Risk Factors for Serum Bilirubin Rebound After Stopping Phototherapy in Neonatal Hyperbilirubinemia

2021 ◽  
pp. 097321792110483
Author(s):  
Abhishek Yadav ◽  
Baljeet Maini ◽  
Bablu Kumar Gaur ◽  
Rupa R Singh
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Sepsis ◽  
G6pd Deficiency ◽  
Serum Bilirubin ◽  
Neonatal Hyperbilirubinemia ◽  
P Value ◽  
Inclusion Criteria ◽  
Abo Incompatibility

Objective: To identify the factors affecting rebound increase in bilirubin levels after stopping phototherapy in neonatal hyperbilirubinemia. Setting: Tertiary-level neonatal unit. Patients: This was a hospital-based cross-sectional observational study. The study was conducted in neonatal division of rural tertiary care hospital. All neonates who were admitted for hyperbilirubinemia treatment and fulfilled the inclusion criteria were included in the study. Inclusion Criteria: All neonates 1.5 kg and above and treated in newborn intensive care unit for hyperbilirubinemia. Exclusion Criteria: (a) Critically ill patients requiring respiratory support any time after delivery, (b) neonates presenting with life-threatening surgical conditions, (c) patient with congenital malformation, (d) conjugated bilirubin elevation, (e) patients with birth asphyxia. Statistical Analysis: All the data were entered into a Microsoft Excel sheet. Appropriate tests of significance were applied. The various variables were sorted and presented as a number or percentage. The categorical variables used in the analysis were evaluated using the chi-square test (Yates’s correction and Fischer exact test were employed where applicable). The continuous data were analyzed by “t” test. The P value of less than 0.05 was taken to be level of statistical significance. Results: One hundred and fifty patients of neonatal hyperbilirubinemia were included in this study. In this study, 81 newborns (54.0%) were male and 78 (52%) of them were born by normal vaginal delivery. One hundred and nine babies (72.6%) were term babies. Fifty babies (33.3%) were low birth weight. Out of 150 neonates, 18(12%) had ABO incompatibility, 13(8.7%) Rh incompatibility, 23(15.7%) neonatal sepsis, and 4 (2.6%) had polycythemia. Out of 150 patients, 15(10%) babies had rebound hyperbilirubinemia at 24 h of life requiring phototherapy prematurity (particularly <34 weeks) ( P value: .03), low birth weight (particularly <2.0 kg) ( P value:.009), onset of jaundice requiring phototherapy before 72 h of life ( P value .04), blood group (both Rh and ABO) incompatibility ( P values: .001 and .002), neonatal sepsis ( P value: .004) were significantly associated with rebound hyperbilirubinemia. Glucose 6 phosphate dehydrogenase (G6PD) deficiency, polycythemia, maturity, mode of feeding, and gender did not show any statistical significant relationship with rebound hyperbilirubinemia. Conclusions: Rebound level of bilirubin need not be checked in all babies. Babies with risk factors like born preterm, low birth weight, having sepsis, requirement of phototherapy before 72 h of life, Rh and ABO group incompatibility, only need to be checked for serum bilirubin rebound. We recommend more studies with larger sample size to evaluate all these factors including polycythemia and G6PD deficiency.

scholarly journals Risk Factors and Causes of Neonatal Hyperbilirubinemia: A Systematic Review Study

2020 ◽  
Vol 8 (4) ◽  
pp. 211-222
Author(s):  
Hassan Boskabadi ◽  
◽  
Forough Rakhshanizadeh ◽  
Ali Moradi ◽  
Maryam Zakerihamidi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Birth Weight ◽  
G6pd Deficiency ◽  
Neonatal Jaundice ◽  
Diabetic Mother ◽  
Neonatal Hyperbilirubinemia ◽  
Abo Incompatibility ◽  
Rh Incompatibility ◽  
Review Study

Context: Jaundice is a common problem and the most common risk factor for hospitalization during the neonatal period.      Objective: The prevention of neonatal hyperbilirubinemia would not be possible without identifying its predisposing risk factors. The present systematic review study aims to determine the risk factors of neonatal jaundice. Data Sources: Databases including Science Direct, Cochrane Library, Web of Science (ISI), PubMed, and Google Scholar were searched to identify all eligible papers concerning the risk factors of neonatal hyperbilirubinemia.  Study Selection: This systematic review was performed to review the causes and risk factors of neonatal hyperbilirubinemia. Finally, 18 articles were defined as eligible for further review. Data Extraction: The keywords included neonates, jaundice, hyperbilirubinemia, and risk factors. The inclusion criteria were studies determining jaundice risk factors, while papers with only published abstracts were excluded. Results: A total of 18 eligible articles (3 retrospective, 4 prospective, 10 cross-sectional, and 1 historical cohort) out of 421 retrieved articles were included in this review. The etiologic causes for neonatal jaundice were ABO incompatibility (24.6%), infection (including UTI and sepsis) (13.7%), G6PD deficiency (9.4%), Rh incompatibility (7%), and cephalohematoma (2.9%), while, known predisposing factors for neonatal jaundice included unknown (33.2%), low birth weight (30.9%), hyperbilirubinemia in siblings (22.7%), prematurity (20.1%), and infant of diabetic mother (6.7%). Conclusion: According to our review with considering the studies, the etiologic causes for neonatal jaundice are ABO incompatibility, infection (including UTI and sepsis), G6PD deficiency, Rh incompatibility, and cephalohematoma. While, known predisposing factors for neonatal jaundice include low birth weight, hyperbilirubinemia in siblings, prematurity, and infant of diabetic mother.

scholarly journals Clinical profile and factors determining outcome of intramural very low birth weight babies in a tertiary care centre: a retrospective study

2017 ◽  
Vol 5 (2) ◽  
pp. 520
Author(s):  
Devi Meenakshi K. ◽  
Arasar Seeralar A. T. ◽  
Srinivasan Padmanaban
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Logistic Regression Analysis ◽  
Very Low Birth Weight ◽  
Tertiary Care ◽  
P Value ◽  
Increased Risk

Background: Very low birth weight (VLBW) babies are at increased risk of a number of complications both immediate and late. Worldwide it has been observed that these babies contribute to a significant extent to neonatal mortality and morbidity. Aim of the study was to study the risk factors contributing to mortality in VLBW babies and to evaluate the morbidity pattern in these infants.Methods: A retrospective analysis of data retrieved from the case records of VLBW babies admitted in the NICU of Kilpauk Medical College between January 2015 to December 2015. Out of the 2360 intramural babies admitted during the study period, 99 babies were less than 1500 gms. The risk factors for these babies were analyzed for their association with the outcome. Data were statistically analyzed.Results: In present study, we found that sex of the baby, gestational age, obstetric score, birth asphyxia, pulmonary haemorrhage, ROP and presence of shock were found to be associated with increased mortality. By logistic regression analysis it was observed that birth weight of the baby (p value 0.002), duration of stay (p value 0.0006), presence of shock (p<0.0001), were the risk factors significantly associated with poor outcome.Conclusions: Among the maternal and neonatal factors analyzed in the study using logistic regression analysis, birth weight, duration of hospital stay and presence of shock were significantly related to poor outcome. Of these presence of shock was the single most important factor that predicted increased mortality.

scholarly journals Clinical profile and outcome of early onset sepsis in high risk very low birth weight neonates

2018 ◽  
Vol 5 (2) ◽  
pp. 389 ◽  
Author(s):  
Omprakash S. Shukla ◽  
Aditi Rawat
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Blood Culture ◽  
Low Birth Weight ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Very Low Birth Weight ◽  
Gram Negative ◽  
Early Onset Sepsis ◽  
Culture Positive

Background: Neonatal sepsis is one of the main causes of mortality and morbidity, especially in very low birth weight neonates (birth weight <1499 grams) despite the progress in hygiene, introduction of new and potent antimicrobial agents for treatment and advanced measures for diagnosis. The aim of the study was to find correlation of clinical features and risk factors of neonatal sepsis in culture positive cases.Methods: A cross- sectional study was carried out in one hundred neonates with risk factors of septicemia after obtaining informed consent. Blood culture was done using Bactec Peds Plus/F Culture as a gold standard to diagnose septicaemia. Correlation of  risk factors, clinical features with laboratory findings was obtained by using chi-square test. p-value of less than 0.05 was considered as significant.Results: Out of 100 neonates with suspected sepsis, BACTEC culture proven sepsis was seen in 40% cases. Gram negative sepsis was seen in 62.5% cases. The most common bacteria for early onset sepsis were Klebsiella, Pseudomonas and MRSA contributing 17% each to the bacteriological profile. The most common predisposing factor and clinical feature in culture positive cases were Premature rupture of membrane >24 hours (67%) and bleeding/petechia/pupura (72%) respectively. The major cause of mortality was pulmonary hemorrhage.Conclusions: Gram negative organism were more common and associated with higher mortality. Blood culture positivity increases with increase in number of risk factors in neonatal septicemia. A detailed history and thorough clinical examination is vital for early recognition of sepsis. 

scholarly journals A study of low birth weight prevalence and risk factors among newborns in a public-hospital at Kilis, Turkey

2020 ◽  
Vol 20 (2) ◽  
pp. 709-714
Author(s):  
Hasan Hüseyin Çam ◽  
Muazzez Harunoğulları ◽  
Yadigar Polat
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Maternal Age ◽  
P Value ◽  
Binary Logistic Regression Analysis ◽  
Cross Sectional ◽  
Important Indicator ◽  
Maternal Risk ◽  
Syrian Refugee

Background: Low birth weight (LBW) is an important indicator of reproductive health and general health status of population. Objectives: The present study was aimed to estimate the prevalence of low birth weight (LBW), and to investigate the associations between some risk factors and LBW in Syrian refugee and Turkish population in Kilis, Turkey. Methods: The population of this study constituted of a total of 4379 infants born in Kilis State Hospital in 2016 using a retrospective cross-sectional study design. The data were collected from birth records. The data were analyzed using SPSS version 16.0. Binary logistic regression analysis was performed to identify predictors of low birth weight. Factors with a p-value < 0.05 were deemed to be statistically significant. Results: The prevalence of LBW was 6.7% in all groups. Significant relationships were found between young maternal age, Syrian refugee mother, female infants, cesarean delivery and LBW. Conclusion: The prevalence of low birth weight in the study area was comparatively lower than that of countrywide figure. Maternal related variables like, maternal age, mother's nationality, and mode of birth (vaginal, cesarean) take after up as well as new-born related variables like gender of the neonate were significantly related with low birth weight. Keywords: Low birth weight; maternal; risk factors,; prevalence.

Study of hematological indices in neonates admitted with non-obstructive jaundice and its outcome in a tertiary care hospital

2017 ◽  
Vol 4 (5) ◽  
pp. 1827
Author(s):  
Vikram R. ◽  
C. S. Balachandran
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Serum Bilirubin ◽  
Complete Blood Count ◽  
Tertiary Care ◽  
Serum Bilirubin Level ◽  
P Value ◽  
Serum Total Bilirubin ◽  
Care Hospital ◽  
Hematological Indices

Background: To study non-obstructive causes and laboratory profile of neonatal hyperbilirubinemia. Design: prospective study.Methods: Selection of cases were done from routine cases reporting to newborn unit in the department of paediatrics, with clinical evidence of jaundice in neonates. Blood group of the mother and baby, Serum bilirubin estimation, Complete blood count with peripheral smear examination, Reticulocyte count, Direct coomb’s test and C-reactive protein of the baby were done.Results: Study includes 89 cases of newborn admitted in our tertiary care institute. Out of 89 neonates, 52 (58.42%) were male while 37 (41.57%) were females. Total number of Pre-term babies was 35 (39.32%). Neonates having low birth weight were 30 (33.7%) and very low birth were 10 (11.23%). Physiological jaundice constituted majority cases. Septicemia was the commonest cause of pathological jaundice and ABO incompatibility is second commonest cause of pathological jaundice. Pre-term and low birth weight babies were having higher levels of serum total bilirubin but the difference was not significant (P >0.05). The rise in serum bilirubin level was found to be more in pathological jaundice as compare to physiological jaundice. Difference was significant statistically with p value of <0.05.Conclusions: Most of the cases were having physiological jaundice although septicemia and ABO-Rh incompatibility were not exceptional. Peak serum bilirubin levels were found to be more among the pathological jaundice. Also, prematurity and low birth weight were having higher levels of serum bilirubin. Special care must be given to them in order to avoid future complications of hyperbilirubinemia.

scholarly journals The Relationship of Birth Weight Infant with Bacteriological Profile and Antibiotic Resistance of Neonatal Sepsis

2019 ◽  
Vol 7 (5) ◽  
Author(s):  
Nisrina Asysyifa ◽  
Husjain Djajaningrat ◽  
Diah Lestari
Keyword(s):  
Antibiotic Resistance ◽  
Birth Weight ◽  
Blood Culture ◽  
Low Birth Weight ◽  
Neonatal Sepsis ◽  
P Value ◽  
Klebsiella Pneumonia ◽  
Bacteriological Profile ◽  
Relationship Of ◽  
The Relationship

Neonatal sepsis is a major issue on neonatal-care field. This incident occurs by many factors, one of the factor is infant with a low birth weight. Blood culture is used as the gold standard for diagnosis. The spectrum of bacteria which caused neonatal sepsis is constantly change and vary due to antibiotic resistance phenomenon. This study aimed to determine the relationship of birth weight infant with bacteriological profile and antibiotic resistance of neonatal sepsis in RSAB Harapan Kita Jakarta. This study used observational method with cross sectional design and purposive sampling method which is analyzed by chisquare test. Medical record data and blood culture and antibiotic resistance test from all subjects in Januari until December 2018 were reviewed. The sample in this research is neonatal sepsis patients who met inclusion criteria were 51 patients. From 51 (55,43%) subjects, there were 39 (76,47%) neonatal sepsis in low birth weight infant. Klebsiella pneumonia spp (41,17%) and Staphylococcus epidermidis (19,60%) were the predominant pathogens. Amikacin (62,74%), and meropenem (50,98%) were the most susceptible antibiotic towards bacteria. Maximum resistance among organisms was seen in cefotaxime (84,31%), ceftazidime (78,43%), and amoxicillin (70,58%).  The result of the analysis found there is a relationship between birth weight infant and bacteriological profile (p-value = 0,035), but there is no relationship between birth weight infant and antibiotic resistance of neonatal sepsis (p-value =0,092; 0,066; and 0,521). There is a relationship between birth weight infant and bacteriological profile , but there is no relationship between birth weight infant and antibiotic resistance of neonatal sepsis.

scholarly journals Risk Factors and Outcome of Neonatal Thrombocytopenia

2020 ◽  
Vol 24 (3) ◽  
pp. 229-234
Author(s):  
Hira Arif ◽  
Nadeem Ikram ◽  
Shangraf Riaz ◽  
Asma Nafisa
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Birth Asphyxia ◽  
P Value ◽  
Maternal Risk ◽  
Significant Difference ◽  
Neonatal Thrombocytopenia ◽  
A Prospective Study

Introduction: About 30% of neonates develop thrombocytopenia during hospital admission. Inevitable and irreversible complications can be prevented by determining the risk factors of neonatal thrombocytopenia. The present study was undertaken to determine the risk factors and outcome of neonatal thrombocytopenia in neonates admitted to Neonatal Intensive Care Unit Benazir Bhutto Hospital Rawalpindi. Materials and Methods: A prospective study was conducted to evaluate the risk factors for neonatal thrombocytopenia (NT) in 160 neonates. Neonatal and maternal risk factors were recorded and neonates were categorized into three groups based on the severity of thrombocytopenia. Results: A higher percentage of the neonates 89 (55.6%) were male. The majority (61.9%) had moderate neonatal thrombocytopenia while 21.9% had severe neonatal thrombocytopenia. A highly significant difference was observed for the distribution of gestational age, platelet count, birth weight, and age at admission (for all p-value ≥0.0001) among different groups. Multivariate logistic regression revealed a significant independent association of prematurity, birth asphyxia, and low birth weight with neonatal thrombocytopenia. Conclusion: Prematurity, low birth weight, and birth asphyxia were the significant causes of Neonatal thrombocytopenia. The mortality rate increased significantly with the severity of thrombocytopenia.

scholarly journals Prospective study to evaluate the risk factors associated with mortality in neonatal septicemia

2017 ◽  
Vol 4 (5) ◽  
pp. 1687
Author(s):  
Mandeep Singh Khurana ◽  
Supriya Malik ◽  
Gursharan Singh Narang ◽  
Ritish Saini
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Blood Culture ◽  
Low Birth Weight ◽  
Positive Blood Culture ◽  
Neonatal Sepsis ◽  
Clinical Syndrome ◽  
Preterm Baby ◽  
Neonatal Septicemia ◽  
Factors Associated

Background: Neonatal sepsis is a clinical syndrome of bacteremia characterized by systemic signs and symptoms of infection in the first month of life. Neonatal sepsis refers to infection occuring within the neonatal period i.e. first 28 days of life for a term baby and up to 4 weeks beyond the expected date of delivery in a preterm baby. Neonatal sepsis is one of the major cause of neonatal morbidity and mortality.Methods: The present study is a prospective observational study conducted in the neonatal intensive care unit (NICU) of Sri Guru Ram Das Institute of Medical Sciences and Research (SGRDIMSAR), Sri Amritsar over a period of one year from January 2015 to January 2016. Aim of the study is to know the incidence of neonatal sepsis, to study bacteriology of neonatal septicemia and to evaluate the risk factors associated with mortality in neonatal sepsis in our hospital.Results: During the study period (January 2015 to January 2016), 727 neonates were admitted in NICU of SGRDIMSAR, Sri Amritsar. Out of them, 109 neonates were diagnosed as having septicemia. Incidence of neonatal sepsis in our hospital in this study is 149.9/1000 neonatal admissions. 59 (54.1%) neonates had positive blood culture. Out of 109 septic neonates, 50 died and 59 survived. Mortality observed in the present study is 45.9%.Conclusions: It is concluded from present study that the main factors associated with neonatal mortality are low birth weight, prematurity, positive blood culture, neutropenia and prolonged prothrombin time. Some of the risk factors like low birth weight and prematurity are preventable by proper antenatal check ups and measures can be taken for safe and hygienic delivery. Babies with risk factors should be monitored closely for early detection of sepsis and the neonates with sepsis having abnormal laboratory parameters should be subjected to appropriate therapeutic intervention in order to decrease the mortality. 

scholarly journals Study of renal profile in septicemic neonates

2018 ◽  
Vol 5 (2) ◽  
pp. 448
Author(s):  
Sharwari J. Bhutada ◽  
Chandrakant M. Bokade
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Gestational Age ◽  
Neonatal Sepsis ◽  
Age Of Onset ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Morbidity And Mortality ◽  
P Value ◽  
Etiological Agents

Background: Neonatal sepsis can cause multiorgan involvement causing neonatal morbidity and mortality. The kidneys are an important organ affected in septicemic newborns. In this study we evaluated the renal functions and its association with various risk factors along with outcome in septicemic neonates.Methods: This study was a prospective observational study conducted in a tertiary care teaching hospital. The sample size was 276 cases of septicemic new-borns and study duration was 2 years. The profile of acute renal failure (ARF) and various risk factors were studied in a sample of 276 septicemic neonates. Detailed clinical examination and investigations were done to confirm the diagnosis of neonatal sepsis and the occurrence of ARF was studied among these septicemic newborns. Risk factors like birth weight, gestational age, shock, etiological agents, DIC were studied for the occurrence of ARF and mortality in ARF patients among septicemic neonates.Results: 30.07% of septicemic neonates developed ARF. DIC (p value=0.014), shock (p value=<0.0001), gestational age (p value=0.005), birth weight (p value=0.003), were found to be analytically significant for the occurrence of ARF. Birth weight (p value=0.006), age of onset of sepsis (p value=0.019), shock (p value =<0.0001), oliguria (p value =<0.0001), and DIC (p value=0.015) were significant predictors of mortality in ARF among septicemic neonates.Conclusions: Awareness and early identification of various risk factors and ARF in septicemic neonates can prevent morbidity and mortality among neonates. 

scholarly journals Neonatal Hyperbilirubinemia: A Retrospective Study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hina Abbas ◽  
Sabih ul Hassan ◽  
Kulsoom Arif ◽  
Sambreen Zameer ◽  
Naseem Ahmed ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Retrospective Study ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Blood Group ◽  
Serum Bilirubin ◽  
Neonatal Hyperbilirubinemia ◽  
Age Group ◽  
East Asians ◽  
Preterm Babies

Background: Neonatal Hyperbilirubinemia is a common problem encountered in neonates and often requires admission and treatment.Almost 60% of the term babies and 80% of the preterm babies develop jaundice. East Asians have higher baseline neonatal bilirubin levelsthan whites and are predisposed to the development of severe neonatal hyperbilirubinemia. .Objectives: To determine the important prognostic factors in Neonatal Hyperbilirubinemia and to correlate variables with severity ofpresentation.Material and Methods: A retrospective study was conducted in the Paediatrics Unit 3 of Civil Hospital Karachi from June to November2017 on admitted patients below one month of age with clinically diagnosed jaundice. Total and indirect serum bilirubin levels, and data ofgender, age, birth weight, blood group incompatibility, and breast feeding were obtained.Results: Of 255 cases, 80% were resolved. Phototherapy was the most common method of treatment (in 91.8% of cases). Males slightlyoutnumbered females (1.39:1). 6.3% of jaundiced neonates died; 3.5% developed kernicterus before death. Low birth weight wasobserved in 50.2% of cases while preterm gestation was seen in 39.2% of cases.Conclusion: Important prognostic factors for Hyperbilirubinemia were presence of kernicterus, anemia, age group of the infant, severityof hyperbilirubinemia and the therapy provided.

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