Identification of neonatal haemolysis: an approach to predischarge management of neonatal hyperbilirubinemia

Acta Paediatrica
Vinod K BhutaniD K Stevenson

Abstract

Relative contributions of increased production [by end-tidal carbon monoxide concentrations (ETCOc)] and decreased elimination of bilirubin to predischarge hour-specific total bilirubin (TB) levels were assessed in healthy late-preterm and term newborns. Secondly, we report predischarge ETCOc ranges to guide clinical management of hyperbilirubinemia. TB and ETCOc (≤3 timepoints) determinations of newborns aged between six hours and <6 days (n = 79) were stratified by postnatal age epochs. Hyperbilirubinemia risk was assessed by plotting TB values as a function of ETCOc. Stratifications of ETCOc (in ppm, mean, median and interquartile ranges) by postnatal age epochs (0-24, 24-48 and 48-72) were as follows: 2.0, 1.9, 1.8-2.2 (n = 11); 1.6, 1.5, 1.1-2.0 (n = 58); and 2.0, 1.8, 1.6-2.3 (n = 9), respectively. Infants with ETCOc ≥ 2.5 were at high risk, between 1.5 and 2.5 at moderate risk and ≤1.5 were at low risk. Risk due to haemolysis alone was not independent (p < 0.01). For infants with TB >75th percentile (n = 31), 23% had ETCO ≤1.5, and 77% had ETCOc > 1.5 (p < 0.00003). Near-simultaneous ETCOc and TB measurements in infants with TB >75th percentile accurately identify haemolytic hyperbilirubinemia.

References

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Citations

Dec 9, 2016·Journal of Perinatology : Official Journal of the California Perinatal Association·J S MercerJ F Padbury
Mar 14, 2018·Acta Paediatrica·Vinod K BhutaniDavid K Stevenson
Feb 8, 2018·Journal of Perinatology : Official Journal of the California Perinatal Association·R D ChristensenS J Ilstrup
Jul 20, 2019·Fetal and Pediatric Pathology·Birol Karabulut, Baran Cengiz Arcagok
Nov 22, 2016·Acta Paediatrica·Vinod K Bhutani, Ronald J Wong
Feb 5, 2019·International Journal of Pediatrics·David OldakBernardo Oldak
Mar 24, 2020·Journal of Perinatology : Official Journal of the California Perinatal Association·A L ElsaieD L Schutzman
Dec 15, 2020·Seminars in Perinatology·Lizhong DuVinod K Bhutani
Jul 15, 2021·The Journal of Pediatrics·Timothy M BahrRobert D Christensen
Jul 25, 2021·International Journal of Nursing Knowledge·Anna Virginia V C DantasViviane M da Silva
Aug 7, 2021·Clinics in Perinatology·Cathy Hammerman, Michael Kaplan
Sep 25, 2021·Journal of Perinatology : Official Journal of the California Perinatal Association·Sasikarn PakdeetoRobert D Christensen

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