Cord blood bilirubin and prediction of neonatal hyperbilirubinemia and perinatal infection in newborns at risk of hemolysis

Abstract Objective To assess the accuracy of umbilical cord bilirubin values to predict jaundice in the first 48 h of life and neonatal infection. Method Newborn infants treated at a regional well-baby nursery born at ≥36 weeks of gestation were included in this retrospective cohort study. All infants born in a 3-year period from mothers with O blood type and/or Rh-negative were included and had the umbilical cord bilirubin levels measured. Hyperbilirubinemia in the first 48 h was defined as bilirubin levels above the phototherapy threshold. Neonatal infection was defined as any antibiotic treatment before discharge. Results A total of 1360 newborn infants were included. Two hundred and three (14.9%) newborn infants developed hyperbilirubinemia in the first 48 h of life. Hyperbilirubinemic infants had smaller birth weight, higher levels of umbilical cord bilirubin, a higher rate of infection and were more often direct antiglobulin test positive. Umbilical cord bilirubin had a sensitivity of 76.85% and a specificity of 69.58% in detecting hyperbilirubinemia in the first 48 h, with the cut-off value at 34 µmol/L. The area under the receiver operating characteristic curve was 0.80 (95% CI: 0.78-0.82). Umbilical cord bilirubin had a sensitivity of 27.03% and specificity of 91.31% in detecting perinatal infection. The area under the receiver operating characteristic (ROC) curve was 0.59 (95% CI: 0.57-0.63). Conclusions A positive correlation was found between umbilical cord bilirubin and hyperbilirubinemia in the first 48 h of life. Umbilical cord bilirubin is a poor marker for predicting neonatal infection.

Consenso de hiperbilirrubinemia del primer trimestre de la vida / Consensus on hyperbilirubinemia of the first trimester of life

La presencia de ictericia en la etapa neonatal puede responder a diversas causas, desde situaciones fisiológicas hasta enfermedades graves. En los neonatos de término que persisten ictéricos más allá de los 14 días de vida, debe determinarse si la hiperbilirrubinemia es no conjugada o conjugada para establecer, a la brevedad, el plan de estudios etiológicos y la terapéutica correspondiente. La hiperbilirrubinemia conjugada (colestasis) refleja una disfunción hepática en la mayoría de los casos, cuyas consecuencias son alteraciones del flujo biliar secundarias a anormalidades estructurales o moleculares del hígado y/o del tracto biliar.Durante la última década, los nuevos estudios moleculares revolucionaron el abordaje de los pacientes colestáticos, lo que permitió el diagnóstico de diversas entidades genéticas. La etiología de la hiperbilirrubinemia del primer trimestre debe determinarse con urgencia, ya que, en muchos casos, el tratamiento instituido de modo precoz puede modificar sustancialmente la evolución de la enfermedad o salvar la vida del paciente.

Neonatal jaundice may be due to different causes, ranging from physiological conditions to severe diseases. In term neonates with persistent jaundice beyond 14 days of life, it should be determined whether hyperbilirubinemia is unconjugated or conjugated, in order to study the etiology and start early treatment. In the majority of cases, conjugated hyperbilirubinemia (cholestasis) is a sign of liver dysfunction possibly associated with alterations in the bile flow secondary to structural or molecular abnormalities of the liver and/or the biliary tract. Over the past decade, new molecular studies have revolutionized the approach of cholestatic patients, leading to the identification of different genetic entities. It is important to determine the etilogy of neonatal hyperbilirubinemia since in many cases early treatment will substantially improve morbidity and mortality.

Remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease / 浙江大学学报·医学版

OBJECTIVE@#To explore the feasibility of remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease.@*METHODS@#Forty six neonates of gestational age >35 weeks with ABO hemolytic disease admitted to Women's Hospital, Zhejiang University School of Medicine from January 20th, 2020 to February 29th, 2020 were enrolled in the study (study group). The newborns were followed up at home after discharge, the transcutaneous bilirubin (TCB) levels were measured by parents using the provided device and the results were sent to the doctor by smart phone using the installed APP. Fifty six newborns with ABO hemolytic disease admitted in 2018 who received conventional outpatient follow-up after discharge served as the control group. The demographic characteristics, total serum bilirubin (TSB) level during hospitalization, number of outpatient visit and rate of re-admission due to rebound hyperbilirubinemia were compared between the two groups.@*RESULTS@#There were no significant differences between the two groups in gestational age, birth weight, delivery mode, gender, length of the first hospitalization, TSB level before phototherapy and before discharge, and the managements during the first hospitalization (all @*CONCLUSIONS@#The remote follow-up for neonatal jaundice at home can effectively reduce the number of outpatient visits without increasing the risk of readmission and severe neonatal hyperbilirubinemia for newborns with ABO hemolytic disease.

Validation of transcutaneous bilirubin nomogram for identifying neonatal hyperbilirubinemia in healthy Chinese term and late-preterm infants: a multicenter study / Validação de um nomograma de bilirrubina transcutânea para identificação de hiperbilirrubinemia neonatal em neonatos a termo e pré-termo tardios saudáveis na China: um estudo multicêntrico

OBJECTIVE: to prospectively validate a previously constructed transcutaneous bilirubin (TcB) nomogram for identifying severe hyperbilirubinemia in healthy Chinese term and late-preterm infants. METHODS: this was a multicenter study that included 9,174 healthy term and late-preterm infants in eight hospitals of China. TcB measurements were performed using a JM-103 bilirubinometer. TcB values were plotted on a previously developed TcB nomogram, to identify the predictive ability for subsequent significant hyperbilirubinemia. RESULTS: in the present study, 972 neonates (10.6%) developed significant hyperbilirubinemia. The 40th percentile of the nomogram could identify all neonates who were at risk of significant hyperbilirubinemia, but with a low positive predictive value (PPV) (18.9%). Of the 453 neonates above the 95th percentile, 275 subsequently developed significant hyperbilirubinemia, with a high PPV (60.7%), but with low sensitivity (28.3%). The 75th percentile was highly specific (81.9%) and moderately sensitive (79.8%). The area under the curve (AUC) for the TcB nomogram was 0.875. CONCLUSIONS: this study validated the previously developed TcB nomogram, which could be used to predict subsequent significant hyperbilirubinemia in healthy Chinese term and late-preterm infants. However, combining TcB nomogram and clinical risk factors could improve the predictive accuracy for severe hyperbilirubinemia, which was not assessed in the study. Further studies are necessary to confirm this combination. .

OBJETIVO: validar de forma prospectiva um nomograma de bilirrubina transcutânea (BTc) para identificar hiperbilirrubinemia grave em neonatos a termo e pré-termo tardios saudáveis na China. MÉTODOS: foi realizado um estudo multicêntrico que incluiu 9174 neonatos a termo e pré-termo tardios saudáveis em oito unidades da China. Foram realizadas dosagens de BTc utilizando um bilirrubinômetro. Os valores de BTc foram traçados em um nomograma de BTc para identificara capacidade de predição de hiperbilirrubinemia significativa. RESULTADOS: 972 recém-nascidos (10,6%) desenvolveram hiperbilirrubinemia significativa. O percentil 40 de nosso nomograma pode identificar todos os recém-nascidos com risco de hiper-bilirrubinemia significativa, porém com baixo valor preditivo positivo (VPP) (18,9%). De 453 recém-nascidos acima do percentil 95, 275 recém-nascidos desenvolveram posteriormente hiperbilirrubinemia significativa, com VPP elevado (60,7%), porém com baixa sensibilidade (28,3%). O percentil de 75 foi altamente específico (81,9%) e moderadamente sensível (79,8%). A área sob a curva (ASC) de nosso nomograma de BTc foi de 0,875. CONCLUSÕES: este estudo validou o nomograma de BTc, que pode ser utilizado para prever hiperbilirrubinemia significativa em neonatos a termo e pré-termo tardios saudáveis na China. Contudo, combinar o nomograma de BTc e fatores de risco clínicos pode melhorar a precisãode predição da hiperbilirrubinemia grave, o que não foi avaliado neste estudo. São necessários estudos adicionais para confirmar essa combinação. .

Effect of induction of meconium evacuation using per rectal laxatives on neonatal hyperbilirubinemia in term infants: A systematic review of randomized controlled trials.

Objective: To study the efficacy of early meconium evacuation using per rectal laxatives on the level of serum bilirubin and the need for phototherapy in healthy term infants. Materials and Methods: Systematic review of randomized controlled trials comparing per rectal laxatives versus no intervention was conducted using English language articles identified from the Cochrane Central Register of Controlled Trials, Medline, Ovid, and CINAHL databases and bibliographies of selected articles. Eligible studies were assessed for the risk of bias in conduct and reporting. Results: A total of three trials (n = 469) mostly with "unclear risk" were eligible for inclusion. Two trials used glycerin suppository whereas one used glycerin enema for meconium evacuation. Meta-analysis was not possible due to clinical heterogeneity in the choice of laxatives and frequency of intervention. In all the three studies, serum bilirubin levels at 48 h and the need for phototherapy was not significantly different between the two groups. Passage of first meconium and the transitional stools occurred significantly early in the intervention group compared to controls. Conclusion: Early evacuation of meconium using per rectal laxatives does not offer any significant clinical advantage for neonatal jaundice.

Estimación visual de la ictericia neonatal y detección del riesgo de hiperbilirrubinemia significativa / Visual estimate of clinical jaundice and detection of the risk of significant hyperbilirubinemia

La predicción del riesgo de hiperbilirrubinemia significativa a través de la medición de una bilirrubina previa al alta ha sido validada en neonatos. La estimación visual de la extensión de la ictericia es comúnmente usada para la decisión de la obtención de la prueba de bilirrubina. Determinar la confiabilidad de la evaluación visual de la ictericia en la detección del riesgo de hiperbilirrubinemia significativa. 123 neonatos fueron examinados antes del alta por un pediatra quien asignó la extensión de la ictericia según su progresión céfalo-caudal. Una medida simultánea de bilirrubina transcutánea fue hecha por otro observador. Luego se comparó la calificación del riesgo de hiperbilirrubinemia significativa por ambos métodos, a través de un nomograma clasificado por zonas de riesgo. Resultados: El porcentaje de coincidencia global en relación a la designación de riesgo por ambos métodos fue 73%, pero esta proporción decreció a 56,3% cuando se analizó sólo para las zonas de alto riesgo. De hecho, 18 (43,7%) de los 32 neonatos calificados de alto riesgo por la prueba transcutánea fueron erróneamente identificados por la evaluación visual como niños de bajo riesgo. A pesar de que la concordancia general entre la estimación visual de la ictericia y la bilirrubina real es aceptable, la confiabilidad de la valoración visual como el procedimiento primario para identificar el riesgo de una hiperbilirrubinemia significativa es limitada. La detección de la severidad de la ictericia debe basarse en otros métodos, como la medición de la bilirrubina sérica o transcutánea

Pre-discharge bilirrubin percentiles have proved to be useful in predicting which infants will develop significant neonatal hyperbilirubinemia. The extent of clinical jaundice is commonly used to decide when to take a sample test for serum bilirubin. To determine the reliability of visual assessment of jaundice in the identification of the risk of significant hyperbilirubinemia. Clinical estimate of cephalocaudal progression of jaundice was carried out by a pediatrician in 123 neonates. Transcutaneous bilirubin (TCB) was simultaneously measured by an independent observer. Measurements by both methods were plotted into a nomogram stratified by risk zones to determine their level of agreement as to the classification of the risk. General agreement between the two measurements was 73%. However, this proportion decreased to 56.3% when only high-risk zones were analyzed. In fact, 18 (43.7%) of the 32 infants with transcutaneous bilirubin levels in high-risk zones were missclasified as low-risk cases by visual estimate. Although there was good general agreement between clinical evaluation of jaundice and TCB, visual assessment was not fully reliable as a primary screening method to identify significant hyperbilirubinemia. Further means should be used to support decisions regarding this risk, such as serum bilirubin sampling or transcutaneous bilirubin

Hyperbilirubinemia in glucose-6-phosphate dehydrogenase-deficient male newborns in Al-Ahsa, Saudi Arabia

To study the clinical and laboratory characteristics of hyperbilirubinemia in glucose-6-phosphate dehydrogenase [G6PD]-deficient male newborns from Al-Ahsa area [Ahsais]. The medical records of inborn male infants at King Abdulaziz Hospital [KAH] in Al-Ahsa area, Kingdom of Saudi Arabia from May 2008 through April 2009 were reviewed. Inclusion criteria were healthy non-polycythemic G6PD-deficient Ahsa males born at >/= 37 weeks gestation, weighing >/= 2.5 kg, with no other cause of hyperbilirubinemia, and were sampled for a total serum bilirubin [TSB] within the first 48 hours of life. Hyperbilirubinemics were compared with non-hyperbilirubinemic newborns. Among the 93 G6PD-deficient newborns that met the inclusion criteria, 67 were hyperbilirubinemic and required phototherapy, and 13 of them required rephototherapy. Phototherapy was started at 11 +/- 4 [mean +/- SD] hours of life, and for a total duration of 42 +/- 28 hours. Hyperbilirubinemics had statistically significant higher levels of both hematocrit [53 +/- 6 versus 49 +/- 8%, p=0.02] and hemoglobin [176 +/- 18 versus 166 +/- 21 g/ L, p=0.04], and lower reticulocyte percentage [4.3 +/- 0.7 versus 5.2 +/- 1.0%, p=0.02], when compared to non-hyperbilirubinemic newborns. Hyperbilirubinemia in G6PD-deficient Ahsai male newborns was characterized by higher levels of both hematocrit and hemoglobin levels, and lower reticulocyte percentage compared to their non-hyperbilirubinemic counterpart. This hyperbilirubinemia required early phototherapy and re-phototherapy. Appropriate follow up should be made available to those high-risk newborns. Further research is needed to understand the exact mechanism of hyperbilirubinemia in G6PD-deficient newborns

Icterícia como causa de internação neonatal: a experiência em um serviço terciário de Porto Alegre, RS / Jaundice in healthy term newborns treated at a tertiary center in Porto Alegre, RS

Introdução: Cerca de 60-80% dos recém-nascidos (RN) tornam-se ictéricos durante os primeiros dias de vida. Apesar de geralmente representar um fenômeno transitório, alguns pacientes necessitam de tratamento hospitalar. O objetivo deste estudo foi determinar a causa principal de icterícia neonatal em recém-nascidos saudáveis internados no Hospital Luterano e possíveis associações com diversas variáveis clínicas. Metodologia: Estudo retrospectivo em que foram estudados todos os casos de RN com icterícia neonatal internados para tratamento de hiperbilirrubinemia na UTI Neonatal do Hospital Luterano da ULBRA, no período de abril de 2007 a dezembro de 2008. Os resultados foram expressos em estatística descritiva e foi utilizado o teste exato de Fischer e o teste Qui-quadrado. O limite alfa considerado foi de 5%, com nível de significância de 0,05. Resultados: Dentre os RNs estudados (74), 52,7% eram do sexo masculino e 45,9% eram do sexo feminino. 14,8% dos pacientes nasceram de parto vaginal, enquanto que 85,1% nasceram de cesárea. A maioria dos recém-nascidos estudados (74,3%) foi considerada a termo. O diagnóstico mais frequente (37,8%) de icterícia dos pacientes internados para tratamento no serviço foi o de baixo aporte. Os pacientes do sexo masculino necessitaram de maior tempo de fototerapia do que as pacientes do sexo feminino (p=0,056). Conclusão: O diagnóstico de baixo aporte recebido pelos pacientes foi a causa mais frequente de icterícia. Os meninos necessitaram de um tempo significativamente maior de fototerapia para o tratamento da icterícia do que as meninas; também houve associação positiva da hiperbilirrubinemia com a baixa idade.

Introduction: About 60-80% of the newborns (NB) experience jaundice in the first days of life. Although jaundice is often a transitory phenomenon, some infants require hospital care. The aim of this study was to determine the main cause of neonatal jaundice among healthy newborns admitted to the Hospital Luterano and the possible associations with a number of clinical variables. Methods: A retrospective study in which all cases of NB with neonatal jaundice admitted for treatment of hyperbilirubinemia at the Neonatal ICU of the Hospital Luterano of ULBRA were studied, from Apr 2007 to Dec 2008. The results were expressed as descriptive statistics, and Fisher’s exact test and the Chi-square test were applied. The alpha limit considered was 5%, with level of significance at 0.05. Results: Among the 74 NB studied, 52.7% were males and 45.9% were females. 14.8% of the infants had a vaginal birth, while 85.1% had a cesarean delivery. Most of the studied infants (74.3%) were born full term. The most frequent cause for (37.8%) jaundice among these patients was inadequate intake. The male patients needed to stay longer on phototherapy than female patients (p=0.056). Conclusion: Low intake by the patient was the most frequent cause of jaundice in this series. The boys needed significantly more time on phototherapy than females, and there was a positive association of hyperbilirubinemia with low age.

Transcutaneous bilirubinometry in preterm neonates.

This prospective study was conducted to evaluate the accuracy of transcutaneous bilirubinometry in preterm newborns less than 32 weeks of gestation. Serum bilirubin values measured by direct spectrophotometry were considered as standard, the range was 2.2-12.5 mg/dL. 32 jaundiced infants of less than 32 weeks of gestation without phototherapy, including 10 ELBW neonates, were enrolled. Close correlation (R=0.933) existed between total serum bilirubin and transcutaneous bilirubin values measured over sternum.

Transcutaneous bilirubin in predicting hyperbilirubinemia in term neonates.

OBJECTIVE: To assess the utility of 24 and 48 hours transcutaneous bilirubin (TcB) index for predicting subsequent significant hyperbilirubinemia in healthy term neonates. METHODS: TcB indices were obtained for healthy, breastfed, term AGA newborns at 24 +/- 2, 48 +/- 2 and subsequently at intervals of 24 hours. Neonates with illness, on treatment and positive Direct Coomb's test were excluded. Serum bilirubin levels were obtained whenever indicated. Neonates having serum bilirubin > or = 17 mg/dL were considered as significant hyperbilirubinemia. The 24 and 48 hour TcB indices, as risk predictors for such hyperbilirubinemia were determined. RESULTS: Study included 461 healthy term neonates. The mean birth weight was 2949 (+/- 390) gm and mean gestation of 38.6 (+/- 1.1) weeks. Eight one (17.6%) had significant hyperbilirubinemia. Of 461, 135 (29.3%) had TcB index. CONCLUSION: The 24 and 48 hour TcB indices are predictive for subsequent significant hyperbilirubinemia and can guide clinician in early discharge of healthy term newborns.

Correlación entre bilirrubina sérica y bilirrubinometría transcutánea en neonatos estratificados por edad gestacional / Correlation between serum bilirubin and transcutaneus bilirubinometry in newborns stratified by gestation age

La ictericia neonatal es un dilema diagnóstico y terapéutico muy común. Las decisiones basadas en mediciones seriadas de bilirrubina sérica se asocian con dolor en el niño, tiempo de espera y ansiedad por los resultados. La bilirrubinometría transcutánea puede ser una alternativa confiable si se demuestra su validez para poblaciones e instituciones particulares. Establecer el grado de correlación entre bilirrubina sérica total (BST) y bilirrubina transcutánea (BTC) en neonatos estratificados por edad gestacional. Estudio de diseño transversal. Cien recién nacidos ictéricos, 50 de término y 50 pretérmino, fueron analizados. A cada niño se le realizó una medición simultánea de BST y BTC. Luego se calcularon los coeficientes de variación de las medias, las diferencias de las medidas, la sensibilidad y el valor predictivo positivo de la BTC, los coeficientes de correlación, la ecuación de la línea de regresión, y la equivalencia de ambas mediciones para predecir el riesgo de hiperbilirrubinemia. El coeficiente de variación de las medias fue similar para ambas mediciones (BST: 3,09 por ciento; BTC: 3,24 por ciento). Las mediciones de BST y BTC fueron diferentes en 95 niños, e iguales en 5 de ellos. En los 95 neonatos con lecturas divergentes, la BTC subestimó la BST en 59 y la sobreestimó en 36, con una diferencia promedio de 1,39 mg/dl (DE 0,58 mg/dl). La sensibilidad de la BTC para identificar una BST >12 mg/dl fue 87 por ciento, con un valor predictivo positivo de 94 por ciento. El coeficiente de correlación de toda la muestra fue 0,88; en los neonatos de término fue 0,92 y en los pretérmino fue 0,84. El 82 por ciento de los neonatos fueron correctamente clasificados por la BTC en los percentiles de riesgo para hiperbilirrubinemia significativa. La precisión de las medidas de BST y BTC es similar en nuestra institución. Aunque hay una correlación aceptable entre ambos métodos de valoración, independientemente de la edad gestacional, la técnica de la BTC...

Newborn jaundice with its potential for producing brain damage remains a continuing problem for pediatricians. Therapeutic decisions based on serial measurements of serum bilirubin (TSB) are time-consuming and associated with stress for the child, parents and practitioners. Transcutaneous bilirubinometry (TCB) may be an alternative method if its reliability is proven for a particular institution and population. To establish the degree of correlation between TSB and TCB in newborn infants classified by gestational age. Cross-sectional study. 100 jaundiced infants, stratified into two groups of 50 preterm and 50 full-term newborns, were analyzed by simultaneous samples of TSB and TCB. Statistical analysis included estimates of differences between the two measurements, coefficients of variation of means, correlation coefficients, sensitivity and positive predictive value of TCB, and accuracy of TCB to predict significant hyperbilirubinemia. The coefficient of variation of means was similar for both methods (TSB: 3.09 percent; TCB: 3.24 percent). Measurements of TSB and TCB were different in 95 infants and equivalent in 5. TCB underestimated TSB in 59 measurements and overestimated it in 36 of them, with a mean difference of 1.39 mg/dl (SD 0.58 mg/dl). Sensitivity of TCB to identify a TSB >12 mg/dl was 87 percent, with a positive predictive value of 94 percent. The global correlation coefficient was 0.88 (term infants: 0.92; preterm infants: 0.84). 82 percent of the infants were correctly classified by the TCB within the percentiles of risk for significant hyperbilirubinemia. Precision of measurements of TSB and TCB is similar in our institution. Despite a good correlation between the two methods, regardless the gestational age, TCB tends to underestimate TSB when bilirubin values go beyond 12 mg/dl. The TCB technique can accurately predict the risk of extreme hyperbilirubinemia, so it can be cautiously used prior to dischange to reduce this risk and to avoid...

Comparação entre a dosagem transcutânea e plasmática de bilirrubina / Comparison of transcutaneous and plasma bilirubin measurement

OBJETIVOS: Comparar dosagens transcutâneas de bilirrubina pelo Bilicheck com a dosagem plasmática capilar pelo bilirrubinômetro Unistat (Leica). MÉTODOS: Foram realizadas 200 dosagens concomitantes (transcutânea e plasmática), calculadas a correlação e concordância entre elas e feita avaliação da influência do peso de nascimento, raça, idade gestacional, idade pós-natal e uso de fototerapia. RESULTADOS: A correlação linear foi de 0,92, e a média da diferença entre as dosagens foi de 0,72 (±1,57) mg/dL, com intervalo de confiança em 95 por cento de -2,42 a +3,86. A curva ROC realizada com a dosagem transcutânea em 14 mg/dL demonstrou melhor sensibilidade (88,2 por cento) e especificidade (97,8 por cento), com valor preditivo positivo de 78,9 por cento, valor preditivo negativo de 98,9 e área abaixo da curva de 0,98. CONCLUSÃO: A dosagem realizada pelo Bilicheck pode substituir a dosagem plasmática capilar até o valor de 14 mg/dL. Acima deste nível, deve ser considerada apenas como rastreador na seleção de pacientes que devem ser submetidos a dosagem sangüínea.

OBJECTIVES: To compare transcutaneous bilirubin measurements made using Bilicheck equipment with assays of capillary plasma using the Unistat bilirubinometer (Leica). METHODS: Two hundred concomitant assays were performed (transcutaneous and in plasma), and the correlation and level of agreement between them was calculated. An assessment was also made of the influence of birth weight, skin color, gestational age, postnatal age and phototherapy. RESULTS: The linear correlation coefficient was 0.92, and the mean difference between assays was 0.72 (±1.57) mg/dL, with a 95 percent confidence interval from -2.42 to +3.86. The best of a series of ROC curves demonstrated that transcutaneous assays at 14 mg/dL offer the best sensitivity (88.2 percent) and specificity (97.8 percent), with a positive predictive value of 78.9 percent, negative predictive value of 98.9 and are below the curve of 0.98. CONCLUSIONS: Assays performed using Bilicheck can be substituted for capillary plasma assays up to 14 mg/dL. Above this level the device should only be used for screening for patients whose bilirubin should be assayed in blood.

Maternal and neonatal metabolic complications in cases of gestational diabetes about 220 cases

We report a retrospective study of 220 cases of gestational diabetes collected during a 5 year period [2001-2006]. Hypoglycemia was the most frequent maternal metabolic complication [11%], whereas ketoacidosis was rare, seen in only two patients [0.8%]. Neonatal metabolic complications were mostly hypoglycemia [19%] and hypocalcaemia [7%]. Pregnancy in diabetic women involves more risks than pregnancy in non-diabetic women. However, these risks are now better controlled

Nomogram for prediction of the risk of neonatal hyperbilirubinemia, using transcutaneous bilirubin.

Assessing the risk of developing severe hyperbilirubinemia, based on a nomogram has been recommended by the American Academy of Pediatrics. The objectives of this study were: 1) To develop an hour-specific nomogram, using transcutaneous bilirubin level (TCB, Bilicheck, SpecRx, Inc, Norcross, GA, USA), in Thai newborn infants and 2) To determine the risk zones that will predict the development of severe hyperbilirubinemia. Three hundred and ninety two (392) healthy neonates, born by C-section, were recruited from November 2003 to May 2004. One hundred and eight (108) infants were excluded from the nomogram development due to hemolytic diseases (ABO incompatibility 51, G6PD deficiency 34, combined ABO incompatibility and G6PD deficiency 3) and requirement of phototherapy (20). Nomogram, using daily hour-specific TcB for 4 days, of 284 neonates was constructed Plotting all 392 infants, TcB on the nomogram, the risk zones in relation to the requirement of phototherapy was determined. The 90th percentile (P90) was designated as high risk track with the sensitivity of 96.9%, specificity 78.8%, positive and negative predictive values 29.1% and 99% respectively, and LR 4.6. P10 was labeled as very low risk track, area between P10-P25 as low risk zone, P25-P90 as intermediate zone with P25-P50 as low intermediate and P50-P90 as high intermediate. In conclusion, an hour-specific TcB nomogram, can be used to identify the risk of subsequent development of severe hyperbilirubinemia. Recognizing the infants risk enables awareness of the problem and prompt intervention which should reduce severe hyperbilirubinemia and chance to develop bilirubin encephalopathy.