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Total Serum Bilirubin (total + serum_bilirubin)
Selected AbstractsSerum bilirubin levels and mortality after myeloablative allogeneic hematopoietic cell transplantation,HEPATOLOGY, Issue 2 2005Ted A. Gooley Many patients who undergo hematopoietic cell transplantation experience liver injury. We examined the association of serum bilirubin levels with nonrelapse mortality by day +200, testing the hypothesis that the duration of jaundice up to a given point in time provides more prognostic information than either the maximum bilirubin value or the value at that point in time. We studied 1,419 consecutive patients transplanted from allogeneic donors. Total serum bilirubin values up to day +100, death, or relapse were retrieved,along with nonrelapse mortality by day +200 as an outcome measure,using Cox regression models with each bilirubin measure modeled as a time-dependent covariate. The bilirubin value at a particular point in time provided the best fit to the model for mortality. With bilirubin at a point in time modeled as an 8th-degree polynomial, an increase in bilirubin from 1 to 3 mg/dL is associated with a mortality hazard ratio of 6.42. An increase from 4 to 6 mg/dL yields a hazard ratio of 2.05, and an increase from 10 to 12 mg/dL yields a hazard ratio of 1.17. Among patients who were deeply jaundiced, survival was related to the absence of multiorgan failure and to higher platelet counts. In conclusion, the value of total serum bilirubin at a particular point in time after transplant carries more informative prognostic information than does the maximum or average value up to that point in time. The increase in mortality for a given increase in bilirubin value is larger when the starting value is lower. (HEPATOLOGY 2005,41:345,352.) [source] A Systems Approach for Neonatal Hyperbilirubinemia in Term and Near-Term NewbornsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2006Vinod K. Bhutani Objective:, To propose and implement a family-centered systems approach to manage newborn jaundice for safer outcomes. Design:, Observational study for known adverse outcomes. Setting:, Semiprivate urban birthing hospital. Patients/Participants:, 31,059 well babies discharged as healthy from a cohort of 41,961 live births (1990-2000). Interventions:, Incremental implementation of a systems approach that incorporated a hospital policy to (a) authorize nurses to obtain a bilirubin (total serum/transcutaneous) measurement for clinical jaundice, (b) universal predischarge total serum bilirubin (at routine metabolic screening), and (c) targeted follow-up, using the bilirubin nomogram (hour-specific, percentile-based total serum bilirubin/transcutaneous bilirubin). Main Outcome Measures:, Known adverse outcomes assessed for early- and late-onset severe hyperbilirubinemia before, during, and after systems approach implementation. Results:, Adverse outcomes decreased for well babies: exchange transfusion, intensive phototherapy, and readmission. During the study period, there were no "never events" (total serum bilirubin greater than or equal to 30 mg/dl), while "close calls" (total serum bilirubin greater than or equal to 25 mg/dl) were 1 in 15,000 as compared to a reported incidence of 1 in 625. Conclusions:, Reduced adverse events, significant reduction in close calls, and no never events met family expectations for safer experiences with this approach. JOGNN, 35, 444,455; 2006. DOI: 10.1111/J.1552-6909.2006.00044.x [source] Indicators Nurses Employ in Deciding to Test for HyperbilirubinemiaJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2001Anita J. Gagnon RN Objective: To identify the indicators nurses employ in deciding to test healthy full-term newborns for total serum bilirubin in the absence of a written protocol. Design: Secondary analysis of data available on 130 mother-newborn pairs and informal interviews of 30 postpartum unit nurses. Setting: Two university teaching hospitals. Participants: All tested newborns and a 33% random sample of remaining newborns from a control group data set created during a previous study and a convenience sample of postpartum nurses from all shifts. Measurement: Outcome data were obtained from a review of records. Background data were obtained from a review of records and questionnaires. Nurse data were obtained through a modified form of participant observation. Results: Ninety-one percent of newborns tested for bilirubin were tested unnecessarily. In logistic regression analyses, variables predictive of nurse-driven total serum bilirubin testing were presence of jaundice, odds ratio (OR) = 31.95 (95% confidence interval, 6.71, 152.03), and feeding frequency, OR = 0.28 (0.11, 0.72). Identifying both presence and location of jaundice simultaneously did not significantly predict testing, OR = 1.82 (0.66, 5.04). Fifty-three percent of nurses who were interviewed identified both the presence of jaundice and feeding as indicators to consider for testing. Conclusion: Newborns are overtested for bilirubin. Indicators used by nurses in deciding to test a healthy newborn for total serum bilirubin are the presence of jaundice and feeding frequency. Nurses who assess feeding frequency are less likely to order bilirubin testing. [source] Effect of infants' position on serum bilirubin level during conventional phototherapyACTA PAEDIATRICA, Issue 8 2010ML Donneborg Abstract Aim:, To compare the decrease in total serum bilirubin (TSB) concentration during conventional phototherapy in infants treated in supine position exclusively versus infants alternated between exposure in supine and prone position every third hour. Moreover, to survey current practice patterns in two Scandinavian countries as far as alternating exposure. Methods:, A total of 112 infants with non-haemolytic hyperbilirubinaemia, but otherwise healthy, and a gestational age ,33 weeks were randomized to one of the treatment groups. All infants received phototherapy for 24 h. TSB was measured at start of phototherapy and after 12 and 24 h of treatment. Questionnaires about routines for position changes in infants during phototherapy were sent to all 41 neonatal departments in Denmark and Norway. Results:, No statistically significant differences in the decrease in TSB were observed between the two treatment groups: at 12 h of therapy, TSB decreased 32% in both groups and at 24 h 49% and 50%, respectively. In two-thirds of Danish and Norwegian departments, the infants were routinely turned during phototherapy, most often every third hours. Conclusion:, The decrease in TSB was not significantly associated with positioning of the infant during conventional phototherapy. Alternating exposure is widely practiced in Scandinavia but is unnecessary. [source] Bhutani-based nomograms for the prediction of significant hyperbilirubinaemia using transcutaneous measurements of bilirubinACTA PAEDIATRICA, Issue 12 2009YA Bental Abstract Aim:, Prospectively establish the relationship between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB), and develop nomograms similar to Bhutani's nomograms, based on our TcB data. Methods:, Our study sample was from a total population of 1069 infants, near term and term healthy newborns, admitted during 2.5 month period of the study. TSB was performed on all infants who were felt to be clinically jaundiced. Before obtaining the TSB, a TcB was performed (Jaundice Meter Minolta/Draeger JM-103). Measurements were performed on two sites: forehead and mid-sternum, and the mean of both measurements was calculated. Results:, A total of 1091 paired measurements were obtained from 628 infants. Linear regression showed a significant relation between TSB and TcB (R2 of 0.846). In multiple regression analysis, all independent variables studied, i.e. gestational age (or birthweight), age at sampling and ethnicity had a negligible influence on the relationship. We subsequently developed our local-nomograms of hour-specific mean TcB with 40, 75 and 95 percentile lines. Conclusions:, In our local settings and population, we found a reliable correlation between laboratory measurements of TSB and TcB. We were able to develop our local-Bhutani-based TcB nomograms for screening babies during hospital stay and pre-discharge for assessing the risk of hyperbilirubinaemia. [source] When should phototherapy be stopped?ACTA PAEDIATRICA, Issue 2 2009A pilot study comparing two targets of serum bilirubin concentration Abstract Objective: The objective of this study was to compare the outcome of two groups of jaundiced newborns randomized to one of the two targets of total serum bilirubin (TSB) for phototherapy discontinuation. Design: Infants treated with phototherapy were assigned to two groups: in the ,high-threshold' group, phototherapy was interrupted when TSB decreased to ,1 mg/dL (17 ,mol/L) below the limit requiring phototherapy and in the ,low-threshold' group when TSB decreased to ,3 mg/dL (51 ,mol/L) below the same limit. Results: Fifty-two infants were enrolled, 25 in the high- and 27 in the low-threshold group. Phototherapy duration was significantly shorter in the high- than in the low-threshold group (22.3 ± 13 vs. 27.6 ± 12 h, respectively, p = 0.03). Length of hospital stay was 84±30 h in the high- and 94 ± 24 h in the low-threshold group (p = 0.05). Additional phototherapy was required in 20% of the high- versus 18% of the low-threshold group (p = 0.58). In the presence of haemolysis or G6PD deficiency, 28% of the infants required re-phototherapy and 8.3% when such factors were absent (p = 0.06). Conclusion: Phototherapy duration may be shortened by using higher TSB limits for interruption. When hyperbilirubinaemia is accompanied by risk factors, the infants should be followed for longer periods, since some of them will need re-phototherapy. [source] Bronze baby syndrome and the risk of kernicterusACTA PAEDIATRICA, Issue 7 2005Giovanna Bertini Abstract Aim: The problem of kernicterus in infants with bronze baby syndrome (BBS) has been reviewed on the basis of cases reported in the literature. In addition, a new case concerning an infant with severe Rh haemolytic disease, who presented with BBS and who has developed neurological manifestations of kernicterus with magnetic resonance images showing basal ganglia abnormalities, is presented. In this patient, the total serum bilirubin (TSB) concentration ranged from 18.0 to 22.8 mg/dl (306 to 388 ,mol/l) and the bilirubin/albumin (B/A) ratio was 6.0 (mg/g) (6.8 is the value at which an exchange transfusion should be considered). The case presented is important due to the fact that kernicterus appeared after an exchange transfusion was performed when the TSB level reached 22.8 mg/dl (388 ,mol/l) on 6th day of life while the haematocrit was 30%. From this case and from other cases reported in the literature, we must stress that, even if the level at which hyperbilirubinemia poses a threat remains undefined, BBS may constitute an additional risk of developing kernicterus. Conclusion: The possible strategies for implementing an approach to the management of hyperbilirubinemia (especially the haemolytic kind) in the presence of BBS may include an exchange transfusion carried out at lower TSB concentration than previously recommended or an early administration of Sn-mesoporphyrin. [source] | ||||||||||