Indirect neonatal hyperbilirubinemia and associated risk factors for long phototheraphy duration in a baby-friendly hospital in Konya, Turkey

Yıl 2021, , 560 - 564, 31.07.2021

Esma Keleş Alp

https://doi.org/10.16899/jcm.910028

Öz

Aim: Indirect neonatal hyperbilirubinemia is a common neonatal disorder worldwide which can remain benign if prompt management is available. However there is a higher morbidity and mortality risk in settings with limited access to diagnosis and care. The aim of this study was to evaluate the etiologies of indirect neonatal hyperbilirubinemia, to determine the effectiveness of phototherapy treatment and to specify the associated risk factors for prolonged phototherapy duration.
Materials and Method: Infants with ≥37 weeks of gestation, postnatal age of ≤14 days, and diagnosis of hyperbilirubinemia at admission, defined as serum bilirubin level at or above the phototherapy treatment threshold were included in the study. All the study participants were treated with intermittent phototherapy. The data were retrospectively analized and duration of phototherapy was classified as ≤24 hours (early discharge) and >24 hours (late discharge).
Results: A total of 205 newborns were included in the study. The mean birth weight was 3171.12±436.19 g and mean gestational age was 38.87±1.18 (37–39) weeks. Also, ABO incompatibility and cephalic hematoma were found to be the most common etiologies in our series. On the other hand, male gender (p=0.03) and formula as the first prelacteal feeds (p=0.03) were significantly higher in late discharge group. Additionally; male gender, formula as the first prelacteal feed, ABO incompatibility, Rh isoimmunization, cephalic hematoma and sepsis were risk factors for long phototherapy duration of >24 hours.
Discussion and Conclusion: Determination of possible risk factors for neonatal jaundice can provide early hospital admissions by informing mothers before discharge after birth.

Anahtar Kelimeler

Neonatal jaundice, indirect hyperbilirubinemia, etiology, phototheraphy treatment, risk factors

Teşekkür

Acknowledgement: We thanks to Ahmet Midhat Elmacı, Assoc. Prof. for the statistical analysis.

Türkiye, Konya'da bebek dostu bir hastanede indirekt neonatal hiperbilirubinemi ve uzun fototerapi süresi ile ilişkili risk faktörleri

Öz

Giriş: İndirekt neonatal hiperbilirubinemi, dünya çapında yaygın bir yenidoğan hastalığıdır ve hızlı tedavi edilirse benign kalabilir. Bununla birlikte, tanı ve sağlık hizmetine sınırlı erişimin olduğu ortamlarda daha yüksek bir morbidite ve mortalite riski vardır. Bu çalışmanın amacı, indirekt neonatal hiperbilirubineminin etiyolojilerini değerlendirmek, fototerapi tedavisinin etkinliğini belirlemek ve uzun süreli fototerapi süresi için ilişkili risk faktörlerini belirlemektir.
Gereç ve Yöntem: Çalışmaya, serum bilirubin düzeyi fototerapi tedavi eşiğinde veya üzerinde olarak tanımlanan 37≤ gebelik haftası, postnatal yaşı 14≥ gün ve başvuru anında hiperbilirübinemi tanısı olan bebekler dahil edildi. Tüm vakalar aralıklı fototerapi ile tedavi edildi. Veriler geriye dönük olarak analiz edildi ve fototerapi süresi 24≥ saat (erken taburculuk) ve 24˂ saat (geç taburculuk) olarak sınıflandırıldı.
Bulgular: Çalışmaya toplam 205 yenidoğan dahil edildi. Ortalama doğum ağırlığı 3171,12±436,19 g ve ortalama gebelik yaşı 38,87±1,18 (37-39) hafta idi. Ayrıca serimizde ABO uyumsuzluğu ve sefal hematom en sık görülen etiyolojiler olarak bulundu. Diğer taraftan, erkek cinsiyet (p=0.03) ve ilk besin olarak mama kullanılması (p=0.03) geç taburculuk grubunda anlamlı olarak daha yüksekti. Bunlara ek olarak; erkek cinsiyet, ilk besin olarak mama kullanılması, ABO uyumsuzluğu, Rh izoimmünizasyonu, sefal hematom ve sepsis, 24˂ saatlik uzun fototerapi süresi için risk faktörleriydi.
Sonuç ve Tartışma: Yenidoğan sarılığı için olası risk faktörlerinin belirlenmesi doğum sonrası taburculuk öncesi anneleri bilgilendirerek erken hastaneye yatışları sağlayabilir.

Anahtar Kelimeler

yenidoğan sarılığı, indirekt hiperbilirubinemi, etyoloji, fototerapi tedavisi, risk faktörleri

Kaynakça

• References 1. Battersby C, Michaelides S, Upton M, Rennie JM; Jaundice Working Group of the Atain. Term admissions to neonatal units in England: a role for transitional care? a retrospective cohort study. British Medical Journal Open 2017;7(5):e016050.
• 2. Shapiro SM. Bilirubin toxicity in the developing nervous system. Pediatr Neurol 2003;29:410–21.
• 3. Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med 2001;344:581–90.
• 4. American Academy of Pediatrics, Subcommittee on hyperbilirubinemia, management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation, Pediatrics 2004;114:297–316.
• 5.Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks' gestation) - Summary. Paediatr Child Health. 2007;12(5):401-18.
• 6. Çoban A, Kaynak Türkmen M, Gürsoy T. Turkish Neonatal Society guideline to the approach, follow-up, and treatment of neonatal jaundice. Turkish Archives of Pediatrics 2018;53:172-9.
• 7. Bhutani VK, Vilms RJ, Hamerman-Johnson L. Universal bilirubin screening for severe neonatal hyperbilirubinemia. Journal of Perinatology 2010;30(Suppl.):6-15.
• 8. Johnson L, Bhutani VK, Karp K, Sivieri EM, Shapiro SM. Clinical report from the pilot USA Kernicterus Registry (1992 to 2004). Journal of Perinatology 2009;29(Suppl.1):25-45.
• 9. Manning D, Todd P, Maxwell M, Platt MJ. Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland. Archives of Disease in Childhood Fetal and Neonatal Edition 2007;92(5):342-46.
• 10. Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. Canadian Medical Association Journal 2006;175(6):587-90.
• 11. Gamaleldin R, Iskander I, Seoud I, Aboraya H, Aravkin A et al. Risk factors for neurotoxicity in newborns with severe neonatal hyperbilirubinemia. Pediatrics 2011;128(4):925-31.
• 12. Hameed NN, Na’ Ma AM, Vilms R, Bhutani VK. Severe neonatal hyperbilirubinemia and adverse short-term consequences in Baghdad, Iraq. Neonatology 2011;100(1):57-63.
• 13. Iskander I, Gamaleldin R, El Houchi S, et al. Serum bilirubin and bilirubin/albumin ratio as predictors of bilirubin encephalopathy. Pediatrics 2014;134(5):1330-9.
• 14. Greco C, Arnolda G, Boo NY, et al. Neonatal jaundice in low- and middle-income countries: lessons and future directions from the 2015 Don Ostrow Trieste Yellow Retreat. Neonatology 2016;110(3):172-80.
• 15. Erdeve O, Okulu E, Olukman O, et al. The Turkish Neonatal Jaundice Online Registry: a national root cause analysis. PLoS One 2018;13(2):0193108.
• 16. Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or = 35 weeks’ gestation: an update with clarifications. Pediatrics 2009;124(4):1193-8.
• 17. Wynn JL. Defining neonatal sepsis. Curr Opin Pediatr. 2016;28(2):135-40.
• 18. Sachdeva M, Murki S, Oleti TP, Kandraju H. Intermittent versus continuous phototherapy for the treatment of neonatal non-hemolytic moderate hyperbilirubinemia in infants more than 34 weeks of gestational age: a randomized controlled trial. Eur J Pediatr 2015;174(2):177-81.
• 19. Bratild D, Nakstad B, Hansen TW. National guidelines for treatment of jaundice in the newborn, Acta Paediatr 2011;100:499–555.
• 20. Shapiro SM. Chronic bilirubin encephalopathy: diagnosis and outcome. Semin Fetal Neonatal Med 2010;15:157–63.
• 21. Radmacher PG, Groves FD, Owa JA, et al. A modified bilirubin-induced neurologic dysfunction (BIND-M) algorithm is useful in evaluating severity of jaundice in a resource-limited setting. BMC Pediatr 2015;15:1–7.
• 22. Bhutani VK, Zipursky A, Blencowe H, et al. Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatric Research 2013;74(Suppl.1):86-100.
• 23. Gartner LM. Breast feeding and jaundice. J Perinatol 2001;21(S1):25–9.
• 24. Hudson JA, Charron E, Maple B, et al. Baby-Friendly Hospital Initiative Is Associated with Lower Rates of Neonatal Hyperbilirubinemia. Breastfeed Med 2020;15(3):176-82.
• 25. Seidman DS, Moise J, Ergaz Z, et al. A new blue light-emitting phototherapy device: A prospective randomized controlled study. J Pediatr 2000;136:771-4.
• 26. Messner KH, Maisels MJ, Leure-DuPree AE. Phototoxicity to the newborn primate retina. Invest Ophthalmol Vis Sci 1978;17:178-82.
• 27. Sisson TR, Kendall N, Shaw E, Kechavarz-Oliai L. Phototherapy of jaundice in the newborn infant. II. Effect of various light intensities. J Pediatr 1972:81:35-8.
• 28. Sachdeva M, Murki S, Oleti TP, Kandraju H. Intermittent versus continuous phototherapy for the treatment of neonatal non-hemolytic moderate hyperbilirubinemia in infants more than 34 weeks of gestational age: a randomized controlled trial. Eur J Pediatr 2015;174(2):177-81.
• 29. Zhou S, Wu X, Ma A, Zhang M, Liu Y. Analysis of therapeutic effect of intermittent and continuous phototherapy on neonatal hemolytic jaundice. Exp Ther Med 2019;17(5):4007-12.