A Method For Detecting Hemolytic Jaundice In Newborn Infants

1. A Method For Detecting Hemolytic Jaundice In Newborn Infants Tsuyoshi Matsuoka1), Kosuke Koyano2), Toru Kuboi1), Saneyuki Yasuda2), Kensuke Okubo1), Hitoshi Okada1), Takashi Kusaka2), Kenichi Isobe1), Susumu Itoh1) 1) Department of Pediatrics, Faculty of Medicine, Kagawa University 2) Maternal Perinatal Center, Faculty of Medicine, Kagawa University

2. Background Jaundice occurs in most newborn infants. The jaundice in most cases is benign, but hemolytic jaundice might be severe hyperbilirubinemia. It is important to detect severe hyperbilirubinemia as soon as possible. Blood exchange transfusion (BET), one of traditional therapies for severe hyperbilirubinemia, has some risks for infants. However, it is difficult to predict the progress of hemolytic jaundice without measuring bilirubin.

3. Objective The aim of this study was to determine the usefulness of a transcutaneous jaundice meter (JM-103, Konica Minolta) and its normogram for detecting hemolytic jaundice.

4. Transcutaneous jaundice meter (Konica Minolta, JM-103) 150 g

5. Transcutaneous jaundice meter (Konica Minolta, JM-103) S Yasuda et al. J Perinat Med. 2003

6. Error distribution of TcB measurement by JM-102, JM-103 and TSB values JM-102 JM-103 TcB: Transcutaneous bilirubin TB: Serum bilirubin S Yasuda et al. J Perinat Med. 2003

7. Methods We retrospectively evaluated 11 infants who were diagnosed as having ABO hemolytic disease of the newborn (HDN) from January 2007 to December 2010.

8. Diagnosis Criteria For ABO HDN Major Criteria Unconjugated Hyperbilirubinemia within the first 24 hours The existence of considerable blood types combination for ABO HDN: blood type O mothers with type A or B infants The presence of IgG anti-A or anti-B antibodies in type O mothers Minor Criteria Positive indirect Coomb’s antiglobulin test (with the same type of adult RBC) Positive elution test in type A or B infants The presence of anti-A or anti-B antibodies in type A or B infants Three items from major criteria, with at least one from minor criteria

9. Results Clinical Characteristics of infants (n=11) Gestational age (weeks) Body Weight (g) APGAR score (at 5 min.) In born: Out born (No.) Male: Female (No.) 39.6 (38.5-41.1) 3,222 (2,598-3,782) 9 (9-10) 5:6 8:3 Median (Min-Max)

10. Results Measurements and Therapies (n=11) No. of infants TcB + TB TB only 9 2 PT only IVIg + PT BET + IVIg + PT 3 8 1 TcB: Transcutaneous bilirubin by JM-103 TB: Serum bilirubin IVIg: Intravenous gamma globulin therapy PT: Phototherapy BET: Blood exchange transfusion

11. 97.5%tile Average 2.5%tile TcB Levels (chest) in the First 72 Hours in a Normal Newborn Population of >36 Weeks’ Gestation in JAPAN 342 TcB (mg/dL) TcB (µM) 171 0 Postnatal Age (hours)

12. 97.5%tile Average 2.5%tile TcB Levels (chest) at the first measurement for 8 infants who had ABO HDN 342 ●Out born ●In born ●Out born (BET) TcB (mg/dL) TcB (µM) 171 ● ● ● ● ● ● ● ● ● 0 Postnatal Age (hours)

13. 97.5%tile Average 2.5%tile TcB Levels (chest) of out born infant who was treated by BET GA 39 weeks 2 days, 3494 g, female 342 ↓Admission to NICU ● TcB (mg/dL) TcB (µM) 171 ● 0 Postnatal Age (hours)

14. Discussion JM-103 is good device to measure transcutaneous bilirubin concentration without blood sampling. However, some papers show that TcB is not better parameter than TB for detecting ABO hemolytic disease of the newborn. Because there is a time lag that bilirubin distributes from serum to skin. Therefore, we have to think about two parameters separately. An hour-specific TcB normogram helps to detect ABO hemolytic disease of the newborn.

15. Conclusion An hour-specific TcB normogram is useful for detecting hemolytic jaundice. JM-103 is a good device for managing hyperbilirubinemia without blood sampling.