Prostaglandin E2

The total serum bilirubin levels at two and occasionally five days after birth were studied in 162 infants whose mothers received either intravenous oxytocin or oral Prostaglandin E2 during labour, and the results were compared with those obtained in forty-two control patients. Following labour of spontaneous onset, whether the mother received intravenous oxytocin or oral Prostaglandin E2, neonatal total serum bilirubin levels were not different from those in controls. After induction by amniotomy and an active agent, higher mean total serum bilirubin levels were found in infants whose mothers received intravenous oxytocin than in those given oral Prostaglandin E2; a significant rise in the total serum bilirubin level appeared to occur when mothers received a total of more than 12,000 milliunits of oxytocin or more than 4,000 milliunits per kg birthweight of the infant.