Neonatal hyperbilirubinaemia after induction of labour with oxytocin and cord serum albumin is compared with cord serum bilirubin as a risk indicator
AbstractIntroduction: Jaundice is one of the commonest problems that can occur in a newborn. Many a times it is physiological in the newborn because liver is not mature enough to handle the bilirubin and there is an increased load of bilirubin due to a higher circulating erythrocyte volume, a shorter erythrocyte life span and a larger early labeled bilirubin peak. Objectives : 1) To know the effect of oxytocin for induction of labour in neonatal hyperbilirubenemia (NH). 2) Comparing Cord Serum Albumin level (CSA) with Cord Serum Bilirubin (CSB) in predicting neonatal hyperbilirubinemia. 3) To know the sensitivity, specificity, Positive predictive value and negative predictive value of CSA and CSB in predicting neonatal jaundice in term neonates. Method: Prospective study was performed on 789 healthy term neonates. Relevant maternal history is collected. Cord blood was collected from the healthy term neonates at birth, CSA and CSB measured. Neonate was assessed clinically every day. Total Serum Bilirubin (TSB) and blood group were assessed in neonate during 72-96 hours of life. TSB value ≥17mg/dl is considered Neonatal Hyperbilirubinemia (NH) which requires intervention like phototherapy (PT) or Exchange transfusion (ET). Result: Out of 388 Infants born after oxytocin induced labour, 122 (56.48%) neonates developed NH (P=0.002).Neonatal hyperbilirubinemia was more significant in neonates with CSA levels ≤ 2.8g/dl and CSB levels ≥2.1mg/dl. At cord serum albumin level ≤2.8g/dl, sensitivity, specificity, PPV and NPV are 75.93 %, 68.06 %, 47.26 and 88.24 % respectively, for predicting NH at birth. At cord serum bilirubin level ≥2.1g/dl, sensitivity, specificity, PPV and NPV are 96.30%, 70.86%, 55.47%and 98.07% respectively, for predicting NH at birth. Conclusion: Oxytocin should be used with caution in view of its ability to develop neonatal hyperbilirubinemia by inducing hemolysis. Both CSA and CSB are equally effective in predicting NH at birth. These study variables can be considered as neonatal screening tools for NH for term neonates.
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