Risk Factors Associated with Neonatal Jaundice: A Cross-Sectional Study from Iran
DOI:
https://doi.org/10.3889/oamjms.2018.319Keywords:
Neonatal Jaundice, Predisposing factors, JaundiceAbstract
BACKGROUND: Neonatal jaundice is one of the main causes of the patient's admission in the neonatal period and is potentially linked to morbidity.
AIM: This study aimed to determine the possible risk factors for neonatal jaundice.
METHODS: We investigated the case of infants who were admitted to the neonatal department of Ziyaeian hospital and Imam Khomeini Hospital for jaundice. Simple random sampling was used to evaluate variables related to maternal and neonatal predisposing factors based on the medical records and clinical profiles. All variables in this study were analysed using SPSS software.
RESULTS: In this study, about 200 mothers and neonates were examined. Our findings depicted that mother's WBC, Hb, PLT, and gestational age were associated with jaundice (P < 0.05). Furthermore, there were significant relationships between different degrees of bilirubin with TSH, T4 levels and G6PD (P < 0.05). In fact, TSH, T4 levels and G6PD were found to be linked to neonatal hyperbilirubinemia. The risk factors for jaundice in our study population comprise some predisposing factors such as WBC, Hb, PLT, gestational age, TSH, and T4 levels, as well as G6PD. Neonates at risk of jaundice are linked to some maternal and neonatal factors that can provide necessary interventions to reduce the burden of the disease. Therefore, identification of associated factors can facilitate early diagnosis, and reduce subsequent complications.
CONCLUSION: Neonatal jaundice should be considered as the main policy in all health care settings of the country. Therefore, identification of factors affecting the incidence of jaundice can be effective in preventing susceptible predisposing factors in newborns and high-risk mothers.Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Jardine LA, Woodgate P. Neonatal jaundice. American Family Physician. 2012; 85:824-825
Paul IM, Lehman EB, Hollenbeak CS, Maisels MJ. Preventable newborn readmissions since passage of the Newborns' and Mothers' Health Protection Act. Pediatrics. 2006; 118(6):2349-2358. https://doi.org/10.1542/peds.2006-2043 PMid:17142518
Hall RT, Simon S, Smith MT.Readmission of breastfed infants in the first 2 weeks of life. J Perinatol. 2000; 20(7):432-437. https://doi.org/10.1038/sj.jp.7200418 PMid:11076327
Newman TB, Xiong B, Gonzales VM, Escobar GJ. Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization. Arch Pediatr Adolesc Med. 2000; 154(11):1140–1147. https://doi.org/10.1001/archpedi.154.11.1140 PMid:11074857
Watchko JF. Identification of neonates at risk for hazardous hyperbilirubinemia: emerging clinical insights. Pediatr Clin North Am. 2009; 56(3):671–87. https://doi.org/10.1016/j.pcl.2009.04.005 PMid:19501698
Stoll BJ, Kliegman RM. Jaundice and hyperbilirubinemiain the newborn, Nelson textbook of pediatrics. 18th ed.Philadelphia: Saunders, 2007: 592-598.
Fanaroff AA, Martin RJ. Neonatal-perinatal medicine: diseases of the fetus and infant. 1987.
National Institute for Health and Care Excellence. Neonatal jaundice [homepage on the Internet]. Clinical guideline 98. London: Royal College of Obstetricians and Gynaecologists, 2010 [cited 2016 Jun 15]. Available from: https://www.nice.org.uk/guidance/cg98/evidence/full-guideline-pdf-245411821
Adhikari M, Mackenjee H. Care of the newborn. In: Wittenberg DF, editor. Coovadia's paediatrics and child health. 6th ed. Cape Town, South Africa: Oxford University Press, 2010:129–130
Porter ML, Dennis BL. Hyperbilirubinemia in the term newborn. Am Fam Physician. 2002; 65(4):599–606. PMid:11871676
Kramer LI. Advancement of dermal icterus in the jaundiced newborn. Am J Dis Child. 1969; 118(3):454–458. https://doi.org/10.1001/archpedi.1969.02100040456007
Moyer VA, Ahn C, Sneed S. Accuracy of clinical judgment in neonatal jaundice. Arch Pediatr Adolesc Med. 2000; 154(4):391–394. https://doi.org/10.1001/archpedi.154.4.391 PMid:10768679
Kleigman R, Bonita S, Richard E,Joseph St. Nelson text book of pediatrics.Translation by Nurozi E, Mohammadpor M. and Fallah R. 3rd ed. Tehran: Andisheh Rafi, 2007.
Bradley JS. Nelson's Pediatric Antimicrobial Therapy 22nd Ed. Am Acad Pediatrics, 2016.
Mercier CE, Barry SE, Paul K, Delaney TV, Horbar JD, Wasserman RC, Berry P, Shaw JS. Improving newborn preventive services at the birth hospitalization: a collaborative, hospital-based quality-improvement project. Pediatrics. 2007; 120(3):481-8. https://doi.org/10.1542/peds.2007-0233 PMid:17766519
Sezik M. Does marriage between first cousins have any predictive value for maternal and perinatal outcomes in pre-eclampsia? J Obstet Gynaecol. 2006; 32:481–475. https://doi.org/10.1111/j.1447-0756.2006.00432.x
Javadi T, Mohsen Zadeh A. Examine the causes of jaundice in newborns admitted in Hospital of shahidmadani khoramabad in 2000. J Lorestan Univ Med Sci. 2005; 4:73-8.
Linn S, Schoenbaum SC, Monson RR, Rosner B, Stubblefield PG, Ryan KJ. Epidemiology of neonatal hyperbilirubinemia. Pediatrics. 1985; 75(4):770-4. PMid:3982909
Maisels MJ, Gifford K, Antle CE, Leib GR. Jaundice in the healthy newborn infant: a new approach to an old problem. Pediatrics. 1988; 81(4):505-11. PMid:3353184
Boskabadi H, Maamouri G, Ebrahimi M, Ghayour-Mobarhan M, Esmaeily H, Sahebkar A. Neonatal hypernatremia and dehydration in infants receiving inadequate breastfeeding. Asia Pac J Clin Nutr. 2003; 19:301-307.
Engle W A, Tomashek K M, Wallman C. "Late-preterm"infants: A population at risk. Pediatrics. 2007; 120:1390-1401. https://doi.org/10.1542/peds.2007-2952 PMid:18055691
Zarrinkoub F, Beigi A. Epidemiology of hyperbilirubinemia in the first 24 hours after birth. Tehran University Medical Journal. 2007; 65(6):54-9.
Stoll BJ, Kliegman RM. Jaundice and hyperbilirubinemia in the newborn. Nelson textbook of pediatrics. 19th ed. Philadelphia: WB Saunders, 2011:562-96.
Halamek LP. Neonatal jaundice and liver disease. Neonatal-perinatal medicine: diseases of the fetus and infant, 1997:1345-89.
Facchini FP, Mezzacappa MA, Rosa IR, Mezzacappa Filho F, Aranha Netto A, Marba ST. Follow-up of neonatal jaundice in term and late premature newborns. Jornal de pediatria. 2007; 83(4):313-8. https://doi.org/10.2223/JPED.1676
Boskabadi H, Maamouri GH. Mafinejad Sh. The relationship between traditional supplements' intake (camelthorn, flix weld and glucose water) and idiopathic neonatal jaundice. Iranian Journal of pediatrics, 2011. PMid:23056809 PMCid:PMC3446180
Boskabad H, Maamouri GA, Mafi nejad SH, Rezagholizadeh F. Clinical Course and Prognosis of Hemolytic Jaundice in Neonates in North East of Iran. Macedonian Journal of Medical Sciences. 2011; 4(4):403-407. https://doi.org/10.3889/MJMS.1857-5773.2011.0177
Segel GB. Glucose-6-phosphate dehydrogenase (G-6-PD) and related deficiencies. Nelson textbook of pediatrics. Philadelphia, PA: WB Saunders, 2004:1636-8.
Wood B, Culley PH, Roginski CL, Powell JE, Waterhouse JO. Factors affecting neonatal jaundice. Archives of disease in childhood. 1979; 54(2):111-5. https://doi.org/10.1136/adc.54.2.111 PMid:434885 PMCid:PMC1545363
Diwan VK1, Vaughan TL, Yang CY, Maternal smoking in relation to the incidence of early neonatal jaundice, Gynecol Obstet Invest. 1989; 27(1):22-25. https://doi.org/10.1159/000293609 PMid:2920968
Sarici SU, Serdar MA, Korkmaz A, Erdem G, Oran O, Tekinalp G, et al. Incidence, course, and prediction of hyperbilirubinemia in near-term and term newborns. Pediatrics. 2004; 113(4):775–780. https://doi.org/10.1542/peds.113.4.775 PMid:15060227
Newman TB, Xiong B, Gonzales VM, Escobar GJ. Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization. Arch Pediatr Adolesc Med. 2000; 154(11):1140–1147. https://doi.org/10.1001/archpedi.154.11.1140 PMid:11074857
Darcy AE. Complications of the late preterm infant. J Perinat Neonatal Nurs. 2009; 23(1):78–86. https://doi.org/10.1097/JPN.0b013e31819685b6 PMid:19209064
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. https://doi.org/10.1542/peds.114.1.297 PMid:15231951
Scrafford CG, Mullany LC, Katz J. Incidence and Risk Factors for Neonatal Jaundice among Newborns in Southern Nepal. Tropical medicine & international health : TM & IH. 2013; 18(11):1317-1328. https://doi.org/10.1111/tmi.12189 PMid:24112359 PMCid:PMC5055829
Huang A, Tai BC, Wong LY, Lee J, Yong EL. Differential risk for early breastfeeding jaundice in a multi-ethnic Asian cohort. Ann Acad Med Singapore. 2009; 38(3):217–224. PMid:19347075
Maisels MJ. Neonatal jaundice. Pediatr Rev. 2006; 27(12):443–454. https://doi.org/10.1542/pir.27-12-443 PMid:17142466
Olusanya BO, Osibanjo FB, Slusher TM. Risk Factors for Severe Neonatal Hyperbilirubinemia in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis. Carlo WA, ed. PLoS ONE. 2015; 10(2):e0117229. https://doi.org/10.1371/journal.pone.0117229
Porter ML, Dennis BL. Hyperbilirubinemia in the term newborn. Am Fam Physician. 2002; 65(4):599–606. PMid:11871676
Olusanya BO, Osibanjo FB, Slusher TM. Risk factors for severe neonatal hyperbilirubinemia in low and middle-income countries: A systematic review and meta-analysis. PLoS One. 2015; 10(2):e0117229. https://doi.org/10.1371/journal.pone.0117229 PMid:25675342 PMCid:PMC4326461
Geiger AM, Petitti DB, Yao JF. Rehospitalisation for neonatal jaundice: risk factors and outcomes. Paediatr Perinat Epidemiol. 2001; 15(4):352–358. https://doi.org/10.1046/j.1365-3016.2001.00374.x PMid:11703683
AAP Subcommittee on Neonatal Hyperbilirubinemia. Neonatal jaundice and kernicterus. Pediatrics. 2001; 108(3):763–765. https://doi.org/10.1542/peds.108.3.763 PMid:11533348
Watchko JF. Hyperbilirubinemia and bilirubin toxicity in the late preterm infant. Clin Perinatol. 2006; 33(4):839–852. https://doi.org/10.1016/j.clp.2006.09.002 PMid:17148008
Differential risk for early breastfeeding jaundice in a multi-ethnic Asian cohort. Ann Acad Med Singapore. 2009; 38(3):217–224. PMid:19347075
Boskabad H, Maamouri GA, Mafinejad S, Rezagholizadeh F. Clinical course and prognosis of hemolytic jaundice in neonates in north east of Iran. Maced J Med Sci. 2011; 4(4):403-7. https://doi.org/10.3889/MJMS.1857-5773.2011.0177
Kaplan M, Hammerman C. The need for neonatal glucose-6-phosphate dehydrogenase screening: a global perspective. Journal of Perinatology. 2009; 29(S1):S46. https://doi.org/10.1038/jp.2008.216 PMid:19177059
WHO Working Group. WHO, glucose-6-phosphate dehydrogenase deficiency. Bull World Health Organ. 1981; 67:61–67.
Bhutani VK, Zipursky A, Blencowe H, Khanna R, Sgro M, Ebbesen F, Bell J, Mori R, Slusher TM, Fahmy N, Paul VK. Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatric research. 2013; 74(S1):86. https://doi.org/10.1038/pr.2013.208 PMid:24366465 PMCid:PMC3873706
Boskabadi H, Ashrafzadeh F, Azarkish F, Khakshour A. Complications of Neonatal Jaundice and the Predisposing Factors in Newborns. J Babol Univ Med Sci. 2015; 17:7-13.
Keren R, Bhutani V, Luan X, Nihtianova S, Cnaan A, Schwartz J. Identifying newborns at risk of significant hyperbilirubinaemia: a comparison of two recommended approaches. Arch Dis Child. 2005; 90(4):415-421. https://doi.org/10.1136/adc.2004.060079 PMid:15781937 PMCid:PMC1720335
Mohammad Beigi AAF, Tabatabaee SHR, Yazdani M, Mohammad Salehi N. Gestational diabetes related unpleasant outcomes of pregnancy. Feyz. 2007; 11(1):33-38.
Steiner LA, Gallagher PG. Erythrocyte Disorders in the Perinatal Period in Adverse Pregnancy Outcome and the Fetus/Neonate. Seminars in perinatology. 2007; 31(4):254-261. https://doi.org/10.1053/j.semperi.2007.05.003 PMid:17825683 PMCid:PMC2098040
Chan V, Chan TK, Liang ST, Ghosh A, Kan YW, Todd D. Hydrops fetalis due to an unusual form of Hb H disease. Blood. 1985; 66:224–228. PMid:2988669
Chan V, Chan VW, Tang M, Lau K, Todd D, Chang TK. Molecular defects in Hb H hydrops fetalis. Br J Haematol. 1997; 96:224–228. https://doi.org/10.1046/j.1365-2141.1997.d01-2017.x PMid:9029003
Han J, Liu X, Zhang F. Effect of the early intervention on neonate with hyperbilirubinemia and perinatal factors. Biomedical Research. 2017; 28:231-236.
Singh B, Ezhilarasan R, Kumar P, Narang A. Neonatal hyperbilirubinemia and its association with thyroid hormone levels and urinary iodine excretion. Indian J Pediatr. 2003; 70(4):311-315. https://doi.org/10.1007/BF02723587 PMid:12793308
Downloads
Published
How to Cite
Issue
Section
License
http://creativecommons.org/licenses/by-nc/4.0