1Fellow, Dept. of Pediatric Hematology, Oncology and Blood & Marrow Transplantation, Mazumdar Shaw Medical Center, Bangalore
2Associate Professor, Dept. of Pediatrics, Kamala Raja Hospital, Gwalior
4Consultant, Dept. of Pediatric Hematology, Oncology and Blood & Marrow Transplantation, Mazumdar Shaw Medical Center, Bangalore
5Consultant and Head, Dept. of Pediatric Hematology, Oncology and Blood & Marrow Transplantation, Mazumdar Shaw Medical Center, Bangalore
*Corresponding Author E-mail: sunilbhat_9@hotmail.com
Online published on 28 July, 2016.
To evaluate the factors associated with conjugated hyperbilirubinemia and its contribution to outcome and prognosis of neonates with jaundice.
A prospective and observational study.
Kamla Raja Hospital, G. R. Medical College, Gwalior (M.P.) for a period of 1 year.
Consecutive term and late preterm LBW neonates reporting with hyperbilirubinemia to the center were recruited in the study.
Relevant history, clinical findings and appropriate laboratory investigations of the eligible cohort were obtained and the cohort was followed-up till discharge or final outcome to assess the risk, the time to and the rate of mortality(n=126).
The median values of total, conjugated and unconjugated bilirubin in the cohort were 18.6 (IQR 7.2), 2.8 (IQR 2.1) and 15.3 (IQR 6.425) mg/dl respectively. These values were used to dichotomize the variables into high and low. A strong association was observed between perinatal hypoxic ischemia and conjugated hyperbilirubinemia (p=0.026, χ2=4.214, κ=0.144, odds ratio=3.886). Conjugated hyperbilirubinemia was found to be strongly associated with sepsis indicating the probable role of sepsis in conjugated hyperbilirubinemia (p<0.001, κ=0.313). Unconjugated hyperbilirubinemia contributed more in terms of number of patients (54.77% vs 45.23%), while maximum proportion of death occurred in neonates with conjugated hyperbilirubinemia (71.42% vs 28.58%). The z values for conjugated bilirubin were significantly higher in those neonates who died when compared to those who survived (p=0.0005), while the z values for unconjugated bilirubin were similar in neonates who died and who survived (Mann Whitney box plots). Further, comparison of ROC curves (AUC 0.824 vs 0.526; SE 0.0688 vs 0.104; p=0.0437) indicated a superior prognostic value of conjugated fraction in predicting death.
The study showed that conjugated bilirubin is a dependable clinical parameter for prognostication of neonates with hyperbilirubinemia. Conjugated bilirubin measurement may be put to greater use in our population where factors associated with conjugated hyperbilirubinemia as sepsis and perinatal hypoxia are quite prevalent.
Conjugated bilirubin, Hyperbilirubinemia, Neonatal Jaundice
