Severe Neonatal Hyperbilirubinemia; Causes and Contributing Factors Leading to Exchange Transfusion at Ghaem Hospital in Mashhad

  • Farhad Heydarian Department of Pediatrics, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Mina Majdi Department of Pediatrics, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Keywords: Hyperbilirubinemia, exchange transfusion, whole blood, kernicterus, blood group incompatibility

Abstract

Hyperbilirubinemia is common in neonates; it can have a serious rising course. Due to its critical morbidity called "kernicterus", severe neonatal hyperbilirubinemia causes which lead to exchange transfusion, should be clarified. This descriptive cross sectional study performed with reviewing of files of 118 neonates weighting 2kg and more who had exchange transfusion in pediatrics ward at Ghaem training hospital in Mashhad from April 2004 to March 2007. Among 118 patients, 75 (63.6%) were male, and 43 patients (36.4%) were female. The most common cause of exchange transfusion was ABO incompatibility (38.1%). In order of frequency, unknown etiology (25.4%), Rh incompatibility (16.1%) with no immune hydrops, Sepsis(8.5%), urinary tract infection (5.1%) and others (3.4%) (Including Crigler-Najjar and cephalohematoma) were next ones. Vaginal delivery and exclusive breast feeding were detected as associated factors. Mean serum bilirubin levels was 28.7 mg/dl (SD. 9.2) ABO incompatibility. ABO incompatibility was the main cause of exchange transfusion. Male gender, vaginal delivery and exclusive breast feeding were seen more among patients who need to be exchanged. So in case of ABO incompatibility especially when delivery route is vaginal, newborns should be visited soon again after early discharge from hospital.

References

Porter ML, Dennis BL. Hyperbilirubinemia in the term

Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. CMAJ 2006;175(6):587-90.

Narang A, Gathwala G, Kumar P. Neonatal jaundice: an analysis of 551 cases. Indian Pediatr 1997;34(5):429-32.

Badiee Z. Exchange transfusion in neonatal hyperbilirubinaemia: experience in Isfahan, Iran. Singapore Med J 2007;48(5):421-3.

Koosha A, Rafizadeh B. Evaluation of neonatal indirect hyperbilirubinaemia at Zanjan Province of Iran in 2001- 2003: prevalence of glucose-6-phosphate dehydrogenase deficiency. Singapore Med J 2007;48(5):424-8.

Sanpavat S. Exchange transfusion and its morbidity in tenyear period at King Chulalongkorn Hospital. J Med Assoc Thai 2005;88(5):588-92.

Martin TC, Shea M, Alexander D, Bradbury L, Lovell- Roberts L, Francis V. Did exclusive breast-feeding and early discharge lead to excessive bilirubin levels in newborns in Antigua and Barbuda? West Indian Med J 2002;51(2):84-8.

Arif MA. Neonatal jaundice in Pakistan. J Trop Pediatr 1984;30(4):213-6.

Dzinović A, Heljić S, Maksić H, Hrnjić Z. Neonatal hyperbilirubinemia: evaluation and treatment. Med Arh 2002;56(3 Suppl 1):44-5.

Tamook A, Salehzadeh F, Aminisani N, Moghaddam yeganeh J. Etiology of Neonatal Hyperbilirubinemia at Ardabil Sabalan Hospital, 2003. J Ardebil Uni Med Sci 2006;5(4):316-20.

Manning D, Todd P, Maxwell M, Jane Platt M. Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland. Arch Dis Child Fetal Neonatal Ed 2007;92(5):F342-6.

Abu-Ekteish F, Daoud A, Rimawi H, Kakish K, Abu-Heija A. Neonatal exchange transfusion: a Jordanian experience. Ann Trop Paediatr 2000;20(1):57-60.

Newman TB, Liljestrand P, Escobar GJ. Infants with bilirubin levels of 30 mg/dL or more in a large managed care organization. Pediatrics 2003;111(6 Pt 1):1303-11. Ebbesen F, Andersson C, Verder H, Grytter C, Pedersen- Bjergaard L, Petersen JR, et al. Extreme hyperbilirubinaemia in term and near-term infants in Denmark. Acta Paediatr 2005;94(1):59-64.

Salas AA, Mazzi E. Exchange transfusion in infants with extreme hyperbilirubinemia: an experience from a developing country. Acta Paediatr 2008;97(6):754-8.

Maisels MJ, Newman TB. Kernicterus in otherwise healthy, breast-fed term newborns. Pediatrics 1995;96(4 Pt 1):730-3.

Ebbesen F. Recurrence of kernicterus in term and nearterm infants in Denmark. Acta Paediatr 2000;89(10):1213-7.

Johnson LH, Bhutani VK, Brown AK. System-based approach to management of neonatal jaundice and prevention of kernicterus. J Pediatr 2002;140(4):396-403.

Bhutani VK, Johnson LH, Jeffrey Maisels M, Newman TB, Phibbs C, Stark AR, et al. Kernicterus: epidemiological strategies for its prevention through systems-based approaches. J Perinatol 2004;24(10):650-62.

Newman TB, Liljestrand P, Jeremy RJ, Ferriero DM, Wu YW, Hudes ES, et al. Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more. N Engl J Med 2006;354(18):1889-900.

How to Cite
1.
Heydarian F, Majdi M. Severe Neonatal Hyperbilirubinemia; Causes and Contributing Factors Leading to Exchange Transfusion at Ghaem Hospital in Mashhad. Acta Med Iran. (No. 6):399-402.
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