Objective: The aim of this study was to evaluate the Bilirubin albumin (B/A) ratio in comparison with total serum Bilirubin (TSB) for predicting acute Bilirubin-induced neurologic dysfunction (BIND).Methods: Fifty two term and near term neonates requiring phototherapy and exchange transfusion for severe hyperBilirubinemia in Children’s Medical Center, Tehran, Iran, during September 2007 to September 2008, were evaluated. Serum albumin and Bilirubin were measured at admission. All neonates were evaluated for acute BIND based on clinical findings.Findings: Acute BIND developed in 5 (3.8%) neonates. B/A ratio in patients with BIND was significantly higher than in patients without BIND (P<0.001). Receiver operation characteristics (ROC) analysis identified a TSB cut off value of 25 mg/dL [area under the curve (AUC) 0.945] with a sensitivity of 100% and specificity of 85%. Also, according to the ROC curve, B/A ratio cut off value for predicting acute BIND was 8 (bil mg/al g) (AUC 0.957) with sensitivity of 100% and specificity of 94%.Conclusion: Based on our results, we suggest using B/A ratio in conjunction with TSB. This can improve the specificity and prevent unnecessary invasive therapy such as exchange transfusion in icteric neonates.

HyperBilirubinemia is one of the most common neonatal disorders. Delayed diagnosis and treatment of the pathologic and progressive indirect hyperBilirubinemia lead to neurological deficits, defined as Bilirubin induced encephalopathy (BIE) (2). The incidence of this disorder in underdeveloped countries is much more than developed areas. All neonates with the risk factors for increased the blood level of indirect Bilirubin are at risk for BIE, especially preterm neonates which are prone to low Bilirubin kernicterus. BIE can be transient and acute (with early, intermediate and advanced phases)or be permanent, chronic and lifelong ( with tetrad of symptoms including visual (upward gaze palsy), auditory (sensory neural hearing loss), dental dysplasia abnormalities, and extrapyramidal disturbances (choreoathetosis cerebral palsy). Beside the abnormal neurologic manifestations of the jaundiced neonates, brain MRI is the best imaging modality for the confirmation of the diagnosis. Although early treatment of extreme hyperBilirubinemia by phototherapy and exchange transfusion can prevent the BIE, unfortunately the chronic Bilirubin encephalopathy does not have definitive treatment.

Background: Jaundice is a prevalent problem among neonates. Patients undergoing phototherapy need a close follow-up of their serum Bilirubin levels to determine the treatment response. To make a comparison between transcutaneous Bilirubin measurements (TcB) from covered skin areas during phototherapy and total serum Bilirubin (TSB) levels. Methods: This prospective observational study was conducted on 30 full-term neonates with indirect hyperBilirubinemia requiring phototherapy. Some parts of the skin (forehead and sternum) were covered in each neonate using the BiliEclipsephoto opaque patch and this covered site was used to measure TcB during phototherapy and compare it with TSB. Both TSB and TcB estimation were performed on icteric newborns before, as well as 24 and 48 h of exposure to phototherapy. Results: As demonstrated by the obtained results, TSB was not significantly different from TcB measured at forehead and sternum before phototherapy. Moreover, no significant difference was detected between TSB and TcB from the covered forehead and sternum in 24 and 48 h of phototherapy initiation. There was a highly significant positive correlation between TSB and covered forehead/sternum TcB during phototherapy. There was no significant difference in both covered forehead and sternum TcB according to different used TcB devices. Conclusion: Measurement of TcB from the covered area of the skin during phototherapy using transcutaneous Bilirubin meters is a reliable method to assess TSB in full-term neonates and could lead to a reduction in blood sampling and its complications.

Background: Neonatal jaundice is an almost common problem among neonates that may cause complications such as kernicterus in severe cases. Since early diagnosis and proper treatment of neonatal jaundice is vital to prevent the related complications, it is necessary to check Bilirubin before discharging the neonates. There are several evaluating and diagnostic methods to measure the level of Bilirubin. Thus, this study aimed to compare the transcutaneous method versus measurement of serum Bilirubin, using spectrophotometry for jaundice screening of full-term neonates before discharge from hospital. Methods: This observational analytic study was conducted on six hundred neonates with birth weight more than 2000 grams and gestational age more than 35 weeks from September 2012 to March 2013 in Hafez hospital, Shiraz University of Medical Sciences. Parameters such as Bilirubin level of neonates were measured and compared, using spectrophotometry and transcutaneous by Bili check with multi waves. Results: Six hundred neonates were enrolled in this study. The Pearson correlation test showed that there was a significant correlation between the two methods of the transcutaneous versus measurement of serum Bilirubin, using spectrophotometry (r=0. 63), (P>0. 05). There was no significant difference between the mean of measured Bilirubin, using each method in some demographic variables such as the different groups of gender (P=0. 896), birth weight (P=0. 419), and type of feeding in neonates (P=0. 323), but it was significant in other demographic variables such as the different groups of gestational age and post-neonatal age (P<0. 0001). Also, the results revealed that there was a significant correlation between two methods of the trans cutaneous versus measurement of serum Bilirubin, using spectrophotometry based on demographic variables (P<0. 0001). Conclusion: In general, the Bilirubin measurement using trans-cutaneous method may estimate Bilirubin significantly less than the serum Bilirubin measurement method, and this difference can be more obviously noticeable in infants with less gestational age and also less post-natal age.