Prediction of hyperbilirubinemia by noninvasive methods in full-term newborns
Abstract
Introduction: The noninvasive screening methods for bilirubin determination were studied prospectively in a group of full-term healthy newborns with the aim of early prediction of pathological neonatal hyperbilirubinemia. Laboratory determination of bilirubin (Jendrassik-Grof (JG)) was compared to the noninvasive transcutaneous bilirubin (TcBIL) together with the determination of bilirubin in cord blood.Methods: The study group consisted of 284 full-term healthy consecutively born infants in the period from March to June 2011. The whole group was divided into a group of physiological (n=199), and a group of pathological hyperbilirubinemia (n=85) according to the level of total bilirubin (220 μmol/L). Bilirubin in cord blood (CbBIL) and from capillary blood at the age of three days was determined according to the JG, on the 3rd day TcBIL was also detected by Bilicheck bilirubinometer. The Kolmogorov-Smirnov and Mann-Whitney tests were used for the statistical analysis.
Results: Bilirubin concentrations were statisti cally significantly different (CbBIL (p<0,001) on the 3rd day control sample (p<0,001), TcBil (p<0,001)) between the groups of newborns with physiological (n=199) and pathological (n=85) hyperbilirubinemia. Using the cut-off value of cord blood bilirubin 28 μmol/L, we could predict the development of pathological hyperbiliru binemia with 98.8% prognostic specificity, and with 100% sensitivity that newborns will not require a phototherapy (all irradiated newborns were taken into account). We confirmed an excellent agreement between bilirubin concentrations determined by the TcBIL and JG methods for both groups of healthy full-term newborns.
Conclusion: Based on our results, we could recommend that determination of the cord blood bilirubin in combination with the measurement of TcBIL should be implemented into practice for early prediction of pathological hyperbilirubinemia in full-term healthy newborns. The advantages of both methods in the routine clinical treatment of hyperbilirubinemia are in noninvasive approach with reduced costs and number of unnecessary treatments.
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