Anvar P Vellamgot
Hamad Medical Corporation, Qatar
Title: Early term gestation- an important risk factor for significant hyperbilirubinemia in neonates
Biography
Biography: Anvar P Vellamgot
Abstract
Introduction: Significant hyperbilirubinemia (HB), defined as Total Serum Bilirubin (TSB) > 95th centile of hour specific Bhutaninomogram is observed in 8-11% of neonates and if severe, it may result in acute bilirubin encephalopathy, kernicterus, and subtle neurodevelopmental disorders. The objective of our study was to look for the risk factors for readmission with significant HB among late preterm and term babies who are discharged home without prior phototherapy. The study aimed to analyze the areas of quality improvement in discharge and follow up of such babies in our institution. Methodology: We performed a retrospective data review of all babies who are 35 weeks or more, born between January 2017 and December 2018, and readmitted due to jaundice with a TSB>300 micro mols/L (>95th centile for any baby during the first week of life).To look for additional risk factors, we compared the baseline data to that of the total population of babies who were born during the same period. Results: Between Jan 2016 and Dec 2018, our hospital recorded 16837 live births. Among them, 16498 babies were born at 35 weeks or more gestational age. From 239 Babies who had TSB >300 micro mols/L, 150 babies qualified the inclusion criteria. Risk factors like ABO/Rh isoimmunization, G6PD deficiency, late prematurity, cephalhematoma, and polycythemia were observed in 46% of the babies. When compared to the general birth cohort, Vaginal birth (P < 0.001, OR 3.09, 95% CI 1.96 to 4.87),instrumental delivery ( P <0.001, OR 3.018, 95% CI 2.02 to 4.49 ) and gestational age below 39 weeks( P <0.001 ) were significantly higher in the study group. We identified a gap between our current practice (43%) and the actual need (73%) for follow up. Conclusion: In addition to late prematurity, early-term gestations, namely 37 and 38 weeks, are significant risk factors of HB. Combining pre-discharge bilirubin with gestational age and risk factors enhances the chances of identifying babies with subsequent risk for significant and severe HB.