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.

Study of clinical spectrum of hyperbilirubinemia with frequency of glucose six phosphate dehydrogenase deficiency in neonates

Background: Jaundice is defined as visible reflexion of serum hyperbilirubinemia on mucous membranes and skin as yellowish discoloration. The frequency of icterus among neonates is about 1 in 2500-5000 live births. When there is disparity between the production of bilirubin, conversion from unconjugated to conjugated bilirubin and excretion of bilirubin results in jaundice. Unconjugated bilirubin is usually harmless but it can also cross blood-brain barrier causing neurotoxicity or kernicterus.Methods: A hospital based prospective observational study which is carried out in the department of paediatrics of Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh from December 2019 to November 2020 on 74 neonates who required admission for hyperbilirubinemia.Results: The most common jaundice occurred in neonates were idiopathic or breastfeeding jaundice as the neonates were breast fed (47.29%). The second most common cause was ABO incompatibility leading to jaundice in 27 (36.48%) neonates. Incidence of neonatal Sepsis, G6PD deficiency, hypothyroidism and cephalhematoma was 22.9%, 4.1%, 2.70% and 4.1% respectively. Polycythemia contributed to 1.35% and the frequency of hyperbilirubinemia in infants of diabetic mother’s or GDM was 10.8%. Rh incompatibility was seen in 13.5%.Conclusions: G6PD deficiency is a significant cause for NNHB and the cases with pathological jaundice if left untreated may lead to severe neurological deficits and lifelong disabilities, hearing impairment, mental retardation, seizures and movement disorders. Hence we recommend G6PD screening in every newborn with significant hyperbilirubinemia to reduce morbidity and mortality.

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

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.

INCIDENCE AND CAUSES OF NEONATAL JAUNDICE IN A POPULATION OF NORTH EAST INDIA

Background: Neonatal jaundice is a common cause of mortality and morbidity in newborn babies and account for up to 60% cases in term and 80% in preterm babies. Studies from different geographical areas should be done to know the causes of hyperbirubinemia properly so that a collective effort can be made to decrease the burden mortality and morbidity associated with it Objectives:To study the incidence and causes of neonatal jaundice in babies admitted in the hospital Methods: It was a hospital based observational study conducted in one of the busiest hospitals of Jorhat over a period of 12 months. Incidence and causes of neonatal jaundice in the babies born in the hospital during the study period were studied. Results: 710 newborns delivered during the study period out of which 439 (61.8%) newborns developed clinical jaundice. 290 (66%) newborns had physiological jaundice and the rest 149 (34%) developed pathological jaundice. Among the 149 babies developing pathological jaundice 87(58.3%) were males and 62(41.6%) were females. Most common cause was ABO incompability(31%) of cases, second was breast feeding jaundice (28%) , third was prematurity (12%) .Other causes were cephalohematoma(1.3%), Rh incompatibility(3.3%) , G6PD deciency(8%), sepsis(4.7%) and in 11.4% babies no denite cause was found. Conclusion: Adequate feeding, preventing premature deliveries, good monitoring of babies with ABO incompability, prematurity, Rh incompability, G6PD deciency can decrease the mortality and morbidity associated with neonatal jaundice.

Neonatal Hyperbilirubinemia treatment by Locally Made Low-Cost Phototherapy Units

BACKGROUND፡ Hyperbilirubinemia is a very common finding in neonates and may occasionally cause severe morbidity and even mortality. Severe hyperbilirubinemia is typically treated, either with phototherapy or exchange transfusions. This study assessed the effectiveness of a locally manufactured phototherapy device for reducing serum bilirubin in neonates with severe hyperbilirubinemia.METHODS: Retrospective chart review was carried out to assess the outcome of 32 infants who were treated for neonatal hyperbilirubinemia at Jimma Medical Center (JMC) from May, 2017 to April, 2018. RESULTS: Out of 75 charts reviewed, only 32 had subsequent bilirubin level determination, 18(56.3%) of them were males. The age at which jaundice was noticed and confirmed with plasma bilirubin level was 4 + 2.7 days (mean+SD). Sepsis was thought to be the cause of hyperbilirubinemia in 13(40.5%) of the cases, while hemolysis from ABO incompatibility or RH incompatibility contributed in 5(15.6%) and 3(9.4) of the infants respectively. The mean (minimum, maximum) level of baseline TSB was 21.4(14, 55) mg/dL. Five infants (15.6%) had exchange transfusions because of extreme hyperbilirubinemia. The duration of phototherapy and decline in TSB were 5.34 +2.8 days and 2.2+1.5mg/dl/day (mean+SD) respectively. The levels of TSB before and at the end of phototherapy were significantly different (p<0.001).CONCLUSION: Acceptable reduction of TSB was achieved by using locally manufactured PT devices. Benefits included better accessibility and lower price and maintenance costs. High mean baseline TSB was observed, and duration of phototherapy is prolonged which could indicate late diagnosis compared to similar studies.

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

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.

Clinical profile and aetiological factors of neonatal jaundice from a rural area of Kutch, Gujarat, India

Background: Etiology of hyperbilirubinemia is not only crucial for optimal management of the patient but also it may have implications for subsequent pregnancies. The objective of this study was to study the clinical profile and the underlying aetiological factors leading to neonatal jaundice in this rural setting of Kutch District, Gujarat, India.Methods: This prospective observational study was conducted in the neonatal intensive care unit (NICU) and Post Natal ward Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. Total of 150 cases were enrolled for the study. Blood grouping and Rh typing of baby and mother were done. Cord blood bilirubin and haemoglobin, direct coomb's test (DCT) and bilirubin monitoring were done whenever there was a setting for Rh incompatibility.Results: Among 150 neonates studied, majority had birth weight between 2501g and 3000g. Only 21 babies had birth weight <2.5kg (14%) (Table 2). Of the 150 neonates 85 were males and 65 were females.Conclusions: This study concludes that physiological jaundice is the most common cause of neonatal jaundice in our hospital. This is followed by ABO incompatibility, sepsis, Rh incompatibility and idiopathic cases.