Transcutaneous bilirubin nomogram for evaluating the risk of hyperbilirubinemia in Iranian healthy newborns.

BACKGROUND: Hyperbilirubinemia, which is mostly benign, is one of the most common problems in neonates. This study was conducted to draw a skin bilirubin nomogram for evaluating the risk of hyperbilirubinemia requiring treatment. METHODS: This cross-sectional study recruited 1066 healthy infants. The first transcutaneous bilirubin (TcB) measurement was performed before hospital discharge and within 12-48 h of birth. The neonates were followed up for 6 days after discharge based on their age at the time of discharge. The neonates were divided into four groups based on the TcB values before discharge and age in hours, including the low-risk, medium-low-risk, medium-high-risk and high-risk groups. The percentage of neonates who progressed toward severe hyperbilirubinemia was then calculated in each percentile based on the follow-up TcB measurement. Stata software was used to draw the nomogram. Based on the TcB values at discharge and the neonate's age in hours, the skin bilirubin nomogram was drawn in 40, 75 and 95 percentiles. RESULTS: A total of 4.9% of the neonates were in the high-risk group, 18.9% in the medium-high-risk group, 34.8% in the medium-low-risk group and 41.2% in the low-risk group. The risk of severe jaundice in the follow-up of the neonates in the highest-risk to the lowest-risk groups was 48.9, 14.5, 9.7 and 3.3%, respectively. CONCLUSION: The skin bilirubin nomogram can be used to predict severe hyperbilirubinemia in Iranian infants.

Effect of metoclopramide administration to mothers on neonatal bilirubin and maternal prolactin: a randomized, controlled, clinical trial.

BACKGROUND: Jaundice is a common neonatal problem. This study was conducted to determine the effect of metoclopramide on neonatal bilirubin and maternal prolactin (primary outcomes) and milk volume (secondary outcome). METHODS: This triple-blind, randomized, controlled, clinical trial was conducted on 112 mothers. The participants were assigned to the intervention (metoclopramide) and control groups (placebo) using block randomization. Ten-mg metoclopramide and placebo tablets were taken by the participants three times a day. The intervention began in the first 2-10 hours after childbirth and continued until the fifth day. The mothers' prolactin level was measured on the first morning after the intervention and on the sixth day (1 day after the intervention was over). Neonatal total bilirubin was also measured before the intervention and on the sixth day. RESULTS: After the intervention, the two groups did not differ significantly in terms of the mean neonatal indirect bilirubin (P = 0.565) and milk volume (P = 0.261), but the mean serum prolactin was significantly higher in the metoclopramide group compared to the placebo group (adjusted mean difference 37; 95% confidence interval 58.1-16.5; P = 0.001). CONCLUSIONS: Metoclopramide increased maternal serum prolactin but had no effects on neonatal jaundice. The insufficient numbers of studies on this subject mandate further research.