Early Prediction Of Significant Hyperbilirubinemia In Preterm Neonates Using 24 Hours Serum Bilirubin- A Prospective Study.

ABSTRACT

Background: Bilirubin induced neurological dysfunction is one of the major causes of morbidity in preterm neonates secondary to uncontrolled hyperbilirubinemia.While jaundice per se is not preventable none the less early detection of threatening bilirubin levels permit initiation of phototherapy and prevents kernicterus. Objectives: To determine the first day total bilirubin value, at 24 hours of life; which will predict with reasonable accuracy, preterm neonates likely to develop subsequent significant hyperbilirubinemia requiring treatment.To establish the cut-off values and comparison of the obtained value for prediction of significant neonatal hyperbilirubinemia in preterm neonates.Material and methods: The study was conducted on a group of 90 preterm neonates, with no comorbidities,over a period of one year. The main outcome measured was hyperbilirubinemia requiring intervention.Serum bilirubin level was sent at 24 hours of age. These babies were followed up clinically for the development of jaundice, and subsequent TSB values were obtained and assessed the need of phototherapy.Results: Mean age at bilirubin estimation was 24 ± 2 hours with mean TSB of 6.03 ± 1.48 mg/dl. Significant hyperbilirubinemia was present in 60/90 babies (66.6%).Neonates belonging to < 32 weeks of gestation age irrespective of their initial TSB values, nearly 100% ended up developing significant hyperbilirubinemia. Whereas in infants belonging to > 32 weeks of gestation age, a TSB level at 24 hours of life, was < <4.0 mg/dl in 4 newborns and none of them developed hyperbilirubinemia subsequently. In the remaining 86 newborns with TSB ≥4.0 mg/dl, subsequent hyperbilirubinemia, requiring phototherapy developed in 60 babies (69.8 %) {Sensitivity 100 %, specificity 13.3 %, positive predictive value 69.8%, negative predictive value 100% }Conclusion:Late Preterm babies with TSB levels higher than 4mg/dl at 24 hours of life have a significant risk of developing hyperbilirubinemia.