U. N. Reddy1, Swathi Chacham2, G. S. Sangamitra3, S. Pratap Rao4, Sugunakar Reddy-5, Mohd. Nasir Mohiuddin6
INTRODUCTION
Hyperbilirubinemia invariably occurs in the newborns and is discerned as clinical jaundice in nearly 50% of infants. It is a cause of concern not only for the parents but also for the paediatricians. Bilirubin production is 2-3 times higher in normal term newborns compared with adults. The colour in jaundice usually results from accumulation of unconjugated, non-polar, lipid soluble, bilirubin pigment in the skin which is formed from haemoglobin by the action of heme oxygenase, biliverdin reductase and non-enzymatic reducing agents in the reticulo-endothelial cells.
AIMS & OBJECTIVE
To determine hour specific serum bilirubin (22-26 hrs) which will predict, subsequent significant hyperbilirubinemia in healthy term newborns.
MATERIALS & METHODS
A total of 250 healthy full term newborns were enrolled into the study. First bilirubin estimation (TSB 1) was estimated at 22-26 hrs. The neonates were followed up clinically every 12 hrs for 72 hrs (till discharge). Second bilirubin estimation (TSB S) was done whenever clinical suspicion of jaundice was present (usually at 72 hours). Depending upon the TSB 1 value, the infants were evaluated by using two available protocols (Arbitrary cut off value of 5 mg/dl and average value of 4.06 mg%). Sensitivity, specificity, negative and positive predictive values and likelihood ratio of the test were calculated. P-value was used to determine the level of significance.
RESULTS
Of 250 neonates included in the study, 13 neonates developed hyperbilirubinemia and were subjected to phototherapy. No infants with average bilirubin value of ≤4.06 mg% developed subsequent hyperbilirubinemia. However, 2 infants with arbitrary cut off value of ≤5 mg/dl developed hyperbilirubinemia. There was significant difference in TSB I value of neonates who subsequently did and those who did not developed significant hyperbilirubinemia (P-value-<0.01). The negative predictive value to these two applied protocol is very high (99.05% & 100%) indicating that infants with serum bilirubin level cuff off value of <5 mg/dl or average value of 4.06 mg% are at very low risk of developing subsequent significant hyperbilirubinemia.
CONCLUSION
The present study infers that total serum bilirubin level of less than 5.0 mg/dl or 4.06% at 22-26 hours of life predicts absence of subsequent hyperbilirubinemia with high probability and these infants can be discharged safely and early from the hospital. Neonates whose first bilirubin level is above the cut off value of 5.0 mg/dl or average value of 4.06 mg% are more prone to develop significant hyperbilirubinemia requiring phototherapy.
