Abstract
Background: Neonatal hyperbilirubinemia, though of common occurrence, is a significant medical condition not only because of its impact on hospital discharge but more importantly because of its potential to cause serious long term neurological complications.
Method: In this retrospective study, data of 258 neonates treated for neonatal hyperbilirubinemia in the neonatal unit of MGM Medical College, Kishanganj, Bihar during the period January 2016 to December 2016 were analyzed and taken up for the study.
Results: In our study ABO incompatibility was the most common cause of neonatal hyperbilirubinemia followed by idiopathic, prematurity, Rh incompatibility and glucose 6 phosphate dehydrogenase deficiency, in addition to other minor causes. Male preponderance was seen. Unfortunately bilirubin encephalopathy (Kernicterus) was seen in a couple of cases.
Conclusion: ABO incompatibility is a very common cause of neonatal hyperbilirubinemia. Although historically Rh incompatibility has been accorded much importance, ABO incompatibility should alert the attending doctors about the impending risk of significant neonatal jaundice. If discharged early a written protocol should be followed where a revisit should be planed within 1 to 3 days for babies with any risk factor so that hyperbilirubinemia , if any, is detected and treated accordingly to prevent long term neurological morbidity.
Key Words: Neonates, Hyperbilirubinemia, ABO incompatibility, Prematurity, Jaundice, G6PD.
References
- Ambalavanan N, Carlo W A. Jaundice and Hyperbilirubinemia in the Newborn. 1st South Asia Eds. Kliegman R M, Stanton B F, Geme J W, Schor N F. Nelson Textbook of Pediatrics. Vil 1. Elsevier; 2016: 871.
- Gregory M L P, Martin C R, Cloherty J P. Neonatal Hyperbilirubinemia. 7th Cloherty J P, Eichenwald E C, Hansen A R, Stark A R. Mannual of Neonatal Care. Lippincott Williams and Wilkins; 2012: 307.
- Watchoko JF. Identification of neonates at risk for hazardous hyperbilirubinemia: Emerging clinical insights. Pediator clin North Am 2009; 56 (3): 671-87.
- Mishra et al: Hematological profile in neonatal jaundice. J Basic Clin Physiol Pharmacol 2014 May 1; 25 (2): 225-8.
- Najib K, Saki F, Hemmati F, Inaloo S. Incidence risk factor and causes of severe neonatal hyperbilirubinemia in South of Iran. (Fars Provinces). Iran Red Cross Med J 2013; 15: 260-3.
- Shetty A, Kumar B S. A study of neonatal hyperbilirubinemia in a tertiary Care Hospital. Int J Med Sci Public Health 2014; 3: 1289-1292.
- Davutoglu M, Garipardic M, Guler E, Karabiber H, Erhan D. The etiology of severe neonatal hyperbilirubinemia and complications of exchange transfusion. Turk J Pediatr 2010; 52 (2): 163-6.
- Badiee Z. Exchange transfusion in neonatal hyperbilirubinemia: Experience in Isfahan, Iran. Singapore Med J 2007; 48: 421-3.
- Singh S K, Singh S N, Kumar M, Tripathi S, Bhriguvanshi A, Chandra T, Kumar A. Etiology and clinical profile of neonates with pathological unconjugated hyperbilir-ubinemia with special reference to Rhesus (Rh) D, C, and E incompatibility: A tertiary care centre experience. Clinical Epidemi-ology and global Health 4. 2016; 95 – 100.
- Heydarian F, Majdi M. Hydarian F, Majdi M. Severe neonatal hyperbilirubinemia; Causes and contributing factors leading to exchange transfusion at Ghaem Hospital in Mashhad. Acta Med Iran 2010; 48 (6): 399-402.
- Sgro M, Campbell D, Shah V.Incidence and causes of severe neonatal hyperbilirubinemia in Canada. CMAJ 2006; 175 (6): 587 – 90.
- Narang A, Gath Wala G, Kumar P. Neonatal jaundice: An analysis of 551 cases. Indian pediatr. 1997; 34: 429-432.
- Ho N K. Neonatal jaundice in Asia. Baillieres. Clin Haematol 2002; 5: 131 - 142.
- Mishra S, Agarwal R, Deorari A K. Jaundice in the newborns. Indian J pediatr 2008; 75: 157-63.
- Sarici S U, Serdar M A, Karkmaz A, Erdem G, Oran O, Tekinalp G et al. Incidence, course and prediction of hyperbilirubinemia in near term and term newborns. Pediatrics 2014; 113 (4): 775-80.
- Kaplan M, Wong R J, Sibley E, Stevenson D K. Neonatal jaundice and liver disease. 9th ed. Martine R J, Fanaroff A A, Walsh M C, eds Neonatal – Perinatal Medicine: Diseases of Fetus and Infant. Vol 2. St Louis: Elsevier Mosby; 2011: 1443.
- Maisels M J, Kring E. Risk of sepsis in newborn severe hyperbilirubinemia. Pediatrics. 1992; 90: 741-743.
- Dennery P A, Seidman D S, Stevenson D K. Neonatal hyperbilirubinemia. N Engl J Med. 2001; 344: 581-90.
- Clemons RM. Issues in newborn care. Prim Care. 2000; 27: 251-67
- Bisoi S, Chakraborty S, Chatopadhyay D, Biswas B, Ray S. glucose 6 phosphate dehydrogenase screening of babies born in a tertiary care hospital in West Bengal. Indian J Public Health 2012; 56 (2): 146-8.
- Weng Y H, Chou Y H, Lien R I. Hyperbilirubinemia in healthy neonates with G6PD deficiency. 2003 Apr; 71 (2): 129-36
- Bizzarro M J, Colson E, Ehrenkranz RA. Differential Diagnosis and management of anemia in the newborn. Pediator Clin North Am. 2004; 51: 1087-107.
- Butler E. G6PD deficiency. Blood. 1994; 84: 3613-36.
- Kaplan M, Vreman H J, Hammerman C, Abramov A, Stevenson D K. Contribution of hemolysis to jaundice in Sephardic Jewish glucose 6 phosphate dehydrogenase defici-ent neonates. Br J Haematol.1996;93:822 - 7
- Seidman D S, Shiloh M, Stevenson D K, Verman H J, Gale R. Role of Himalayas in neonatal jaundice associated with glucose 6 phosphate dehydrogenase deficiency. J Pediatr. 1995; 127: 804 - 6.
- Peevy K J, Landaw S A, Gross S J. Hyperbilirubinemia in infants of diabetic mothers. Pediatrics. 1980 Sep; 66 (3):417 - 9
- Meredith L. Peter, Cpt MC USA. Beth L Dennis, Maj MC USA. Hyperbilirubinemia in term newborn. Am Fam Physician. 2002 Feb; 65 (4): 599 - 607.
- Practice parameter: Management of hyperbilirubinemia in the healthy term newborn. Paediatrics. 1994;944 pt 1:558-62.
- Melton K, Akinbi H T. Neonatal jaundice. Strategies to reduce bilirubin induced complications. Postgrad Med. 1999; 106: 167-8, 171-4, 177-8.
- Gartner L M, Herschel M. Jaundice and breast-feeding. Pediatr Clin North Am. 2001; 48: 389-99.
- Poland R L. Breast milk jaundice. J Pediatr. 1981; 99: 86-8.
- Brodersen R, Herman L S. Intestinal reabsorption of unconjugated bilirubin. Lancet. 1963; 1: 1242.
Corresponding Author
Dr Niru Chhetri
Associate Professor in Biochemistry,
MGM Medical College and LSK Hospital, Kishanganj, Bihar
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v5i9.03
