Etiological Evaluation of Term Neonates with Indirect Hyperbilirubinaemia

Öz

Aim: Indirect hyperbilirubinemia is a common disease in newborns with many risk factors. In our study, we aimed to investigate the effects of history, physical examination and investigations on treatment and follow-up of patients admitted to our neonatal intensive care unit with the diagnosis of indirect hyperbilirubinemia. Methods: In our cross-sectional and retrospective study, 226 patients who were born at term and hospitalized with the diagnosis of indirect hyperbilirubinemia were included. History, physical examination and examination data were evaluated from the patient files. Results: Of 226 patients included in the study, 126 (55.8%) were boys and 100 (44.2%) were girls. The mean gestational age was 38.3±0.4 weeks and the mean birth weight was 3146±32 grams. The mean postnatal days at the time of hospitalization were 4.1±0.1 days, hospitalization bilirubin was 17.1±0.2 mg/dl, duration of phototherapy was 38.2±1 hours, and weight loss during hospitalization was 3.7±0.3%. The most common diagnosis was ABO incompatibility (27.9%). Bilirubin levels were statistically significantly higher in patients with weight loss. When blood incompatibility and other diagnoses were compared, bilirubin and hemoglobin levels and postnatal age at the time of hospitalization were statistically significantly lower and length of hospitalization was statistically significantly higher in patients with blood incompatibility. Conclusion: Gender and mode of delivery were not significantly associated with hospitalization total bilirubin and duration of phototherapy. Patients with weight loss had statistically higher hospitalization total bilirubin than those without weight loss. In addition, the length of hospitalization of patients with ABO incompatibility was statistically significantly longer than patients hospitalized with other diagnoses.

Anahtar Kelimeler

• Neonate
• Indirect hyperbilirubinemia
• Risk factors

Kaynakça

1. 1.Anderson NB, Calkins KL. Neonatal IndirectHyperbilirubinemia. Neo Reviews. 2020; 21(11):749-60.
2. 2.Burgos AE, Schmitt SK, Stevenson DK, Phibbs CS.Readmission for neonatal jaundice in California,1991-2000: trends and implications. Pediatrics.2008; 121(4): 864-9.
3. 3.Aktas S, Öztürk S, Güleç S. Investigation of thepotential risk factors of indirect hyperbilirubinemiain patients admitted to the neonatal intensive careunit with hyperbilirubinemia. Akdeniz MedicalJournal. 2017; 3: 171-6.
4. 4.Harris MC, Bernbaum JC, Polin JR, Zimmerman R,Polin RA. Developmental follow-up of breastfedterm and near-term infants with markedhyperbilirubinemia. Pediatrics. 2001; 107(5): 1075-80.
5. 5.Sgro M, Campbell D, Shah V. Incidence and causesof severe neonatal hyperbilirubinemia in Canada.CMAJ : Canadian Medical Association journal =journal de l'Association medicale canadienne.2006;175(6):587-90.
6. 6.Boskabadi H, Ashrafzadeh F, Azarkish F,Khakshour A. Complications of neonatal jaundiceand the predisposing factors in newborns J BabolUniv Med Sci. 2015;17:7–13
7. 7.Par EJ, Hughes CA, DeRico P. Neonatalhyperbilirubinemia: evaluation and treatment.American family physician. 2023; 107(5): 525-34.
8. 8.Sivaslı E. Yenidoğan bebeklerde uzamış sarılık.Gaziantep Tıp Dergisi. 2019; 15(2): 49-55.

9. 9.Clark M. Clinical update: understanding jaundicein the breastfed infant. Community Pract.2013;86(6):42-5.
10. 10.Remon JI, Raghavan A, Maheshwari A.Polycythemia in the newborn. NeoReviews.2011;12(1):e20–8.
11. 11.Demir N, Peker E, Aslan O, Ceylan N, Tuncer O.Assessing term newborns hospitalized in ourneonatal unit with the diagnosis of indirecthyperbilirubinemia. Anatolian Journal of ClinicalInvestigation. 2015; 9: 66-9.
12. 12.Bülbül A, Okan F, Uslu S, İşçi E, Nuhoğlu A. Termbebeklerde hiperbilirübineminin klinik özelliklerive risk etmenlerinin araştırılması OrijinalAraştırma. Türk Pediatri Arşivi. 2005; 40(3): 204-10.
13. 13.Hegyi T, Chefitz D, Weller A, et al. Unboundbilirubin measurements in term and late-preterminfants. The Journal of Maternal-Fetal & Neonatalmedicine : The official journal of the EuropeanAssociation of Perinatal Medicine, the Federation ofAsia and Oceania Perinatal Societies, theInternational Society of Perinatal Obstet. 2022;35(8): 1532-8.
14. 14.Aslan Y, Kader Ş, Mutlu M, et al. The effect ofdelivery type on uncoupling protein-2 levels. TheJournal of Maternal-Fetal & Neonatal Medicine:theofficial journal of the European Association ofPerinatal Medicine, the Federation of Asia andOceania Perinatal Societies, the InternationalSociety of Perinatal Obstet. 2016; 29(18): 2940-3.
15. 15.Yang WC, Zhao LL, Li YC, et al. Bodyweight loss in predicting neonatal hyperbilirubinemia 72 hoursafter birth in term newborn infants. BMC Pediatrics.2013; 13: 145-6.
16. 16.Salas AA, Salazar J, Burgoa CV, et al. Significantweight loss in breastfed term infants readmitted forhyperbilirubinemia. BMC pediatrics. 2009; 9: 82-4.
17. 17.Tavakolizadeh R, Izadi A, Seirafi G, Khedmat L,Mojtahedi SY. Maternal risk factors for neonataljaundice: a hospital-based cross-sectional study inTehran. European journal of translational myology.2018; 28(3): 7618-20.
18. 18.Yu C, Li H, Zhang Q, et al. Report about terminfants with severe hyperbilirubinemia undergoingexchange transfusion in Southwestern China duringan 11-year period, from 2001 to 2011. PloS one.2017; 12(6): 179550-3.
19. 19.Ekin RE, Ertugrul S, Deger İ, Yolbas İ.Retrospective Evaluation of Term Neonatal Caseswith Indirect Hyperbilirubinemia East J Med 27(2):295-301, 2022.
20. 20.American Academy of Pediatrics Subcommitteeon Hyperbilirubinemia. Management ofhyperbilirubinemia in the newborn infant 35 ormore weeks of gestation. Pediatrics. 2004; 114(1):297-316.
21. 21.Olusanya BO, Osibanjo FB, Slusher TM. Riskfactors for severe neonatal hyperbilirubinemia inlow and middle-income countries: a systematicreview and meta-analysis. PloS one. 2015; 10(2):117229-32.
22. 22.Stevenson DK, Vreman HJ, Oh W, et al. Bilirubinproduction in healthy term infants as measured bycarbon monoxide in breath. Clinical chemistry.1994; 40(10): 1934-9.
23. 23.Yogev-Lifshitz M, Leibovitch L, Schushan-Eisen I,et al. Indication of mild hemolytic reaction amongpreterm infants with abo incompatibility. Pediatricblood & cancer. 2016; 63(6): 1050-3.
24. 24.Kristinsdottir T, Kjartansson S, Hardardottir H,Jonsson T, Halldorsdottir AM. Positive Coomb's testin newborns; causes and clinical consequencesSummary of cases diagnosed in the Blood Bank inthe years 2005 to 2012. Laeknabladid. 2016; 102(7-8): 326-31.
25. 25.Hameed NN, Hussein MA. BIND score: A systemto triage infants readmitted for extremehyperbilirubinemia. Seminars in perinatology.2021; 45(1): 151354-7.