The Turkish Neonatal Jaundice Online Registry: A national root cause analysis

Abstract

BackgroundNeonatal jaundice (NNJ) is common, but few root cause analyses based on national quality registries have been performed. An online registry was established to estimate the incidence of NNJ in Turkey and to facilitate a root cause analysis of NNJ and its complications.MethodsA multicenter prospective study was conducted on otherwise healthy newborns born at ≥35 weeks of gestation and hospitalized for only NNJ in 50 collaborator neonatal intensive care units across Turkey over a 1-year period. Patients were analyzed for their demographic and clinical characteristics, treatment options, and complications.ResultsOf the 5,620 patients enrolled, 361 (6.4%) had a bilirubin level ≥25 mg/dL on admission and 13 (0.23%) developed acute bilirubin encephalopathy. The leading cause of hospital admission was hemolytic jaundice, followed by dehydration related to a lack of proper feeding. Although all infants received phototherapy, 302 infants (5.4%) received intravenous immunoglobulin in addition to phototherapy and 132 (2.3%) required exchange transfusion. The infants who received exchange transfusion were more likely to experience hemolytic causes (60.6% vs. 28.1%) and a longer duration of phototherapy (58.5 ± 31.7 vs. 29.4 ± 18.8 h) compared to infants who were not transfused (p < 0.001). The incidence of short-term complications among discharged patients during follow-up was 8.5%; rehospitalization was the most frequent (58%), followed by jaundice for more than 2 weeks (39%), neurological abnormality (0.35%), and hearing loss (0.2%).ConclusionsSevere NNJ and bilirubin encephalopathy are still problems in Turkey. Means of identifying at-risk newborns before discharge during routine postnatal care, such as bilirubin monitoring, blood group analysis, and lactation consultations, would reduce the frequency of short- and long-term complications of severe NNJ.

Determinants of neonatal jaundice among neonates admitted to five referral hospitals in Amhara region, Northern Ethiopia: an unmatched case-control study

“…Besides, a male has a higher concentration of bilirubin and hige risk of acute bilirubin encephalopathy as compared with females. 12 35 …”

“…7 11 12 Hyperbilirubinaemia can be described in the form of pathological, physiological, jaundice secondary to breast milk or breastfeeding failure, and haemolytic jaundice due to glucose-6-phosphate dehydrogenase deficiency, ABO and Rh incompatibility. [12][13][14] Jaundice can be severe when it is seen anywhere on the body on the first day or the What is known about the subject?…”

“… 7 11 12 Hyperbilirubinaemia can be described in the form of pathological, physiological, jaundice secondary to breast milk or breastfeeding failure, and haemolytic jaundice due to glucose-6-phosphate dehydrogenase deficiency, ABO and Rh incompatibility. 12–14 …”

Severe neonatal hyperbilirubinemia in the south-east region of Turkey

“…The model expected no severe hyperbilirubinemia due to Rh disease in HIC [24]. The Turkish Neonatal Registry reported the frequency of Rh disease as 5.4 % of all admissions due to hyperbilirubinemia [16]. Rh isoimmunization constituted 11.3% of all severe hyperbilirubinemia cases in our study population but its frequency increased to about 18% among infants receiving exchange transfusion and developing ABE.…”

Management of neonatal jaundice in low-income and middle-income countries

“…Erdeve etal conducted a nationwide root cause analysis of NJ in Turkey and found several noteworthy observations, such as the two most common risk factors for NJ were a haemolytic aetiology followed by lack of initiation of proper breastfeeding, and recommended blood type screening and adequate follow-up during the first week of life to national healthcare system. 3 A meta-analysis on risk factors for severe neonatal hyperbilirubinaemia in LMICs also showed that infants at risk of severe hyperbilirubinaemia in LMICs are associated with maternal and neonatal factors that can be effectively addressed by available interventions to curtail the disease burden prevailing in the affected countries. 5 …”