Neonatal hiperbilirubineminin prediktörü olarak umblikal kord kanı kırmızı hücre dağılım genişliği

Year 2022, Volume: 19 Issue: 4, 1506 - 1511, 31.12.2022

Berna Saygın Hekimoğlu Atalay Demirel Didem Arman

https://doi.org/10.38136/jgon.974006

Abstract

Amaç: Yenidoğanların doğum sonrası erken taburcu edilmesi, çoğunlukla neonatal hiperbilirubinemi nedeniyle hastaneye yeniden yatış riskine yol açar. Bu nedenle hiperbilirubinemi riski yüksek olan yenidoğanların erken teşhisi önemlidir. Kırmızı hücre dağılım genişliği (RDW), rutin tam kan sayımında bulunan basit bir testtir. Bu çalışmada, hiperbilirubinemi gelişme riski yüksek olan yenidoğanları belirlemek için kord kanı kırmızı hücre dağılım genişliği (RDW) düzeylerinin kullanılıp kullanılamayacağını değerlendirmeyi amaçladık.
Gereç ve yöntem: Ocak-Haziran 2017 tarihleri arasında hastanemizde doğan ve kordon kanı örneği alınan tüm term bebeklerin verileri geriye dönük olarak incelendi. Kord kanı RDW, kord kanı bilirubin, yenidoğan/anne kan grupları ve direkt Coombs testi (DCT) sonuçları analiz edildi.
Bulgular: Çalışmaya toplam 175 yenidoğan dahil edildi. 58 yenidoğana postnatal ilk 48 saatte fototerapi verildi. Hiperbilirubinemili yenidoğanlarda ortalama kord kanı RDW düzeyleri kontrollere göre anlamlı derecede yüksekti (18±1.6'ya karşı 16.4±1.0, p<0.001). Belirgin hiperbilirubinemi gelişme riskini öngörmek için kord kanı RDW düzeyinin cut off değeri, %70.7 duyarlılık ve %88 özgüllük ile 17.1 idi. DCT pozitif olan infantların hemoglobin değerleri daha düşük ve kord kanı RDW ve bilirubin düzeyleri daha yüksekti (p<0.05). DCT pozitif olan bebeklerde kord kanı RDW ve bilirubin değerleri arasında pozitif güçlü bir korelasyon tespit edildi (p=<0,001, r:0.663). Çoklu regresyon analizinde kord kanı RDW, bilirubin düzeyi ve DCT pozitifliğinin fototerapi gereksinimi için bağımsız birer risk faktörü olduğu bulundu.
Sonuç: Kord kanı RDW, belirgin hiperbilirubinemi geliştirme riski taşıyan yenidoğanların belirlenmesinde yararlı bir belirteç olabilir

Keywords

RDW, umblikal kord kanı bilirubin, yenidoğan, hiperbilirubinemi, hemolitik hastalık

Umbilical cord blood red cell distribution width as a predictor of neonatal hyperbilirubinemia

Abstract

Aim: Early postnatal discharge of newborns leads to the risk of hospital readmission, mostly due to neonatal hyperbilirubinemia. Therefore, early identification of newborns at high risk of hyperbilirubinemia is important. In this study, we aimed to evaluate whether cord blood red cell distribution width (RDW) levels could be used to identify newborns at high risk of developing hyperbilirubinemia.
Material and methods: The data of all term infants who were born in our hospital between January and June 2017 whose cord blood samples were examined were reviewed retrospectively. Cord blood RDW, cord blood bilirubin, newborn/mother’s blood groups and direct Coombs’test (DCT) results were analyzed.
Results: A total 175 newborns were included. Phototherapy was required 58 newborns in the first 48 hours postnatally. The mean cord blood RDW levels among newborns with hyperbilirubinemia was significantly higher compared to controls (18±1.6 vs. 16.4±1.0, p<0.001). The cut-off value of cord blood RDW to predict the occurrence of significant hyperbilirubinemia was 17.1 with a sensitivity of 70.7 % and specificity of 88 %. Infants with positive DCT had lower hemoglobin values and higher cord blood RDW and bilirubin levels (p<0.05). There was a strong positive correlation between cord blood RDW and bilirubin values in infants with positive DCT (p=<0.001, r:0.663). Multiple regression analysis showed that cord blood RDW, bilirubin level and DCT positivity were found to be an independent risk factor for phototherapy requirement.
Conclusion: Cord blood RDWcan be used as a useful marker to identify the newborns at high risk of developing hyperbilirubinemia.

Keywords

RDW, umbilical cord blood bilirubin, newborn, hyperbilirubinemia;, hemolytic disease

References

• 1. Stevenson DK , Fanaroff AA, Maisels MJ, Young BW, Wong RJ, Vreman HJ, et al. Prediction of hyperbilirubinemia in near-term and term infants. Pediatrics 2001; 108:31–9.
• 2. Jones KDJ, Grossman SE, Kumaranayakam D, Rao A, Fegan G, Aladangady N. Umbilical cord bilirubin as a predictor of neonatal jaundice: a retrospective cohort study BMC Pediatr 2017; 20;17:186.
• 3. Kaplan M, Wong RJ, Sibley E, Stevenson DK. Neonatal Jaundice and Liver Diseases. In: Fanaroff and Martin’s neonatal-perinatal medicine. Eds: Martin RJ, Fanaroff AA, Walsh MC. 9th ed. Philadelphia Mosby Elsevier; 2011.
• 4. Yaseen H, Khalaf M, Rashid N, Darwich M. Does prophylactic phototherapy prevent hyperbilirubinemia in neonates with ABO incompatibility and positive Coombs' test?. J Perinatol 2005; 25:590-4.
• 5. Castillo A, Grogan TR, Wegrzyn GH, Ly KV, Walker VP, Calkins KL. Umbilical cord blood bilirubins, gestational age, and maternal race predict neonatal hyperbilirubinemia. PLoS One 2018;13: e0197888.
• 6. Christensen RD, Yaish HM, Henry E, Bennett S. Red blood cell distribution width: reference intervals for neonates.J Matern Fetal Neonatal Med 2015;28:883-8.
• 7. Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications.Crit Rev Clin Lab Sci 2015;52:86-105.
• 8. Tonbul A, Tayman C, Catal F, Kara S, Tatli M. Red cell distribution width (RDW) in the newborn: normative data. J Clin Lab Anal 2011;25:422-5.
• 9. Qurtom HA, al-Saleh QA, Lubani MM, Hassanein A, Kaddoorah N, Qurtom MA, et al. The value of red cell distribution width in the diagnosis of anaemia in children. Eur J Pediatr. 1989; 148:745-8.
• 10. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn 35 or more weeks of gestation. Pediatrics 2004: 114:297-316.
• 11. Adediron A, Gbadegesin A, Adeyemo TAMJ, Akinbami A, Osunkalu V, Ogbenna A, et al. Cord blood haemoglobin and ferritin concentrations in newborns of anaemic and non-anaemic mothers in Lagos, Nigeria. Niger Med J 2013; 54:22-6.
• 12. Bhutani VK, Stark AR, Lazzeroni LC, Poland R, Gourley GR, Kazmierczak S, et al. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr 2013; 162: 477-82.
• 13. Alpay F, Sarıcı SU, Tosuncuk HD, Serdar MA, Inanç N, Gökçay E. The value of first-day bilirubin measurement in predicting the development of significant hyperbilirubinemia in healthy term newborns. Pediatrics 2000; 106:16.
• 14. Sarici SU, Yurdakok M, Serdar MA, Oran O, Erdem G, Tekinalp G, et al. An early (sixth-hour) serum bilirubin measurement is useful in predicting the development of significant hyperbilirubinemia and severe ABO hemolytic disease in a selective high-risk population of newborns with ABO incompatibility. Pediatrics 2002; 109:53.
• 15. Knudsen A. Prediction and non-invasive assessment of neonatal jaundice in the term healthy newborn infant. Acta Paediatr 1996; 85:393–7.
• 16. Maisels MJ, Kring E. The contribution of hemolysis to early jaundice in normal newborns. Pediatrics 2006; 118:276-9.
• 17. Aktas S, Dogan C, Okmen ZH, Gulec SG. Is cord blood bilirubin level a reliable predictor for developing significant hyperbilirubinemia? Am J Perinatol 2019; 36:317-21.
• 18. Ipek IO, Bozaykut A, Çağrıl SC, Sezer RG.Does cord blood bilirubin level help the physician in the decisionof early postnatal discharge? The Journal of Maternal-Fetal and Neonatal Medicine 2012; 25:1375–8.
• 19. Calkins K, Roy D, Molchan L, Bradley L, Grogan T, Elashoff D, et al. Predictive value of cord blood bilirubin for hyperbilirubinemia in neonates at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn. J Neonatal Perinatal Med 2015; 8:243–50.
• 20. Davutoglu M, Guler E, Olgar S, Kurutas EB, Karabiber H, Garipardic M, et al. Oxidative stress and antioxidant status in neonatal hyperbilirubinemia. Saudi Med J 2008; 29:1743-8.
• 21. Tsuboi S, Miyauchi K, Kasai T, Ogita M, Dohi T, Miyazaki T, et al. Impact of red blood cell distribution width on long-term mortality in diabetic patients after percutaneous coronary intervention. Circ J 2013; 77:456-61.
• 22. Bessman JD, Gilmer PRJr, Gardner FH. Improved classification of anemias by MCV and RDW. Am J Clin Pathol 1983; 80:322–6.