Prediction of severe neonatal hyperbilirubinemia using cord blood hydrogen peroxide: a prospective study.
BACKGROUND
We hypothesized that cord blood hydrogen peroxide (H2O2) could be utilized to predict the severity of neonatal hyperbilirubinemia.


METHODS
We prospectively enrolled term or near-term healthy neonates. Cord blood and capillary blood at three days of age were measured for hydrogen peroxide and bilirubin concentrations. For newborns with hyperbilirubinemia, further blood samples were obtained at five and seven days of age. Newborns were divided into severe or less severe hyperbilirubinemic groups (peak bilirubin ≥17 mg/dL or not). The sensitivity, specificity, and negative predictive values were determined.


RESULTS
There were 158 neonates enrolled. The incidence of neonatal hyperbilirubinemia was 30.5% for a concentration ≥15 mg/dl. The rising patterns were similar among bilirubin concentrations and hydrogen peroxide levels during the first few days of life. There was a strong positive correlation between bilirubin concentrations and hydrogen peroxide levels after correlation analysis. The rate of severe hyperbilirubinemia was 13.3%. It revealed that a cord blood hydrogen peroxide signal level of 2500 counts/10 seconds was an appropriate cut-off for predicting severe hyperbilirubinemia. Sensitivity and the negative predictive value were 76.2% and 93.3%, respectively.


CONCLUSIONS
Our findings confirm that hydrogen peroxide levels and bilirubin concentrations in cord and neonatal blood are closely related. A cord blood hydrogen peroxide level above 2500 counts/10 seconds associated with a high predictive value for severe hyperbilirubinemia. This method provides information about which neonate should be closely followed after discharge from the nursery.
National Taiwan University College of Medicine Graduate Institute of Clinical Medicine, Taipei, Taiwan ; Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Medical College, Taipei, Taiwan.
Hung-Chieh
HC
Chou
Department of Life Science, National Taiwan Normal University, Taipei, Taiwan.
Chiang-Ting
CT
Chien
Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Medical College, Taipei, Taiwan.
Po-Nien
PN
Tsao
Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Medical College, Taipei, Taiwan.
Wu-Shiun
WS
Hsieh
National Taiwan University College of Medicine Graduate Institute of Clinical Medicine, Taipei, Taiwan ; Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Medical College, Taipei, Taiwan.
Chien-Yi
CY
Chen
Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Medical College, Taipei, Taiwan.
Mei-Hwei
MH
Chang
D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D005312:Fetal Blood / Q000378:metabolism*; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D006861:Hydrogen Peroxide / Q000097:blood*; D051556:Hyperbilirubinemia, Neonatal / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D015994:Incidence; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D013624:Taiwan / Q000453:epidemiology
D015415:Biomarkers; D006861:Hydrogen Peroxide; D001663:Bilirubin