Evaluation of hospitalized newborns due to indirect hyperbilirubinemia: A cross-sectional study

Sefer Üstebay; Ömer Ertekin; Döndü Ülker

doi:10.28982/josam.670531

Authors

Sefer Üstebay https://orcid.org/0000-0003-1507-5921
Ömer Ertekin https://orcid.org/0000-0002-7846-7634
Döndü Ülker https://orcid.org/0000-0003-3270-8305

DOI:

https://doi.org/10.28982/josam.670531

Keywords:

Newborn, Indirect hyperbilirubinemia, Etiology, Risk factors

Abstract

Aim: Indirect hyperbilirubinemia, a widespread problem in the newborn period, may need emergency treatment for prevention of neurological sequelae and mortality in some cases. We aimed to report the incidence, etiological factors, clinical findings, and the treatment of neonates with indirect hyperbilirubinemia.

Methods: Ninety-six cases of non-physiological indirect hyperbilirubinemia and prolonged jaundice which were followed-up in the Neonatology Unit of Kafkas University Hospital between January 2018-October 2019 were evaluated. The therapeutic approach was determined according to the recommendations of American Academy of Pediatrics in 2004.

Results: The incidence of IHB was 24.8% (n=96) among 387 hospitalized neonates. The mean gestational age, birth weight (BW), and bilirubin level on admission were 36.2 (2.5) weeks, 2628.9 (820) g, and 12.1 (5.29) mg/dL, respectively. Among all, vaginal delivery ratio was 38.5%, and cesarean delivery rate was 61.5%. About 34.4% were first-time mothers. The rates of breastfeeding and formula feeding were 39.6% and 1%, respectively. Around 59.4% were both breast- and formula-fed. The etiological factors of IHB were as follows: Prematurity and/or low birth weight (LBW) (20.9%), breast feeding jaundice (8.3%), ABO incompatibility (17.7%), Rh incompatibility (7.3%), ABO+Rh incompatibility (3.1%), cephal hematoma (2.1%), urinary infection (4.2%), sepsis (4.2%), pneumonia (2.1%), omphalitis (1%), subgroup incompatibility (1%), Glucose 6 phosphate dehydrogenase deficiency (1%) and unknown etiology (7.3%). Exchange transfusion rate was 1% (n=1), and 5 neonates (5.2%) were administered immunoglobulin therapy among 27 (28.1%) with hemolytic hyperbilirubinemia.

Conclusion: Indirect hyperbilirubinemia is an important risk factor for mortality and morbidity in newborn period. Defining the risk factors for non-physiologic indirect hyperbilirubinemia, adequate follow up and prompt treatment would reduce neurological sequelae and mortality rates.

Downloads

Download data is not yet available.

References

Wong RJ, Desandre GH, Sibley E, Stevenson DK. Neonatal jaundice and liver diseases. In: Martin RJ, Fanaroff AA, Walsh MC (eds). Neonatal-Perinatal Medicine. Diseases of the Fetus and Infant, 8th ed, Philadelphia: Mosby Elsevier. 2006;1419-65.

Doğan Y, Güngör S, Gürgöze MK, Taşkın E, Yolmaz E, Aygün D. Yenidoğan Hiperbilirubinemili olguların değerlendirilmesi. Hipokrat Pediatri Dergisi. 2003;3:108-11.

Alpay F. Sarılık. In: Yurdakök M, Erdem G. Neonatoloji. Türk Neonatoloji Derneği. Ankara: Alp Ofset 2004;559-78.

Ülgenalp A, Duman N, Schaefer FV. Analysis of Polymorphism for UGT1˟1 EXON 1 Promoter in Neonates with Pathologic and Prolonged Jaundice. Biol Neonate. 2003;83(4):258-62.

Bertini G, Dani C, Tronchin M, Rubaltelli FF. Is breast-feeding really favoring early neonatal jaundice? Pediatrics. 2001;107-41.

Kültürsay N, Çalkavur Ş. İndirekt Hiperbilirubinemi/nedenler ve tanı. Güncel Pediatri. 2006;2:21-5.

Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001;344:581-90.

Stoll BJ, Kliegman RM. The fetüs and Neonatal Infant. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB Saunders Company; 2004;592-98.

American Academy of Pediatrics, Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia. Practice parameter: Management of hyperbilirubinemia in the healthy term newborn. Pediatrics. 1994;94:558-65.

Monaghan G, McLellan A, McGeehan A. Gilbert’ssyndrome is a contributary factor in prolonged unconjugated hyperbilirubinemia of the newborn. J Pediatr. 1999;134:441-6.

No authors listed. Practice parameter management of hyperbilirubinemia in the healty term newborn. American Academy of Pediatrics Provisional Commitee for Qualitiy Improvoment and Subcommittee on Hyperbilirubinemia. Pediatrics. 1994;94:558-65.

Alpay F. Yenidoğan Sarılığı. Türkiye Klinikleri J Pediatr Sci. 2004;2:689-97.

Ünal S, Eker S, Kılıç G, Yılmaz A, Özaydın E. İndirekt Hiperbilirubinemili Yenidoğanların Geriye Dönük olarak Değerlendirilmesi. Türkiye Klinikleri J Pediatr. 2008;17(4).

Narlı N, Satar M, Özlü F, Yapıcıoğlu H, Özkan K. Çukurova Üniversitesi Yenidoğan Yoğunbakım Ünitesi’ne yatırılan hiperbilirubinemili bebeklerin etiyolojik yönden değerlendirilmesi. Çukurova Üniversitesi Tıp Fakültesi Dergisi. 2004;29:51-5.

Kılıç İ, Ergin H, Çakaloz I. The Evaluation of Indırect Hyperbilirubinemia cases ın Newborn Period. Türkiye Klinikleri J Pediatr. 2005;14:20-5.

Özkaya H, Bahar A, Özkan A, Kandemir F, Göçmen I, Mete Z. İndirekt hiperbilirubinemili yenidoğanlarda ABO, Rh ve subgrup (Kell,c,e) uyuşmazlıkları. Türk Pediatri Arşivi. 2000;35:30-5.

Büyükokuyan ME, Süleyman H. Glucose 6-phosphate dehydrogenase deficienscy. Türkiye Klinikleri J Med Sci. 2001;21:415-9.

Atay E, Bozaykut A, İpek IO. Glucose 6-phosphate dehydrogenase deficienscy in neonatal indirect hyperbilirubinemia. J Trop Pediatr. 2006;52:56-8.

Bigen H, Özek E, Unver T, Bıyıklı N, Alpay H, Cebeci D. Urinary tract infection and hyperbilirubinemia. Turk J Pediatr. 2006;48:51-5.

Tekinalp G, Ergin H, Erdem G, Yurdakök M, Yiğit Ş. Yenidoğan döneminde uzamış sarılıklar: 82 vakanın değerlendirilmesi. Çocuk Sağlığı ve Hastalıkları Dergisi. 1996;39:441-8.

Atadağ Y, Aydın A, Kaya D, Öksüz A, Köşker HD. Risk assessments, pregnancy and birth processes of pregnant women at primary health care center: A retrospective study. J Surg Med. 2017;1(1):5-8.