Evaluation of neonatal hyperbilirubinemia cases

Purpose (Aim): Although neonatal jaundice is very common, it usually improves spontaneously without treatment. Approximately 50-70% of healthy term newborns and 80% of preterm babies are seen. However, it requires close follow-up due to potential toxic effects of bilirubin in newborns with jaundice, kernicterus, bilirubin encephalopathy and severe hyperbilirubinemia. The aim of this study was to retrospectively evaluate the patients who were admitted with the diagnosis of hyperbilirubinemia. Materials and Methods: In this study, 250 infants who were followed-up and treated with the diagnosis of hyperbilirubinemia in the Neonatal Intensive Care Unit of the Dicle University Medical Faculty between 1 January 2016 and 31 October 2018 were examined retrospectively. Newborns diagnosed as neonatal jaundice with the diagnosis of neonatal jaundice between 37 and 42 weeks of gestation, birth weight over 1500 g, and laboratory tests with indirect hyperbilirubinemia were included in the study. Results: Of the 250 newborn babies included in the study, 43.2% were female and 56.8% were male. The rate of those born by normal means was 66%, and the rate of those born by cesarean was 34%. The mean gestational week was 38.42 ± 1.30 weeks and the mean birth weight was 3051.2 ± 457.1 grams. The mean age at admission of the hospitalized patients was 5.46 ± 3.9 days and the mean hospitalization time was 7.38 ± 4.4 days. The rate of patients with jaundice in the siblings of the cases was 17.6% and the rate of phototherapy in their siblings was 13.6%. When the total bilirubin values at the time of hospitalization were evaluated, the mean value was 22.38 ± 6.3 mg / dL in the male cases and 22.69 ± 6.06 mg / dL in the male cases and 21.98 ± 6.78 mg / dL in the female patients. Of the infants, 89.2% had blood type Rh (+) and 49.2% blood group A blood group, 24.8% B blood group, 22% O blood group, 4% AB blood group. Of the mothers of the infants, 72% were Rh (+) and 53.6% of the mothers had blood group O blood group, 21.2% A blood group, 11.6% B blood group, 6.4% AB blood group. Direct Coombs test was found positive in 30% of the cases and the diagnosis of positive Coombs test positive was 29.3% Rh and subgroup incompatibility. When all the cases were evaluated ethiologically, ABO incompatibility was the highest, only ABO incompatibility was 15.2%, Rh incompatibility and subgroup incompatibility was 10.4%, ABO incompatibility and subgroup incompatibility was 10%, urinary tract infection was 7.2%, only subgroup the incidence of non-compliance was found to be 5.2%, glucose 6 phosphate dehydrogenase (G6PD) enzyme deficiency 4%, cause unknown 3.6%, nutritional deficiency 3.2%, hypothyroidism 1.2%, breast milk jaundice 0.4%. All patients were treated with phototherapy. The mean duration of phototherapy was 24.07 ± 17.85 hours. The rate of cases who had only phototherapy treatment was 84%, blood transfusion rate was 6.4%, the rate of IVIG treatment was 5.2%, blood exchange and IVIG treatment was 4.4%. Conclusion: In order to reduce the neonatal jaundice which is frequently encountered in our society, some precautions should be taken. Early and frequent feeding of the newborn, prevention of premature births, taking measures for blood group incompatibilities, explaining the importance and benefits of breast milk to families, close follow-up of the babies in the risk group, raising the awareness of the families in this regard, prevention of birth trauma, questioning the story of the sibling during the newborn examinations In the first week, it is necessary to reevaluate in terms of nutrition, weight control and jaundice, and should be called early for the control examination of the babies who are discharged early. Brain damage is an important problem for the community when early diagnosis and treatment of neonatal hyperbilirubinemia is not performed. Early diagnosis and treatment of these patients will reduce morbidity and even mortality. While ABO and Rh discrepancies, which are an important etiologically important problem, are closely observed, other etiologic conditions such as infections, G6PD deficiency, subgroup incompatibility, hypothyroidism should be kept in mind and early diagnosis treatments should be made. Key Words: Newborn, hyperbilirubinemia, phototherapy, blood exchange