value of bilicheck[registered sign] as a screening tool for neonatal jaundice in the South of Iran

The gold standard to assess jaundice in neonates is the serum bilirubin measurement. Blood sampling for the determination of total serum bilirubin [TSB] is painful for newborns and stressful for parents. The Bilicheck[registered sign], a new transcutaneous bilirubinometer, is considered as a more accurate measurement of bilirubin compared to the previous bilirubinometers courtesy of its advanced technology. The objective of this study was to evaluate the correlation between transcutaneous bilirubin [TcB] measurements using the Bilicheck[registered sign] device and TSB in some Iranian neonates and to determine the most reliable cut-off value with the highest sensitivity and desirable specificity for bilirubin measured by the Bilicheck[registered sign] on the forehead. This prospective observational study was conducted in 2011 on 560 healthy neonates with jaundice. TcB was measured using the Bilicheck[registered sign] [Respironic, USA] within 30 minutes of TSB measurement via direct spectrophotometry. The results were assessed by simple linear regression analysis and receiver operative characteristic curve. There was good a correlation between TcB and TSB [r=0.969, r2=0.94], and this was not affected by sex, gestational age, postnatal age, and birth weight. TSB can be calculated through the measurement of TcB and use of the linear regression equation: TSB=-0.99+1.06TcB. Sensitivity and specificity of the Bilicheck[registered sign] at the most reliable cut-off value [15 mg/dl] were 96.6% and 99%, respectively. The findings of the present study indicate that the Bilicheck[registered sign] is a non-invasive, simple, easy, and reliable method for bilirubin measurement in neonatal jaundice, especially in neonates with bilirubin levels

Frequency of profound congenital hearing loss in healthy newborn infants in Fars province

Deafness is one of the most important sensory disturbances at birth. Hearing loss can affect the development of speaking and learning during life. Early diagnosis and intervention improve language outcome. The current study aimed to determine the frequency of profound congenital hearing loss in healthy newborn infants in Fars province. In a multicenter prospective study, from August 2010 to August 2011, 12573 newborns were screened for hearing loss prior to discharge from the wellborn nursery at nine teaching and private hospitals in Fars province. A three-stage hearing screening protocol using transient evoked otoacoustic emissions [TEOAE] screening with referral for diagnostic second TEOAE and auditory brainstem evoked response [ABER] assessment was employed. All neonates with abnormal initial TEOAE screening, followed with phone call for language outcome after one year. Newborns with hospital admission or drug administration excluded from the study. The overall pass rate in the initial screening was 91.8%, thus 1019[8.1/1000] neonates referred for diagnostic audiological assessments. Out of 1019 infants scheduled for follow-up study, only 619 neonates returned. Using follow-up letters and phone calls, it was managed to improve the response rate for language outcome after one year. Two infants were identified with profound bilateral congenital hearing impairment. These infants were immediately referred for cochlear implantation. Findings of the current study showed that the frequency of profound congenital hearing loss is 0.159/1000 normal newborn infants in Fars province. The initial TEOAE has high false positive that may be due to occlusion of external ear canal by vernix in the early postnatal period

Prevalence of Gilbert syndrome in parents of neonates with pathologic indirect hyperbilirubinemia

The cause of hyperbilirubinemia cannot be found in about 45% of cases of neonatal jaundice. Gilbert syndrome [GS] is the most common congenital disease associated with bilirubin metabolism in the liver. Since the screening value of genetic tests cannot be fully determined until accurate data on the prevalence and penetrance of the GS genotype are known, we sought to estimate whether the prevalence of GS is higher in the parents of neonates with severe unexplained indirect hyperbilirubinemia. Case-control study of parents of neonates with severe unexplained indirect hyperbilirubinemia admitted to a neonatal ward. We used the rifampin test [checked bilirubin before and 4 hours after administration of 600 mg rifampin] for diagnosis of GS in parents of 115 neonates with severe unexplained indirect hyperbilirubinemia. We compared the prevalence of GS in these parents with that of a control group of 115 couples referred for premarital counseling. The 115 neonates were aged 5.2 [1.6] days [mean, standard deviation], all were breast-fed, and males constituted 56.5%. Mean total serum bilirubin [TSB] level was 20.96 [5.48] mg/dL. 14.8% were glucose 6 phosphate dehydrogenase [G6PD] deficiency was present in 14.8%, and 10.4% had A, B or O blood group [ABO] incompatibilities with their mothers. There was no difference in the prevalence of GS between parents of the group with hyperbilirubinemia [22.2%] and the control group [19.13%] [P=.42]. Mean TSB in neonates with parents who had GS was more [about 3 mg/dL] than in neonates with normal parents [P=.004]. Fathers had GS twice as often as the mothers among the parents of neonates with hyperbilirubinemia [P=.003], among the control group [P=.009] and among neonates [P=.014]. This study showed that GS cannot cause severe indirect hyperbilirubinemia by itself, but it may have a summative effect on rising bilirubin when combined with other factors, for example, G6PD. Our results showed that in GS, males are affected about twice as much as the females