Evaluation of neonates with the diagnosis of indirect hyperbilirubinemia followed up at the pediatric clinics of Düzce University Medical School between 2006 and 2007

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: 259 neonatal hyperbiliribunemia cases who had been hospitalized and followed up at the Pediatric Clinics of Duzce University of Medical School between 2006 and 2007 were evaluated retrospectively.Results: 192 aut of the 259 cases (74.1 %) included in this study were patients hospitalized with the diagnosis of indirect hyperbilirubinemia, whereas 67 infants (25.9 %) were hospitalized with another diagnoses, and developed jaundice during their follow-up in our clinic. 133 of the patients (51.4 %) were male, whereas 126 of them (48.6%) were female. Mean gestational age at birth was 37.3 ± 2.8 weeks. 70 cases (27%) were premature, 186 (71.8 %) mature, and 3 (1.2 %) postmature infants. Regarding their nutritional status, 171 infants (66 %) were receiving only breast milk, 87 (33.6 %) both breast milk and formula, and 1 (0.4 %) only formula. 176 patients (68%) had passed their first meconium during the first six hours, 56 (21.6 %) between 6th-24th hours, 13 (5 %) between 24th-48th hours. Apgar scores had been recorded as 8 in 37 infants (14.3 %), 9 in 71 infants (27.5 %), and 10 in 150 infants (58.2 %). 77 of the patients (29.7 %) had not received vitamin K postnatally, whereas 182 (70.3 %) had received it. 207 of the infants (79.9 %) had been fed for the first time during the first 6 hours after birth, 2 (0.8 %) between 6th-12th hours, 17 (6.6 %) between 12th-24th hours, 4 (1.5 %) between 24th-48th hours, and 29 (11.2 %) after 48 hours postnatally. Regarding the mode of birth, 147 cases (56.8 %) had been born vaginally, whereas 112 (43.2 %) had been delivered by cesarean section. The mothers of 64 infants delivered by cesarean section had received general anesthesia , whereas 48 had received epidural anesthesia. 39 of the mothers who had given birth vaginally (26.5 %) had been medicated by oxytocin, whereas 108 (73.5) had not received it. 249 of the mothers had not have any disorder, while 10 of them (3.8 %) had had either preeclampsia or eclampsia. At the time of hospital admission, 53.7 % of the patients had icterus on their heels. Regarding the etiology of the jaundice, in 89 of 259 infants (34.4 %), the etiology could not be identified, while 40 infants (15.4 %) were prematurity, 33 cases (12.7 %) had ABO incompatibility, 28 patients (10.8 %) had early breast milk jaundice, 14 (5.4 %) were dehydrated and had received insufficient calories, 12 (4.6 %) had sepsis, 12 infants (4.6 %) had the diagnosis of urinary tract infection, 5 (1.9 %) had late breast milk jaundice, 5 neonates (1.9 %) had been diagnosed as G6PD deficiency, 4 patients (1.5 %) had Rh incompatibility, 3 (1.2 %) had both G6PD deficiency and early breast milk jaundice, 3 (1.2 %) had cephalhematoma, 3 (1.2 %) had both early breast milk jaundice and urinary tract infection, 2 (0.8 %) had both ABO incompatibility and early breast-milk jaundice, 2 (0.8 %) had both ABO and Rh incompatibility, 1 infant (0.4 %) had subgroup incompatibility, 1 patient (0.4 %) was hypothyroid, 1 (0.4 %) had hereditary spherocytosis, and 1 infant (0.4 %) was polycythemic.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 as nowadays early discharge postnatally is relatively common 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: Neonatal jaundice, hyperbilirubinemia, risk factors, G6PD, exchange transfusion.