Etiology analysis for full-term newborns with severe hyperbilirubinemia in eastern Guangdong

Abstract

Objective To explore the etiological characteristics of severe hyperbilirubinemia in full-term newborns of eastern Guangdong. Methods Full-term newborns with severe hyperbilirubinemia in one hospital from January 2012 to December 2021 were retrospectively analyzed. The etiology was determined according to the laboratory results and clinical manifestations. Results Among 1602 full-term newborns with hyperbilirubinemia in Chaozhou area, 32.20% (580/1602) was severe hyperbilirubinemia, including 213 newborns with TSB levels reaching the recommended exchange transfusion levels and 52 cases diagnosed with prolonged jaundice. Among the causes of severe hyperbilirubinemia, neonatal hemolysis accounted for 15.17%, infection accounted for 10.17%, G6PD deficiency accounted for 9.13%, and the coexistence of multiple etiologies accounted for 6.55%, unknown etiology accounted for 50.00%. ABO hemolysis and G6PD deficiency were the most common causes in the 20 cases with bilirubin encephalopathy. 94 severe hyperbilirubinemia newborns were tested for UGT1A1*6 variant (rs4148323, c.211G > A, p.Arg71Gly,), 9 cases were 211 G to A homozygous variant, 37 cases were 211 G to A heterozygous variant, and 48 cases were wild genotypes. Conclusion The main cause for severe hyperbilirubinemia and bilirubin encephalopathy were the hemolytic disease of the newborn, G6PD deficiency and infection. UGT1A1 gene variant was also a high risk factor for neonatal hyperbilirubinemia. Targeted prevention and treatment according to the etiology may reduce the occurrence of bilirubin encephalopathy and kernicterus.

Prevalence and association of early onset severe hyperbilirubinemia in newborn in the East China region: Retrospective medical record analyses

“…The current reported that lower genotype rs4149056 frequencies, higher genotype rs2306283 frequencies, and higher genotype rs1805173 frequencies are associated with early onset severe hyperbilirubinemia in newborns. The results of genetic predictors for early onset severe hyperbilirubinemia in newborns of the current study are consistent with those of a case-control study on neonatal severe hyperbilirubinemia in Southeastern China, [5] a meta-analysis, [4] a retrospective analysis of neonatal severe hyperbilirubinemia in eastern Guangdong, China, [3] and a study on Indian neonatal hyperbilirubinemia. [13] Risk factors should be monitored, and clinicians should predict early onset severe hyperbilirubinemia in newborns and its treatment.…”

“…The prevalence of early onset severe hyperbilirubinemia in the current study is consistent with that of available studies on African neonates [12] but is not consistent with a retrospective analysis of neonatal severe hyperbilirubinemia in eastern Guangdong, China. [3] Its prevalence is affected by environmental factors. [3] Hyperbilirubinemia in newborns is a global issue that requires identifying its cause and etiology.…”

“…[3] Its prevalence is affected by environmental factors. [3] Hyperbilirubinemia in newborns is a global issue that requires identifying its cause and etiology.…”

“…Generally, infection increases serum bilirubin levels, [15] and hyperbilirubinemia is associated with an increase in bilirubin levels. [3] Early diagnosis of infection in newborns is required to overcome hyperbilirubinemia.…”

“…[2] Hyperbilirubinemia mainly results in an imbalance between the production and elimination of bilirubin in newborns. [3] The detection and association of hyperbilirubinemia is important for the early treatment of hyperbilirubinemia in newborns because hyperbilirubinemia causes autism, jaundice, encephalopathy, life-long disabilities, or death of newborns. [4] The research on the prevalence and association of hyperbilirubinemia is controversial; for example, the prevalence of severe hyperbilirubinemia in eastern Guangdong, China is 32%, and neonatal hemolysis and infection are the main predictors of severe hyperbilirubinemia in eastern Guangdong, China.…”