Early predictors of neonatal hyperbilirubinemia in full term newborn.

BACKGROUND: Reliable predictive markers enabling physicians to identify which newborns will develop significant hyperbilirubinemia have become mandatory for prevention of severe hyperbilirunemia. We aimed at determining the critical cord serum bilirubin and albumin levels and bilirubin/albumin ratio early as reliable markers. STUDY DESIGN: This prospective study included 175 full-term neonates. Measurement of cord bilirubin, albumin and bilirubin/albumin ratio was done to predict significant hyperbilirubinemia in healthy term newborns based on serum bilirubin measurements made within 5 days of life. RESULTS: Most cases that developed significant neonatal hyperbilirubinemia (67.9%) had cord albumin level ≤ 2.8 gm/dl. Cord Bilirubin/albumin ratio cut off value > 0.61 had a good predictive value with a sensitivity of 100% and specificity of 88.4%, and cord serum albumin cut off value ≤ 3.0 mg/dl also had a good predictive value with a sensitivity of 85.7% and specificity of 67.3%. ROC curve analysis of cord total bilirubin demonstrated that a cut off value of ≥1.84 mg/dl had a good predictive value with a sensitivity of 100.0% and specificity of 87.1%. CONCLUSION: Cord bilirubin/albumin ratio, serum bilirubin and albumin could be early predictors for neonatal hyperbilirubinemia.

Incidence and risk factors of post-phototherapy neonatal rebound hyperbilirubinemia.

BACKGROUND: To determine the incidence and risk factors of post-phototherapy rebound hyperbilirubinemia because data about bilirubin rebound in neonates are lacking and few studies have concerned this condition. METHODS: A prospective observational study was conducted on 500 neonates with indirect hyperbilirubinemia who were treated according to standard guidelines. Total serum bilirubin (TSB) was measured at 24-36 h after phototherapy; significant bilirubin rebound (SBR) is considered as increasing TSB that needs reinstitution of phototherapy. RESULTS: A total of 124 (24.9%) neonates developed SBR with TSB increased by 3.4 (2.4-11.2) mg/dL after stopping phototherapy. Multiple logistic regression model revealed the following significant risk factors for rebound: low birth weight (B = 1.3, P <  0.001, OR 3.5), suspected sepsis (B = 2.5, P <  0.001, OR 12.6), exposure to intensive phototherapy (B =  0.83, P =  0.03, OR 2.3), hemolysis (B =  1.2, P <  0.001, OR 3.1), high discharge bilirubin level (B =  0.3, P =  0.001, OR 1.3), and short duration of conventional phototherapy (B =  - 1.2, P <  0.001, OR 0.3). CONCLUSIONS: SBR should be considered in neonates with hemolysis, low birth weight, suspected sepsis, short duration of conventional phototherapy, exposure to intensive phototherapy, and relatively high discharge TSB. These risk factors should be taken into account when planning post-phototherapy follow-up.

Hearing loss among high-risk newborns admitted to a tertiary Neonatal Intensive Care Unit.

PURPOSE: The aim of this work is to identify the most significant risk factors for hearing impairment in high risk neonates hospitalized at our Neonatal Intensive Care Unit (NICU) and to assess the sensitivity of hearing screening tests. METHODS: This study involved 260 neonates admitted to a tertiary NICU; they were classified into two groups; 150 preterm and 110 full terms with risk factors for hearing loss. The hearing screening tests performed were transient evoked otoacoustic emissions (TEOAEs) and the automated auditory brainstem response (AABR). RESULTS: Forty-eight preterm neonates (32%) and 30 full term neonates (27.3%) had pathological AABR. In preterm group, mechanical ventilation more than five days, sepsis, usage of aminoglycosides, loop diuretics, vancomycin alone or in combination with aminoglycosides and prolonged duration of admission were considered risk factors of hearing affection whereas in full term group mechanical ventilation more than five days was the risk factor of hearing affection (p<.05). CONCLUSIONS: The prevalence of hearing loss is highest among high risk neonates and TEOAE and AABR were found to be reliable screening tools. Use of ototoxic drugs and mechanical ventilation for more than five days were significant risk factors for hearing loss in our study population.