Risk Assessment for Adverse Outcome in Term and Late Preterm Neonates with Bilirubin Values of 20 mg/dL or More

ABSTRACT

The aim of this study is to identify clinical, etiologic, and laboratory factors that potentiate adverse outcome of hyperbilirubinemia among term and late preterm neonates in logistic regression analysis. A retrospective cohort of infants with total serum bilirubin (TSB) ≥ 20 mg/dL from 1995 to 2007 was surveyed. Eighteen infants had adverse outcome. Controls were 270 infants without sequelae. Risks were significantly higher in infants with six etiologies causing hyperbilirubinemia: sepsis (odds ratio [OR] = 161.7, 95% confidence interval [CI] = 11.7 to 2242.8), gastrointestinal obstruction (OR = 39.2, 95% CI = 2.7 to 567.3), Rh incompatibility (OR = 31.0, 95% CI = 5.1 to 188.9), hereditary spherocytosis (OR = 19.6, 95% CI = 1.6 to 235.5), ABO incompatibility (OR = 5.1, 95% CI = 1.3 to 19.7), and glucose-6-phosphate dehydrogenase deficiency (OR = 4.7, 95% CI = 1.3 to 16.7). Infants with acute bilirubin encephalopathy were more likely to have adverse outcome than subjects without acute bilirubin encephalopathy (OR = 281.7, 95% CI = 25.8 to 3076.7). Adverse outcome was more common in infants with a positive direct Coombs test (OR = 4.5, 95% CI = 1.3 to 15.4). Infants with hemoglobin < 10 g/dL tended to have adverse outcome more often than those with hemoglobin ≥ 13 g/dL (OR = 11.8, 95% CI = 3.3 to 42.9). Infants with TSB of 35 mg/dL or more (OR = 472.5, 95% CI = 47.8 to 4668.8) and of 30 to 34.9 mg/dL (OR = 9.5, 95% CI = 1.6 to 57.9) carry greater risks as compared with those with TSB of 20 to 24.9 mg/dL. In conclusion, this study quantitatively verified the potential risks for adverse outcome of neonatal hyperbilirubinemia.

KEYWORDS

Hemolytic disease - kernicterus - neonatal hyperbilirubinemia - odds ratio - risk factors

REFERENCES

• 1 Dennery P A, Seidman D S, Stevenson D K. Neonatal hyperbilirubinemia.  N Engl J Med. 2001;  344 581-590
• 2 Shapiro S M, Bhutani V K, Johnson L. Hyperbilirubinemia and kernicterus.  Clin Perinatol. 2006;  33 387-410
• 3 Ebbesen F. Recurrence of kernicterus in term and near-term infants in Denmark.  Acta Paediatr. 2000;  89 1213-1217
• 4 Bhutani V K, Johnson L H, Shapiro S M. Kernicterus in sick and preterm infants (1999–2002): a need for an effective preventive approach.  Semin Perinatol. 2004;  28 319-325
• 5 Manning D J, Todd P, Maxwell M, Jane Platt M. Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland.  Arch Dis Child Fetal Neonatal Ed. 2007;  92 F342-F346
• 6 Katar S. Glucose-6-phosphate dehydrogenase deficiency and kernicterus of South-East anatolia.  J Pediatr Hematol Oncol. 2007;  29 284-286
• 7 Newman T B, Maisels M J. Less aggressive treatment of neonatal jaundice and reports of kernicterus: lessons about practice guidelines.  Pediatrics. 2000;  105 (1 Pt 3) 242-245
• 8 Maisels M J, Bhutani V K, Bogen D, Newman T B, Stark A R, Watchko J F. Hyperbilirubinemia in the newborn infant > or =35 weeks' gestation: an update with clarifications.  Pediatrics. 2009;  124 1193-1198
• 9 Chen W X, Wong V C, Wong K Y. Neurodevelopmental outcome of severe neonatal hemolytic hyperbilirubinemia.  J Child Neurol. 2006;  21 474-479
• 10 AlOtaibi S F, Blaser S, MacGregor D L. Neurological complications of kernicterus.  Can J Neurol Sci. 2005;  32 311-315
• 11 Yilmaz Y, Karadeniz L, Yildiz F, Degirmenci S Y, Say A. Neurological prognosis in term newborns with neonatal indirect hyperbilirubinemia.  Indian Pediatr. 2001;  38 165-168
• 12 Weng Y H, Chou Y H, Lien R I. Hyperbilirubinemia in healthy neonates with glucose-6-phosphate dehydrogenase deficiency.  Early Hum Dev. 2003;  71 129-136
• 13 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia . Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.  Pediatrics. 2004;  114 297-316
• 14 Watchko J F. Vigintiphobia revisited.  Pediatrics. 2005;  115 1747-1753
• 15 Hansen T W. Mechanisms of bilirubin toxicity: clinical implications.  Clin Perinatol. 2002;  29 765-778 viii
• 16 Johnson L, Bhutani V K, Karp K, Sivieri E M, Shapiro S M. Clinical report from the pilot USA Kernicterus Registry (1992 to 2004).  J Perinatol. 2009;  29 (Suppl 1) S25-S45
• 17 Weng Y H, Chiu Y W. Comparison of efficacy and safety of exchange transfusion through different catheterizations: femoral vein versus umbilical vein versus umbilical artery/vein.  Pediatr Crit Care Med. 2011;  12 61-64
• 18 Weng Y H, Chiu Y W. Spectrum and outcome analysis of marked neonatal hyperbilirubinemia with blood group incompatibility.  Chang Gung Med J. 2009;  32 400-408
• 19 Berardi A, Lugli L, Ferrari F et al.. Kernicterus associated with hereditary spherocytosis and UGT1A1 promoter polymorphism.  Biol Neonate. 2006;  90 243-246
• 20 Christensen R D, Henry E. Hereditary spherocytosis in neonates with hyperbilirubinemia.  Pediatrics. 2010;  125 120-125
• 21 Kaplan M, Hammerman C. Glucose-6-phosphate dehydrogenase deficiency: a hidden risk for kernicterus.  Semin Perinatol. 2004;  28 356-364
• 22 Nair P A, Al Khusaiby S M. Kernicterus and G6PD deficiency—a case series from Oman.  J Trop Pediatr. 2003;  49 74-77
• 23 Maisels M J, Newman T B. Kernicterus in otherwise healthy, breast-fed term newborns.  Pediatrics. 1995;  96 (4 Pt 1) 730-733
• 24 Gourley G R. Breast-feeding, neonatal jaundice and kernicterus.  Semin Neonatol. 2002;  7 135-141
• 25 Huang M J, Kua K E, Teng H C, Tang K S, Weng H W, Huang C S. Risk factors for severe hyperbilirubinemia in neonates.  Pediatr Res. 2004;  56 682-689
• 26 Newman T B, Liljestrand P, Escobar G J. Combining clinical risk factors with serum bilirubin levels to predict hyperbilirubinemia in newborns.  Arch Pediatr Adolesc Med. 2005;  159 113-119
• 27 Johnson L H, Bhutani V K, Brown A K. System-based approach to management of neonatal jaundice and prevention of kernicterus.  J Pediatr. 2002;  140 396-403
• 28 Kuzniewicz M, Newman T B. Interaction of hemolysis and hyperbilirubinemia on neurodevelopmental outcomes in the collaborative perinatal project.  Pediatrics. 2009;  123 1045-1050