Predicting significant hyperbilirubinaemia and early discharge for glucose-6-phosphate dehydrogenase deficient newborns

Introduction: This study aims to assess the usefulness of day 3 (49 to 72 hours) pre-phototherapy total serum bilirubin (TSB) in predicting subsequent significant hyperbilirubinaemia (SHB) and the feasibility of early discharge for term and near-term glucose-6-phosphate dehydrogenase (G6PD) deficient newborns. Materials and Methods: This prospective cohort study involved inborn G6PD deficient neonates who were greater than or equal to35 weeks and weighed greater than or equal to2000 g at birth. TSB levels and phototherapy requirements in their first two weeks of life were studied. Day 3 pre-phototherapy TSB in the subgroup weighing greater than or equal to2500 g at birth was analysed for its value in predicting subsequent SHB. Results: Of the 129 neonates, 58 (45%) required phototheropy in the first week. Of these, only 4 patients (3.1%) needed phototheropy to be restarted in the second week. Seventy-one (55%) neonates did not require phototherapy at all. In the absence of SHB in the first week, the probability of its development in the second week was zero (95% confidence interval, 0 to 0.057). In the subgroup weighing greater than or equal to2500 g at birth, day 3 pre-phototherapy TSB less than or equal to154 umol/L predicted no measurable risk of subsequent SHB (sensitivity, 100%; 95% confidence interval, 91.4% to 100%; negative predictive value, 100%; 95% confidence interval, 86.7% to 100%). Conclusions: G6PD deficient newborns without SHB in their first week of life were at no measurable risk of its development in the second week. Day 3 pre-phototherapy TSB in the subgroup weighing greater than or equal to2500 g was useful for predicting the risk of subsequent SHB. Low-risk infants, thus identified, may be eligible for discharge on or before day 7 of life. Evidence-based early discharge can decrease the social and financial burden of G6PD deficiency in Singapore.