Abstract
Amaç: Çalışmamızı fototerapi ilişkili direkt hiperbilirubineminin sıklığını ve olası risk faktörlerini saptamak amacıyla planladık.Gereç ve Yöntemler: Yenidoğan ünitesine indirekt hiperbilirubinemi tanısı ile 2005 ve 2013 yılları arasında yatan 1301 yenidoğanın dosyaları geriye dönük olarak tarandı. Hiperbilirubinemi haricinde başka hastalığı da olan yenidoğanlar çalışmadan çıkartıldı.Bulgular: Fototerapiyi takiben hem direkt bilirubin seviyesi hem de direkt bilirubin/total bilirubin oranı artmaktadır (sırasıyla p < 0.001 ve p < 0.001). Patolojik direkt bilirubin/total bilirubin sınırı %20 alındığında, fototerapi ile ilişkili direkt hiperbilirubinemi sıklığı %0.9 olarak bulundu. Artmış direkt bilirubin seviyeleri ve direkt bilirubin/total bilirubin oranı 3 gün içerisinde normale dönmekteydi, fakat bu değerler halen fototerapi öncesindeki değerlere göre anlamlı olarak yüksekti (sırasıyla p < 0.001 ve p < 0.001). ABO uygunsuzluğu olan hastalarda direkt bilirubindeki ve direkt bilirubin/total bilirubin değerindeki artışın daha hızlı olduğu saptandı (sırasıyla p < 0.001 ve p < 0.001).Sonuç: Fototerapi sonrasında direkt bilirubin düzeyi ve direkt bilirubin / total bilirubin oranı geçici olarak artabilmektedir. Bu durum kısa sürelidir ve saptanabilen tek risk faktörü ABO uygunsuzluğudur. Gereksiz ileri araştırmaların önüne geçilmesi açısından yenidoğanların tedavisinde görev alan doktorların bu durumu akılda tutmaları yararlı olacaktır.
Keywords
References
- Bhutani VK, Committee on Fetus and Newborn; American Academy of Pediatrics. Phototherapy to prevent severe neonatal hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2011;128:e1046-52.
- Vreman HJ, Wong RJ, Stevenson DK. Phototherapy: Current methods and future directions. Semin Perinatol 2004;28:326-33.
- Scheidt PC, Bryla DA, Nelson KB, Hirtz DG, Hoffman HJ. Phototherapy for neonatal hyperbilirubinemia: Six-year follow-up of the National Institute of Child Health and Human Development clinical trial. Pediatrics 1990;85:455-63.
- Tatli MM, Minnet C, Kocyigit A, Karadag A. Phototherapy increases DNA damage in lymphocytes of hyperbilirubinemic neonates. Mutat Res 2008;654:93-5.
- Cohen AN, Ostrow JD. New concepts in phototherapy: Photoisomerization of bilirubin IX alpha and potential toxic effects of light. Pediatrics 1980;65:740-50.
- Cetinkursun S, Demirbag S, Cincik M, Baykal B, Gunal A. Effects of phototherapy on newborn rat testicles. Arch Androl 2006;52: 61-70.
- Newman TB, Hope S, Stevenson DK. Direct bilirubin measurements in jaundiced term newborns. A reevaluation. Am J Dis Child 1991; 145:1305-9.
- Feldman AG, Sokol RJ. Neonatal cholestasis. NeoReviews 2013;14.
- Moyer V, Freese DK, Whitington PF, Olson AD, Brewer F, Colletti RB, et al. Guideline for the evaluation of cholestatic jaundice in infants: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2004;39:115-28.
- Sokol RJ, Shepherd RW, Superina R, Bezerra JA, Robuck P, Hoofnagle JH. Screening and outcomes in biliary atresia: Summary of a National Institutes of Health Workshop. Hepatology 2007;46:566-81.
- American Academy of Pediatrics Subcommittee on Hyperbilirubi- nemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114:297-316.
- Cherry Uy. Conjugated Hyperbilirubinemia. In: Gomella TL (ed). Neonatology; Management, Procedures, On-Call Problems, Diseases, and Drugs. 7th ed. United States of America: McGraw- Hill Companies; 2013:392-400.
Abstract
Objective: We aimed to investigate the frequency and possible risk factors of phototherapy-related direct hyperbilirubinemia.Material and Methods: We scanned the medical records of 1301 patients who were admitted to the neonatology unit for indirect hyperbilirubinemia between 2005 and 2013. Infants with a clinical condition other than hyperbilirubinemia were excluded. Results: Following phototherapy both the direct bilirubin level and direct bilirubin/total bilirubin ratio increased (p<0.001 and p<0.001, respectively). The frequency of phototherapy-related direct hyperbilirubinemia was found to be 0.9% if the direct bilirubin/total bilirubin cut-off level was set to 20%. The elevated direct bilirubin level and direct bilirubin/total bilirubin ratio returned to normal within three days, although they were still significantly higher than the pre-phototherapy levels (p < 0.001; p < 0.001, respectively). The increase in direct bilirubin level and direct bilirubin/total bilirubin ratio were found to be brisker in patients with ABO incompatibility (p < 0.001 and p < 0.001, respectively).Conclusion: The direct bilirubin level and direct bilirubin/total bilirubin ratio may temporarily rise following phototherapy. This deviation is short term, and ABO incompatibility is the only identified risk factor.To prevent unnecessary investigations this phenomenon should kept in mind by the physicians caring for infants
References
- Bhutani VK, Committee on Fetus and Newborn; American Academy of Pediatrics. Phototherapy to prevent severe neonatal hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2011;128:e1046-52.
- Vreman HJ, Wong RJ, Stevenson DK. Phototherapy: Current methods and future directions. Semin Perinatol 2004;28:326-33.
- Scheidt PC, Bryla DA, Nelson KB, Hirtz DG, Hoffman HJ. Phototherapy for neonatal hyperbilirubinemia: Six-year follow-up of the National Institute of Child Health and Human Development clinical trial. Pediatrics 1990;85:455-63.
- Tatli MM, Minnet C, Kocyigit A, Karadag A. Phototherapy increases DNA damage in lymphocytes of hyperbilirubinemic neonates. Mutat Res 2008;654:93-5.
- Cohen AN, Ostrow JD. New concepts in phototherapy: Photoisomerization of bilirubin IX alpha and potential toxic effects of light. Pediatrics 1980;65:740-50.
- Cetinkursun S, Demirbag S, Cincik M, Baykal B, Gunal A. Effects of phototherapy on newborn rat testicles. Arch Androl 2006;52: 61-70.
- Newman TB, Hope S, Stevenson DK. Direct bilirubin measurements in jaundiced term newborns. A reevaluation. Am J Dis Child 1991; 145:1305-9.
- Feldman AG, Sokol RJ. Neonatal cholestasis. NeoReviews 2013;14.
- Moyer V, Freese DK, Whitington PF, Olson AD, Brewer F, Colletti RB, et al. Guideline for the evaluation of cholestatic jaundice in infants: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2004;39:115-28.
- Sokol RJ, Shepherd RW, Superina R, Bezerra JA, Robuck P, Hoofnagle JH. Screening and outcomes in biliary atresia: Summary of a National Institutes of Health Workshop. Hepatology 2007;46:566-81.
- American Academy of Pediatrics Subcommittee on Hyperbilirubi- nemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114:297-316.
- Cherry Uy. Conjugated Hyperbilirubinemia. In: Gomella TL (ed). Neonatology; Management, Procedures, On-Call Problems, Diseases, and Drugs. 7th ed. United States of America: McGraw- Hill Companies; 2013:392-400.
Details
| Other ID | JA48GC52ZU |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | June 1, 2016 |
| Submission Date | June 1, 2016 |
| Published in Issue | Year 2016 Volume: 10 Issue: 2 |
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