Predicting Pathologic Jaundice: The Chinese Perspective

Abstract

A high incidence of hyperbilirubinemia among neonates of Asian ethnicity has been observed in Hong Kong, 1,2 Singapore, 3 England, 4 and the United States. 5 More than 80% of Chinese newborns develops visible jaundice during the first few days of life. 2 The contributing causes have not been fully elucidated, although an imbalance between the processes of increased production and decreased elimination of bilirubin is likely to play a role. 6 A recent international, multiracial study 7 has shown that, among Chinese newborns, high serum total bilirubin (STB) levels may be still observed at 96 hours of life. Moreover, this ''non-specific neonatal jaundice'' appears to be different from the ''physiological jaundice'' seen in the newborn population of the United States. 6,8 The jaundice is more intense, peaks on day 4 rather than day 3 of life, and persists much longer. 6,9 With improvements in the socioeconomic environment, the health care system, and health education (particularly, on avoidance of herbal consumption in the neonatal and nursing period), there has been marked decline of the occurrence of kernicterus in Hong kong in recent years. 10 However, significant hyperbilirubinemia is still a common problem today. 1,2 This may be due, in part, to a dramatic increase in the rate of breastfeeding from 5% in 1978 to 41% in 1997. In addition, like in the United States, efforts are being made in Hong Kong to decrease costs of medical care by reducing the length of postnatal hospitalization. Therefore, in view of the high incidence of hyperbilirubinemia, an improved predischarge risk assessment of hyperbilirubinemia in Chinese newborns is highly warranted in order to avoid the re-emergence of kernicterus, which has occurred in the United States during last decade. 11 As described in previous studies, the measurement of end-tidal breath carbon monoxide (CO) corrected for inhaled CO (ETCOc) can be used as a non-invasive index of total bilirubin production. 12 -14 Furthermore, other studies have reported a strong correlation between measurements of transcutaneous bilirubin measurements (TcB) and STB. 15 -17 Therefore, the use of the non-invasive TcB may provide an attractive alternative to serial STB measurements. It has also been suggested that measurements of cord serum total bilirubin (STB cord ) could serve as an index of fetal bilirubin production 18 and therefore may be a predictor of the development of subsequent hyperbilirubinemia. 19 Although a direct assessment of reduced bilirubin clearance due to either hepatic immaturity or enhanced enterohepatic circulation is difficult, a high level of cord serum alpha-fetoprotein (AFP cord ) has been reported to be inversely related to hepatic immaturity. 20 AFP cord has been positively correlated with peak STB in the neonatal period. Cord serum albumin (ALB cord ) has also been considered a marker of liver maturity with an inverse relationship with AFP cord and a low level in preterm infants. 20 It has been suggested that because the levels of cord blood STB reflect ...

Prenatal Training Improves New Mothers’ Understanding of Jaundice

“…In this study, it is encouraging that most of the respondents in both groups considered that blood tests help identify the causes of NNJ. Since the levels of serum total bilirubin reflect erythrocyte turnover and the levels of serum alpha-fetoprotein (and possibly albumin) reflect liver maturity, these parameters might be used to predict the development of hyperbilirubinemia after birth [15]. …”