Strategies to reduce neonatal bilirubin-induced complications

Abstract EN

Objective : Jaundice is the most common condition requiring medical attention in newborns (affects 60% of full-term infants and 80 % of preterm infants in the first week after birth).

Neonatal hyperbilirubinemia is the most common reason for hospital readmission in the first 2 weeks of life, with risk of bilirubin induced complications (bilirubin encephalopathy, kernicterus, complications of exchange blood transfusion and expensive cost requirement), in spite of all the above there is no schedule to prevent these complications in Iraq till now.

The aim of present study was to define risk factors of jaundice.

Methods : A cross-sectional study was conducted on one hundred jaundiced neonates attending the Babylon Gynecology and Children Teaching Hospital, Hilla, Babil, Iraq.

A full history was taken from their close family members.

Thorough clinical examination and important investigations were done for them.

They were classified into two groups according to mode of therapy depended on serum level of indirect bilirubin and evaluation of risk factors.

One group was treated by phototherapy only and the other group was treated by phototherapy and exchange blood transfusion.

Results : The variables which found to be as risk factors for exchange blood transfusion with significant or highly significant p-value include; male gender, age of neonates more than 3 days on admission, appearance of jaundice in the first 3 days, duration of jaundice on admission of 3 days or less, serum bilirubin level on admission (as % from bilirubin level of exchange) of >70 %, ABO incompatibility, no follow up in first 3 days of life, delayed initiation of phototherapy treatment, no history of hospital admission, history of discharge from hospital with jaundice, and delayed phototherapy with delayed follow up.

The following variables are also regarded as risk factors: term active baby with normal body weight, normal packed cell volume and blood sugar on admission, no family history of jaundice in other siblings, and normal vaginal delivery in side hospital.

Conclusions: The risk factors for jaundiced neonates to have exchange transfusion is related to, early discharge from hospital, failure to check bilirubin level in first 24 hours of life, failure to recognize risk factors for development of severe hyperbilirubinemia, clinical underassessment of jaundice severity, delay in initiation phototherapy, and lack of concern regarding presence of jaundice.