Predischarge bilirubin screening in glucose-6-phosphate dehydrogenase-deficient neonates

Citation
M. Kaplan et al., Predischarge bilirubin screening in glucose-6-phosphate dehydrogenase-deficient neonates, PEDIATRICS, 105(3), 2000, pp. 533-537
Citations number
19
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Pediatrics,"Medical Research General Topics
Journal title
PEDIATRICS
ISSN journal
0031-4005 → ACNP
Volume
105
Issue
3
Year of publication
2000
Pages
533 - 537
Database
ISI
SICI code
0031-4005(200003)105:3<533:PBSIGD>2.0.ZU;2-U
Abstract
Objective. To assess the validity of predischarge serum bilirubin values in determining or predicting hyperbilirubinemia in glucose-6-phosphate dehydr ogenase (G-6-PD)-deficient neonates, and to facilitate appropriate discharg e planning. Methods. Serum total bilirubin values were determined between 44 and 72 hou rs of life in a cohort of term, healthy neonates at high-risk for G-6-PD de ficiency but with no other risk factors for hyperbilirubinemia. Percentile- based bilirubin nomograms were constructed for G-6-PD-deficient infants and normal infants according to age at sampling. The incidence of hyperbilirub inemia (serum bilirubin value greater than or equal to 256 mu mol/L [15 mg/ dL]) for each group was determined according to the percentiles for that gr oup. Results. In both G-6-PD-deficient neonates (n = 108) and control neonates ( n = 215) with serum bilirubin values <50th percentile for age, the incidenc e of hyperbilirubinemia was low in the G-6-PD-deficient neonates, with no m easurable incidence in the controls. The incidence of hyperbilirubinemia be came clinically consequential, and significantly higher in the G-6-PD-defic ient groups, when the percentiles were greater than or equal to 50: for tho se in the 50% to 74% range the incidence was moderate (23%) for the G-6-PD- deficient and small (7%) for the control infants (relative risk, 3.29; 95% confidence interval, 1.01-10.67). Among those infants greater than or equal to 75th percentile, 82% of the G-6-PD-deficient infants, compared with 25% of the control infants, were either already hyperbilirubinemic at the time of screening or subsequently developed hyperbilirubinemia (relative risk, 3.23; 95% confidence interval, 1.99-5.24). Conclusions. Timed, predischarge serum bilirubin screening can be used to i dentify G-6-PD-deficient neonates at low, intermediate, or high-risk of dev eloping severe neonatal hyperbilirubinemia, and thus offer a selective appr oach to the discharge and follow-up surveillance of these infants.