Incidence and risk factors of post-phototherapy neonatal rebound hyperbilirubinemia

Predictive factors for readmission due to neonatal hyperbilirubinemia: A retrospective case-control study

OBJECTIVE

Hyperbilirubinemia is a common cause of hospital readmission among neonates, but the factors contributing to post-discharge readmission remain unclear. Our study aimed to identify predictive factors associated with readmission for neonatal hyperbilirubinemia.

METHODS

This retrospective case-control study included 421 neonates born at ≥ 35 weeks of gestation with hyperbilirubinemia between January and December 2021. The neonates were divided into a readmission group and a control group, and logistic regression was used to identify predictive factors associated with readmission.

RESULTS

Among the 421 neonates studied, 32 (7.6%) were readmitted. Logistic regression analysis identified preterm birth (<37 weeks), ABO hemolysis, Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, and Total Serum Bilirubin (TSB) level at discharge as significant predictive factors for readmission due to hyperbilirubinemia in newborns. Additionally, a decrease in birth weight was significantly linked to an increased risk of readmission (OR = 0.998, P = 0.013), although the effect size was relatively small.

CONCLUSIONS

Prolonging hospitalization and implementing robust post-discharge monitoring may be essential for neonates with prematurity, ABO hemolysis, G6PD deficiency, or elevated TSB levels at discharge.

Risk factors for readmission for hyperbilirubinemia in neonates with ABO hemolytic disease: a single-center retrospective cohort study

OBJECTIVE

ABO hemolytic disease of the newborn (ABO-HDN) is a major risk factor for severe hyperbilirubinemia, a common readmission reason for newborns. In this study, we aimed to assess the risk factors for readmission associated with hyperbilirubinemia in neonates with ABO-HDN.

METHODS

A retrospective cohort study was conducted including newborns with gestational age ≥35 weeks and ABO-HDN in 2018. Among 291 newborns, 36 were readmitted for hyperbilirubinemia and defined as the readmission group. The remaining 255 cases were used as a control group. We then performed between-group comparisons of clinical conditions associated with hyperbilirubinemia. Logistic regression was used to select risk predictors of readmission associated with hyperbilirubinemia due to ABO-HDN.

RESULTS

Baseline characteristics were similar between both groups (p > .05, respectively). However, total serum bilirubin (TSB) before initiating phototherapy was significantly higher in the readmission group when compared with that in the control group at 0-24 h, 24-48 h, and 48-72 h (183.70 µmol/L [interquartile range (IQR) 161.18-196.48] vs. 150.35 µmol/L [IQR 131.73-175.38], p = .005; 229.90 µmol/L [IQR 212.45-284.30] vs. 212.50 µmol/L [IQR 197.85-230.28], p = .026; 268.10 µmol/L [IQR 257.70-279.05] vs. 249.50 µmol/L [IQR 236.80-268.70], p = .045, respectively). The age of initiation of phototherapy in the readmission group was significantly lower than that in control group (30.0 h [IQR 18.0-49.00] vs. 42.0 h [IQR 23.0-61.0], p = .012). The rate of rebound hyperbilirubinemia after the first phototherapy treatment was significantly higher in the readmission group compared to that in the control group (9 [25%] vs. 13 [5.1%], p = .000), and the rate of positive direct antiglobulin testing was significantly higher than that in control group (17 [47.2%] vs. 74 [29.0%], p = .027). Logistic regression analysis showed that the age of initiation of photography, TSB level before the first phototherapy, and rebound hyperbilirubinemia after first phototherapy were independent risk factors for readmission in newborns with hyperbilirubinemia associated with ABO-HDN.

CONCLUSIONS

Earlier age of phototherapy initiation, higher TSB levels at the time of initiating phototherapy and rebound hyperbilirubinemia after the first phototherapy treatment may increase the risk of readmission for hyperbilirubinemia in neonates with ABO-HDN. These factors should be considered in discharge planning and follow-up for newborns with ABO-HDN associated hyperbilirubinemia.

Risk Factors and Predictors of Rebound Hyperbilirubinemia in a Term and Late-Preterm Infant with Hemolysis

OBJECTIVE

This study aimed to assess the incidence and predictors of rebound in term and late-preterm infants with hemolytic hyperbilirubinemia postphototherapy.

STUDY DESIGN

A 4-year retrospective data analysis of neonates with hemolytic indirect hyperbilirubinemia admitted to the neonatal intensive care unit (NICU) of Medina Maternity and Children's Hospital was conducted. Bilirubin rebound was defined as the return of total serum bilirubin (TSB) to phototherapy threshold within 72 hours of postphototherapy.

RESULTS

Of 386 identified neonates; 44 (11%) experienced rebound. Neonates in the rebound group demonstrated significantly higher levels of peak TSB, TSB at discontinuation of phototherapy, and lower value of relative TSB (difference between TSB at phototherapy termination and the American Academy of Pediatrics [AAP] threshold for phototherapy at concurrent age) compared with nonrebound group (p-value: <0.001, <0.001, and 0.007, respectively). Lower value of relative TSB at stoppage of phototherapy was the single independent predictor for rebound hyperbilirubinemia by mutivariate regression (p < 0.001). A cut-off value for relative TSB at stoppage of phototherapy of 190 µmol/L had 98% sensitivity and 32% specificity to predict rebound hyperbilirubinemia.

CONCLUSION

Relative TSB at phototherapy termination is the best predictor for postphototherapy rebound hyperbilirubinemia in neonates with hemolytic etiology.

KEY POINTS

· 11% of neonates showed postphototherapy rebound.. · The relative TSB at stoppage of phototherapy is the best predictor for rebound hyperbilirubinemia.. · The first cohort to assess rebound in neonates with hemolysis..

Relationship between infectious screening and early unconjugated hyperbilirubinemia in well-appearing neonates

BACKGROUND

Neonatal hyperbilirubinemia (NH) may be the initial and solitary sign of infectious condition in neonates. This retrospective cohort study aims to evaluate the risk of sepsis or urinary tract infection in well-appearing infants with NH below 7 days old.

METHODS

All neonates (n = 8779) born in Taipei Veterans General Hospital from 2013 to 2017 were evaluated retrospectively. A total of 2523 initially well-appearing babies were admitted because of NH. After being hospitalized, patients were categorized into two groups according to the initial transcutaneous bilirubin (TCB) level. Infectious screening results, which include C-reactive protein (CRP), differential count, blood culture, urinalysis, and urine culture, were analyzed.

RESULTS

Regarding CRP, 2.7% (18/667) of neonates with NH had elevated CRP (≥1 mg/dL). Among 547 blood cultures, eight were positive, with 0.4% (2/547) non-coagulase-negative staphylococcus (CoNS) bacteremia and 1.1% (6/547) CoNS bacteremia. In urinalysis, 16.6% (182/1094) of NH neonates had pyuria, and 6.7% (25/372) had positive urine cultures. NH with a higher initial TCB level was related to an increased chance of elevated CRP (4.7% vs. 1.5%, odds ratio: 3.29, p = 0.024) and pyuria (20.6% vs. 12.6%, odds ratio: 1.79, p < 0.001). The rate of positive urine culture between the higher and lower TCB groups had no significant difference (6.6% vs. 6.9%, p > 0.99). Significant bacteriuria was more common in NH neonates admitted at later age (>2 days) (4.9% vs. 11.5%, p = 0.035).

CONCLUSION

In well-appearing neonates below 7 days old, NH with a higher initial TCB is associated with an increased rate in pyuria and abnormal CRP. No difference was found in the rate of positive urine culture between higher and lower TCB levels. Significant bacteriuria was more common in older NH neonates. Septicemia is rare among well-appearing neonates with NH.