Cephalocaudal progression of jaundice in i̇nfants of gestational age under 35 weeks and the relationship with clinical outcomes

Neonatal hyperbilirubinemia is manifested by the yellow colour found in the sclera and skin of infants with increased bilirubin concentration in the plasma. It is one of the most common problems of neonatal period, the most frequent hospitalization in the first two weeks of life. The frequency of jaundice is 60 % of term and nearterm infants, 80 % of preterm infants in the first week of life although jaundice requiring treatment is % 5 - 6 of newborns. This prospective cross-sectional analytical case study was carried out at Dokuz Eylul University Premature Intensive Care Unit and Obstetrics and Gynecology Department . In this study, cephalocaudal progression of jaundice and effects of clinical and laboratory factors to the cephalocaudal progression of jaundice were investigated under 35 weeks of gestational age. 88 newborns of participating to this study were 53 boys (% 60,2) and 35 girls (% 39,8) . In our study, mean birth weight was 1617.9 ± 672.2, the lowest birth weight was 506 grams and the highest birth weight was 3384 grams. Prematurity and low birth weight are related with hyperbilirubinemia. We measured the level of bilirubin from six different sides of patients (forehead, chest, back, abdomen, knee, footback) by transcutaneous bilirubinometry (TcB) and evaluated the laboratory values and clinical characteristics of patients. We observed that there is no significant difference between capillary and transcutaneous bilirubin measurements. As a result TcB measurement is reliable method for measuring serum bilirubin level in term and premature infants. In conclusion in our society TcB measurements in infants under 35 weeks can be used in a safe manner. Newborn screening for bilirubin in premature infants TcB measurements can be used as the first method. In our study, transcutan bilirubin levels of preterm infants before 35 weeks were higher at the back on the first day, forehead on the fourth day, chest on the other days. In preterm newborns below 35 gestational age, the most significant elevation of transcutaneous bilirubin measurement is on the chest area, transcutaneous bilirubin measurement should be made from the chest area. This shows that unlike term newborns who show cephalocaudal progression, spread of jaundice can be different in preterm newborns below 35 gestational age. It also determines that cephalocaudal progression and mean differences are correlated with the level of bilirubin. We didn?t observe the association between the existence of their own cephalocaudal progression in preterm newborns and followed laboratory data-factors associated with mother and baby. Cephalocaudal gradient may be a risk factor for bilirubin encephalopathy. Even if unproven, damage due to bilirubin in the brain can be associated with the amount of bilirubin acid that accumulates in the phospholipid membrane.