Takuya Akimoto, Nobuhiko Nagano, Yuki Sato, Hidetoshi Go, Koichiro Hara, Takayuki Imaizumi, Ryoji Aoki, Midori Hijikata, Aya Okahashi, Ichiro Morioka
Nihon University School of Medicine.
Japan
Pediatrics International
Pediatr Int 2025;
DOI: 10.1111/ped.70026
Abstract
Backgrounds: This study aimed to identify the incidence and clinical predictors of hyper-direct bilirubinemia (hyper-DB) in preterm infants without underlying diseases.
Methods: We enrolled neonates born at <34 weeks of gestational age (GA) between 2019 and 2020. The incidence of hyper-DB was calculated, and neonates were categorized into hyper-DB and nonhyper-DB groups. Hyper-DB was defined as DB ≥ 1 mg/dL when total bilirubin (TB) was <5 mg/dL or DB ≥20% of TB when TB was ≥5 mg/dL during their neonatal intensive care unit stay. Clinical data regarding maternal and neonatal factors were compared using univariate and multivariate analyses, respectively. A receiver operating characteristic curve was generated and the threshold value of the GA was determined using the Youden index.
Results: Hyper-DB was diagnosed in 16 of the 131 infants (12%). Eleven clinical factors, including GA, birth weight, absence of premature rupture of membranes (PROM), and incidence of neonatal persistent pulmonary hypertension (PPHN), were significantly different between the two groups (p < 0.05). Multivariate analyses showed that a shorter GA (odds ratio [OR]: 0.48), presence of PPHN (OR: 87.2), and absence of PROM (OR: 0.01) were independent clinical predictors of the development of hyper-DB. Using the Youden index, a cutoff value of 30 weeks for GA was determined as the threshold to manifest hyper-DB.
Conclusions: We observed that 12% of preterm infants at <34 weeks’ GA without an underlying disease developed hyper-DB. Low GA (less than 30 weeks), presence of PPHN, and absence of PROM were associated with the development of hyper-DB.
Category
Class I. Persistent Pulmonary Hypertension of the Newborn
Acquired Patient Factors Associated with Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
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