Abstract
Amaç: Sarılık yenidoğan döneminde sık karşılaşılan sorundur ve hastane yatışlarının en sık nedenidir. Bu çalışmada, indirekt hiperbilirübinemi nedeni ile hospitalize edilen geç preterm ve term yenidoğanların özelliklerini ortaya koymak ve etiyolojik faktörlerini belirlemek amaçlanmıştır.
Yöntem: İndirekt hiperbilirübinemi tanısı ile 1 Ocak 2009-31 Aralık 2014 tarihleri arasında hastaneye yatırılan geç preterm ve term yenidoğanlar çalışmaya alındı. Hastaların demografik ve klinik özellikleri, tedavi süreleri ve şekilleri retrospektif hasta dosyalarından elde edildi. Etiyolojik faktörler belirlendi.
Bulgular: 1 Ocak 2009-31 Aralık 2014 tarihleri arasında hastanemiz yenidoğan yoğun bakım ünitesinde takip edilmiş 4831 hastanın 412’si dahil edilme kriterlerini karşılayan indirekt hiperbilirübinemili geç preterm ve term bebeklerdi. Hastaların %54,6’sı erkek, %40,8’i ilk bebek, doğum haftası ortalama 38,3±1,1 ve doğum ağırlığı 3031±520 gram olarak saptandı. Vakaların %84,5’i yalnızca anne sütü alıyordu. Başvuru zamanı 4,6±2,6 gün ve serum total bilirübin düzeyi 18,6±4,7 mg/dl idi. Hastaların %29’unda ABO uyuşmazlığı, %10,7’sinde dehidratasyon ve %7,1’inde Rh uyuşmazlığı vardı. Ortalama yatış süresi 3,1±2,2 gün ve fototerapi süresi 44,8±22,8 saat olarak bulundu. 16 hastaya intravenöz immünglobülin verilmişti. 14 hastaya kan değişimi yapılmıştı. Serum total bilirübin düzeyi ≥20 mg/dl olan grupta erkek cinsiyet ve normal spontan vajinal yol ile doğan bebek serum total bilirübin düzeyi 20 mg/dl’nin altında olan gruptan istatistiksel olarak anlamlı yüksek saptandı (her ikisi için p=0,02).
Sonuç: Yenidoğan döneminin sık görülen indirekt hiperbilirübinemi erken fark edilmesi gereken ve tedavi edilebilir bir durumdur. Nedeni hızlıca saptanmalı ve komplikasyon gelişmeden tedavi edilmelidir.
Ethical Statement
Etik Kurul Onayı: Çalışma XXX Etik Kurulu tarafından onaylanmıştır (Karar no:04/07, Tarih: 2015).
Supporting Institution
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Thanks
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References
- 1. Anderson NB, Calkins KL. Neonatal Indirect Hyperbilirubinemia. Neoreviews. 2020;21(11):e749-60.
- 2. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297-316.
- 3. Lo YS, Lu CC, Chen LY, Tsai LT. Clinical studies of neonatal hyperbilirubinemia treated with blood exchange transfusion. Gaoxiong Yi Xue Ke Xue Za Zhi. 1990;6(10):556-64.
- 4. Gartner LM, Herschel M. Jaundice and breastfeeding. Pediatr Clin North Am. 2001;48(2):389-99.
- 5. Newman TB, Maisels MJ. Evaluation and treatment of jaundice in the term newborn: a kinder, gentler approach. Pediatrics. 1992;89(5 Pt 1):809-18.
- 6. Burgos AE, Schmitt SK, Stevenson DK, Phibbs CS. Readmission for neonatal jaundice in California, 1991-2000: trends and implications. Pediatrics. 2008;121(4):e864-9.
- 7. Kaplan M, Bromiker R, Schimmel MS, Algur N, Hammerman C. Evaluation of discharge management in the prediction of hyperbilirubinemia: the Jerusalem experience. J Pediatr. 2007;150(4):412-7.
- 8. Polat A, Öktem F, Koç H. Evaluation of 963 neonates with hyperbilirubinemia. Türkiye clinical Pediatri 2.2. 1993:26-30.
- 9. Bravi F, Wiens F, Decarli A, Dal Pont A, Agostoni C, Ferraroni M. Impact of maternal nutrition on breast-milk composition: a systematic review. Am J Clin Nutr. 2016;104(3):646-62.
- 10. Bülbül A, Okan F, Cigerci N, Nuhoğlu A. Clinical characteristics and causes of exchange transfusion in term neonates with hyperbilirubinemia. Turk Arch Ped. 2007:107-11.
- 11. Trikalinos TA, Chung M, Lau J, Ip S. Systematic review of screening for bilirubin encephalopathy in neonates. Pediatrics. 2009;124(4):1162-71.
- 12. Donneborg ML, Hansen BM, Vandborg PK, Rodrigo-Domingo M, Ebbesen F. Extreme neonatal hyperbilirubinemia and kernicterus spectrum disorder in Denmark during the years 2000-2015. J Perinatol. 2020;40(2):194-202.
- 13. Phuapradit W, Chaturachinda K, Auntlamai S. Risk factors for neonatal hyperbilirubinemia. J Med Assoc Thai. 1993;76(8):424-8.
- 14. Stoll BJ, Kliegman RM. Jaundice and hyperbilirubinemia in the newborn. In: Behrman RE, Jenson HB. editor. Nelson Textbook of Pediatrics. Philadelphia, 2003:592-6.
- 15. Sahoo T, Sahoo M, Gulla KM, Gupta M. Rh Alloimmunisation: Current Updates in Antenatal and Postnatal Management. Indian J Pediatr. 2020;87(12):1018-28.
- 16. Kaini NR, Chaudhary D, Adhikary V, Bhattacharya S, Lamsal M. Overview of cases and prevalence of jaundice in neonatal intensive care unit. Nepal Med Coll J. 2006;8(2):133-5.
- 17. Sarici SU, Yurdakök M, Serdar MA, Oran O, Erdem G, Tekinalp G, et al. An early (sixth-hour) serum bilirubin measurement is useful in predicting the development of significant hyperbilirubinemia and severe ABO hemolytic disease in a selective high-risk population of newborns with ABO incompatibility. Pediatrics. 2002;109(4):e53.
- 18. Eissa AA, Haji BA, Al-Doski AA. G6PD Deficiency Prevalence as a Cause of Neonatal Jaundice in a Neonatal Ward in Dohuk, Iraq. Am J Perinatol. 2021;38(6):575-80.
- 19. M Abo El Fotoh WM, Rizk MS. Prevalence of glucose-6-phosphate dehydrogenase deficiency in jaundiced Egyptian neonates. J Matern Fetal Neonatal Med. 2016;29(23):3834-7.
- 20. Schneider AP 2nd. Breast milk jaundice in the newborn. A real entity. JAMA. 1986;255(23):3270-4
- 21. Bhat SR, Lewis P, David A, Liza SM. Dehydration and hypernatremia in breast-fed term healthy neonates. Indian J Pediatr. 2006;73(1):39-41.
- 22. Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. CMAJ. 2006;175(6):587-90.
- 23. Bilgen H, Ozek E, Unver T, Biyikli N, Alpay H, Cebeci D. Urinary tract infection and hyperbilirubinemia. Turk J Pediatr. 2006;48(1):51-5.
- 24. Deger I, Ertuğrul S, Yolbaş I, Tekin R. Evaluation of urinary tract infections in neonatal indirect hyperbilirubinemia. Minerva Pediatr (Torino). 2022;74(5):562-7.
- 25. Baz AMK, El-Agamy OAE, Ibrahim AM. Incidence of urinary tract infection in neonates with significant indirect Hyperbilirubinemia of unknown etiology: case-control study. Ital J Pediatr. 2021;47(1):35.
- 26. Gartner LM, Lee KS, Keenan WJ, White NB Jr, Bryla DA. Effect of phototherapy on albumin binding of bilirubin. Pediatrics. 1985;75(2 Pt 2):401-6.
- 27. Sharma DC, Rai S, Mehra A, Kaur MM, Sao S, Gaur A, et al. Study of 25 cases of exchange transfusion by reconstituted blood in hemolytic disease of newborn. Asian J Transfus Sci. 2007;1(2):56-8.
- 28. Watchko JF. ABO hemolytic disease of the newborn: a need for clarity and consistency in diagnosis. J Perinatol. 2023;43(2):242-7.
- 29. Khurana R, Batra P, Faridi M, Khan N. Revisiting ABO incompatibility as a risk factor for significant neonatal hyperbilirubinemia. Trop Doct. 2019;49(3):201-4.
- 30. Murki S, Kumar P. Blood exchange transfusion for infants with severe neonatal hyperbilirubinemia. Semin Perinatol. 2011;35(3):175-84.
Abstract
Objective: Neonatal jaundice is a common problem and is the most common cause of hospitalization. We aimed to determine the characteristics and etiological factors of late preterm and term newborns hospitalized due to indirect hyperbilirubinemia.
Methods: Late preterm and term newborns hospitalized between January 1,2009 and December 31,2014 with a diagnosis of indirect hyperbilirubinemia were included. Demographic and clinical characteristics, duration, and patterns of treatment were obtained retrospectively. Etiological factors were determined.
Result: Late preterm and term infants with indirect hyperbilirubinemia were included (n=412). 54.6% of the patients were male, 40.8 % were first babies, the mean gestational age was 38.3±1.1 weeks, and the mean birth weight was 3031±520 grams. 84.5 % were exclusively breastfed. The time of presentation was 4.6 ±2.6 days, and the serum total bilirubin level was 18.6 ±4.7 mg/dl. ABO incompatibility was found in 29 %, dehydration in 10.7 %, and Rh incompatibility in 7.1% of the patients. The mean duration of hospitalization was 3.1 ±2.2 days, and the mean duration of phototherapy was 44.8±22.8 hours. 16 patients received intravenous immunoglobulin. An exchange transfusion was performed in 14 patients. In the group with a serum total bilirubin level of ≥ 20 mg/dl, male gender and normal spontaneous vaginal delivery were statistically significantly higher than the group with a serum total bilirubin level below 20 mg/dl (p = 0.02 for both).
Conclusion: Indirect hyperbilirubinaemia, which is common in the neonatal period, should be recognized early and is a treatable condition. We should promptly identify and treat the cause before complications arise.
Ethical Statement
Etik Kurul Onayı: Çalışma XXX Etik Kurulu tarafından onaylanmıştır (Karar no:04/07, Tarih: 2015).
Supporting Institution
yok
Thanks
yok
References
- 1. Anderson NB, Calkins KL. Neonatal Indirect Hyperbilirubinemia. Neoreviews. 2020;21(11):e749-60.
- 2. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297-316.
- 3. Lo YS, Lu CC, Chen LY, Tsai LT. Clinical studies of neonatal hyperbilirubinemia treated with blood exchange transfusion. Gaoxiong Yi Xue Ke Xue Za Zhi. 1990;6(10):556-64.
- 4. Gartner LM, Herschel M. Jaundice and breastfeeding. Pediatr Clin North Am. 2001;48(2):389-99.
- 5. Newman TB, Maisels MJ. Evaluation and treatment of jaundice in the term newborn: a kinder, gentler approach. Pediatrics. 1992;89(5 Pt 1):809-18.
- 6. Burgos AE, Schmitt SK, Stevenson DK, Phibbs CS. Readmission for neonatal jaundice in California, 1991-2000: trends and implications. Pediatrics. 2008;121(4):e864-9.
- 7. Kaplan M, Bromiker R, Schimmel MS, Algur N, Hammerman C. Evaluation of discharge management in the prediction of hyperbilirubinemia: the Jerusalem experience. J Pediatr. 2007;150(4):412-7.
- 8. Polat A, Öktem F, Koç H. Evaluation of 963 neonates with hyperbilirubinemia. Türkiye clinical Pediatri 2.2. 1993:26-30.
- 9. Bravi F, Wiens F, Decarli A, Dal Pont A, Agostoni C, Ferraroni M. Impact of maternal nutrition on breast-milk composition: a systematic review. Am J Clin Nutr. 2016;104(3):646-62.
- 10. Bülbül A, Okan F, Cigerci N, Nuhoğlu A. Clinical characteristics and causes of exchange transfusion in term neonates with hyperbilirubinemia. Turk Arch Ped. 2007:107-11.
- 11. Trikalinos TA, Chung M, Lau J, Ip S. Systematic review of screening for bilirubin encephalopathy in neonates. Pediatrics. 2009;124(4):1162-71.
- 12. Donneborg ML, Hansen BM, Vandborg PK, Rodrigo-Domingo M, Ebbesen F. Extreme neonatal hyperbilirubinemia and kernicterus spectrum disorder in Denmark during the years 2000-2015. J Perinatol. 2020;40(2):194-202.
- 13. Phuapradit W, Chaturachinda K, Auntlamai S. Risk factors for neonatal hyperbilirubinemia. J Med Assoc Thai. 1993;76(8):424-8.
- 14. Stoll BJ, Kliegman RM. Jaundice and hyperbilirubinemia in the newborn. In: Behrman RE, Jenson HB. editor. Nelson Textbook of Pediatrics. Philadelphia, 2003:592-6.
- 15. Sahoo T, Sahoo M, Gulla KM, Gupta M. Rh Alloimmunisation: Current Updates in Antenatal and Postnatal Management. Indian J Pediatr. 2020;87(12):1018-28.
- 16. Kaini NR, Chaudhary D, Adhikary V, Bhattacharya S, Lamsal M. Overview of cases and prevalence of jaundice in neonatal intensive care unit. Nepal Med Coll J. 2006;8(2):133-5.
- 17. Sarici SU, Yurdakök M, Serdar MA, Oran O, Erdem G, Tekinalp G, et al. An early (sixth-hour) serum bilirubin measurement is useful in predicting the development of significant hyperbilirubinemia and severe ABO hemolytic disease in a selective high-risk population of newborns with ABO incompatibility. Pediatrics. 2002;109(4):e53.
- 18. Eissa AA, Haji BA, Al-Doski AA. G6PD Deficiency Prevalence as a Cause of Neonatal Jaundice in a Neonatal Ward in Dohuk, Iraq. Am J Perinatol. 2021;38(6):575-80.
- 19. M Abo El Fotoh WM, Rizk MS. Prevalence of glucose-6-phosphate dehydrogenase deficiency in jaundiced Egyptian neonates. J Matern Fetal Neonatal Med. 2016;29(23):3834-7.
- 20. Schneider AP 2nd. Breast milk jaundice in the newborn. A real entity. JAMA. 1986;255(23):3270-4
- 21. Bhat SR, Lewis P, David A, Liza SM. Dehydration and hypernatremia in breast-fed term healthy neonates. Indian J Pediatr. 2006;73(1):39-41.
- 22. Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. CMAJ. 2006;175(6):587-90.
- 23. Bilgen H, Ozek E, Unver T, Biyikli N, Alpay H, Cebeci D. Urinary tract infection and hyperbilirubinemia. Turk J Pediatr. 2006;48(1):51-5.
- 24. Deger I, Ertuğrul S, Yolbaş I, Tekin R. Evaluation of urinary tract infections in neonatal indirect hyperbilirubinemia. Minerva Pediatr (Torino). 2022;74(5):562-7.
- 25. Baz AMK, El-Agamy OAE, Ibrahim AM. Incidence of urinary tract infection in neonates with significant indirect Hyperbilirubinemia of unknown etiology: case-control study. Ital J Pediatr. 2021;47(1):35.
- 26. Gartner LM, Lee KS, Keenan WJ, White NB Jr, Bryla DA. Effect of phototherapy on albumin binding of bilirubin. Pediatrics. 1985;75(2 Pt 2):401-6.
- 27. Sharma DC, Rai S, Mehra A, Kaur MM, Sao S, Gaur A, et al. Study of 25 cases of exchange transfusion by reconstituted blood in hemolytic disease of newborn. Asian J Transfus Sci. 2007;1(2):56-8.
- 28. Watchko JF. ABO hemolytic disease of the newborn: a need for clarity and consistency in diagnosis. J Perinatol. 2023;43(2):242-7.
- 29. Khurana R, Batra P, Faridi M, Khan N. Revisiting ABO incompatibility as a risk factor for significant neonatal hyperbilirubinemia. Trop Doct. 2019;49(3):201-4.
- 30. Murki S, Kumar P. Blood exchange transfusion for infants with severe neonatal hyperbilirubinemia. Semin Perinatol. 2011;35(3):175-84.
Details
| Primary Language | English |
|---|---|
| Subjects | Family Medicine, Medical Education |
| Journal Section | Research Article |
| Authors | |
| Publication Date | September 30, 2024 |
| Submission Date | July 24, 2024 |
| Acceptance Date | September 10, 2024 |
| Published in Issue | Year 2024Volume: 46 Issue: 3 |
