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Published on: December 31, 2015
Value of twelfth hour bilirubin level in predicting significant hyperbilirubinemia in preterm infants
Izi Mayer1, Tugba Gursoy1, Mutlu Hayran2
1Zeynep Kamil Maternity and Children's Research and Training Hospital, Istanbul, Turkey.
Insights
Measuring capillary bilirubin at 12 hours can predict significant hyperbilirubinemia in preterm infants. Early prediction allows for timely intervention to prevent brain injury in high-risk neonates.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Clinical Chemistry
Background:
- Hyperbilirubinemia poses a significant risk of brain injury in neonates.
- Predictive data for preterm infants are limited.
- Early identification of at-risk preterm infants is crucial.
Purpose of the Study:
- To predict significant hyperbilirubinemia in preterm infants.
- To evaluate the efficacy of measuring capillary bilirubin at 12 hours of life for prediction.
Main Methods:
- 150 neonates born at or before 35 weeks gestation were studied.
- Infants were categorized by birth weight (1000-1499g vs. 1500-2000g).
- Capillary bilirubin levels were measured at 12 hours and daily for 5 days; risk nomograms were generated.
Main Results:
- Capillary bilirubin levels of 3.55 mg/dL (group 1) and 4.55 mg/dL (group 2) at 12 hours showed high predictive value.
- These levels demonstrated the highest sensitivity, negative, and positive predictive values for significant hyperbilirubinemia.
- Phototherapy was administered to 94.7% of group 1 and 80.7% of group 2 infants.
Conclusions:
- 12-hour capillary bilirubin levels are effective predictors of significant hyperbilirubinemia in preterm infants.
- Close monitoring and attention to infants with elevated 12-hour bilirubin levels are recommended.
- This approach aids in preventing bilirubin-induced brain injury in vulnerable neonates.
Background:
As hyperbilirubinemia is a significant cause of brain injury, it is important to predict the cases who are at risk. Data for preterm infants are scarce. The aim of this study is to predict significant hyperbilirubinemia in preterm infants by measuring capillary bilirubin at 12th hour of life.
Methods:
One hundred and fifty neonates born ≤ 35 weeks were included in the study. They were categorized into two groups according to their birth weights (group 1: 1,000 - 1,499 g; group 2: 1,500 - 2,000 g). Their bilirubin levels were measured at 12th hour and daily thereafter for 5 days. Risk nomograms were generated based on their bilirubin measurements and postnatal ages. On the age-specific percentile-based nomogram, the zone above the 90th percentile was determined as high risk and those below the fifth percentile as low risk. Infants who had bilirubin levels over the limits defined according to their postnatal ages and birth weights were accepted to have significant hyperbilirubinemia and received phototherapy and predictive value of the 12th hour bilirubin was asssessed.
Results:
Fifty-four of 57 infants (94.7%) in group 1 and 75/93 infants (80.7%) in group 2 received phototherapy. Capillary bilirubin levels of 3.55 mg/dL and 4.55 mg/dL for group 1 and group 2 measured at the 12th hour of life had the highest sensitivity, negative and positive predictive value to predict the neonates who will develop significant hyperbilirubinemia.
Conclusion:
Bilirubin levels of preterm infants should be monitored closely. More attention should be paid to the ones who had 12th hour bilirubin level above the cutoff values.
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