Predicting significant hyperbilirubinaemia and early discharge for glucose-6-phosphate dehydrogenase deficient newborns.
BACKGROUND
This study aims to assess the usefulness of day 3 (49 to 72 hours) pre-phototherapy total serum bilirubin (TSB) in predicting subsequent significant hyperbilirubinaemia (SHB) and the feasibility of early discharge for term and near-term glucose-6-phosphate dehydrogenase (G6PD) deficient newborns.


METHODS
This prospective cohort study involved in born G6PD deficient neonates who were > or = 35 weeks and weighted > or = 2000 g at birth. TSB levels and phototherapy requirements in their first two weeks of life were studied. Day 3 pre-phototherapy TSB in the subgroup weighing > or = 2500 g at birth was analysed for its value in predicting subsequent SHB.


RESULTS
Of the 129 neonates, 58 (45%) required phototherapy in the first week. Of these, only 4 patients (3.1%) needed phototherapy to be restarted in the second week. Seventy-one (55%) neonates did not require phototherapy at all. In the absence of SHB in the first week, the probability of its development in the second week was zero (95% confidence interval, 0 to 0.057). In the subgroup weighing > or = 2500 g at birth, day 3 pre-phototherapy TSB < or = 154 umol/L predicted no measurable risk of subsequent SHB (sensitivity, 100%; 95% confidence interval, 91.4% to 100%; negative predictive value, 100%; 95% confidence interval, 86.7% to 100%).


CONCLUSIONS
G6PD deficient newborns without SHB in their first week of life were at no measurable risk of its development in the second week. Day 3 pre-phototherapy TSB in the subgroup weighing > or = 2500 g was useful for predicting the risk of subsequent SHB. Low-risk infants, thus identified, may be eligible for discharge on or before day 7 of life. Evidence-based early discharge can decrease the social and financial burden of G6PD deficiency in Singapore.
Lim
H H
HH
Department of Neonatology, KK Women's and Children's Hospital.
Daniel
L M
LM
Lee
J
J
Tan
M C
MC
D001363:Awards and Prizes; D001663:Bilirubin / Q000097:blood*; D001724:Birth Weight; D015331:Cohort Studies; D005260:Female; D005954:Glucosephosphate Dehydrogenase / Q000097:blood; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000097:blood / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D015997:Neonatal Screening; D010351:Patient Discharge; D010789:Phototherapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012846:Singapore / Q000453:epidemiology; D013997:Time Factors
D005954:Glucosephosphate Dehydrogenase; D001663:Bilirubin