Assessments at week 2 and 3 in Term Newborns Diagnoses with Prolonged Jaundice

Öz

Introduction: Jaundice is one of the most common problems at neonatal period and seen in 60-70% of all newborns at first days of life. Prolonged jaundice is defined as hyperbilirubinemia persisting at the end of week 2 in term newborns. In this study, we reviewed term newborns diagnosed with prolonged jaundice. It was aimed to demonstrate delaying laboratory evaluations for a week in infants with favorable clinical presentation can prevent unnecessary tests in majority of newborns. Materials and methods: The study included full-term newborns who presented after day 14 of life and diagnosed with prolonged jaundice at neonatology outpatient clinic of Health Sciences University, Keçiören Teaching and Research Hospital in 2016. Overall, 336 infants with prolonged jaundice were screened. The infants with congenital anomaly, those with findings of sepsis or severe infection, those with history of intrauterine infection, those with history of acholic stool and those with no available data were excluded. In 180 patients included, clinical evaluations, bilirubin levels and advanced test results were assessed at baseline and weekly follow-up. Findings: Of the infants included, 51.7% were boys while 48.3% were girls. The most common blood type was A Rh (+). There was ABO incompatibility alone in 24 infants (14.2%), Rh incompatibility alone in 6 infants (3.5%) and ABO plus Rh incompatibility in 3 infants (1.2%). In 130 infants, total bilirubin was studied on both week 2 and 3. At week 3, total bilirubin value was ≥10 mg/dl in only 36 infants (27.7%) while it was decreased below 10 mg/dL in 94 infants (72.3%). Urinary tract infection (UTI) was detected in 7 of 38 infants with available tests at week 2. Two of 6 infants with UTI had other clinical signs of UTI. Mean total bilirubin value was 17.9 mg/dL in 5 infants. A significant correlation was found between UTI and vomiting, breastfeeding and feeding pattern (p<0.05). Congenital hypothyroidism was detected in 6 of 38 infants with available tests at week 2. It was seen that 2 infants had suspected congenital hypothyroidism in neonatal heel prick test and underwent further evaluations while mean total bilirubin value was 17.5 mg/dL at week 2 in remaining 4 infants. Given the vast majority of cases are breast milk jaundice, a novel cut-off value was defined for total bilirubin measurement at week 2 to distinguish the cases in which total bilirubin decreases below 10 mg/dL at week 3. Conclusions: Although several disorders that may lead prolonged jaundice at neonatal period have been identified, it is well-known that prolonged jaundice can be seen without any pathological condition in majority of infants fed by breast milk. Delaying laboratory evaluations recommended at week for prolonged jaundice is an approach that may prevent unnecessary testing in most infants.

Anahtar Kelimeler

• Prolonged jaundice
• total bilirubin
• newborn

Kaynakça

1. 1- Piazza AJ, Stoll BJ, Jaundice and hyperbilirubinemia in the newborn. In: Kliegman RM, Geme JS, Berhman RE, Stanton BF (ed), Nelson Textbook of Pediartics, 20th ed, WB Saunders Comp, Philadelphia. 2015:756-65
2. 2- Melton K, Akinbi HT. Neonatal jaundice: strategies to reduce bilirubin – induced complications. Postgraduate Med 1999; 106:167-178.)( Oran O, Gürakan B, Bilirubin metabolizması. Katkı Pediatri Dergisi. 1995; 16:667-
3. 3- National Institute for Health and Clinical Excellence. Neonatal Jaundice. (Clinical Guideline 98). See www.nice.org.uk/CG98 (last checked 1 June 2012
4. 4- Çoban A, Türkmen M, Gürsoy T. Türk Neonatoloji Derneği Yenidoğan Sarılıklarında Yaklaşım, İzlem Ve Tedavi Rehberi 2014.
5. 5- Tyrell M, Hingley S, Giles C, Menakaya JO. Impact of delayed screening for prolonged jaundice in the newborn. Arch Dis Child Fetal Neonatal Ed 2009; 94:F154
6. 6- Hannam S, McDonnell M, Rennie JM. Investigation of prolonged neonatal jaundice. Acta Paediatr 2000; 89:694–7.
7. 7- Çetinkaya M, Özkan H, Köksal N, Akacı O. Uzamış sarılıklı bebeklerde etiyolojik dağılım. Güncel Pediatri 2008; 6: 99-103
8. 8- Koç F, Koturoğlu G, Akşit S, Kurugöl Z. Uzamış Sarılıklı Bebeklerin Değerlendirilmesi. Ege Pediatri Bülteni 2008; 15(2): 89-92

9. 9- Tekinalp G,Ergin H, Erdem G, Yurdakök M, Yiğit Ş. Yenidoğan döneminde uzamış sardıklar: 82 vakanın değer¬ lendirilmesi. Çocuk sağlığı ve Hastalıkları Dergisi 1996; 39:441-8
10. 10- Maisels MJ, Kring E. Length of stay, jaundice and hospital readmission. Pediatrics 1998; 101:995-998.
11. 11- Jennifer E Frank, Maj MC, Diagnosis and management of G6PD deficiency. Am Fam Physician. 2005; 72:1277-82
12. 12- Osborn L.M., Reiff M.L., Bolus R. Jaundice in the full- Term Neonate, Pediatrics, 1984; 73:520-525.
13. 13- Frisberg Y, Zelicovic I. Merlob P. Hyperbilirubinemia and Influencing Faktors inTerm Infants, Israel Journal of Medikal Sciences, 1989; 25:28-31
14. 14- Tuygun N, Tıraş Ü, Şıklar S, Erdeve Ö, Tanyer G, Dallar Y. Yenidoğan uzamış sarılığının etiyolojik yönden değerlendirilmesi ve anne sütü sarılığı. Türk Pediatri Arşivi 2002; 37: 138-143
15. 15- Araz NÇ. Uzamış Sarılığı Olan Yenidoğanlarda Konjenital Hipotiroidi Sıklığı. Gaziantep Tıp Dergisi 2009; 15(1):28-30
16. 16- Sıklar Z, Tezer H, Dallar Y, Tanyer G. Borderline congenital hypothyroidism in the neonatal period. J Pediatr Endocrinolo Metab 2002;15; 817-821
17. 17- Yüksel S, Yüksel G, Çakar N. Çocuklarda İdrar Yolu Enfeksiyonları. T Klin J Pediatr 2002; 11:41-9
18. 18- Littlewood JM. 66 infants with urinary infecti- on in the first month of life. Arch Dis Child 1972; 47:218-26
19. 19- Ökten A, Mocan H, Erduran E, Gedik Y. Uzamış sarılığı olan 121 bebekte prospektif bir çalışma. OMÜ Tıp Dergisi 1992; 9: 112-116
20. 20- Macmillian JA, De angelis CD, Feigin RD. Oski’s pediatrics In: Cashore JW. Jaundice lippincott Co 2000; 197-200