Predicting hyperbilirubinemia in babies

June 1, 2016

Newborn babies are more likely to develop jaundice requiring treatment if they have significant hemolysis contributing to their bilirubin levels (ie, bruising, ABO blood group incompatibility, glucose-6-phosphate dehydrogenase [G6PD] deficiency).

Newborn babies are more likely to develop jaundice requiring treatment if they have significant hemolysis contributing to their bilirubin levels (ie, bruising, ABO blood group incompatibility, glucose-6-phosphate dehydrogenase [G6PD] deficiency). To detect hemolysis and predict hyperbilirubinemia (HB), investigators tested a bedside end-tidal carbon monoxide concentration (ETCOc) monitor used in conjunction with hour-of-life stratified bilirubins.

A total of 79 infants—gestational age of ≥35 weeks, birth weight ≥2000 g, and postnatal age >6 hours and <6 days—underwent up to 4 ETCOc measurements a day for up to 4 days of life in conjunction with routine total bilirubin (TB) level measurements. Investigators followed these infants for 30 to 35 days after birth for clinical outcomes and results from laboratory tests and determined the relationship between ETCOc and risk for HB.

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Infants with ETCOc ≥2.5 ppm were at high risk of neonatal HB; those with ETCOc between 1.5 and 2.5 ppm were at moderate risk; and those with ≤1.5 ppm were at low risk. Of the 31 infants whose TB was >75th percentile, 23% had ETCOc ≤1.5 ppm and 77% had ETCOc >1.5 ppm, suggesting that highest-risk babies have the highest degree of hemolysis (Bhutani VK, et al. Acta Paediatrica. 2016;105[5]:e189-e194).

Commentary: To understand this article, you need to reach all the way back to biochemistry class to remember that breakdown of a molecule of heme leads to production of 1 molecule of bilirubin and 1 molecule of carbon monoxide. By using both bilirubin level by hour of life and ETCOc, the researchers propose that we will be able to more accurately predict which babies will likely need treatment for their jaundice. —Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.