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Predicting the risk of jaundice in full-term healthy newborns: a prospective population-based study
1Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Insights
Early assessment of infant jaundice risk is crucial. Day 1 serum bilirubin levels and changes in bilirubin are key predictors of severe hyperbilirubinemia in newborns.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Bilirubin Metabolism
Background:
- Infant jaundice is common, and early hospital discharge increases the risk of severe hyperbilirubinemia.
- Identifying newborns at high risk for jaundice is essential for timely intervention.
Purpose of the Study:
- To prospectively predict severe hyperbilirubinemia in healthy term newborns.
- To evaluate the efficacy of early bilirubin measurements in risk assessment.
Main Methods:
- Prospective study of 1177 healthy term newborns across two Jerusalem hospitals.
- Multiple logistic regression analysis to identify predictive factors for neonatal jaundice.
Main Results:
- Day 1 serum bilirubin and its change from day 1 to day 2 were significant predictors of neonatal jaundice.
- Maternal factors like blood type O, age, schooling, and breastfeeding also showed associations with jaundice risk.
Conclusions:
- Day 1 total serum bilirubin is valuable for identifying infants at higher risk of neonatal jaundice.
- Individualized risk assessment upon discharge, incorporating day 1 bilirubin, aids in managing neonatal jaundice.
Objective:
The need to recognize infants that are at high risk for developing significant jaundice is apparent in the era of routine early discharge. The aim of the present study was to prospectively determine the ability to predict severe hyperbilirubinemia in term healthy newborns (defined as total serum bilirubin of > 10.0 mg/dl at day 2, > 14.0 mg/dl at day 3, and > 17.0 mg/dl at days 4 and 5 of life).
Design:
Prospective study of 1177 healthy term newborns.
Setting:
Two university-affiliated community hospitals in Jerusalem.
Results:
Using a multiple logistic regression analysis, neonatal jaundice was best predicted (p < 0.0001) by day 1 serum bilirubin (adjusted odds ratio of 3.1 [per mg/dl] [95% confidence limits of 2.4 to 4.1]) and by a change in serum bilirubin from the first to the second day of life (2.4 [per mg/dl] [1.9 to 3.0]). Maternal blood type 0 (2.9 [1.5 to 5.8]), age (1.1 [per year] [1.0 to 1.2]), schooling (0.8 [per year] [0.7 to 0.9]), and full breastfeeding (0.4 [0.2 to 0.9]) were also associated with jaundice (p < 0.005). Other factors considered in the regression model but not found to be significantly related to jaundice included maternal ethnic origin, smoking, hypertension, diabetes mellitus, intranatal administration of oxytocin, meperidine, anesthesia, premature rupture of the membranes, parity, newborn sex, birth weight, gestational age, presentation. Apgar scores, blood type, hematocrit, cephalohematoma, and history of jaundice in other siblings. A model for predicting neonatal jaundice based on the above factors had a sensitivity of 81.8%, a specificity of 82.9%, a false positive rate of 80.2%, and a false negative rate of 1.1%.
Conclusion:
Individual risk assessment on discharge in association with day 1 total serum bilirubin is of value in identifying infants at greater risk for neonatal jaundice.