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Predischarge bilirubin screening in glucose-6-phosphate dehydrogenase-deficient neonates
M Kaplan1, C Hammerman, R Feldman
1Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel. kaplan@cc.huji.ac.il
Insights
Predischarge serum bilirubin screening effectively identifies neonates with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency at risk for hyperbilirubinemia. This allows for targeted discharge planning and follow-up surveillance for these infants.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Genetics
Background:
- Neonatal hyperbilirubinemia is a common concern, particularly in infants with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency.
- Effective predischarge screening is crucial for preventing severe outcomes and guiding appropriate infant care.
Purpose of the Study:
- To evaluate the accuracy of predischarge serum bilirubin levels in predicting hyperbilirubinemia in G-6-PD-deficient newborns.
- To inform discharge planning and follow-up strategies for at-risk neonates.
Main Methods:
- Serum total bilirubin levels were measured in term, healthy neonates at high-risk for G-6-PD deficiency between 44 and 72 hours of life.
- Percentile-based nomograms were created for G-6-PD-deficient and normal infants.
- Hyperbilirubinemia incidence was assessed based on percentile groups.
Main Results:
- Neonates with serum bilirubin below the 50th percentile had a low incidence of hyperbilirubinemia.
- G-6-PD-deficient infants in the 50th-74th percentile range showed a moderate incidence (23%) compared to controls (7%).
- A significant majority (82%) of G-6-PD-deficient infants in the >=75th percentile developed or presented with hyperbilirubinemia, versus 25% of controls.
Conclusions:
- Predischarge serum bilirubin screening is a valid tool for stratifying G-6-PD-deficient neonates into low, intermediate, or high-risk categories for severe hyperbilirubinemia.
- This selective screening approach enables tailored discharge and follow-up care for these infants.
Objective:
To assess the validity of predischarge serum bilirubin values in determining or predicting hyperbilirubinemia in glucose-6-phosphate dehydrogenase (G-6-PD)-deficient neonates, and to facilitate appropriate discharge planning.
Methods:
Serum total bilirubin values were determined between 44 and 72 hours of life in a cohort of term, healthy neonates at high-risk for G-6-PD deficiency but with no other risk factors for hyperbilirubinemia. Percentile-based bilirubin nomograms were constructed for G-6-PD-deficient infants and normal infants according to age at sampling. The incidence of hyperbilirubinemia (serum bilirubin value > or =256 micromol/L [15 mg/dL]) for each group was determined according to the percentiles for that group.
Results:
In both G-6-PD-deficient neonates (n = 108) and control neonates (n = 215) with serum bilirubin values <50th percentile for age, the incidence of hyperbilirubinemia was low in the G-6-PD-deficient neonates, with no measurable incidence in the controls. The incidence of hyperbilirubinemia became clinically consequential, and significantly higher in the G-6-PD-deficient groups, when the percentiles were > or =50: for those in the 50% to 74% range the incidence was moderate (23%) for the G-6-PD-deficient and small (7%) for the control infants (relative risk, 3.29; 95% confidence interval, 1.01-10.67). Among those infants > or =75th percentile, 82% of the G-6-PD-deficient infants, compared with 25% of the control infants, were either already hyperbilirubinemic at the time of screening or subsequently developed hyperbilirubinemia (relative risk, 3.23; 95% confidence interval, 1.99-5.24).
Conclusions:
Timed, predischarge serum bilirubin screening can be used to identify G-6-PD-deficient neonates at low, intermediate, or high-risk of developing severe neonatal hyperbilirubinemia, and thus offer a selective approach to the discharge and follow-up surveillance of these infants.