Causes of Neonatal Jaundice Requiring Exchange Transfusion

Background: Neonatal jaundice is highly prevalent in Asia and has serious complications, such as kernicterus. Therefore, it is very important to identify the risk factors of jaundice requiring exchange transfusion since it can be helpful in the prevention of the disease and early diagnosis of its complications. Objectives: The present study aimed to identify the causes of neonatal jaundice requiring blood exchange. Methods: The present cross-sectional study was performed on 251 term and preterm neonates. The studied newborns were 2-14 days old (born at ≥ 35 weeks of gestation) with jaundice and bilirubin of more than 17 mg/dL and received exchange transfusion during 2011 - 2020 in Ghaem teaching hospital, Mashhad, Iran. The required data of the study variables, such as hyperbilirubinemia risk factors, laboratory tests, the documented history of the mothers and neonates, and physical examination results, were collected through a questionnaire and the medical records of the patients. Finally, the collected data were analyzed in SPSS software (version 20). Results: Based on the results, the mean value of the total serum bilirubin level in neonates who received exchange transfusion was 27.53 ± 10.05 mg/dL. The blood types of about 40% of mothers and their neonates were O and A/B, respectively. Moreover, 11.4% of mothers were Rh-negative; however, their neonates were Rh-positive. The results also revealed that the causes of exchange transfusion were unknown, ABO incompatibility, Rh incompatibility, glucose-6-phosphate dehydrogenase deficiency (G6PDD), and sepsis in 52.7 %, 24%, 7.1%, 5.3%, and 5.3% of the neonates, respectively. Conclusions: The findings of this study suggest that after unknown causes, the most common causes of exchange transfusion were ABO incompatibility, Rh incompatibility, G6PDD, and sepsis. Therefore, since most of these causes can be recognized, it is recommended to perform related tests and take related measures in the Midwifery Department of the hospital to prevent the occurrence and exacerbation of jaundice. Moreover, it is recommended to perform an early follow-up after the discharge.

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Risk Factors of Early Breastfeeding Jaundice: How Can Gynecologists and Nurses be Effective in Reducing It?

Journal of Comprehensive Pediatrics ◽

10.5812/compreped.103578 ◽

2020 ◽

Vol 11 (3) ◽

Author(s):

Soheila Siroosbakht ◽

Ali Reza Aminian ◽

Bijan Rezakhaniha

Keyword(s):

Risk Factors ◽

Breast Feeding ◽

Neonatal Jaundice ◽

Preterm Neonates ◽

Cross Sectional ◽

Breastfeeding Education ◽

High Prevalence ◽

Rh Incompatibility ◽

Study Population ◽

Neonatal Problems

Background: Neonatal jaundice is one of the most common neonatal problems. About 60% of term and 80% of preterm neonates have jaundice. Objectives: Due to the high prevalence of early neonatal jaundice, which can lead to mothers’ concerns and even hospitalization of neonates, we decided to study the frequency and risk factors of breast feeding jaundice to determine the role of gynecologists and nurses in the development of this type of jaundice. Methods: This study was a cross-sectional descriptive study. The sampling method was by convenience. Study populations included one hundred terms, exclusively breastfed neonates aged equal or less than seven days with jaundice who were admitted in Golestan and Khanevadeh hospitals Tehran, Iran from July 2019 to January 2020. Results: The percentage of causes of jaundice in the study population was 65% non-breastfeeding jaundice (29 male, 36 female), including 36% blood group incompatibility, 19% Rh incompatibility and 10% G6PD deficiency. The amount of breast feeding jaundice was 35% (18 male, 17 female). The most significant factors in breastfeeding jaundice were: use of water or sugar water, depressed nipple, mother’s unwillingness to breastfeed; inappropriate breastfeeding technique, and birth weight < 2500 g. Conclusions: The high prevalence of breastfeeding jaundice indicates that policies of breastfeeding education need to be revised. Breastfeeding education before delivery, attention of gynecologists to breast problems of mothers during pregnancy, professional coordination of nurses and physicians for effective breastfeeding training, and early mothers’ revisit after the initial discharge of neonates can reduce the frequency of breastfeeding jaundice and readmission of neonates.

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Outcome of neonatal jaundice in term neonates with ABO incompatibility at tertiary level center

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20203969 ◽

2020 ◽

Vol 7 (10) ◽

pp. 1973

Author(s):

Amit Kumar Thakur ◽

Mohammad Ashfaque Ansari ◽

Atindra Mishra ◽

Saroj Kumar Jha

Keyword(s):

Positive Result ◽

Exchange Transfusion ◽

Neonatal Jaundice ◽

Serum Bilirubin Level ◽

Cross Sectional ◽

Haemolytic Disease ◽

Term Neonates ◽

True Incidence ◽

New Born ◽

Abo Incompatibility

Background: Neonatal jaundice is extremely common as almost every new-born develops an unconjugated serum bilirubin level of more than 1.8 mg/dl during the first seven days of life. ABO incompatibility is associated in about 20% of all pregnancies but manifestations of ABO haemolytic disease of new-born occurs in <10% of these cases. True incidence of ABO incompatibility, particularly in developing countries like Nepal, is not understood sufficiently. Furthermore, the confirmation of severe ABO incompatibility cannot be made accurately using only a single test. Hence, this study was done to know the outcome of jaundice in ABO incompatibility patients.Methods: This was a descriptive cross-sectional study done at Department of Paediatrics, between August 2018 to July 2019. All term neonates born to ‘O’ positive mother, with blood group A or B positive, and fulfilling the selection criteria were included in the study. Sample size was calculated to be 114 with confidence level at 95% and prevalence of ABO haemolytic disease as 11.4% with margin of error 5%.Results: Severe ABO incompatibility as evident by presence of jaundice within 24 hours of life, a positive result on direct coomb’s test and haemolytic picture on peripheral blood smear was observed in 12% of the total enrolled 200 neonates. Modalities of treatment showed significant relation with severe ABO incompatibility indicating increased need for double volume exchange transfusion in neonates with severe ABO incompatibility.Conclusions: Phototherapy was found to be effective in the management of most of the cases of neonatal jaundice in term ABO incompatible neonates but some cases, requiring exchange transfusion can occur, mostly in presence of positive result on direct Coomb’s test.

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Effectiveness of conventional phototherapy, intensive phototherapy and exchange transfusion in treating neonatal jaundice at Fatima Al-Zahra Hospital for maternity and children in Baghdad

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v16i2.262 ◽

2020 ◽

Vol 16 (2) ◽

pp. 25-29

Author(s):

Ahmed Salih Marzoog ◽

Hussein Naeem Mohammed ◽

Kholod Dhaher Habib

Keyword(s):

Exchange Transfusion ◽

Neonatal Jaundice ◽

Neonatal Care ◽

Neonatal Hyperbilirubinemia ◽

Total Serum ◽

Common Disease ◽

Female Ratio ◽

Abo Incompatibility ◽

Rh Incompatibility ◽

Neonatal Care Unit

Background: Neonatal hyperbilirubinemia is a common disease in neonates especially in early days of birth that requires a good and successful treatment for reducing the severity and its complications that can produce important and irreversible effects. Objectives: To evaluate the effectiveness of conventional phototherapy, intensive phototherapy and exchange transfusion on outcomes of neonatal jaundice at Fatima Al-Zahra Hospital for maternity and child care in Baghdad. Patients & Methods: A retrospective study was carried out using medical records of neonates with diagnosis of unconjugated jaundice, admitted in the septic neonatal care unit of Fatima Al-Zahra hospital over 6 months period between 1st May till 31st October 2018. The total serum bilirubin, fractionations and blood group were done in all cases. They treated with conventional phototherapy, intensive phototherapy and exchange transfusion according to the severity of jaundice. Results: Total neonates admitted from 1st may to 31st October 2018 in septic neonatal care unit were 1254, among them 432 (35%) were diagnosed as unconjugated neonatal jaundice “indirect hyperbilirubinemia”. Male: Female ratio (1.4:1), males 256(59.3%), females 176(40.7%). Physiological jaundice was the most common cause 129(29.9%) cases. Prematurity in 104(24.1%) and ABO incompatibility 59(13.7%) while Rh incompatibility 14(3.2%), sepsis 8(1.9%) and unknown causes of jaundice were 118(27.3%) because lack of lab facilities. Conventional phototherapy was the most common kind of treatment in 237(55%) while intensive phototherapy used in 175(40.3%) cases with successful reduction in T.S.B level and the rate of improvement without need for exchange transfusion (92%) (161/175).Only 20(4.5%) cases were treated with exchange transfusion especially for ABO incompatibility 8 (42.1%) cases and Rh incompatibility 4 (21.1%) cases. Most of neonates 429 (99.3%) discharged with complete improvement and only 2 (0.5%) neonates suffered from kernicterus and one death (0.2%). Conclusion: Conventional phototherapy is still the standard treatment of mild to moderate indirect hyperbilirubinemia. Use of intensive phototherapy in the treatment of unconjugated neonatal hyperbilirubinemia is effective in reducing T.S.B level, need for exchange transfusion and hospital staying. Recommendations: provide aseptic neonatal care unit in the hospital with further number of intensive phototherapy devices as it is so effective in treating unconjugated neonatal jaundice and reduces need for exchange transfusion as it is proven in the study.

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Frequency of Hypocalcemia with Exchange Transfusion in Neonatal Jaundice

10.53350/pjmhs211581849 ◽

2021 ◽

Vol 15 (8) ◽

pp. 1849-1851

Author(s):

Ambreen Ali ◽

Ashfaq Ahmad Shah Bukhari ◽

Shameela Majeed ◽

Saira Gul ◽

Nomana Khalil ◽

...

Keyword(s):

Serum Level ◽

Study Design ◽

Selection Criteria ◽

Exchange Transfusion ◽

Neonatal Jaundice ◽

Serum Bilirubin ◽

Cross Sectional Study ◽

Total Serum ◽

Sectional Study ◽

Cross Sectional

Aim: To determine the frequency of hypocalcemia with exchange transfusion in neonatal jaundice. Study design: Descriptive cross-sectional study Place and duration of study: Departments of Pediatrics and Pathology, Naseer Teaching Hospital Peshawar from 1stJanuary 2018 to 31st December 2018. Methodology: One hundred and sixty twopatients of jaundiced neonates having total serum bilirubin >20mg/dl, both gender and patients having age up to 14 days were included. Patients fulfilling the selection criteria had undergone exchange transfusion. Hypocalcaemia was evaluated and considered positive if calcium serum level is <8 mg/dl or <2 mmol/L. Results: 50% of neonates were between 1-5 days, 45% of neonates were between 5-10 days, and 3% of neonates were in age 10-14 days. One hundred and ten (68%) of neonates were males and 52 (32%) of neonates were females. 30% neonates had hypocalcemia while 70% were without hypocalcemia. Conclusion: The incidence of hypocalcemia was found to be 30% with exchange transfusion in neonatal jaundice. Keywords: Hypocalcemia, Exchange transfusion, Neonatal jaundice

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The prevalence of prolonged jaundice due to breast milk jaundice in hospitalized newborn; a study among Iranian neonates

Immunopathologia Persa ◽

10.34172/ipp.2021.22 ◽

2020 ◽

Vol 7 (2) ◽

pp. e22-e22

Author(s):

Fatemeh Eghbalian ◽

Roya Raeisi ◽

Shadi Eslah ◽

Nasrin Jiryaee

Keyword(s):

Breast Milk ◽

Neonatal Jaundice ◽

Cross Sectional Study ◽

Serum Bilirubin Level ◽

Total Serum ◽

Cross Sectional ◽

Main Determinant ◽

Breast Milk Jaundice ◽

Glucose 6 Phosphate Dehydrogenase ◽

Prolonged Jaundice

Introduction: Breast milk jaundice is considered as the most common cause for neonatal jaundice; however, its epidemiological aspects in some population remain unclear. Objectives: The present study aimed to assess the prevalence of breast milk jaundice and its main determinant among a group of neonates in western Iran. Patients and Methods: This cross-sectional study was conducted on 413 neonates hospitalized due to prolonged jaundice in Besat hospital in Hamadan, Iran. The study information was collected by reviewing the hospital’s recorded files. Results: In total, 413 neonates hospitalized were assessed in this study. The main reason for appearing jaundice included; 72.4% of cases of jaundice were due to breast milk, urinary tract infection in 4.2% of cases, glucose-6-phosphate dehydrogenase deficiency (G6PD) in 5.8% of cases, hypothyroidism in 1.2% of cases. Out of 299 neonates suffering from breast milk jaundice, 126 (42.1%) were male, and 173 (57.9%) were female with the overall average age of 16.68 ± 2.14 days. Jaundice appeared at less than two days of age in 29.4% of neonates, between 15 to 20 days of age in 64.9%, and more than 20 days of age in 5.7% of cases. Conclusion: Breast milk jaundice is considered as the most common reason for neonatal jaundice in our population, which affects more than two-thirds of our neonates. Additionally, the peak age of this phenomenon is between 15 and 20 days. The appearing breast milk jaundice is independent of gender, age, and birth weight or baseline total serum bilirubin level.

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Unconjugated Neonatal Hyperbilirubinemia: Evaluation and Treatment

Diyala Journal of Medicine ◽

10.26505/djm.19025330426 ◽

2020 ◽

Vol 19 (2) ◽

pp. 31-40

Author(s):

Zaid T Yaseen ◽

◽

Jalil I Alezzi ◽

Suad M Khaleel

Keyword(s):

Exchange Transfusion ◽

Serum Bilirubin ◽

Daily Practice ◽

Cross Sectional Study ◽

Total Serum Bilirubin ◽

Total Serum ◽

Term Infants ◽

Cross Sectional ◽

Unconjugated Hyperbilirubinemia ◽

Abo Incompatibility

Background: Neonatal jaundice is a common problem with a lot of faults that may happen during its management. Objective:To study the epidemiological features of the unconjugated hyperbilirubinemia(UHB)in Diyala Governorate and discuss the proper lines of therapy, as well as to discuss the daily practice adopted in our hospital, and its complications. Patients and Methods: A cross-sectional study included 100 neonates (term and preterm babies) with unconjugated hyperbilirubinemia aged 0-7 days who were admitted to the Al-Batool Teaching Hospital in Baqubah, Iraq, from 1st February 2018 to the 1st November 2018. Term infants with total serum bilirubin (TSB) ≥ 22mg/dL were treated with exchange transfusion and phototherapy (Group A, 44 neonates). Those with total serum bilirubin levels from 13-<22mg/dL were treated with phototherapy only (Group B, 56 neonates). These decisions were made according to the TSB level and risk factors. Results: Forty-eight percent of neonates had hemolytic causes (Rh-isoimmunization 13%; ABO-incompatibility 10%; G6PD-deficiency 25%). Other include: sepsis 8%; prematurity 33%; congenital CMV infection 1%; and there were 10% had no evidence of hemolysis or other serious problems. The mortality rate was 3.8% of those who had an exchange transfusion. Conclusion: The decision of kind of treatment is dependent on the underlying etiology of unconjugated hyperbilirubinemia. Keywords: Unconjugated hyperbilirubinemia, Neonates, complications

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Exchange Transfusion: Indication and Adverse Effect

Bangladesh Journal of Child Health ◽

10.3329/bjch.v36i1.13029 ◽

2012 ◽

Vol 36 (1) ◽

pp. 16-19 ◽

Cited By ~ 2

Author(s):

Suraiya Begum ◽

Md Abdul Baki ◽

Gopen Kundu ◽

Imnul Islam ◽

Manik Kumar Talukdar ◽

...

Keyword(s):

Adverse Effect ◽

Adverse Events ◽

Medical Records ◽

Exchange Transfusion ◽

Neonatal Jaundice ◽

Common Complication ◽

Abo Incompatibility ◽

Special Care Baby Unit ◽

Common Causes ◽

Rh Incompatibility

Objective: To determine the indication and complications of exchange transfusion (ET) performed for neonatal hyperbilirubinaemia. Methods: The medical records of infants < 28 days old who required exchange transfusion (ET) due to neonatal jaundice in Special Care Baby Unit (SCABU), BIRDEM hospital from January 2009 to April 2010 were retrospectively reviewed. Results: Exchange transfusion was performed in 30 neonates during the study period. Indications of exchange transfusion were ABO incompatibility (30.0%), Rh incompatibility (13.3%), septicaemia (6.6%) and in majority causes, were unidentified (50%). Most common complication were thrombocytopenia (33.3%) hyperkalaemia (20%), hypocalcaemia (16.7%) Conclusion: Indication of ET was unidentified in majority cases and among identified cases most common causes was ABO incompatibility. Adverse events were common after exchange transfusion.DOI: http://dx.doi.org/10.3329/bjch.v36i1.13029Bangladesh J Child Health 2012; Vol 36 (1): 16-19

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

Journal of Pediatrics Review ◽

10.32598/jpr.8.4.293.3 ◽

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.

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Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia in Neonates from Eastern Part of Nepal

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v41i1.31040 ◽

2021 ◽

Vol 41 (1) ◽

pp. 67-72

Author(s):

Sunil Kumar Yadav ◽

Arun Giri ◽

Bbita Khanal

Keyword(s):

Risk Factors ◽

Gestational Age ◽

Exchange Transfusion ◽

Prospective Observational Study ◽

Neonatal Period ◽

P Value ◽

Abo Incompatibility ◽

Rh Incompatibility ◽

The Mean ◽

One Year

Introduction: Neonatal hyperbilirubinemia continues to be the commonest cause of nursery and NICU admissions and readmissions in the neonatal period worldwide. Although most cases are physiological, toxic levels of un-conjugated bilirubin can lead to acute and chronic bilirubin encephalopathy. Hence, this study aimed to study the risk factors for exchange range hyperbilirubinemia in neonates. Methods: This was a hospital-based prospective observational study conducted in a teaching and referral NICU over a period of one year from July 2019 to August 2020. All neonates with diagnosis of hyperbilirubinemia requiring double volume exchange transfusion were included in the study. Risk factors for significant hyperbilirubinemia were analysed with descriptive statistics. P-value of < 0.05 was considered significant wherever applicable. Results: The mean gestational age and birth weight were 38.06 ± 2.13wks and 2611.72 ± 389.39 gm respectively. Fifteen percent of the babies (162) developed hyperbilirubinemia and 28 (17.3%) required double volume exchange transfusion. Among neonates requiring exchange transfusion, 17 were females and 11 were males. Among 28 babies who required DVET, 20 (71.4%) were SGA. ABO incompatibility was present in 14 (50.0%) neonates and Rh incompatibility in 13 (46.4%) neonates. ABO along with Rh incompatibility was present in eight (28.6%) neonates. DCT was positive in six neonates with ABO incompatibility and nine neonates in Rh incompatibility. G6PD deficiency was present in four (14.3%) neonates. Conclusions: The most important risk factors identified were small for gestational age, ABO and Rh incompatibility followed by oxytocin use and sibling treated for jaundice.

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A Study of Neonatal Hyperbilirubinemia in Mid-Western Part of Nepal

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v15i2.22843 ◽

2017 ◽

Vol 15 (2) ◽

pp. 41-43 ◽

Cited By ~ 1

Author(s):

K.M. Roma ◽

Piush Kanodia ◽

Manita Pyakurel ◽

Veena Gupta

Keyword(s):

Neonatal Jaundice ◽

Hospital Admissions ◽

Serum Bilirubin ◽

Study Data ◽

Neonatal Hyperbilirubinemia ◽

Treatment Modalities ◽

Total Serum ◽

Common Cause ◽

Abo Incompatibility ◽

Satisfactory Outcome

Introduction: Neonatal hyperbilirubinemia is a common cause of hospital admissions. Serum Bilirubin depends on birth weight and gestational age. Common causes of neonatal jaundice are physiological jaundice, breast feeding/milk jaundice, prematurity and pathological causes. Surmount total serum bilirubin over critical level, crosses the blood brain barrier leading to kernicterus. Prompt identification and proper management is of great importance otherwise there is a risk of bilirubin encephalopathy. Objectives: To find out the prevalence and causes of neonatal jaundice in our setting and treatment modalities undertaken. Materials and methods: A hospital based descriptive study was done among total newborns including both inborn and out born admitted in NICU, NGMC over the period of one year. A total 288 newborns with jaundice were enrolled in the study .Data were entered in excel and th analyzed in SPSS 18 version. Descriptive data were presented through pie, bar graph, and table with frequency and percentage. Results: Prevalence of neonatal jaundice was 31%. Causes of neonatal jaundice were physiological and pathological in 56% and 44% cases respectively. Among the pathological causes ABO incompatibility was the most common cause seen in 11.4% cases followed by sepsis seen in 8.7% cases. Conclusions: Phototherapy is very effective treatment modality to reduce the serum bilirubin in most of the cases neonatal hyperbilirubinemia and if the bilirubin crosses the cut off limit according to Bhutani's chart then we have to consider exchange transfusion. Appropriate management in time leads to satisfactory outcome.

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