Can Anesthesiologic Strategies for Caesarean Section Influence Newborn Jaundice?

Abstract

Rationale and Objectives: Neonatal jaundice is a frequent problem in neonatology and can be influenced by many factors. Our study arose from the clinical observation that among all newborns delivered by caesarean section in our center, some had a more intense physiological jaundice. We began by reviewing clinical anesthesiological case-sheets to ascertain whether this difference was linked to the use of different anesthesiologic strategies. We then performed a prospective study on healthy preterm and term newborns to verify this hypothesis. Study Design: We retrospectively considered all healthy term newborns with weight >2,400 g delivered by caesarean section from January 1998 to May 1999. In the prospective studies we included healthy term and preterm newborns consecutively delivered by caesarean section from May 1999 to December 1999. We excluded preterm newborns with gestational age <31 weeks and with weight <1,400 g. Results: Both in retrospective and in prospective studies anesthetic agents employed were isoflurane (A), sevoflurane (B), or bupivacaine (C). The statistical comparison of the three groups in retrospective study confirmed the clinical observation: the total bilirubin levels were significantly higher in the isoflurane group than in the sevoflurane group (p = 0.0000) and bupivacaine group (p = 0.0002). Analysis of data from the prospective study on term newborns confirmed our previous results. In preterm infants total bilirubin is statistically higher in group A starting from 96 h postdelivery. Conclusions: It is likely that anesthetic technique can be included among factors with possible influence on neonatal jaundice.

Evaluation of the Effects of Different Anesthetic Techniques on Neonatal Bilirubin Levels

“…It is expected that anesthetic agents cross the placenta, considering the time from induction of anesthesia to clamping of the umbilical cord. Therefore, it is likely that anesthetic technique can be included among factors with possible influence on neonatal jaundice (7). Recently, Alkan et al showed that bupivacaine did not effect neonatal bilirubin levels and that sevoflurane increased bilirubin levels (8).…”

Bilirubin Production Is Increased in Newborn Mice Exposed to Isoflurane

“…Hoetzel and Schmidt [16] also reported that not only volatile anesthetics (ISO and sevoflurane) but also other commonly used anesthetics (propofol and opioids) can induce HO-1 expression. Interestingly, De Amici et al [17] performed retrospective and prospective studies of term and preterm newborns delivered by cesarean section and found that some had a more intense physiologic jaundice. They found that total bilirubin levels were higher in infants exposed to ISO (∼2-fold) than in those exposed to sevoflurane 72–120 h after delivery, but they could not draw any definitive conclusions regarding the mechanism(s) involved.…”

Evaluation of relation between neonatal hyperbilirubinemia and time of birth

“…Sezaryen doğum sırasında kullanılan anestezik maddelerin bebekte sarılık oluşumunu kolaylaştırdığı bildirilmiştir (16) .…”