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Predicting significant hyperbilirubinaemia and early discharge for glucose-6-phosphate dehydrogenase deficient
1Department of Neonatology, KK Women's and Children's Hospital.
Insights
Day 3 total serum bilirubin (TSB) effectively predicts significant hyperbilirubinaemia (SHB) in glucose-6-phosphate dehydrogenase (G6PD) deficient newborns. This allows for safe early discharge, reducing healthcare burdens.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
- Clinical Chemistry
Background:
- Hyperbilirubinaemia is a common concern in newborns, particularly those with glucose-6-phosphate dehydrogenase (G6PD) deficiency.
- Early identification of infants at risk for significant hyperbilirubinaemia (SHB) is crucial for timely intervention and preventing complications.
Purpose of the Study:
- To evaluate the predictive value of day 3 (49-72 hours) pre-phototherapy total serum bilirubin (TSB) for subsequent SHB in G6PD-deficient neonates.
- To assess the feasibility of early discharge for term and near-term G6PD-deficient newborns based on early TSB levels.
Main Methods:
- A prospective cohort study of 129 G6PD-deficient neonates (gestational age >= 35 weeks, birth weight >= 2000 g).
- Monitoring of TSB levels and phototherapy requirements during the first two weeks of life.
- Analysis of day 3 pre-phototherapy TSB in neonates weighing >= 2500 g for predicting subsequent SHB.
Main Results:
- 45% of neonates required phototherapy in the first week; only 3.1% needed re-initiation in the second week.
- No SHB developed in the second week if absent in the first week (95% CI, 0-0.057).
- In neonates >= 2500 g, day 3 TSB <= 154 umol/L predicted no subsequent SHB risk (sensitivity 100%, NPV 100%).
Conclusions:
- G6PD-deficient newborns without SHB in the first week are at no significant risk of developing it later.
- Day 3 pre-phototherapy TSB is a reliable predictor of subsequent SHB risk in G6PD-deficient infants weighing >= 2500 g.
- Early discharge by day 7 is feasible for identified low-risk infants, reducing social and financial burdens associated with G6PD deficiency.
Introduction:
This study aims to assess the usefulness of day 3 (49 to 72 hours) pre-phototherapy total serum bilirubin (TSB) in predicting subsequent significant hyperbilirubinaemia (SHB) and the feasibility of early discharge for term and near-term glucose-6-phosphate dehydrogenase (G6PD) deficient newborns.
Materials And Methods:
This prospective cohort study involved in born G6PD deficient neonates who were > or = 35 weeks and weighted > or = 2000 g at birth. TSB levels and phototherapy requirements in their first two weeks of life were studied. Day 3 pre-phototherapy TSB in the subgroup weighing > or = 2500 g at birth was analysed for its value in predicting subsequent SHB.
Results:
Of the 129 neonates, 58 (45%) required phototherapy in the first week. Of these, only 4 patients (3.1%) needed phototherapy to be restarted in the second week. Seventy-one (55%) neonates did not require phototherapy at all. In the absence of SHB in the first week, the probability of its development in the second week was zero (95% confidence interval, 0 to 0.057). In the subgroup weighing > or = 2500 g at birth, day 3 pre-phototherapy TSB < or = 154 umol/L predicted no measurable risk of subsequent SHB (sensitivity, 100%; 95% confidence interval, 91.4% to 100%; negative predictive value, 100%; 95% confidence interval, 86.7% to 100%).
Conclusions:
G6PD deficient newborns without SHB in their first week of life were at no measurable risk of its development in the second week. Day 3 pre-phototherapy TSB in the subgroup weighing > or = 2500 g was useful for predicting the risk of subsequent SHB. Low-risk infants, thus identified, may be eligible for discharge on or before day 7 of life. Evidence-based early discharge can decrease the social and financial burden of G6PD deficiency in Singapore.