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Clinical Trial
. 2016 May;105(5):e189-94.
doi: 10.1111/apa.13341. Epub 2016 Feb 29.

Identification of Neonatal Haemolysis: An Approach to Predischarge Management of Neonatal Hyperbilirubinemia

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Clinical Trial

Identification of Neonatal Haemolysis: An Approach to Predischarge Management of Neonatal Hyperbilirubinemia

Vinod K Bhutani et al. Acta Paediatr. .

Abstract

Aim: 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.

Methods: 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.

Results: 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).

Conclusion: Near-simultaneous ETCOc and TB measurements in infants with TB >75th percentile accurately identify haemolytic hyperbilirubinemia.

Keywords: Bilirubin; Bilirubin elimination; Bilirubin production; End-tidal carbon monoxide; Newborn jaundice.

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