Showing Latest Articles
Risk Factors for Neurotoxicity in Newborns With Severe Neonatal Hyperbilirubinemia
Pediatrics, 10/10/2011
Gamaleldin R et al. – Newborns without risk factors for neurotoxicity have a higher tolerance for hyperbilirubinemia than recognized in management guidelines. The risk for BE in hemolytic disease varies with etiology. The great variation in response to total serum bilirubin (TSB) indicates that biological factors other than TSB values are important in the pathogenesis of bilirubin encephalopathy (BE).
Methods- The authors analyzed the interaction of TSB and risk factors as determinants of ABE and BE in 249 newborns admitted with a TSB level of >25 mg/dL (427 umol/L) to Cairo University Children's Hospital during a 12-month period.
- Admission TSB values ranged from 25 to 76.4 mg/dL.
- Forty-four newborns had moderate or severe ABE at admission; 35 of 249 infants (14%) had evidence of BE at the time of discharge or death.
- Rh incompatibility (odds ratio [OR]: 48.6) and sepsis (OR: 20.6) greatly increased the risk for ABE/BE, but TSB levels correlated poorly with the presence or absence of ABE or BE in these patients.
- The OR for ABO incompatibility with anemia (1.8) was not statistically significant.
- Low admission weight (OR: 0.83 per 100 g) increased the risk for BE, especially when other risk factors were present.
- The threshold TSB level that identified 90% of infants with ABE/BE was 25.4 mg/dL when neurotoxicity risk factors were present.