Frequency of Different Causes of Hyperbilirubinemia in Neonates Admitted to NICU in Hazrat Ali Asghar Hospital in 1396

Background: Approximately 60% of term and 80% of pre-term neonates experience some degree of jaundice, especially in the first week of life. Although it is almost benign but if it is severe enough and untreated, jaundice can cause permanent complications like kern icterus. Common causes for neonatal hyperbilirubinemia are breast milk, breast feed jaundice, idiopathic jaundice, sepsis, ABO and Rh incompatibilities, hemolysis, G6PD deficiency, hypothyroidisim, maternal diabetes and some other conditions. In this study we determine the Frequency of Different Causes of Hyperbilirubinemia in Neonates Admitted to NICU in Hazrat Ali Asghar Hospital in 1396. Methods: In This descriptive cross sectional study, the baseline information of 190 patients was collected from their medical records in the archive of the Ali Asghar hospital from April 2017 to February 2018. All of the neonates who were diagnosed by hyperbilirubinemia and hospitalized in NICU department entered in this study except those who had congenital anomalies, gastrointestinal obstruction, and biliary atresia. The status of kern icterus, ABO and Rh compatibility, sepsis, breast milk jaundice, G6PD deficiency, maternal DM, hypothyroidism were evaluated and then analysed by SPSS V.20. T-test used for mean bilirubin levels between NVD and C/S and ANOVA test used for comparison between 9 groups. The study was approved by ethics committee in this center. Findings: Among 190 patients, 117 (61.6%) were male and 73 (38.4%) were female. The most frequent causes of icter were: 68 (35.8%) idiopathic, 31 (16.3%) ABO compatibility, 1 (0.5%) Rh compatibility, 22(11.6%) sepsis, 30 (15.8%) breast milk jaundice, 25 (13.2%) breast feed jaundice, 3(1.6%) maternal DM, 2 (1.1%) hypothyroidism, and 8 (4.2%) G6PD deficiency. Mean total bilirubin level was 16.84 mg/ml (SD=3.74). 135 cases (71.1%) were born by caesarian section (C/S) and 55 (28.9%) were born by normal vaginal delivery (NVD). Mean bilirubin level was significantly higher in NVD than C/S (p=0.016). Mean hospitalization was significantly longer in sepsis than other diagnosis (p=0.0001. There was no difference in bilirubin level between two genders (p= 0.111). Mean bilirubin level was significantly higher in term neonates than pre term ones (p=0.001). Conclusion: According to the high prevalence of neonatal icter and the possibility of permanent complication, rapid survey of affected neonates, assessing the bilirubin level by LAB facilities and rapid treatment according to present guidelines is advocated. Improvement of LAB techniques in IRAN can result in identifying common causes like Gilbert syndrome that currently are classified as idiopathic hyperbilirubinemia. Moreover, we think that C/S adversely affect the bilirubin levels in neonates and in cases of ABO incompatibility especially when delivery route is vaginal, newborns should be visited soon again after early discharge from hospital. We also advise sepsis workup in symptomatic infants especially in the first days of birth.

Keywords:

hyperbilirubinemia , neonate , G6PD deficiency , jaundice , Gilbert syndrome , sepsis