Sheikh, Sajad Ahmad
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UMBILICAL ARTERIAL PROFILES AS PREDICTORS OF SEVERITY OF HYPOXIC ISCHEMIC ENCEPHALOPATHY AFTER PERINATAL ASPHYXIA Bhat, Jehangir Allam; Sheikh, Sajad Ahmad; Ara, Roshan
Paediatrica Indonesiana Vol 60 No 1 (2020): January 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background: Perinatal hypoxic-ischemic encephalopathy (HIE) remains a major cause of neurodevelopmental impairment. Umbilical cord blood analysis provides an objective assessment of newborn metabolic status. Accordingly, it is recommended that physicians attempt to obtain venous and arterial samples when there is high risk of neonatal compromise. Objective To compare the predictive value of umbilical arterial blood pH, lactate and base deficit for subsequent development of severity of hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia and comparison of these parameters to determine which one is superior in predicting severity. Methods Umbilical cord arterial blood of newborns with perinatal asphyxia was tested for pH, lactate, and base deficit estimation. These newborns were evaluated in level III NICU and divided into two groups. Group 1 had no or signs and symptoms of HIE I and group 2 had signs and symptoms of HIE II/III. Values of pH, lactate, and base deficit were tabulated and analyzed by receiver-operating characteristic curves. Optimal cut-off values were estimated based on the maximal Youden index. Results Mean pH was significantly lower in group 2 than in group 1, while lactate and base deficit were significantly higher in group 2 than in group 1. Cut-off points for determining severity of HIE were pH <7.13, lactate >6.89 mg/dL, and base deficit >7 mEq/L. Sensitivity and specificity for these cut-off points were 100% and 91.49% for pH, 100% and 85.11% for lactate, and 82.4% and 91.76% for base deficit, respectively. Predictive abilities of all three parameters were similar in determination of HIE severity. Conclusion Umbilical arterial pH, lactate, and base deficit have excellent accuracy to predict the severity of HIE. All three parameters have similarly good predictive ability.
CORD BLOOD BILIRUBIN, ALBUMIN, AND BILIRUBIN /ALBUMIN RATIO FOR PREDICTING SUBSEQUENT NEONATAL HYPERBILIRUBINEMIA Bhat, Jehangir Allam; Sheikh, Sajad Ahmad; Ara, Roshan
Paediatrica Indonesiana Vol 59 No 5 (2019): September 2019
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (279.71 KB) | DOI: 10.14238/pi59.5.2019.244-51

Abstract

Background Early discharge of healthy term newborns after delivery has become a common practice, because of medical and social reasons, as well as economic constraints. Thus, the recognition, follow-up, and early treatment of jaundice has become more difficult as a result of early discharge from the hospital. Since the dreaded complication of neonatal hyperbilirubinemia is kernicterus, an investigation which can predict the future onset of neonatal pathological jaundice is needed. Objective To investigate the predictability of neonatal hyperbilirubinemia by using cord blood bilirubin, albumin and bilirubin/albumin ratio. Methods This study was conducted on 300 healthy newborns. Umbilical cord blood was used to measure albumin and bilirubin. All infants were regularly followed up to 5th day of life. Neonates were divided into two groups: group A was consisted of neonates who developed jaundice which was in physiological range, while group B was consisted of neonates who developed neonatal hyperbilirubinemia (requiring phototherapy or other modality of treatment). Babies suspected to have bilirubin level which cross physiological limit on any day after birth were subjected to serum bilirubin measurement. Infants whose serum bilirubin level measurement revealed bilirubin levels crossing physiological values were sent to nursery for phototherapy. Results The incidence of neonatal hyperbilirubinemia was 11%. Statistically significant correlations between cord blood bilirubin, albumin, and bilirubin/albumin ratio to the development of neonatal hyperbilirubinemia were observed. On ROC analysis, cut-off points to predict significant hyperbilirubinemia in newborn were cord blood bilirubin >3 mg/dL (sensitivity 60.61%, specificity 97.63%), albumin <2.4 mg/dL (sensitivity 78.79%, specificity 98.13%), cord blood bilirubin/albumin ratio >0.98  (sensitivity 78.79%, specificity 95.51%). Conclusion Cord blood total bilirubin, albumin. and bilirubin/albumin ratio are excellent parameters to predict the occurrence of neonatal hyperbilirubinemia. However, cord blood albumin is better compared to cord blood bilirubin and bilirubin/albumin ratio.