الفهرس 
Neonatal bilirubin metabolismOnly 14 pages are availabe for public view
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Abstract
Early discharge of healthy term newborns after delivery has become a common practice for either medical or social reason and economic constraints. However, an association between the decreased length of stay and the risk of readmission to the hospital has been shown, and the most common cause for readmission during the early neonatal period is hyperbilirubinemia .
Severe hyperbilirubi¬naemia can occur without apparent reason in healthy infants, and some may develop kernicterus. Therefore, it is important to establish safe markers for the devel¬opment of excessive jaundice in these infants.
The possibility of using a noninvasive, painless, and reliable method to determine the bilirubin level and its increment in the first 36 to 48 hours after birth could be very important in prevention of kernicterus Since the early 1980s,
Some of noninvasive measures are in accurate such as visual assessment and others frequent follow up over two days every 6 hours which may be difficult with early discharge.
It is difficult also to provide and monitor compliance of a follow-up program for every infant who is discharged. Therefore, it is impossible to use hour-specific bilirubin percentile to predict subsequent jaundice. The present study was conducted to evaluate the ability of cord bilirubin level in identifying healthy term infants at risk of hyperbilirubinemia.
Our study have been done on 200 healthy new born with gestational age from 34 to 40 weeks has been born in Berket El Sabaa Hospital during period of six months (from April 2012 to October 2012).U.C.S.B was obtained immediately at birth and at day 3 using Minolta/AirShields Jaundice Meter .
We divide infants into three groups:
Group I: consisted of 20 preterm with GA 34-36weeks.
Group II: consisted of 40 fullterm SGA.
Group III:consisted of 140 fullterm AGA.
We use 1.7 mg/dl level as cutoff for need of PT for pretem, 1.8mg/dl for term SGA and 2.0mg/d for term AGA as the power of UCS bili¬rubin as a predictor for the development of signifi¬cant hyperbilirubinaemia.
Clear relation between UCSB and develop subsequent significant hyperbilirubi¬nemia then need of PT was found in the 3 studied groups including preterm.
In preterm neonates, this group of preterm generally developed higher bilirubin values with higher need for PT. For the prediction of hyperbilirubinaemia using a UCS bilirubin cutoff of 1.7mg/dl, we found a sensitivity53.3% and a positive predictive value of 88.9%, This might probably be due to the lower birth weight and, therefore, the earlier initiation of PT.
In fullterm SGA neonates we use the value of 1.8 mg/dl as cutoff point for predicting a hyperbilirubinaemia. There was a probability of 82.4% (Sensitivity) that the UCS bilirubin value was higher or equal to 1.8mg/dl in neonates who exhibited hyperbilirubi-anemia. The probability that the UCSB was below 1.8 mg/dl in neonates with postnatal hyperbilirubi¬anemia was 78.3% (Specificity). The likelihood that a child with UCS bilirubin higher or equal to 1.8 mg/dl will later develop hyperbilirubinaemia was 73.7% (Positive predictive value), whereas the probability that a UCS bilirubin level below or equal to 1.8mg/dl would not later progress to hyperbilirubi-anemia was 85.7% (Negative predictive value).
Correspondingly, in term AGA neonates for predicting a hyperbilirubinaemia using a UCS bilirubin cut-off of 2.0mg/dl we found 69.0%sensitivity and a negative predictive value of 91.6% . In contrast to this, the risk of developing hyperbilirubinaemia effectively predicted with a specificity of 88.3% and a positive predictive value of 60.6%.
Finally our study also show that UCSB below 1.2mg/dl is unlikely to develop hyperbilirubi¬anemia and hence no need for PT.