Özlem BOZKURT, Ebru YÜCESOY, Baran OĞUZ, Ömür AKINEL, Mehmet Fatih PALALI, Nurgül ATAŞ

Severe neonatal hyperbilirubinemia in the southeast region of Turkey

Background/aim: Severe neonatal hyperbilirubinemia is an important cause of morbidity and mortality in developing countries. The aim was to assess etiologic reasons for development of severe hyperbilirubinemia and define risk factors for exchange transfusion and acute bilirubin encephalopathy (ABE) in Şanlıurfa located in the southeast region of Turkey.Materials and methods: An observational cohort study included 115 infants with ≥35 weeks of gestation admitted with diagnosis of severe hyperbilirubinemia in a period of 18 months. Potential risk factors associated with exchange transfusion and development of ABE were analyzed.Results: Among 115 infants, 67 (58.3%) received exchange transfusion and 45 (39.1%) developed ABE. Rh isoimmunization (OR: 24.6, 95% CI = 2.2-271, P = 0.009), glucose-6-phosphate dehydrogenase deficiency (G6PD) (OR: 21.1, 95% CI = 1.8-238.4, P = 0.01), early discharge (OR: 14.4, 95% CI = 4.2-48.9, P ≤ 0.001), and male sex (OR: 4.3, 95% CI = 1.3-14.1, P = 0.02) were independently associated with an increased risk for exchange transfusion. Being a refugee (OR: 6.8, 95% CI = 1.8-25.8, P = 0.005) and G6PD deficiency (OR: 9.9, 95% CI = 1.3-71.9, P = 0.02) were associated with development of ABE.Conclusion: Early discharge, Rh isoimmunization, and G6PD deficiency are significant risk factors for severe hyperbilirubinemia and exchange transfusion. Prevention of early hospital discharges, family education to increase awareness for hazardous effects of hyperbilirubinemia, and early follow-up visits after discharge would reduce the disease burden.

Keywords:

Neonatal hyperbilirubinemia; exchange transfusion; bilirubin encephalopathy; neurotoxicity, glucose-6-phosphate dehydrogenase deficiency,

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1. Burke BL, Robbins JM, Bird TM, Hobbs CA, Nesmith C et al. Trends in hospitalizations for neonatal jaundice and kernicterus in the United States, 1988-2005. Pediatrics 2009; 123 (2): 524-532.
2. Battersby C, Michaelides S, Upton M, Rennie JM; Jaundice Working Group of the Atain. Term admissions to neonatal units in England: a role for transitional care? a retrospective cohort study. British Medical Journal Open 2017; 7 (5): e016050.
3. Maisels MJ, Newman TB. Kernicterus in otherwise healthy, breast-fed term newborns. Pediatrics 1995; 96 (4 Pt 1): 730- 733.
4. Hansen TW. Mechanisms of bilirubin toxicity: clinical implications. Canadian Medical Association Journal 2006; 175 (6): 587-590.
5. Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. Clinics in Perinatology 2002; 29 (4): 765-778.
6. Kaplan M, Bromiker R, Hammerman C. Severe neonatal hyperbilirubinemia and kernicterus: are these still problems in the third millennium? Neonatology 2011; 100 (4): 354-362.
7. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114 (1): 297-316.
8. Bhutani VK, Vilms RJ, Hamerman-Johnson L. Universal bilirubin screening for severe neonatal hyperbilirubinemia. Journal of Perinatology 2010; 30 (Suppl.): S6-15.
9. Johnson L, Bhutani VK, Karp K, Sivieri EM, Shapiro SM. Clinical report from the pilot USA Kernicterus Registry (1992 to 2004). Journal of Perinatology 2009; 29 (Suppl. 1): S25-45.
10. Manning D, Todd P, Maxwell M, Platt MJ. Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland. Archives of Disease in Childhood Fetal and Neonatal Edition 2007; 92 (5): F342-346.
11. Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. Canadian Medical Association Journal 2006; 175 (6): 587-590.
12. Gamaleldin R, Iskander I, Seoud I, Aboraya H, Aravkin A et al. Risk factors for neurotoxicity in newborns with severe neonatal hyperbilirubinemia. Pediatrics 2011; 128 (4): e925-931.
13. Hameed NN, Na’ Ma AM, Vilms R, Bhutani VK. Severe neonatal hyperbilirubinemia and adverse short-term consequences in Baghdad, Iraq. Neonatology 2011; 100 (1): 57-63.
14. Iskander I, Gamaleldin R, El Houchi S, El Shenawy A, Seoud I et al. Serum bilirubin and bilirubin/albumin ratio as predictors of bilirubin encephalopathy. Pediatrics 2014; 134 (5): e1330-1339.
15. Greco C, Arnolda G, Boo NY, Iskander IF, Okolo AA et al. Neonatal jaundice in low- and middle-income countries: lessons and future directions from the 2015 Don Ostrow Trieste Yellow Retreat. Neonatology 2016; 110 (3): 172-180.
16. Erdeve O, Okulu E, Olukman O, Ulubas D, Buyukkale G et al. The Turkish Neonatal Jaundice Online Registry: a national root cause analysis. PLoS One 2018; 13 (2): e0193108.
17. Johnson L, Brown AK, Bhutani V. BIND: A clinical score for bilirubin induced neurological dysfunction in newborns. Pediatrics 1999; 104 (Suppl. 4): 746-747.
18. Bjerre JV, Petersen JR, Ebbesen F. Surveillance of extreme hyperbilirubinaemia in Denmark. A method to identify the newborn infants. Acta Paediatrica 2008; 97: 1030-1034.
19. Zoubir S, Mieth RA, Berrut S, Roth-Kleiner M. Swiss Paediatric Surveillance Unit: Incidence of severe hyperbilirubinaemia in Switzerland: a nationwide population-based prospective study. Archives of Disease in Childhood Fetal and Neonatal Edition 2011; 96: F310-F311.
20. Olusanya BO, Osibanjo FB, Mabogunje CA, Slusher TM, Olowe SA. The burden and management of neonatal jaundice in Nigeria: a scoping review of the literature. Nigerian Journal of Clinical Practice 2016; 19 (1): 1-17.
21. Özmert E, Erdem G, Topçu M, Yurdakök M, Tekinalp G et al. Long-term follow-up of indirect hyperbilirubinemia in fullterm Turkish infants. Acta Paediatrica 1996; 85: 1440-1444.
22. Newman TB, Liljestrand P, Jeremy RJ, Ferriero DM, Wu YW et al. Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more. New England Journal of Medicine 2006; 354: 1889-1900.
23. Kuzniewicz M, Newman TB. Interaction of hemolysis and hyperbilirubinemia on neurodevelopmental outcomes in the collaborative perinatal project. Pediatrics 2009; 123: 1045-1050.
24. Bhutani VK, Zipursky A, Blencowe H, Khanna R, Sgro M et al. Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatric Research 2013; 74 (Suppl. 1): 86-100.
25. Valaes T. Severe neonatal jaundice associated with glucose-6- phosphate dehydrogenase deficiency: pathogenesis and global epidemiology. Acta Paediatrica Supplement 1994; 394: 58-76.
26. Kaplan M, Hammerman C. Glucose-6-phosphate dehydrogenase deficiency: a potential source of severe neonatal hyperbilirubinaemia and kernicterus. Seminars in Neonatology 2002; 7 (2): 121-128.
27. Kilicdag H, Gökmen Z, Ozkiraz S, Gulcan H, Tarcan A. Is it accurate to separate glucose-6-phosphate dehydrogenase activity in neonatal hyperbilirubinemia as deficient and normal? Pediatrics and Neonatology 2014; 55 (3): 202-207.
28. Farhat R, Rajab M. Length of postnatal hospital stay in healthy newborns and re-hospitalization following early discharge. North American Journal of Medical Sciences 2011; 3 (3): 146- 151.
29. Bayoumi YA, Bassiouny YA, Hassan AA, Gouda HM, Zaki SS et al. Is there a difference in the maternal and neonatal outcomes between patients discharged after 24 h versus 72 h following cesarean section? A prospective randomized observational study on 2998 patients. Journal of Maternal Fetal and Neonatal Medicine 2016; 29 (8): 1339-1343.
30. Lee KS, Perlman M, Ballantyne M, Elliott I, To T. Association between duration of neonatal hospital stay and readmission rate. Journal of Pediatrics 1995; 127 (5): 758-766.
31. Liu S, Wen SW, McMillan D, Trouton K, Fowler D et al. Increased neonatal readmission rate associated with decreased length of hospital stay at birth in Canada. Canadian Journal of Public Health 2000; 91 (1): 46-50.
32. Fetus and Newborn Committee, Canadian Paediatric Society (CPS). Facilitating discharge home following a normal term birth. Paediatrics and Child Health 1996; 1: 165-168.
33. Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 1999; 103 (1): 6-14.
34. Büyüktiryaki M, Canpolat FE, Dizdar EA, Okur N, Simşek GK. Neonatal outcomes of Syrian refugees delivered in a tertiary hospital in Ankara, Turkey. Conflict and Health 2015; 9: 38.
35. Çelik İH, Arslan Z, Ulukbaş Işık D, Tapısız ÖL, Mollamahmutoglu L et al. Neonatal outcomes in Syrian and other refugees treated in a tertiary hospital in Turkey. Turkish Journal of Medical Sciences 2019; 49 (3): 815-820.