Document Type : Research Paper

Authors

1 Associate professor of Pediatrics, Babol University of Medical Sciences, Babol, Iran

2 Professor of Pediatrics, Babol University of Medical Sciences, Babol, Iran

3 Resident of Pediatrics, Babol University of Medical Sciences, Babol, Iran

4 BSc in nurse, Babol University of Medical Sciences, Babol, Iran

10.22038/mjms.2011.5322

Abstract

Introduction
Total Serum Bilirubin level (TSB) has been the gold standard indicator for exchange transfusion (ET) in the neonates for many years. This study was designed to assess the bilirubin/albumin (B/A) ratio as an indicator for ET in comparison with TSB.
Materials and Methods
In the NICU and newborn services at Amirkola Children's Hospital (ACH) in the north of Iran, 90 neonates in 3 groups were selected. The first group was 30 neonates who required exchange transfusion (ET), because of severe hyperbilirubinemia (HB) based on the TSB according to the ACH protocol .The second group was 30 neonates, treated with phototherapy due to pathologic HB and the Other 30 neonates had only physiologic neonatal jaundice. Blood samples were checked for serum bilirubin, albumin and B/A ratio in addition to the routine lab tests for HB. Sensitivity, specificity, negative predictive value, positive predictive value, and relative risk were assessed for B/A ratio as a determinant to do ET.
Results
The mean±SD of B/A ratio was 6.0847±0.9870 in blood exchange group, 4.1680±0.5480 in phototherapy group and 1.7677±0.5061 in healthy neonate group. “Cut off level” of B/A ratio calculated to do ET was 4.50.The B/A ratio of 4.5 has a “positive predictive value” of 75% and a “negative predictive value” of 100%.
Conclusion
A B/A ratio equal to 4.5 among newborns Who required exchange transfusion has a high value as a criterion to do ET, although further study is required to recommend it alone in clinical practice. So we recommend doing B/A ratio in accompaniment with TSB as an adjunctive test.

Keywords

References

1- American Academy of Pediatrics, Provisional Committee for Quality Improvement and Subcommittee on
Hyperbilirubinemia. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics
1994; 94:558–562.
2- Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med 2001; 344:581-590.
3- Ahlfors CE, Herbsman O. Unbound Bilirubin in a Term Newborn with Kernicterus. Pediatrics 2003; 111:1110-1112.
4- Khosravi N, Samaei H, Mojdehi Azar K. Serum Albumin level in full term neonates in Shahid Akbar Abadi
Hospital. J Iran Univ Med Sci 2001; 23:17-15.
5- Rosenthal P. Assessing liver function and hyperbilirubinemia in the newborn, National Academy of Clinical
Biochemistry. Clin Chem 1997; 43:228.
6- American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of Hyperbilirubinemia in the
Newborn Infant 35 or More Weeks of Gestation. Pediatrics 2004; 114:1138.
7- Ahlfors CE. Criteria for exchange transfusion in jaundiced newborns. Pediatrics 1994; 93:488-494.
8- Buchanan N, Moodley GP, Strickwold B, Eyberg C, Rothberg AD. A laboratory investigation into bilirubin binding
in neonates. S Afr Med J 1977; 51:197-199.
9- Funato M, Tamai H, Shimada S, Nakamura H, Vigintiphobia. Unbound Bilirubin, and Auditory Brainstem
Responses. Pediatric 1994; 93:50-53.
10- Hulzebos CV, van Imhoff DE, Bos AF, Ahlfors CE, Verkade HJ, Dijk PH. Usefulness of the bilirubin/albumin ratio for
predicting bilirubin-induced neurotoxicity in premature infants. Arch Dis Child Fetal Neonatal Ed 2008; 93:F384-388.
11- Behjati Ardakani Sh, Ghobadi Dana V, Ziaee V, Haghi Ashtiani MT, Esmaeeli Djavid G, Alijani M, et al.
Bilirubin/Albumin ratio for predicting acute Bilirubin-induced neurologic dysfunction. Iran J pediatr 2011; 21: 28-32.
12- Amin SB, Ahlfors C, Orlando MS, Dalzell LE, Merle KS, Guillet R. Bilirubin and serial auditory brainstem
responses in premature infants. Pediatrics 2001; 107:664-670.
13- Robertson AF, Karp WB, Brodersen R. Comparison of the bilirubin concentration and the bilirubin/albumin ration
with the bilirubin-binding ability in neonatal serum. J Pediatr 1998; 132:343-344.
medical journal of mashhad university of medical sciences
Volume 54, Issue 3 - Serial Number 3
September and October 2010
Pages 137-142

Files

Share

How to cite

Statistics