Risk Assessment for Adverse Outcome in Term and Late Preterm Neonates with Bilirubin Values of 20 mg/dL or More.

The aim of this study is to identify clinical, etiologic, and laboratory factors that potentiate adverse outcome of hyperbilirubinemia among term and late preterm neonates in logistic regression analysis. A retrospective cohort of infants with total serum bilirubin (TSB) ≥20 mg/dL from 1995 to 2007 was surveyed. Eighteen infants had adverse outcome. Controls were 270 infants without sequelae. Risks were significantly higher in infants with six etiologies causing hyperbilirubinemia: sepsis (odds ratio [OR]=161.7, 95% confidence interval [CI]=11.7 to 2242.8), gastrointestinal obstruction (OR=39.2, 95% CI=2.7 to 567.3), Rh incompatibility (OR=31.0, 95% CI=5.1 to 188.9), hereditary spherocytosis (OR=19.6, 95% CI=1.6 to 235.5), ABO incompatibility (OR=5.1, 95% CI=1.3 to 19.7), and glucose-6-phosphate dehydrogenase deficiency (OR=4.7, 95% CI=1.3 to 16.7). Infants with acute bilirubin encephalopathy were more likely to have adverse outcome than subjects without acute bilirubin encephalopathy (OR=281.7, 95% CI=25.8 to 3076.7). Adverse outcome was more common in infants with a positive direct Coombs test (OR=4.5, 95% CI=1.3 to 15.4). Infants with hemoglobin <10 g/dL tended to have adverse outcome more often than those with hemoglobin ≥13 g/dL (OR=11.8, 95% CI=3.3 to 42.9). Infants with TSB of 35 mg/dL or more (OR=472.5, 95% CI=47.8 to 4668.8) and of 30 to 34.9 mg/dL (OR=9.5, 95% CI=1.6 to 57.9) carry greater risks as compared with those with TSB of 20 to 24.9 mg/dL. In conclusion, this study quantitatively verified the potential risks for adverse outcome of neonatal hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

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