Abstract
Objective: To determine clinical features, etiology and risk factors in term and near term newborns with severe hyperbilirubinemia. Methods: During ten years period (2000 - 2009), infants of ≥ 35 gestational weeks who received phototherapy were evaluated retrospectively. The study population was divided into two groups and clinical features, etiology and risk factors were compared. Group 1 defined by those who had bilirubin level ≥25 mg/dl (severe hyperbilirubinemia) and group 2 defined by bilirubin level <25 mg/dl. Results: During the study period 1335 babies were evaluated. Severe hyperbilirubinemia was found in 137 (10.3%) patients. Total serum bilirubin level was 29.7±4.7 mg/dl in group 1 and 18.9±3.5 mg/dl in group 2. Pathological weight loss, vaginal delivery and supplementary feeding were identified as significant risk factors for development of severe hyperbilirubinemia (p <0.001, p <0.001 and p = 0.04, respectively). The time at recognition of jaundice by family and postnatal age at admission were significantly higher in group 1. The ratios of previous sibling received phototherapy and being the second child or after were found higher in group 1. Conclusion: Pathological weight loss, vaginal delivery and supplementary feeding were determined as risk factors for development of severe hyperbilirubinemia. The newborns with severe hyperbilirubinemia had late recognition of jaundice and admission to hospital by their families.
Highlights
Neonatal jaundice remains the most common and probably often preventable problem in full-term and near-term infants during the early postnatal period
A total serum bilirubin level of more than 25 mg/ dl is accepted as severe hyperbilirubinemia since an infant with this degree of jaundice is thought to be at high risk of kernicterus.[8]
Risk factors recognized to be associated with severe hyperbilirubinemia in newborns have included rhesus and ABO incompatibility, as well as glucose-6-phosphate dehydrogenase (G6PD) deficiency, jaundice in the first 24 hours of life, jaundice noted before discharge from hospital, previous sibling received phototherapy, near - term gestational age of 35–36 weeks, Asian race and the presence of bruising or cephal hematoma.[3,4,9,10]
Summary
Neonatal jaundice remains the most common and probably often preventable problem in full-term and near-term infants during the early postnatal period In both developed and developing countries like Turkey the most common cause of infant readmission is hyperbilirubinemia, especially severe hyperbilirubinemia.[1,2,3,4] Long-term effects of severe hyperbilirubinemia, including kernicterus, were thought to be rare since the advance of exchange transfusion, maternal rhesus immunoglobulin prophylaxis and phototherapy.[4,5,6] In the world, reported patients of kernicterus are mostly from the United States (27 %), Singapore (19 %) and Turkey (16 %).[7] Considering the frequency of kernicterus in our country (the third country all over the world), it is clear that further studies concentrating on the etiology and treatment outcomes of neonatal jaundice are necessary. Risk factors recognized to be associated with severe hyperbilirubinemia in newborns have included rhesus and ABO incompatibility, as well as glucose-6-phosphate dehydrogenase (G6PD) deficiency, jaundice in the first hours of life, jaundice noted before discharge from hospital, previous sibling received phototherapy, near - term gestational age of 35–36 weeks, Asian race and the presence of bruising or cephal hematoma.[3,4,9,10] To provide appropriate epidemiologic data, it is necessary to document the incidence of kernicterus in the newborn population, the incidence of other adverse effects attributable to hyperbilirubinemia and its management, and the number of infants whose TSB (total serum bilirubin) levels exceed or 30 mg/dl.[5]
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