Incidence,Course,Outcome And Prediction of Significant Hyperbilirubinemia in Newborn

Jaundice is a clinical condition that is often present is pediatric practice and constitutes one of the major issues within the neonatal period. Although most newborn with jaundice are otherwise healthy, they need to be monitored because bilirubin is potentially toxic to central nervous system .A prospective cohort study was conducted in Neonatal intensive care unit of Gauhati medical college and hospital over 1 year period from 1 st June 2012 to 31 st May 2013. Hence, the present study is designed with the objective to study the hospital incidence of significanthyperbillirubinemia, its causes, course & outcome and to determine the value of an early (6th hr.) serum billirubinmeasurment in predicting development of significanthyperbillirubinemia late during the first week of life. Out of 500 eligible infants, 50 cases were lost during study period and 450 cases completed the study for the incidence, course & prediction of significant hyperbilirubinemia and 50 newborns with hyperbilirubinemia cases were followed up for outcome .50 cases with significant hyperbilirubinemia in the present study group of 450 newborns represented a hospital incidence of 11.11%.There were no significant differences between the cases who did and who did not develop significant hyperbilirubinemia with respect to various risk factors except cephalohematoma (p value<0.05) .The present study shows ABO Incompatibility in 14 cases (28%) , Rh Incompatibility-4 cases (8%), ABO & Rh Incompatibility-3 case (6%), G6PD Deficiency-5 cases (10%), Cephalohematoma2 cases (4%) ,sepsis associated with 3 cases (6 %),Unknown cases19 (38%) for development of significant hyperbilirubinemia .At 6 th hr of life, mean TSB level was 6.79 ± 1.02(range 2-9) mg/dl and Peak serum bilirubin of the 50 babies with significant hyperbilirubinemia , at 94.4 ± 24.5 hr of age, was 19.3 ± 1.9 mg/dlOut of 50 newborn with significant hyperbilirubinemia 37 were treated with phototherapy ,1 with exchange transfusion.12 neonates were below phototheraylevel.Of 50 cases eligible for the study for outcome of significant hyperbilirubinemia , 30 ≥ (60%) were followed up . 20 cases lost to follow-upAlmost all the infants were normal during physical, visual, and auditory evaluation & free of neurological sequelae on follow up .Brainstem auditory evoked responses (BAER) was also normal .Out of 450 newborns, 172 (38.22%) who had a bilirubin level of ≥ 6 mg/dl in the first 24 hours of life, 45 cases (26.16%) developed significant hyperbilirubinemia, whereas 5 cases (1.8 %) of the 278 newborns (61.77%) whose bilirubin level was <6 mg/dl on the first day of life developed significant hyperbilirubinemia.Bilirubin level of 6 mg/dl at 6 th hr. of life had the high sensitivity (90 %), specificity (68.25 %), low positive predictive value (26.16 %) and high (98.20 %) negative predictive value and likehood ratio 2.83.At the mean serum bilirubin level of 6 mg/dl at 6th hr. of life, the sensitivity and negative predictive value were very high in predicting development of significanthyperbillirubinemia late during the first week of life and the subsequent need of a phototherapy treatment.