DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20193656

Etiology and clinico-hematological profile of neonates with pathological unconjugated hyperbilirubinemia: a tertiary care centre experience

Sujaya Mukhopadhyay, Najia Hassan

Abstract


Background: Jaundice is visible manifestation of raised serum bilirubin. Jaundice in newborns is not an uncommon occurrence. Usually jaundice in newborn is due to elevation of unconjugated bilirubin. There are varied causes of unconjugated hyper bilirubenemia. This study was conceptualized to see the etiology and clinico-hematological profile of neonates with pathological unconjugated hyperbilirubinemia who were admitted in the specific time frame in Sharda Hospital, Greater Noida which is a tertiary care hospital in Western U.P.

Methods: This is a retrospective study in which data of all neonates admitted to NICU with unconjugated hyperbilirubinemia requiring phototherapy and/or exchange transfusion in the period 1.7.2018 to 31.12.2018 was collected and analyzed. History including birth weight, mode of delivery, gestational age, mother's blood group, etc. was recorded. Complete physical examination and investigation done for diagnosis noted.

Results: It was seen that out of 438 admissions in NICU, 63% had neonatal jaundice and 18.8% of this had pathological unconjugated hyper bilirubenemia. 63.5% were males and 36.5% females. Majority were term babies. Most of the babies developed jaundice on day 3 of life. In 61% cases no cause for jaundice could be ascertained despite investigations for the same. ABO and Rh incompatibility accounted for 15.30% and 5.7% cases respectively. All patients received phototherapy and 3.8% underwent exchange transfusion.

Conclusions: From the study it can be concluded that although blood group incompatibility is an important cause of pathological unconjugated hyper bilirubenemia but in most of the cases no cause is usually found.


Keywords


Breast feeding jaundice, Pathological unconjugated hyper bilirubinaemia, Western Uttar Pradesh

Full Text:

PDF

References


Euchenwald, Hansen, Martin, Stark. Cloherty and Stark’s manual of neonatal care. 8th ed. China: Wolters Kluwer; 2016.

Maisels MJ, McDonagh AD. Phototherapy for Neonatal Jaundice. N Engl J Med. 2008 Feb 28;358(9):920-8.

Agarwal R, Deorari AK. Unconjugated hyperbilirubinemia in newborns: current perspective. Indian pediatr. 2002 Jan;39(1):30-42.

Narang A, Gathwala G, Kumar P. Neonatal Jaundice: An analysis of 551 cases. Indian Pediatr. 1997 May;34:429-32.

Singhal PK, Singh M, Paul VK, Deorari AK, Ghorpade MG. Spectrum of neonatal hyperbilirubinemia: An analysis of 454 cases. Indian Pediatr. 1992 Mar;29(3):319-25.

Bahl L, Sharma R, Sharma J. Etiology of neonatal jaundice at Shimla. Indian Pediatr. 1994 Oct 1;31(10):1275-8.

Sarici SÜ, Serdar MA, Korkmaz A, Erdem G, Oran O, Tekinalp G, Yurdakök M, Yigit S. Incidence, course, and prediction of hyperbilirubinemia in near-term and term newborns. Pediatri. 2004 Apr 1;113(4):775-80.

Maisels MJ, Clifford K, Antle CE. Jaundice in the healthy newborn infant: A new approach to an old problem. Pediatr. 1988; 81(4):505-11.

Gupta A, Gupta P, Ali SSL, Gupta S. Effect of mode of delivery: Normal, induced and caesarean section on neonatal serum bilirubin. Indian J Clin Anat Physiol. 2016;3(3);269-72.

Najib KS, Saki F, Hemmati F, Inaloo S. Incidence, risk factors and causes of severe neonatal hyperbilirubinemia in the South of Iran. Iran Red Crescent Med J. 2013;15(3):260-3.

Maisels MJ, Kring E. The contribution of hemolysis to early jaundice in normal newborns. Pediatr. 2006;118(1):276-9.

Porter ML, Dennis BL. Hyperbilirubinemia in the term newborn. Am Fam Physician. 2002;65(4):599-606.

Linn S, Schoenbaum SC, Monson RR, Rosner B, Stubblefield PG, Ryan KJ. Epidemiology of neonatal hyperbilirubinemia. Pediatr. 1985;75(4):770-4.

National Institute for Health and Care Excellence Neonatal jaundice. Clinical guideline 98. London: Royal College of Obstetricians and Gynaecologists; 2010.

Adhikari M, Mackenjee H. Care of the newborn. In: Wittenberg DF, editor. Coovadia’spaediatrics and child health. 6th ed. Cape Town, South Africa: Oxford University Press; 2010:129-130.

Ullah S, Rahman K, Hedayati M. Hyperbilirubinemia in neonates: types, causes, clinical examinations, preventive measures and treatments: a narrative review article. Iranian J public health. 2016 May;45(5):558-68.

Chou SC, Palmer RH, Ezhuthachan S, Newman C, Pradell-Boyd B, Maisels MJ, et al. Management of hyperbilirubinemia in newborns: measuring performance by using a benchmarking model. Pediatr. 2003 Dec 1;112(6):1264-73.

Sahoo M, Arigela V, L Pramitha, Sudarsini P, Rao KU. Pediatric Review: International Journal of Pediatric Research, 2016;3(8).

Sarici SÜ, Yurdakök M, Serdar MA, Oran O, Erdem G, Tekinalp G, et al. An early (sixth-hour) serum bilirubin measurement is useful in predicting the development of significant hyperbilirubinemia and severe ABO hemolytic disease in a selective high-risk population of newborns with ABO incompatibility. Pediatr. 2002;100(3):600-11.

Xavier R, Manoj VC, Cherian VJ. Cherian, Breastfeeding jaundice: how big is the problem. Int J Contemp Pediatr. 2016 May;3(2):498-503.

Ambalavanan N, Carlo WA. Jaundice and hyperbilirubinemia in the newborn. Eds: Kleigman RM, Schor NF, Geme JWS, Behrman RE, Stanton BF. Nelson textbook of Pediatrics. 20th edition. Philadelphia Mosby: Elsevier; 2016:870-875.

Yang WC, Zhao L, Li Y, Chen C, Chang Y, Fu Y, et al. Bodyweight loss in predicting neonatal hyperbilirubinemia 72 hours after birth in term newborn infants. BMC Pediatrics. 2013 Dec;13(1):145.

Noel-Weiss J, Courant G, Woodend AK. Physiological weight loss in the breastfed neonate: a systematic review. Open Med. 2008;2(4):e99-110.

Dennery PA. Pharamacological interventions for the treatment of neonatal jaundice. Semin Neonatol, 2002;7(2):111-9.

Maruo Y, Nishizawa K, Sato H, Sawa H, Shimada M. Prolonged unconjugated hyperbilirubinemia associated with breast milk and mutations of the bilirubin uridine diphosphate- glucuronosyltransferase gene. Pediatr, 2000 Nov 1:106(5):E59.

Lauer BJ, Spector ND. Hyperbilirubinemia in the newborn. Pediatrics in Review-Elk Grove. 2011 Aug 1;32(8):341.

Watchko JF, Maisels MJ. Jaundice in low birthweight infants: pathobiology and outcome. Arch Dis Child Fetal Neonatal Ed. 2003 Nov 1;88:F455-8.

Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Weiss J, Evans S. Risk factors for neonatal morbidity and mortality among “healthy,” late preterm newborns. In Seminars in perinatal. 2006 Apr 1:30(2)54-60.