Ali Bülbül, Füsun Okan, Sinan Uslu, Emre İşçi, Asiye Nuhoğlu

Term bebeklerde hiperbilirübineminin klinik özellikleri ve risk etmenlerinin araştırılması Orijinal Araştırma

Amaç: Çalışmada hiperbilirübinemili sağlıklı yenidoğanların klinik özellikleri ve hiperbilirübinemi açısından risk etmenlerinin belirlenmesi amaçlandı Gereç ve Yöntem: Şişli Etfal Hastanesi Yenidoğan Kliniğinde 2000 ile 2003 yılları arasında hiperbilirübinemi tanısı ile yatırılan sağlıklı term 427 bebeğin dosyaları geriye dönük olarak incelendi Hemolitik hastalık enfeksiyon veya başka hastalığı olan bebekler çalışmaya alınmadı Hiperbilirübinemi saptanan hastalara fototerapi başlama ve kan değişimi kararı Amerikan Pediatri Akademisi’nin önerilerine göre alındı Bulgular: Hastaların cinsiyet dağılımı 59 erkek 41 kız; gebelik haftası 38 7±0 7 hafta 38 42 ; doğum ağırlığı 3152±469 g 1990 4600 olarak saptandı Hastaneye yatırıldıklarında vücut ağırlığı 3030 ± 490 g 1740 4450 doğum sonrası yaş 5 8±3 6 gün 2 18 total serum bilirübin değeri 20 1±4 8 mg dl 12 9 36 5 bilirübin düzeyi gt;25 mg dl olan bebek sayısı 21 4 8 idi Hastanede kalış süresi 4 2±3 3 gün 1 8 fototerapi uygulama süresi 29 5±13 7 saat 12 96 idi Bebeklerin hiçbirine kan değişimi yapılmadı Hiperbilirübinemi ilk bebekte ve erkek cinsiyette daha sık görülmekle beraber bu özellikler daha yüksek bilirübin değeri için anlamlı bir risk etmeni değildi Sadece anne sütü ile beslenen bebekler ile vakumla doğan bebeklerin hastaneye yatıştaki bilirübin değerlerinin ortalaması daha yüksek bulundu Aşırı tartı kaybının doğum tartısına göre 10’dan fazla yüksek bilirübin değeri için anlamlı bir risk etmeni olduğu saptandı p: 0 006 Doğum ağırlığı doğum yeri ve doğum şekli sezaryen ve vajinal gibi diğer nedenler ile bilirübin düzeyleri arasındaki ilişki regresyon analizi ile değerlendirildiğinde anlamlı ilişki bulunmadı Çıkarım: Çalışmamız sağlıklı term bebeklerde çok yüksek bilirübin değerlerinin sık olmadığını ancak riskli bebeklerin dikkatle izlenmesi gerektiğini desteklemektedir Yetersiz kalori alımı ve aşırı oranda tartı kaybı yüksek bilirübin değeri gelişimi için anlamlı bir risk etmeni olarak bulunmuştur Anahtar Kelimeler: hiperbilirübinemi risk etmenleri tartı kaybı term yenidoğan

Anahtar Kelimeler:

hiperbilirübinemi, risk etmenleri, tartı kaybı, term yenidoğan

Clinical characteristics of term newborns with hiperbilirubinemia and identification of the risk factors for hiperbilirubinemia Original Article

Objective: The aim of this study was to evaluate the clinical characteristics of newborns with nonhemolytic hiperbilirubinemia and identify the risk factors for hiperbilirubinemia Material and Methods: This study was a retrospective medical chart review The records of 427 full term healthy newborns who were admitted to Şişli Etfal Hospital Neonatology Department from 2000 to 2003 with the diagnosis of hyperbilirübinemia were reviewed Infants with hemolytic diseases infection or other underlying causes were excluded Hyperbilirubinemia was defined and phototherapy was initiated according to the guidelines proposed by the American Academy of Pediatrics Results: The gender mean gestational age and mean birth weight of the infants were 59 male 41 female; 38 7±0 7 weeks and 3152±469 g 1990 4600 respectively At the hospital admission their mean body weight was 3030±490 g 1740 4450 mean postnatal age was 5 8±3 6 days 2 18 and mean total serum bilirubin level was 20 1±4 8 mg dl 12 9–36 5 The lenght of hospital stay was 4 2±3 3 days 1 8 and the duration of exposure to phototherapy was 29 5± 13 7 hours 12 96 None of the babies required exchange transfusion Hyperbilirubinemia was found to be more frequent in the first babies and male gender however there was no significant association with severity of hyperbilirubinemia Infants who were fully breast fed and delivered by vacum extraction had higher bilirubin levels at the hospital admission Excessive weight loss gt;10 of their birth weight was found to be a significant risk factor for developing hyperbilirubinemia p:0 006 Other factors including birth weight place and mode of delivery sectio vs normal vaginal were considered in the regression model but not found to be significantly related to hyperbilirubinemia Conclusion: This study confirms that although severe hyperbilirubinemia is relatively uncommon in healthy full term babies infants at risk must be carefully monitored Poor caloric intake and excessive weight loss have been correlated with an increased risk of hyperbilirubinemia Key words: hyperbilirubinemia risk factors term newborn weight loss

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Huang MJ, Kua KE, Teng HC, Tang KS, Weng HW, Huang CS. Risk factors for severe hyperbilirubinemia in neonates. Pediatr Res 2004; 56: 682- 9.
American Academy of Pediatrics. Provisional committee for quality improvment and subcommittee on hyperbilirubinemia. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics 1994; 94: 558.
Niestijl AL, S auer PJ. Breast feeding during the first few days after birth: sometimes insufficient. Ned Tijdschr Geneeskd 2004; 148: 504- 5.
Giovanna B, Carlo D, Michele T, Firmino FR. Is breastfeeding really favoring early neonatal jaundice ? Pediatrics 2001; 107: 41- 7.
Raskin A, David M, Peksin B, et al. The role of umblical cord alpha fetoprotein as a screening tool for neonatal hyper- bilirubinemia. Am J Perinatol 2004; 21: 93- 8.
Hintz SR, Gaylord TD, Oh W, et al; NICHD, Neonatal Research Netwo rk. Seru m bilirub in leve ls at 72 hours b y sele cted characteristic s in br eastfed and formula-fe d ter m infa nts delivered by cesarean section. Acta Paediatr 2001; 90: 776- 81.
Kalkan I, Heljic S, Dzinovic A, Kurtagic S, Maksic H. Neonatal hyperbilirubinemia: evaluation and treatment. Med Arh 1999; 53: 43- 5.
Alpay F. Sarılık. İçinde: Yurdakök M, Erdem G (yazarlar). Neonatoloji. 1. baskı Ankara: Alp Ofset 2004: 559- 78.
Bertini G, Dani C, Tronchin M, Rubaltelli FF. Is breastfeeding really favoring early neonatal jaundice? Pediatrics 2001; 107: 41- 4.
Bertini G, Dani C, Pezzati M, Rubaltelli FF. Prevention of bilirubin encephalopathy. Biol Neonate 2001; 79: 219- 23.
Ebbesen F, Mortensen BB. Difference in plasma bilirübin concentration between monozygotic and dizygotic newborn twins. Acta Paediatr 2003; 92: 569- 73.
Gartner LM. Breastfeeding and jaundice. J Perinatol 2001; 21: 25- 9.
Huang MJ, Kua KE, Teng HC, Tang KS, Weng HW, Huang CS. Risk factors for severe hyperbilirubinemia in neonates. Pediatr Res 2004; 56: 682- 9. 11. American Academy of Pediatrics. Provisional committee for quality improvment and subcommittee on hyperbilirubinemia. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics 1994; 94: 558.
Niestijl AL, Sauer PJ. Breast feeding during the first few days after birth: sometimes insufficient. Ned Tijdschr Geneeskd 2004; 148: 504- 5.
Giovanna B, Carlo D, Michele T, Firmino FR. Is breastfeeding really favoring early neonatal jaundice ? Pediatrics 2001; 107: 41- 7.
Raskin A, David M, Peksin B, et al. The role of umblical cord alpha fetoprotein as a screening tool for neonatal hyper- bilirubinemia. Am J Perinatol 2004; 21: 93- 8.
Hintz SR, Gaylord TD, Oh W, et al; NICHD, Neonatal Research Network. Serum bilirubin levels at 72 hours by selected characteristics in breastfed and formula-fed term infants delivered by cesarean section. Acta Paediatr 2001; 90: 776- 81.
Kalkan I, Heljic S, Dzinovic A, Kurtagic S, Maksic H. Neonatal hyperbilirubinemia: evaluation and treatment. Med Arh 1999; 53: 43- 5.
Alpay F. Sarılık. İçinde: Yurdakök M, Erdem G (yazarlar). Neonatoloji. 1. baskı Ankara: Alp Ofset 2004: 559- 78.
Bertini G, Dani C, Tronchin M, Rubaltelli FF. Is breastfeeding really favoring early neonatal jaundice? Pediatrics 2001; 107: 41- 4.
Bertini G, Dani C, Pezzati M, Rubaltelli FF. Prevention of bilirubin encephalopathy. Biol Neonate 2001; 79: 219- 23.
Ebbesen F, Mortensen BB. Difference in plasma bilirübin concentration between monozygotic and dizygotic newborn twins. Acta Paediatr 2003; 92: 569- 73.
Gartner LM. Breastfeeding and jaundice. J Perinatol 2001; 21: 25- 9.
Schneider AP: Breast Milk Jaundice in the newborn. JAMA 1986; 255: 3270- 4.
Tan KL. Decreased response to phototherapy for neonatal jaundice in breast-fed infants. Arch Pediatr Adolesc Med 1998; 152: 1187- 90. 1.
Maisels MJ, Kring EA. Length of stay, jaundice and hospital
readmission. Pediatrics 1998; 101: 995- 9. 2.
Madam A, MacMahon JR, Stevenson DK. Neonatal Hyper
bilirubinemia. In: HW Taeusch, Ballard RA, Gleason CA
(eds). Avery’s Diseases of Newborn. 8th ed. Philadelphia:
Elsevıer Saunders, 2005: 1226- 9. 3.
Ip S, Chung M, Kulig J, et al and Subcommittee on Hyper
bilirubinemia. An evidence-based review of important issues
Huang MJ, Kua KE, Teng HC, Tang KS, Weng HW, Huang CS. Risk factors for severe hyperbilirubinemia in neonates. Pediatr Res 2004; 56: 682- 9.
American Academy of Pediatrics. Provisional committee for quality improvment and subcommittee on hyperbilirubinemia. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics 1994; 94: 558.
Niestijl AL, Sauer PJ. Breast feeding during the first few days after birth: sometimes insufficient. Ned Tijdschr Geneeskd 2004; 148: 504- 5.
Giovanna B, Carlo D, Michele T, Firmino FR. Is breastfeeding really favoring early neonatal jaundice ? Pediatrics 2001; 107: 41- 7.
Raskin A, David M, Peksin B, et al. The role of umblical cord alpha fetoprotein as a screening tool for neonatal hyper- bilirubinemia. Am J Perinatol 2004; 21: 93- 8.
Hintz SR, Gaylord TD, Oh W, et al; NICHD, Neonatal Research Network. Serum bilirubin levels at 72 hours by selected characteristics in breastfed and formula-fed term infants delivered by cesarean section. Acta Paediatr 2001; 90: 776- 81.
Kalkan I, Heljic S, Dzinovic A, Kurtagic S, Maksic H. Neonatal hyperbilirubinemia: evaluation and treatment. Med Arh 1999; 53: 43- 5.
Alpay F. Sarılık. İçinde: Yurdakök M, Erdem G (yazarlar). Neonatoloji. 1. baskı Ankara: Alp Ofset 2004: 559- 78.
Bertini G, Dani C, Tronchin M, Rubaltelli FF. Is breastfeeding really favoring early neonatal jaundice? Pediatrics 2001; 107: 41- 4.
Bertini G, Dani C, Pezzati M, Rubaltelli FF. Prevention of bilirubin encephalopathy. Biol Neonate 2001; 79: 219- 23.
Ebbesen F, Mortensen BB. Difference in plasma bilirübin concentration between monozygotic and dizygotic newborn twins. Acta Paediatr 2003; 92: 569- 73.
Gartner LM. Breastfeeding and jaundice. J Perinatol 2001; 21: 25- 9.
Schneider AP: Breast Milk Jaundice in the newborn. JAMA 1986; 255: 3270- 4. Tan KL. Decreased response to phototherapy for neonatal jaundice in breast-fed infants. Arch Pediatr Adolesc Med 1998; 152: 1187- 90. 1.
Maisels MJ, Kring EA. Length of stay, jaundice and hospital
readmission. Pediatrics 1998; 101: 995- 9. 2.
Madam A, MacMahon JR, Stevenson DK. Neonatal Hyper
bilirubinemia. In: HW Taeusch, Ballard RA, Gleason CA
(eds). Avery’s Diseases of Newborn. 8th ed. Philadelphia:
Elsevıer Saunders, 2005: 1226- 9. 3.
Ip S, Chung M, Kulig J, et al and Subcommittee on Hyper
bilirubinemia. An evidence-based review of important issues
Huang MJ, Kua KE, Teng HC, Tang KS, Weng HW, Huang CS. Risk factors for severe hyperbilirubinemia in neonates. Pediatr Res 2004; 56: 682- 9.
American Academy of Pediatrics. Provisional committee for quality improvment and subcommittee on hyperbilirubinemia. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics 1994; 94: 558.
Niestijl AL, S auer PJ. Breast feeding during the first few days after birth: sometimes insufficient. Ned Tijdschr Geneeskd 2004; 148: 504- 5.
Giovanna B, Carlo D, Michele T, Firmino FR. Is breastfeeding really favoring early neonatal jaundice ? Pediatrics 2001; 107: 41- 7.
Raskin A, David M, Peksin B, et al. The role of umblical cord alpha fetoprotein as a screening tool for neonatal hyper- bilirubinemia. Am J Perinatol 2004; 21: 93- 8.
Hintz SR, Gaylord TD, Oh W, et al; NICHD, Neonatal Research Netwo rk. Seru m bilirub in leve ls at 72 hours b y sele cted characteristic s in br eastfed and formula-fe d ter m infa nts delivered by cesarean section. Acta Paediatr 2001; 90: 776- 81.
Kalkan I, Heljic S, Dzinovic A, Kurtagic S, Maksic H. Neonatal hyperbilirubinemia: evaluation and treatment. Med Arh 1999; 53: 43- 5.
Alpay F. Sarılık. İçinde: Yurdakök M, Erdem G (yazarlar). Neonatoloji. 1. baskı Ankara: Alp Ofset 2004: 559- 78.
Bertini G, Dani C, Tronchin M, Rubaltelli FF. Is breastfeeding really favoring early neonatal jaundice? Pediatrics 2001; 107: 41- 4.
Bertini G, Dani C, Pezzati M, Rubaltelli FF. Prevention of bilirubin encephalopathy. Biol Neonate 2001; 79: 219- 23.
Ebbesen F, Mortensen BB. Difference in plasma bilirübin concentration between monozygotic and dizygotic newborn twins. Acta Paediatr 2003; 92: 569- 73.
Gartner LM. Breastfeeding and jaundice. J Perinatol 2001; 21: 25- 9.
Schneider AP: Breast Milk Jaundice in the newborn. JAMA 1986; 255: 3270- 4. Tan KL. Decreased response to phototherapy for neonatal jaundice in breast-fed infants. Arch Pediatr Adolesc Med 1998; 152: 1187- 90.