title: 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.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan. yihaoweng@adm.cgmh.org.tw
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Weng
authors.forename: Ya-Wen
authors.initials: YW
authors.lastname: Chiu
authors.forename: Shao-Wen
authors.initials: SW
authors.lastname: Cheng
authors.forename: Meng-Ying
authors.initials: MY
authors.lastname: Hsieh
mesh_terms: D001663:Bilirubin / Q000097:blood*; D003298:Coombs Test; D005260:Female; D017219:Gastric Outlet Obstruction / Q000150:complications; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000150:complications; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000097:blood* / Q000150:complications* / Q000401:mortality; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000150:complications; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D012203:Rh Isoimmunization / Q000150:complications; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D013103:Spherocytosis, Hereditary / Q000150:complications
chemical_list: D006454:Hemoglobins; D001663:Bilirubin