Academic literature on the topic 'Hyperbilirubinemia, umbilical cord bilirubin, TSB, phototherapy'

CONTEXT: With early discharge, many newborns have to be readmitted to hospital for hyperbilirubinemia to be treated, and this has been held responsible for the reappearance of kernicterus. OBJECTIVE: To evaluate whether bilirubin levels in cord blood could predict neonatal hyperbilirubinemia that would require treatment, in full-term newborns up to their third day of life. TYPE OF STUDY: Prospective study. SETTING: Neonatal Unit of Hospital Israelita Albert Einstein, São Paulo, Brazil. PARTICIPANTS: 380 full-term newborns considered normal: with or without ABO/Rh blood group incompatibility and without other complications. PROCEDURES: Blood was taken from the umbilical cord for analysis of conjugated, unconjugated and total bilirubin serum levels. The newborns were followed up until discharge, and unconjugated bilirubin that required phototherapy was compared to the cord bilirubin assay. Discriminant analysis was used to classify newborns: with or without risk of needing phototherapy by the third day of life. MAIN MEASUREMENTS: Bilirubin assay in cord blood; mother's and newborn's blood groups; phototherapy indication. RESULTS: The mean value for unconjugated bilirubin in cord blood was significantly higher in newborns whose unconjugated bilirubin required phototherapy. The presence of ABO blood group incompatibility was a significant variable in relation to unconjugated bilirubin that required phototherapy. The most useful cutoff point for unconjugated bilirubin in cord blood was 2.0 mg/100 ml. DISCUSSION: Cord blood could be collected, stored and used for further analysis of unconjugated bilirubin levels as a means for considering whether or not to discharge a moderately jaundiced child from hospital, in association with other resources. CONCLUSIONS: Blood incompatibility between mother and child was a predictor for the appearance of hyperbilirubinemia that required treatment. Considering a cutoff point of 2.0 mg/100 ml, it could be concluded that 53% of the newborns who had greater unconjugated bilirubin levels in cord blood would reach levels requiring phototherapy by the third day of life.

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.

Background: Most unconjugated bilirubin formed by the fetus is cleared by the placenta into the maternal circulation. Albumin constitutes 70 - 75% of Plasma oncotic pressure. Another important function of albumin is its antioxidant property. Bilirubin binds to albumin in an equimolar ratio. Free bilirubin is anticipated when the molar bilirubin- to- albumin (B: A) ratio is >0.8 Objective of the study was to predict the proportion of newborn requiring intervention for NH (phototherapy or exchange transfusion) based on cord serum albumin level at birth.Methods: The present prospective study was conducted at Navodaya Medical College, Raichur from October 2018 to November 2019. A total of 180 babies which were born during the study period were included in the study. INCLUSION CRITERIA• Term babies both genders• Mode of delivery (normal and C-section)• Birth weight ≥2.5kg.• APGAR ≥7/10 at 1 min. Cord Serum Albumin level was estimated at birth. Total Serum Bilirubin (TSB) estimation was done at 72-96 hours of age. All the babies were followed up daily for first 4 postnatal days and babies were daily assessed for NH and its severity.Results: In our study nearly 54.4% of them had Cord Serum Albumin levels of less than 2.8 gm/dl, 27.3% of them had albumin levels of 2.9 to 3.3 gm/dl, 18.3% of them had Serum Albumin of 3.4 gm/dl. Out of 180 study subjects, 13.9% of them required phototherapy to treat neonatal hyper bilirubinemia and 2.8% of the study subjects required exchange transfusion.Conclusions: From the present study, cord serum albumin level of ≤2.8g/dl has a correlation with incidence of significant hyperbilirubinemia in term newborns. So, this ≤2.8g/dl of cord serum albumin level can be used as risk indicator to predict the development of significant hyperbilirubinemia.

Objective We aimed to investigate whether cord blood bilirubin (CBB) level could be used to identify the newborns at a high risk of developing hyperbilirubinemia. Study Design Total and direct serum bilirubin level were evaluated from umbilical cord blood of newborns. We checked blood groups and Rh status of all mothers and determined blood groups and direct Coombs test (DC) of newborns born to mothers whose blood group was O type or Rh negative to determine the maternal–fetal blood group or Rh incompatibility. Results A total of 418 newborns were included, and phototherapy (PT) was required in 17 newborns. The cutoff value of CBB for predicting the occurrence of significant hyperbilirubinemia requiring PT was 1.67 mg/dL, with a sensitivity of 82% and specificity of 99%. The mean CBB level in babies receiving PT was 2.4 ± 0.9 mg/dL. When blood group, CBB level, DC, gender, and mode of delivery were assigned as possible risk factors, multıvariate analysis showed ABO, Rh incompatibility, and CBB level increased the risk of PT requirement. Conclusion CBB could be useful to determine newborns at a risk of developing hyperbilirubinemia and prevent developing severe complications due to delay in diagnosis.

Background: Neonatal hyperbilirubinemia is one of the most commonly encountered conditions in neonatal period. Early recognition and prompt intervention can prevent its dreadful complication like bilirubin encephalopathy. nucleated red blood cells (nRBC) are released into the peripheral circulation in conditions causing oxidative stress. This study aims at finding the relation between nRBC and neonatal hyperbilirubinemia. Methods: This hospital based prospective cohort study was conducted on 100 neonates. The neonates were divided into 2 groups: Group 1- cases (n=50) included neonates born to O positive mothers with A/B blood groups and Group 2-controls (n=50) with neonates born to O positive mothers with O blood group. The cord blood nRBC, TSB at 48 hours and requirement of phototherapy were the variables which were considered. Statistical analysis was done using SPSS 22 version software with appropriate statistical methods applied. Results: The mean cord nRBC was 7.26±2.65 (Group 1) and 3.04±0.92 (Group 2) respectively. ROC curve for cord nRBC revealed AUC 0.944 at 4.0 cut-off with sensitivity of 92%, specificity of 94%, LR+15.33 and LR-6.085 with p<0.0001. Conclusions: Cord blood nucleated RBCs is a simple, easily available test to predict the neonatal hyperbilirubinemia in ABO incompatibility susceptible neonates.

Introduction: Neonatal hyperbilirubinaemia is common problem which is benign in majority of neonates. Rh iso immune hemolytic disease as a cause of hyperbilirubinemia is becoming nearly nonexistent due to the use of prophylactic anti D. Hence Isoimmune hemolytic disease due to ABO incompatibility assumes significance as a cause of significant hyperbilirubinaemia. This study was conducted to determine the incidence of ABO incompatibility, ABO iso immune disease in new born, to determine critical cord serum bilirubin level to predict subsequent significant hyperbilirubinemia.Material and Methods: The study was done in neonatal ICU of a tertiary care hospital where 100 full term healthy newborns with B.W≥2500gm and gestational age ≥37 wk with blood group A, B, AB, born to mothers with O blood group without simultaneous Rh incompatibility at SGRDIMSR were included. Serum bilirubin was measured approximately at 12-24hrs, 36-48hrs, 60-72hrs. Results: Out 100 ABO incompatible newborns 33(33%) developed ABO isoimmune disease manifesting as significant hyperbilirubinaemia with any of the four total serum bilirubin levels exceeding threshold levels defined for phototherapy. TSB of ≥ 2.16mg/d1 from cord blood has a sensitivity of 100% specificity of 89.55%, NPV 100% and PPV of 82.50% to predict significant hyperbilirubinaemia. Conclusion: A critical cord S.bilirubin between 2.16 mg/d1 and 4.09mg/d1 will predict all newborns who will have significant hyperbilirubinaemia and can be used as a safe demarcator to decide time of discharge. Any therapeutic intervention if necessary can be started as early as possible.J Nepal Paediatr Soc 2015; 35(3): 231-236

Background: Early cord clamping and cutting of the umbilical cord is widely practiced as part of the management of labor; it could deprive the neonate of about a quarter of its blood volume and iron. This thesis is aimed at comparing effects of delayed cord clamping versus umbilical cord milking at birth in preterm and early term infants.Methods: This single centered randomized study was conducted in Department of Pediatrics and data collection was done on the basis of the preterm and early term infants delivered by vaginal or cesarean delivery in Department of Gynecology, Geetanjali Medical College and Hospital, Udaipur during period of January 2016 to January 2017. Total of 120 infants were included in the study.Results: Statistically it has been analyzed that in both pre-term and early term infants who underwent DDC and UCM, there was insignificant difference in level of hemoglobin (Hb), haematocrit (HCT), blood sugar, bilirubin level (TSB) and temperature of body. On the other hand, significant difference was observed in weight and cord pH of neonates of both groups. There is also insignificant difference in terms of NICU admission for RDS, sepsis, phototherapy, need of oxygen, saline boluses, PRBC transfusion, polycythemia.Conclusions: Thus, overall it was observed that there is insignificant difference in delayed cord clamping and umbilical cord milking group. Thus, both are found to be equally effective in improving hematologic parameters.

Abstract Introduction: The direct antiglobulin test (DAT) detects the presence of IgG and/or C3 on the red blood cell (RBC) membrane and is used to diagnose autoimmune hemolytic anemias as well as hemolytic disease of the fetus and newborn (HDFN). A positive DAT in a neonate occurs when maternal IgG crosses the placenta and binds to fetal RBCs, which may lead to hemolysis and clinical manifestations of HDFN such as hyperbilirubinemia. Historically, DATs in umbilical cord blood samples were performed manually. We have recently switched to using the Ortho Vision Analyzer (gel technology) for this purpose in our institution, and noticed a trend toward stronger positive reactions. The purpose of this study was to compare the DAT results obtained with the conventional tube method and the gel method, and their association with hyperbilirubinemia and/or the need for phototherapy in the neonates tested. Methods: We retrospectively reviewed all cord DAT results of infants born between January 2016 and June 2018. We included all tests of neonates of blood group A or B born to blood group O mothers who had a positive DAT and performed a retrospective chart review to collect the following data: DAT strength, gestational age, birth weight, hematocrit, blood type, initial and peak serum total bilirubin levels, use of phototherapy, antibody screening results, and transfusion history. Neonates whose mothers had a positive antibody screen were excluded from the analysis. Results: During the study-period, 100 ABO-incompatible neonates with a positive DAT were tested by the tube and gel methods (50 with each methodology) and met our inclusion criteria. Their demographic information and laboratory results, including the strength of the positive DAT are in Table 1. There was a clear trend toward stronger DAT results since the gel methodology was introduced; the most common result in the Ortho Vision Analyzer was 1+ positive (52%), and 40% of neonates had a 2+ positive result. The latter was only seen in 2% with the tube method. Furthermore, although there were no significant differences in any demographic or laboratory parameters between the two groups of neonates, an increased percentage of those tested with the new methodology (23/50 or 46%) received phototherapy compared with 14/50 (28%) of those tested manually (Figure 1). Conclusions: We found that the Ortho Vision Analyzer produced stronger DAT results compared to the tube method without evidence of increased hemolysis. It is essential that Transfusion Medicine physicians communicate the change in methodology to neonatologists to make them aware of the reason for the stronger DAT results in order to avoid unnecessary phototherapy. Disclosures No relevant conflicts of interest to declare.

Aims: To evaluate significance of cord blood bilirubin, albumin, bilirubin /albumin ratio and hydrogen peroxide as early predictors of significant neonatal hyperbilirubinemia. Place and Duration of Study: Egypt, Tanta University Hospital (at delivery room and follow up was done in Neonatal Intensive Care Unit (NICU) over one year from April 2019 to April 2020. Methodology: We included 80 neonates allocated into two groups (40 each), Group I included neonates with gestational age between 30 to less than 35 weeks, Group II neonates with gestational age ≥35 weeks. They were subjected to history taking, clinical assessment and lab investigations (cord blood albumin, bilirubin, hydrogen peroxide level and blood bilirubin/albumin ratio, 3rd day total and direct serum bilirubin level and others). Follow up done for developing jaundice on 3rd day. Results: There was statistically significant increase in the incidence of significant hyperbilirubinemia in group I (82.5%) in comparison with group II (27.5%) (P-value <0.001). There was positive significant correlation between cord blood bilirubin (P<0.001), bilirubin/albumin ratio (P <0.001) and hydrogen peroxide (P=0.012 in GI) (P = 0.001 in GII) and 3rd day TSB levels in the studied groups. There was negative significant correlation between cord blood albumin and 3rd day TSB levels in the studied groups (P < 0.001). There was positive significant correlation between cord blood bilirubin (P <0.001 in GI) (P =0.024 in GII), bilirubin/ albumin ratio (P <0.001 in GI) (P =0.002 in GII) and hydrogen peroxide (P <0.001) and the duration of phototherapy in the studied groups. There was negative significant correlation between cord blood albumin and the duration of phototherapy in group I (P =0.001), while there was no significant correlation between cord blood albumin and the duration of phototherapy in group II (P = 0.118). Conclusion: When comparing the four cord predictors for significant indirect hyperbilirubinemia; bilirubin/albumin ratio was the most accurate predictor with higher sensitivity and specificity, followed by cord blood bilirubin, then albumin, while hydrogen peroxide was the least accurate in all neonates ≥ 30 weeks.

Background: Anemia during infancy causes irreversible physical, cognitive, motor, and behavioral development disorders. This study aimed to determine the effect of delaying umbilical cord clamping time on certain parameters regarding anemia during the infancy. Methods: This randomized controlled trial was conducted at a university hospital in west of Turkey (Dec 2017- Dec 2018). Overall, 110 participants were evaluated for the research, 65 participants were randomized after excluding those who did not meet the inclusion criteria (intervention=32, control=33). Randomly assigned to delayed clamping (1 min after delivery) or early clamping (in 15 sec after delivery), and followed up until 4 months postpartum. 48th-hour hematocrit, bilirubin values, need for phototherapy and hematocrit, hemoglobin values, diagnosis of anemia at the postnatal fourth month were compared between two groups. The data showing normal distribution were assessed using the parametric tests. The level of statistical significance was determined as P<0.05. Results: The 48th-hour hematocrit and bilirubin levels of the intervention group were significantly higher than the control (P<0.01 and P<0.05, respectively). No significant difference regarding the need for phototherapy due to postnatal hyperbilirubinemia was observed between the two groups (P>0.05). Means of the intervention group hematocrit and hemoglobin levels measured during anemia screening performed at the fourth month were found to be higher than those of the infants in the control group (P<0.05 and P<0.05, respectively). Conclusion: Delaying umbilical cord clamping had a positive impact on the haematological parameters of infants. Clamping the cord at least one minute in birth can be performed to prevent the iron deficit anemia that could be seen during the first years of infants’ lives.

Eine Erhöhung des Bilirubins über 2 mg/dl betrifft 90 % aller Neugeborenen. Sie ist meist physiologisch und tritt optisch sichtbar bei 60-70 % dieses Kollektivs auf. In der pathologischen, exzessiv erhöhten Form ist sie der häufigste Grund für eine stationäre Wiederaufnahme während der ersten sieben Lebenstage. Ihre schwerste Komplikation, der Kernikterus, scheint - trotz allgemein verfügbarer, preiswerter und sicherer Therapiemöglichkeiten - wieder vermehrt aufzutreten. Die Gründe liegen im Überwachungsdefizit bei früher Entlassung von schlecht aufgeklärten Eltern, Nichtbeachtung der Besonderheiten der Neugeborenen ≤ 38 Schwangerschaftswochen und der zunehmenden Tendenz zum Stillen bei häufig unzureichender Anleitung. Ferner werden ikterische Kinder nur zu oft lediglich visuell bezüglich des Grades der Bilirubinämie eingeschätzt und die Therapie somit erheblich verzögert. Gegenstand dieser Arbeit ist die Frage, ob aus der Dynamik des Serumbilirubinspiegels von der Geburt bis zum 3. Lebenstag die Wahrscheinlichkeit des Auftretens einer phototherapiepflichtigen Hyperbilirubinämie abgeschätzt werden kann. Dazu wurde der Serumbilirubinspiegel direkt postnatal aus dem Nabelschnurblut, bzw. am 3. Lebenstag gleichzeitig mit dem Stoffwechselscreening ermittelt und der Phototherapiebedarf im Verlauf festgehalten. Um die Aussage zu präzisieren, wurde die Studienpopulation aus 2573 Kindern weiter unterteilt in 2180 reife tAGA- (hier Eu- und Hypertrophe), 267 reife tSGA-Kinder (Hypotrophe) und 126 FG (Frühgeborene). In allen 3 Gruppen korrelierten das Nabelschnurbilirubin und der Serumbilirubinwert vom 3. Lebenstag positiv mit der Entwicklung einer Hyperbilirubinämie. Anhand dieser Ausgangswerte konnten Grenzen für Hoch-, Mittelhoch-, Mittelniedrig- und Niedrigrisikogruppen definiert werden, welche die Entwicklung einer Hyperbilirubinämie mit einer Wahrscheinlichkeit von ≥ 20 %, 5-20 %, 0 < x <5 % und 0 % voraussagen. Damit kann man bereits früh eine Vorabselektion entsprechend dem Gefährdungspotential treffen und die Verlaufskontrollen entsprechend terminieren. Als Risikofaktoren einer therapiepflichtigen Hyperbilirubinämie wurden außerdem Frühgeburtlichkeit, seltener tSGA, geringes Geburtsgewicht und niedriges Gestationsalter (in der vorliegenden FG-Gruppe nicht signifikant) gefunden. Im Falle einer Sectiogeburt und bei Zuhilfenahme von Hilfsmitteln im Rahmen einer vaginalen Entbindung nahm der Bedarf an Phototherapie in der tAGA- und tSGA-Gruppe zu.

Eine Erhöhung des Bilirubins über 2 mg/dl betrifft 90 % aller Neugeborenen. Sie ist meist physiologisch und tritt optisch sichtbar bei 60-70 % dieses Kollektivs auf. In der pathologischen, exzessiv erhöhten Form ist sie der häufigste Grund für eine stationäre Wiederaufnahme während der ersten sieben Lebenstage. Ihre schwerste Komplikation, der Kernikterus, scheint - trotz allgemein verfügbarer, preiswerter und sicherer Therapiemöglichkeiten - wieder vermehrt aufzutreten. Die Gründe liegen im Überwachungsdefizit bei früher Entlassung von schlecht aufgeklärten Eltern, Nichtbeachtung der Besonderheiten der Neugeborenen ≤ 38 Schwangerschaftswochen und der zunehmenden Tendenz zum Stillen bei häufig unzureichender Anleitung. Ferner werden ikterische Kinder nur zu oft lediglich visuell bezüglich des Grades der Bilirubinämie eingeschätzt und die Therapie somit erheblich verzögert. Gegenstand dieser Arbeit ist die Frage, ob aus der Dynamik des Serumbilirubinspiegels von der Geburt bis zum 3. Lebenstag die Wahrscheinlichkeit des Auftretens einer phototherapiepflichtigen Hyperbilirubinämie abgeschätzt werden kann. Dazu wurde der Serumbilirubinspiegel direkt postnatal aus dem Nabelschnurblut, bzw. am 3. Lebenstag gleichzeitig mit dem Stoffwechselscreening ermittelt und der Phototherapiebedarf im Verlauf festgehalten. Um die Aussage zu präzisieren, wurde die Studienpopulation aus 2573 Kindern weiter unterteilt in 2180 reife tAGA- (hier Eu- und Hypertrophe), 267 reife tSGA-Kinder (Hypotrophe) und 126 FG (Frühgeborene). In allen 3 Gruppen korrelierten das Nabelschnurbilirubin und der Serumbilirubinwert vom 3. Lebenstag positiv mit der Entwicklung einer Hyperbilirubinämie. Anhand dieser Ausgangswerte konnten Grenzen für Hoch-, Mittelhoch-, Mittelniedrig- und Niedrigrisikogruppen definiert werden, welche die Entwicklung einer Hyperbilirubinämie mit einer Wahrscheinlichkeit von ≥ 20 %, 5-20 %, 0 < x <5 % und 0 % voraussagen. Damit kann man bereits früh eine Vorabselektion entsprechend dem Gefährdungspotential treffen und die Verlaufskontrollen entsprechend terminieren. Als Risikofaktoren einer therapiepflichtigen Hyperbilirubinämie wurden außerdem Frühgeburtlichkeit, seltener tSGA, geringes Geburtsgewicht und niedriges Gestationsalter (in der vorliegenden FG-Gruppe nicht signifikant) gefunden. Im Falle einer Sectiogeburt und bei Zuhilfenahme von Hilfsmitteln im Rahmen einer vaginalen Entbindung nahm der Bedarf an Phototherapie in der tAGA- und tSGA-Gruppe zu.:Bibliographische Beschreibung……………………………………………………………………….1 Abkürzungsverzeichnis………………………………………………………………………………..2 1. Einleitung…………………………………………………………………………………...3 1.1. Geschichtliche Entwicklung……………………………………………………………………...3 1.2. Wandel der Anschauungen zu den Therapiegrenzen…..…………………………….................4 1.3. Hyperbilirubinämie……………………………………………………………………………….7 1.4. Kernikterusregister………………………………………………………………………………..8 1.5. Problemstellung…………………………………………………………………………………...9 2. Patienten und Methoden………………………………………………………………..11 2.1. Patientenkollektiv………………………………………………………………………………...11 2.2. Ausschlusskriterien………………………………………………………………………………11 2.3. Datenerfassung………………………………………………………………………………...…11 2.4. Phototherapie (PT)………………………………………………………………………………12 2.5. statistische Analyse………………………………………………………………………………13 2.5.1. konkrete Fragestellung………………………………………………………………………………...…13 2.6. Signifikanzniveau……………………………………………………..………………………….13 3. Ergebnisse………………………………………………………………………………..14 3.1. Gesamtpopulation…………………………………………………………….………………….14 3.2. Charakteristika der Studienpopulation…………………………….…………………………..14 3.3. tAGA (reife eu- und hypertrophe Neugeborene)………………………………………………16 3.4. tSGA (reife hypotrophe Neugeborene).……….……………………………………………….18 3.5. Frühgeborene (FG)………………………………..…………………………….……………….20 3.6. direkter Vergleich der 3 Untergruppen (tAGA, tSGA und FG)…………………………...…22 3.7. Charakteristika der Population der zweiten Studienphase…………………………………...28 3.8. tAGA-Kinder in der zweiten Studienphase (TSB3-tAGA)……………………………………30 3.9. tSGA in der zweiten Studienphase (TSB3-tSGA)….…………………………………………..32 3.10. Frühgeborene in der zweiten Studienphase (TSB3-FG)……………….…………………….35 3.11. direkter Vergleich der drei Untergruppen der zweiten Studienphase…………….………..37 3.12. Vergleich der retro- und prospektiven Teile der Studie…….……………………………….43 3.13. Die Phototherapiegruppe………………………………………………………………………45 3.13.5. Zusammenhang zwischen Phototherapie und Geburtsmodus………………………………………..47 3.13.6. Zusammenhang zwischen Phototherapie und Nabelschnurbilirubin………………………………..48 3.13.7. Zusammenhang zwischen Phototherapie und Serumbilirubin vom 3.LT (TSB3)…………………..51 3.14. Vorhersage der therapiepflichtigen Hyperbilirubinämie anhand der Nabelschnurbilirubin-Werte…..………………………………………………….…………………………………….……..54 3.14.1. statistische Begriffe………………………………………………………………………………………54 3.14.2. Vorhersage der therapiepflichtigen Hyperbilirubinämie anhand der Nabelschurbilirubin-Werte.54 3.15. Vorhersage der therapiepflichtigen Hyperbilirubinämie anhand TSB3 (Serumbilirubin vom 3. Lebenstag)……………………...………………………………………..……………………56 3.16. Zusammenhang zwischen NS-Bili und TSB3(Serumbilirubin vom 3. Lebenstag)…………58 3.17. Regressionsanalyse…………………………………...…………………………………………59 3.17.1. univariate Regressionsanalyse………………………………………………………………………….59 3.17.2. multivariate Regressionsanalyse………………………………………………………………………..59 3.18. Odds Ratio einer therapiepflichtigen Hyperbilirubinämie………………………………….61 3.19. Beginn und Dauer der Phototherapie…………………………………………………………62 4. Diskussion……………………………………….…………………………………..…….64 Nabelschnurbilirubin und Phototherapie………………………………………………….……….64 Serumbilirubin vom 3. Lebenstag und Phototherapie….………………………………………….67 Kombination aus Nabelschnurbilirubin und Serumbilirubin vom 3.Lebenstag…………………71 Phototherapiegruppe…………………………………………………………………………………73 Schlussfolgerung…………………………...…………………………………………………………76 5. Zusammenfassung der Arbeit……………………………………………………………78 6. Literaturverzeichnis………………………………………………………………………82 7. Abbildungsverzeichnis……………………………………………………………………98 8. Tabellenverzeichnis……………………………………………………………………….99 Erklärung über die eigenständige Abfassung der Arbeit…………………………..……101 Danksagung…………………...…………………………………………………..………..102 Lebenslauf……………………………………………………………………………………………103