DYNAMICS OF TOTAL BILIRUBIN DURING THE NEONATAL PERIOD IN TERM NEWBORN
Keywords:
hyperbilirubinemia, newborn, nomogramAbstract
Background: The first nomogram reflecting bilirubin (BR) levels was created 22 years ago, based on serum levels of total BR in healthy full-term or near-term newborns (NB), which resulted in a significant decline in NB re-admission due to hyperbilirubinemia. (HB). No systematic studies have been conducted in Bulgaria and no nomogram of BR levels during the neonatal period has been performed.
Objective: To study the dynamics of total BR in full-term newborns during the neonatal period, to build a nomogram of BR. To calculate the rate of BR increase and to evaluate its correlation with BR levels in prolonged forms of neonatal jaundice.
Material and methods: The study lasts from 1.01.2017 to 31.10.2020 and is conducted in Neonatology Department of University Hospital Medica Ruse, Bulgaria. Inclusion criteria: full term newborns with indirect HB. Transcutaneous measurement of total BR with bilirubinometer KJ-8000 is performed in dynamics from the 12th hour after birth, daily until discharge. Then, bilirubinometry was performed again in the period 12-14th day and 28-30th day.
Results: A total of 566 full-term NB are included in the study. A total of 2636 measurements of BR are performed – 1685 of them during the hospital stay and 951 after discharge. The mean BR values in the whole group from the 1st to the 5th days are: 98.4±31.4, 135.5 ± 40.5, 154.4±38.8, 157.2±32.6, 147.3±31.1 µmol/L. On day 14th, the level of BR was 125.3 ± 49.5 µmol/L, 12% of the NB suffer from HB with the mean BR value 194.0 ± 28.0 µmol/L. On 28th day, the level of BR was 77.6 ± 45.6 µmol/L and 14.5% of the NB suffer from HB with the mean BR value 137.3 ± 30.9 µmol/L. The rate of BR increase is calculated from the first to second (V₁-₂), from the second to third (V₂-₃) and from the third to fourth (V₃-₄) postnatal day on percentiles 10, 25, 50, 75 and 90. The NB with V₂-₃ above 4.3 µmol/L/h on the third day characterize by significantly higher BR levels on day 14 (p=0.005) and day 28 (p=0.008).
Conclusions: According to our data, the rate of BR increase in the first postnatal days does not differ from that cited by other authors. We prove that the proportion of prolonged jaundice is 14.5% to the 28th postnatal day, which is lower than cited in the literature. Increasing BR rate above 4.3 µmol/L/h on the third day correlates with higher BR levels to the day 14 and the end of the neonatal period.
References
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. (2004). Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1), 297-316.
Bhutani, V. K., Johnson, L., & Sivieri, E. M. (1999). Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics, 103(1), 6-14.
Bhutani, V. K., Johnson, L. H., Schwoebel, A., & Gennaro, S. (2006). A Systems Approach for Neonatal Hyperbilirubinemia in Term and Near‐Term Newborns. Journal of Obstetric, Gynecologic & Neonatal Nursing, 35(4), 444-455.
Bromiker, R., Goldberg, A., & Kaplan, M. (2017). Israel transcutaneous bilirubin nomogram predicts significant hyperbilirubinemia. Journal of Perinatology, 37(12), 1315-1318.
Draque, C. M., Sañudo, A., de Araujo Peres, C., & de Almeida, M. F. B. (2011). Transcutaneous bilirubin in exclusively breastfed healthy term newborns up to 12 days of life. Pediatrics, 128(3), e565-e571.
Engle, W. D., Lai, S., Ahmad, N., Manning, M. D., & Jackson, G. L. (2009). An hour-specific nomogram for transcutaneous bilirubin values in term and late preterm Hispanic neonates. American journal of perinatology, 26(06), 425-430.
Fouzas, S., Mantagou, L., Skylogianni, E., Mantagos, S., & Varvarigou, A. (2010). Transcutaneous bilirubin levels for the first 120 postnatal hours in healthy neonates. Pediatrics, 125(1), e52-e57.
Luca, D., Romagnoli, K., Tiberi, E., Zuppa, A., & Zecca, E. (2008). Skin bilirubin nomogram for the first 96 h of life in a European normal healthy newbornnpopulation, obtained with multiwavelength transcutaneous bilirubinometry. Acta Pediatrica, 97, 146-150.
Maisels, M. J., Clune, S., Coleman, K., Gendelman, B., Kendall, A., McManus, S., & Smyth, M. (2014). The Natural History of Jaundice in Predominantly Breastfed Infants. PEDIATRICS, 134(2), e340–e345. doi:10.1542/peds.2013-4299
Maisels, M. J., Clune, S., Coleman, K., Gendelman, B., Kendall, A., McManus, S., & Smyth, M. (2014). The natural history of jaundice in predominantly breastfed infants. Pediatrics, 134(2), e340-e345.
Mishra, S., Chawla, D., Agarwal, R., Deorari, A. K., & Paul, V. K. (2010). Transcutaneous bilirubin levels in healthy term and late preterm Indian neonates. The Indian Journal of Pediatrics, 77(1), 45-50.
Sarici, S. U., Gunes, O., Koklu, E., & Serdar, M. A. (2017). Transcutaneous bilirubin levels during the first month of life in term and late-preterm newborns. Journal of tropical pediatrics, 63(1), 4-9.
Tiker, F., Gürakan, B., & Tarcan, A. (2002). Serum bilirubin levels in 1-month-old, healthy, term infants from southern Turkey. Annals of tropical paediatrics, 22(3), 225-228.
Varvarigou, A., Fouzas, S., Skylogianni, E., Mantagou, L., Bougioukou, D., & Mantagos, S. (2009). Transcutaneous bilirubin nomogram for prediction of significant neonatal hyperbilirubinemia. Pediatrics, 124(4), 1052-1059.
Wainer, S., Rabi, Y., Parmar, S. M., Allegro, D., & Lyon, M. (2009). Impact of skin tone on the performance of a transcutaneous jaundice meter. Acta Paediatrica, 98(12), 1909-1915.
Yu, Z. B., Han, S. P., & Chen, C. (2014). Bilirubin nomograms for identification of neonatal hyperbilirubinemia in healthy term and late-preterm infants: a systematic review and meta-analysis. World Journal of Pediatrics, 10(3), 211-218.
