Evaluation of neonates with the diagnosis of indirect hyperbilirubinemia followed up at the pediatric clinics of Dicle University Hospital between 2007 and 2009

Aim: Neonatal jaundice is one of the common problems during neonatal period. It usually develops due to transient disruption of the balance between bilirubin elimination and production. Besides, it may cause mortality and neurologic sequela due to the neurotoxic effects of bilirubin if it is not diagnosed early and treated properly. In this study, we aimed to determine the etiology of cases with the diagnosis of neonatal jaundice and to evaluate the risk factors for jaundice and the treatment.Materials and Methods: 405 neonatal hyperbiliribunemia cases who had been hospitalized and followed up at the Pediatric Clinics of Dicle University of Medical School between 2007 and 2009 were evaluated retrospectively.Results: 283 of the 405 cases (69,8 %) included in this study were patients hospitalized with the diagnosis of indirect hyperbilirubinemia, whereas 122 infants (30,2 %) were hospitalized with another diagnoses, and developed jaundice during their follow-up in our clinic. 214 of the patients (52,8 %) were male, whereas 191 of them (47,2 %) were female. Mean gestational age at birth was 36,49 ± 3,21 weeks. 165 cases (40,7 %) were premature, 240 (59,2 %) mature infants. Regarding their nutritional status, 272 infants (67,4 %) were receiving only breast milk, 74 (18,2 %) both breast milk and formula, and 59 (14,5 %) only formula. 138 patients (34 %) had passed their first meconium during the first six hours, 228 (56,2 %) between 6th-24th hours, 37 (8,8 %) between 24th-48th hours. Regarding the mode of birth, 236 cases (58,2 %) had been born vaginally, whereas 169 (41,7 %) had been delivered by cesarean section. 367 (90,6) of the mothers had not have any disorder, while 38 of them (9,3 %) had had either preeclampsia or eclampsia. At the time of hospital admission, 64,1 %of the patients had icterus on their heels. Regarding the etiology of the jaundice, in 151 of 259 infants (37,3 %) the etiology could not be identified, while 65 infants (16,0 %) were prematurity, 51 cases (12,6 %) had ABO incompatibility, 12 patients (3 %) had early breast milk jaundice, 35 (8,6 %) had sepsis, 2 infants (0,5 %) had the diagnosis of urinary tract infection, 18 (4,4 %) had late breast milk jaundice, 5 neonates (1,2 %) had been diagnosed as G6PD deficiency, 54 patients (13,3 %) had Rh incompatibility, 6 infant (1,5 %) had subgroup incompatibility.Conclusion: Firstly, appropriate antenatal care should be ensured to prevent the development of jaundice which may cause unexpected results in the neonatal period. Serious complications such as kernicterus can be avoided by identifiying the existence of risk factors that may contribute to the increase of jaundice, educating the mother properly regarding breast-feeding, emphasizing the importance of early breast-feeding, regularly examining the neonate postnatally and educating the families. Determining the blood groups of the parents prenatally, giving information to the families about neonatal jaundice before birth, and necessarily performing the control physical examination of the newborn infants are easy, cheap, and cost effective measures. While evaluating the etiology of neonatal jaundice, underlying diseases such as G6PD deficiency, hereditary spherocytosis and hypothyroidism should be kept in mind besides the common etiologies such as hemolytic disorders, early breast-milk jaundice, prematurity and infections.Key words: G6PD, hyperbilirubinemia, exchange transfusion, risk factors, neonatal jaundice.