الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 143 |  |  |
| | | from | 143 | | |
Abstract
¨ Neonatal jaundice is a common disorder with more than half of all newborns being affected in the first three to five postnatal days. Because of the increasing number of early discharged newborns, there is a corresponding danger of failing to diagnose severe hyperbilirubinemia and start the treatmentin time, as reports about kernicterus in full term healthy new born demonstrate. Therefore, it is important to establish safe markers for the development of excessive jaundice in these infants. The prevention of fatal outcomes is based on the early detection of children at risk of developing significant hyperbilirubinemia, and especially of detecting those in further need of therapeutic intervention. Increased heme catabolism is an important mechanism responsible for hyperbilirubinemia in the first days after birth Hemoglobin released from erythrocytes into the circulation by intravascular hemolysis binds immediately with haptoglobin, a serum glycoprotein synthesized primarily by hepatocytes, and forms a stable hemoglobin-haptoglobin (Hb-Hp) complex. Hb binding by haptoglobin is thought to be important in the rapid hepatic clearance of hemoglobin from the plasma and in the inhibition of glomerular filtration of hemoglobin. The aim of this study is to determine if low umbilical cord and fifth day haptoglobin levels can be an early predictors of neonatal jaundice. This study was conducted on 45 full term neonate that had been recruited from the delivery room and neonatal intensive care unit (NICU) of El Galaa Teaching Hospital. Neonates included were those with gestational ages between 37 and 42 completed weeks. ¨ Summary And Conclusion - 103 - Nenates who were excluded were preterm < 37 weeks gestational age, SGA & LGA, congenital malformations, suspected or diagnosed neonatal sepsis, respiratory distress, Inborn error of metabolism and inability to initiate or maintain oral feedings within 3 hr after birth Investigations done at birth and on fifth day post natal were serum bilirubin (with direct fraction), complete blood picture (including reticulocytic count), maternal & neonatal blood group and RH, serum creactive protein (CRP) and serum haptoglobin level which measured by using Radial immune diffusion technique. The age of neonates ranged from 38.0–41.0 weeks with a mean age 39.0± 0.9 weeks. 26 candidates were females (57.8%) and 19 were males (42.2%). 60% of the studied candidates (27 neonates) were delivered by N.V.D., while 40% (18 neonates) were delivered by C.S. In this study, neonates were divided retrospectively into 2 groups, those who didn’t need treatment for jaundice (control) were 33 neonates (73.3%) & those who needed treatment in the form of phototherapy for jaundice (cases) were 12 neonates (26.7%).Non of the cases needed blood exchange. In this study, cord blood haptoglobin was in control neonates with insignificant hyperbilirubinemia (2.8± 1.8 mg/dl) and decreased in cases with significant hyperbilirubinemia (0.61± 0.34 mg/dl). 5th day haptoglobin in control was (97.0 ± 21.5 mg/dl) and decreased in cases it was (45.4± 15.5 mg/dl). ¨ Summary And Conclusion - 104 - In this study, umbilical cord blood haptoglobin level (<0.090) mg/dl was an excellent test to predict requirement of treatment for jaundice at fifth day. Which had sensitivity 83.3%, specificity 90.0%, 76.9% positive predictive value, 93.8% negative predictive value and diagnostic accuracy was 88.9%. In conclusion, our data clearly demonstrate that the quantification of umbilical cord blood haptoglobin is a useful test to predict hyperbilirubinemia in healthy newborns. This study found that cord blood haptoglobin cut of value of 0.09 mg/dl has a good prognostic value for children with neonatal jaundice who will need treatment and could differentiate them from others who will not need treatment.