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Objective:To study the predictive value of total serum bilirubin (TSB) and the ratio of bilirubin to albumin (B/A) in neonatal acute bilirubin encephalopathy (ABE).Methods:Neonates with extremely severe hyperbilirubinemia (TSB≥425 μmol/L) treated in the Nanjing Maternal and Child Health Hospital, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Northwest Women and Children's Hospital, Yinchuan Maternal and Child Health Hospital and Liaocheng People's Hospital from March 2018 to August 2019 were selected as prospective subjects for this study. According to the score of brain injury induced by bilirubin, the subjects were divided into ABE group and non-ABE group, and the predictive value of TSB peak and B/A for neonatal ABE were analyzed.Results:A total of 194 infants with extremely severe hyperbilirubinemia were recruited in this study, including 20 in ABE group and 174 in non-ABE group. The peak value of bilirubin ranged from 427 to 979 μmol/L. The optimal critical values of TSB peak value and B/A for ABE prediction were 530 μmol/L and 9.48, respectively. The sensitivity and specificity of ABE prediction were 85.0% and 92.8% when combined with TSB peak and B/A values.Conclusions:TSB peak combined with B/A value can effectively identify neonatal ABE. When the TSB peak value was greater than 530 μmol/L and the B/A value was greater than 9.48, the neonates had a higher risk of neonatal ABE.
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Objective:To study the predictive value of hour-specific total serum bilirubin(TSB) nomogram combined with clinical risk factors in the risk of hyperbilirubinemia.Method:Perinatal clinical data of newborns born in Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai Pudong New Area People's Hospital and Shanghai Pudong Hospital from August 2017 to July 2018 were collected in this prospective study. Transcutaneous bilirubin (TcB) was monitored before discharge from hospital. Enrolled neonates were followed up for 28 days. The patients were assigned to neonatal hyperbilirubinemia group (NHB) and non-hyperbilirubinemia group (Non-HB) according to the occurrence of hyperbilirubinemia. The predictive value of models for the risk of hyperbilirubinemia was evaluated by receiver operating characteristic (ROC) curves and Logistic regression analysis.Result:A total of 8 664 newborns were included in this study, with 1 196 cases of hyperbilirubinemia, with an incidence of 13.8%. Logistic regression analysis showed that maternal blood type O, premature rupture of membranes, male gender, gestational age 35~37 weeks, subcutaneous ecchymosis/cranial edema, and breastfeeding were independent risk factors for NHB ( P<0.05). The area under receiver operative characteristic curve (ROC) of predischarge bilirubin risk zone only was 0.874(95% CI 0.861~0.885, P<0.05)and for all independent risk factors was 0.664 (95% CI 0.647~0.680, P<0.05). The area under ROC curve was 0.891 (95% CI 0.880~0.902, P<0.05) by combining predischarge bilirubin risk zone with clinical risk factors. Conclusion:Predischarge bilirubin risk zone combined with clinical risk factors can reasonably predict neonatal hyperbilirubinemia well.
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Background: NH affects nearly 60% of term and 80% of preterm neonates during first week of life. 6.1% of well term newborn have a serum bilirubin over 12.9 mg%. Serum bilirubin over 15 mg% is found in 3% of normal term newborns. Neonatal Hyperbilirubinemia (NH) is a cause of concern for the parents as well as for the paediatricians. Aim of study to find out the association between various levels of cord serum albumin (CSA) and significant neonatal hyperbilirubinemia requiring interventions like phototherapy or exchange transfusion and whether it can be used as a risk indicator for subsequent development of significant jaundice.Methods: The present study was conducted on 150 randomly selected eligible term neonates delivered at Department of Pediatrics, Rajkiya Mahila Chikitsalaya, JLN Medical College and Associated Group of Hospitals, Ajmer, India.Results: Authors conducted a prospective study on 150sequentially born term babies. Cord blood was collected at birth and cord serum albumin estimation was done within 4-6 hours of collection of the blood. Cohort was grouped into Group 1, Group 2 and Group 3 based on CSA level ≤ 2.8g/dl, 2.9-3.3g/dl and ≥ 3.4 g/dl respectively. Knowledge of risk factors of NH in neonates could influence decision of early discharge vs. prolonged observation cord serum albumin level of ≤ 2.8g/dl has a correlation with incidence of significant hyperbilirubinemia in term newborns. So this ≤ 2.8g/dl of cord serum albumin level can be used as risk indicator to predict the development of significant hyperbilirubinemia. Whereas cord serum albumin level ≥3.4g/dl is considered safe.Conclusions: Term neonates with hyperbilirubinemia with a total serum bilirubin level ≥17 mg/dl had levels of cord serum albumin of ≤ 2.8 g/dl, and this can be used as a risk indicator to predict the development of NH.
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Background: Hyperbilirubinemia is one of the common problems in neonates. The transcutaneous bilirubin (TCB) measurement is non-invasive, easy and rapid not requiring expertise and manpower. Fewer studies have been carried out to whether newer TCB measurements can correlate with serum bilirubin measurements using newer generation of transcutaneous bilirubinometer in our region.Methods: An observational cross-sectional study to compare serum and transcutaneous bilirubin measurements in newborns admitted to a neonatal intensive care unit, conducted from December 2015 to November 2017. Blood samples were obtained from neonates collected from venous sample into plain bulb and sent for analysis. For transcutaneous bilirubin measurement, the reading from forehead and sternum were taken using bilirubinometer and an average reading was taken for comparison.Results: Total 172 neonates were admitted during study period and enrolled in the study. It was observed that out of 172 patients, studied 102(59%) patients were male and 70(41%) patients were female. Out of 172 patients maximum 89(51.74%) mother have O positive blood group and only 2(1.1%) have O negative blood group. Common cause of neonatal hyperbilirubinemia was ABO incompatibility 81(48%), Rh incompatibility 11(6%), and other causes 80(46%). The mean and standard deviation of TSB for first, second and third reading were 19.21'3.44, 15.76'2.79 and 12.89'2.44 respectively. While mean and standard deviation of TCB for first, second and third reading were 18.34'2.99, 15.48'2.36 and 12.31'2.28 respectively with correlation coefficient of r=0.806513, r=0.694273, r=0.785471 respectively indicating linear relationship between two.Conclusions: There was a strong correlation between serum and transcutaneous bilirubin levels before and even after the phototherapy. As transcutaneous bilirubin estimation is non-invasive, gives quick and reproducible results. So, by using this method has potential screening value especially in the high-risk neonates to start early intervention.
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Introducción: Las pautas para prevención y tratamiento de hiperbilirrubinemia neonatal recomiendan medición de bilirrubina sérica total (BST) o bilirrubina transcutánea (BTc) para determinar el grado de ictericia antes del alta del recién nacido (RN); ésta última no invasiva, proporciona información instantánea y de calidad superior a la evaluación clínica. A pesar de ello aún no ha sido aplicada en forma sistemática en los hospitales de Paraguay. Objetivo: evaluar la aplicación en nuestro medio de la medición de bilirrubinemia transcutánea antes del alta correlancionando con la bilirrubina sérica. Materiales y Métodos: Estudio observacional, descriptivo con componente analítico, de corte transversal. Fueron incluidos RN con edad gestacional ≥ a 35 semanas, con peso ≥ a 2000 gramos, luego de las 24 hs de vida hasta los 8 días; bajo consentimiento informado de los padres, durante un año. Los datos fueron consignados en una planilla de Microsoft Excel y procesado por el software IBM SPSS Statistics ®. Resultados: De 271 RN que ingresaron al estudio, en la primera medición con el Bilirrubinómetro transcutáneo, cumplían con criterios para toma de bilirrubina sérica 90 (33,2%) de ellos. En los restantes 181 RN (66,8%), los datos emparejados no estaban disponibles debido a que siguiendo las recomendaciones de las guías actuales no fue necesario medir la bilirrubina sérica. El valor del coeficiente de correlación para la primera medición fue r = 0.574. Para la segunda medición las medidas emparejadas estaban disponibles para 131 RN. En este caso se encontró correlación positiva entre ambos métodos de 0,590. Conclusión: La bilirrubina transcutánea puede utilizarse en forma rápida, segura y válida, como un test de screening para la detección de hiperbilirrubinemia y podría evitar una proporción importante de toma de muestras sanguíneas, mejorando la seguridad del paciente.
Introduction: The guidelines for prevention and treatment of neonatal hyperbilirubinemia recommend measurement of total serum bilirubin (BST) or transcutaneous bilirubin (BTc) to determine the degree of jaundice before discharge of the newborn (NB); the latter non-invasive method provides instant information which is superior to the clinical evaluation. Despite this, it has not yet been systematically applied in hospitals in Paraguay. Objective: to evaluate transcutaneous measurement of bilirubin concentration as compared to serum bilirubin levels prior to discharge in our setting. Materials and Methods: This was an observational, cross-sectional, descriptive study with an analytical component. For a period of one year, we tracked NBs with a gestational age ≥ 35 weeks, weighing ≥ 2000 grams, from 24 hours of life until 8 days of life, obtaining the informed consent of the parents. The data was entered in a Microsoft Excel spreadsheet and processed by the IBM SPSS Statistics ® software. Results: Of 271 NBs who entered the study, 90 (33.2%) met criteria for measurement of serum bilirubin at their first measurement with the transcutaneous bilirubinometer. In the remaining 181 RN (66.8%), the paired data were not available as measurement of serum bilirubin was not required per the recommendations of current guidelines. The correlation coefficient value for the first measurement was r = 0.574. For the second measurement, paired measurements were available for 131 NBs. In this case, a positive correlation was found between both methods of 0.590. Conclusion: Transcutaneous bilirubin can be used quickly, safely and accurately as a screening test for the detection of hyperbilirubinemia and could avoid a significant proportion of blood sampling, improving patient safety.
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Bilirubin , Infant, Newborn , Hyperbilirubinemia, Neonatal , HyperbilirubinemiaABSTRACT
OBJECTIVE: To analyze the relationship between clinical characteristics and postoperative complications in patients with hilar cholangiocarcinoma(HCCA) who underwent major liver resection(MLR).METHODS: Clinical characteristics and postoperative complications of 335 patients with HCCA who underwent MLR from January 2010 to October 2017 were retrospectively analyzed.According to the severity of complications,the patients were divided into two groups:low clavien-dindo group(LCD)and high clavien-dindo group(HCD).RESULTS: There were 219 patients in LCD group and 116 patients in HCD group.Elevated INR,Bismuth Ⅲa/Ⅳ type and the right liver/expanding right/right trilobites resection were high risk factors of postoperative serious complications.The incidence of severe postoperative complications in the group with preoperative biliary drainage was 34.18%(67/196),which was not statistically significant different from that in the group without preoperative biliary drainage [35.25%(49/139),P=0.8396].The dose-response curve and Logistic regression indicated that there was a statistical difference in postoperative complication risk between patients with total bilirubin(TB)<140 mol/L and patients with TB≥ 140 mol/L(OR=1.917,95% CI 1.147～3.203,P=0.0130).After statistical correction,the statistical correlation remained,among which,the preoperative biliary drainage rate was 59.2%(151/255) in the group with TB<140 mol/L,and 56.3%(45/80)in the group with TB≥ 140 mol/L.CONCLUSION: In patients with HCCA combined with MLR,patients with TB ≥ 140 mol/L should be routinely treated with preoperative biliary drainage.Especially for the right liver resection,preoperative high INR patients,more attention should be paid to.METHODS: of preoperative biliary drainage have no significant effect on the overall postoperative complications and can be flexibly selected according to the needs of the disease.
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Objective To evaluate the accuracy of the transcutaneous bilirubin (TcB) at different sites including the chest (covered and uncovered),forehead and scapula,compared with total serum bilirubin (TSB) before and after phototherapy.Method Neonates who underwent blood test of TSB together with the average TcB at chest over 6 mg/dl from September 2015 to July 2016 in our Hospital were enrolled in our study.TcB measurements were done by the transcutaneous bilirubinometer (JH20-1 C) at the sites of the chest,forehead and scapula within 30 minutes after venous or arterious blood sampling for testing TSB after admission.An area of 2 cm diameter over the left chest was covered during phototherpy.TSB was tested immediately and within 12 ～ 24 hours after phototherapy,while TcB was measured within 0.5 hour after blood sampling at the covered sites over the left chest,right chest,forehead and scapula.IBM SPSS 20.0 software was used for data analysis.Data were compared via Pearson correlation analysis,ANOVA of repeated measurement data,student's t test and Bland-Altman analysis.Result A total of 437 data were collected from 364 neonates were enrolled in our study.Before phototherapy,the values of TcB at different sites were highly correlated and consistent with TSB (P ＜ 0.05),especially taken from the chest (the difference value of TcB and TSB-1.2 ± 2.3 mg/dl).Immediately and within 12 ～ 24 hours after the phototherapy,the values of TSB and TcB taken from the covered left chest showed the highest consistency (-1.2±2.3 mg/dl and-0.5 ± 1.6 mg/dl).When TSB exceeded 15 mg/dl before phototherapy,the difference between TSB and TcB taken from chest was 1.5 ± 1.6 mg/dl,while if TSB was below 15 mg/dl,the difference was-1.9 ± 1.9 mg/dl.They were significantly different (P ＜ 0.001).And difference between TSB and TcB taken from chest was not affected by gender gestational age,birth weight,days of birth and different measurements.When TcB taken from the covered or uncovered chest was less than the TSB threshold value of 3.3 mg/dl for phototherapyl,or the TcB of the left covered sternum lower than the threshold value of 2.6 mg/ml for cessation of phototherapy,97.5％ of the TSB would not exceed the corresponding value.Conclusion The TcB values of both uncovered chest before phototherapy and covered chest after phototherapy were highly consistent with TSB,and could be applied in the replacement of TSB in the assessment and management of neonatal jaundice.
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ObjectiveTo establish the mathematical model of transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) after phototherapy in neonates.MethodsNeonates with pathological jaundice were enrolled from October 2013 to June 2014. The neonates were divided into three groups by gestational age: full-term neonates (gestation age of 37-42 weeks), late preterm neonates (gestation age of 34-36+6 weeks), early and mid-preterm neonates (gestation age of 28-33+6 weeks). The neonates received single or double sided phototherapy. During the phototherapy, the forehead and chest were covered by opaque material. The TcB was measured at forehead, mid sternum, perineum area three times each before and after phototherapy. Mean-while the TSB was tested.Results Two hundred and sixty-one neonates with hyperbilirubinemia were enrolled, among whom there were 169 full-term neonates, 63 late preterm neonates and 29 early and mid-preterm neonates. Before phototherapy, there were signiifcantly correlation of TSB with TcB on forehead, mid sternum and perineum (r=0.813, 0.827, 0.754;P<0.001) and the best correlation was with TcB on mid sternum. The linear regression equation was TSB=1.35TcB-5.50. After phototherapy, there were signiifcantly correlateion of TSB with TcB on forehead, mid sternum, and perineum (r=0.751, 0.807, 0.683;P<0.001) and the best correlation was with TcB on mid sternum. The linear regression equation was TSB=1.01×TcB-0.62. Among three groups, the full-term neonates had the best correlation.ConclusionsAfter phototherapy, the TcB measured on mid sternum which was covered by opaque material is well correlated with TSB. The linear regression model can be established.
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Neonatal hyperbilirubinemia,a common disease in the newborn period,account for about 8％ ～ 11％ in all newborns.Without getting proper controlling or being treated on time,severe hyperbilirubinemia may develop bilirubin encephalopathy leading to nerve damage and functional disability,which causes society and family problems.The hour-specific bilirubin nomogram is used to evaluate neonatal bilirubin discharge risks,intervention and follow-up.All pediatricians all over the world are focus on reducing the occurrence of bilirubin encephalopathy.In this study,we reviewed all researches about predicting the occurrence of neonatal hyperbilirubinemia after discharge using the hour-specific bilirubin nomogram which will better guide clinical diagnosis and treatment.