Clinical Course and Prognosis of Hemolytic Jaundice in Neonates in North East of Iran

Abstract

Background: Hemolytic jaundice is the most serious cause of hyperbilirubinemia among neonates. It may develop to kernicterus due to misdiagnosis or inappropriate treatment. The aim of this study is to determine the prevalence rate of hemolytic jaundice, predisposing factors and assessment of treatment and complications in hemolytic jaundice. Methods: This prospective descriptive study has been performed on 1568 newborns with jaundice as their chief complaint, in a seven-year period at Ghaem hospital in Mashhad, Iran. 795 neonates were included in our study (237 infants with hemolytic jaundice and 558 infants with idiopathic jaundice). Complete physical examinations and laboratory tests were performed and data were recorded. Statistical analysis was carried out, using SPSS 11.5 statistical package. Results: In the present study, significant differences were determined between two groups of hemolytic and idiopathic jaundice for total serum bilirubin, hematocrit, time of jaundice appearance, age of admission, hospitalization period and incidence of kernicterus (p<0.001). Newborns with ABO incompatibility (17%), Rh disease (7%), G6PD deficiency (6%) and minor blood group immunization (2%) were developed to hyperbilirubinemia, respectively. Among the newborns affected with kernicterus, 12 cases were placed in group with ABO hemolytic disease (9%), 3 cases were in Rh isoimmunization group (5.5%), 4 cases were in G6PD deficiency group (8.9%) and 9 cases were idiopathic (1.6%). Conclusion: Jaundice due to hemolysis is associated with a higher serum bilirubin and more complications like kernicterus. ABO incompatibility was the most common reason of hemolytic jaundice among neonates in north east of Iran. Special attention to ABO incompatibility and G6PD enzyme screening may decrease complications and improve the prognosis.