Evaluation of Etiological, Clinical and Laboratory Findings in Infants with Prolonged Jaundice

Abstract

Objectives: Prolonged jaundice is a common condition among neonates. İt is defined as persisting hyperbilirubinemia after the 14th day following birth for term babies and after the 21st day for premature babies with serum bilirubin level higher than 5mg/dL. Prolonged unconjugated hyperbilirubinemia may be associated with some pathological conditions. We aimed to evaluate the etiological, clinical and laboratory findings of babies with prolonged jaundice.Methods: This descriptive cross-sectional study included 90 infants with prolonged jaundice in the pediatric outpatient clinic of Ordu University Training and Research Hospital between 1 January 2015 and 1 October 2020. Demographic characteristics, physical examination and laboratory findings of the babies were collected and analyzed to determine the etiology of neonatal hyperbilirubinemia. Results:In total 90 infants with prolonged jaundice were presented in this study, including 50 male and 40 female neonates. The most common causes of prolonged neonatal jaundice were breastfeeding, Rh or ABO incompatibility, and urinary tract infection 73%, 13% and 8% of neonates, respectively. Conclusion:Breast milk jaundice is the most common cause of prolonged jaundice in infants. Although there are some explanations for breast milk jaundice, the exact mechanism leading to breast milk jaundice is not clear. Other reasons that may affect the infants later in life should be investigated in a short time.

Frequency of Urinary Tract Infection (UTI) in Neonates Admitted with Indirect Hyperbilirubinemia

“…Another study noted overall prevalence of UTI in jaundiced neonates to be 11% 14 . similarly, Erhan et al enrolled patients with neonatal jaundice and searched to find out cause of jaundice.…”

Prolonged Jaundice in Newborn

“…Prolonged jaundice is defined as a serum bilirubin level higher than 85 μmol/L (5 mg/dl), which persists at postnatal 14 days in term infants and 21 days following the birth in preterm infants. It affects 2-15% of all newborns and 40% of breastfed infants [1].…”

The pathophysiology of neonatal jaundice in urosepsis is complex with mixed bilirubin!!!

“…This with unconjugated bilirubin, principally from polycythemia with shortened erythrocytes' half-life, poor liver conjugation or bilirubin displacement from glucuronidation by fatty acids from breastmilk. 5 Other pathological causes of jaundice with indirect bilirubin include pre-hepatic hemolytic etiologies such as ABO, Rh or rare blood groups incompatibility, constitutional abnormalities of red blood cells (enzymopathies of which G-6 PD and pyruvate kinase deficits, cytoskeleton anomalies as elliptocytosis and spherocytosis), cephalhematoma or blood caput succedaneum resorption and sepsis mainly. 5,6 On the other hand, neonatal jaundice with mixed direct and indirect bilirubin are due to intrahepatic specific alterations of bilirubin conjugation in hepatic cells (Gilbert and Crigler-Najjar syndromes, hepatitis, drugs intoxictaion) or anomalies of bilirubin secretion into biliary canals (Dubin-Johnson and Rotor syndromes, cystic fibrosis, alpha-1 antitrypsin deficiency, Alagille disease, Niemann-Pick disease, galactosemia).…”

“…5 Other pathological causes of jaundice with indirect bilirubin include pre-hepatic hemolytic etiologies such as ABO, Rh or rare blood groups incompatibility, constitutional abnormalities of red blood cells (enzymopathies of which G-6 PD and pyruvate kinase deficits, cytoskeleton anomalies as elliptocytosis and spherocytosis), cephalhematoma or blood caput succedaneum resorption and sepsis mainly. 5,6 On the other hand, neonatal jaundice with mixed direct and indirect bilirubin are due to intrahepatic specific alterations of bilirubin conjugation in hepatic cells (Gilbert and Crigler-Najjar syndromes, hepatitis, drugs intoxictaion) or anomalies of bilirubin secretion into biliary canals (Dubin-Johnson and Rotor syndromes, cystic fibrosis, alpha-1 antitrypsin deficiency, Alagille disease, Niemann-Pick disease, galactosemia). 5,6 Moreover, post-hepatic causes of neonatal jaundice may occur as well, including biliary atresia and other malformations, cholangitis as inflammation, cholangiocarcinoma as most frequent neoplasia and gall bladder stones from metabolism just to name a few.…”

“…5,6 On the other hand, neonatal jaundice with mixed direct and indirect bilirubin are due to intrahepatic specific alterations of bilirubin conjugation in hepatic cells (Gilbert and Crigler-Najjar syndromes, hepatitis, drugs intoxictaion) or anomalies of bilirubin secretion into biliary canals (Dubin-Johnson and Rotor syndromes, cystic fibrosis, alpha-1 antitrypsin deficiency, Alagille disease, Niemann-Pick disease, galactosemia). 5,6 Moreover, post-hepatic causes of neonatal jaundice may occur as well, including biliary atresia and other malformations, cholangitis as inflammation, cholangiocarcinoma as most frequent neoplasia and gall bladder stones from metabolism just to name a few. Nevertheless, endocrine disorders such as hypothyroidism may equally be responsible for jaundice in neonates.…”