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INTRODUCTION: Hyperbilirubinaemia is one of the most important causes of re-admission in the early neonatal period. The socioeconomic factors are one of the most common reasons for early discharge in a developing country like India. OBJECTIVES: This study aims to evaluate and analyze the statistical correlation of umbilical cord blood bilirubin, albumin, nucleated red blood cells (nRBC), and reticulocyte count as early predictors of neonatal hyperbilirubinemia. METHOD: A prospective observational study was conducted from November 2015 to April 2017 in a tertiary care hospital in North Karnataka, India. Umbilical cord blood was collected at birth for analysis of bilirubin, albumin, reticulocyte count, and nRBC in term neonates. Total serum bilirubin (TSB) levels were estimated using the VITROS BuBc Slide method at 72 hours of life. Data were analyzed using SPSS version 23 (IBM Corp., Armonk, NY). RESULTS: A total of 200 term neonates were enrolled in the study, out of which 123 completed follow-ups. Of the 66 newborns who had cord bilirubin levels ≥1.75 mg/dl, 23 (34.8%) developed hyperbilirubinemia after 72 hours of life, whereas 10 of the 57 newborns (17.5%) whose cord bilirubin levels <1.75 mg/dl developed hyperbilirubinemia after 72 hours of life. Cord blood albumin of ≥3.75 g/dl was seen in 93 neonates, of which 18 (19.4%) developed hyperbilirubinemia after 72 hours of life and 15 (50%) with <3.75 g/dl developed hyperbilirubinemia after 72 hours of life. Cord reticulocyte count ≥4.95% was seen in 54 neonates; 20 (37.03%) developed hyperbilirubinemia, whereas in 69 neonates with <4.95%, 13 (18.84%) developed hyperbilirubinemia after 72 hours of life. Of the 62 neonates who had cord nRBC ≥3.5%, 28 (45.2%) neonates developed hyperbilirubinemia after 72 hours of life, whereas 5 of the 61 neonates (8.19%) with cord nRBC <3.5% developed hyperbilirubinemia after 72 hours of life. CONCLUSIONS: Cord blood bilirubin, albumin, reticulocyte counts, and nucleated RBC can be used as predictors of subsequent neonatal hyperbilirubinemia.
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BACKGROUND: The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain. METHODS: We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale. RESULTS: A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P = 0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P = 0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events. CONCLUSIONS: Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. (Funded by the Bill and Melinda Gates Foundation and the World Health Organization; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000476336; Clinical Trials Registry-India number, CTRI/2017/04/008326.).
