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Published on: August 24, 2011
Neonatal and Maternal Risk Factors for Indirect Hyperbilirubinemia: A Cross-Sectional Study from Bahrain
Hasan M Isa1,2, Noor Y AlBuainain3, Fatema Y Bunajem4
1Pediatric Department, Salmaniya Medical Complex, Manama, Bahrain.
Insights
ABO incompatibility and G6PD deficiency are key risk factors for neonatal indirect hyperbilirubinemia. Early screening for these and other factors like maternal age can help manage this common condition.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Clinical Research
Background:
- Neonatal indirect hyperbilirubinemia is a common condition requiring careful management.
- Identifying risk factors is crucial for preventing severe outcomes.
Purpose of the Study:
- To identify the common neonatal and maternal risk factors for indirect hyperbilirubinemia in Bahraini neonates.
- To analyze the association between risk factors and bilirubin levels, treatment modalities, and outcomes.
Main Methods:
- Retrospective analysis of 404 neonates with indirect hyperbilirubinemia.
- Data collection on demographic factors, risk factors (ABO incompatibility, G6PD deficiency, maternal age), and treatment (phototherapy, IVIG, exchange transfusion).
Main Results:
- ABO incompatibility (37.6%) and G6PD deficiency (32.5%) were the most frequent neonatal risk factors. Advanced maternal age (>25 years) was the primary maternal risk factor (81.9%).
- Neonates with ABO incompatibility had higher bilirubin levels. Phototherapy use increased with bilirubin levels. IVIG and exchange transfusion were used in 10.9% and 3.5% of cases, respectively.
- Male gender, Bahraini ethnicity, reticulocytosis, and IVIG use were associated with increased risk factors.
Conclusions:
- ABO incompatibility, G6PD deficiency, and older maternal age are significant risk factors for neonatal indirect hyperbilirubinemia.
- Associated factors include Bahraini ethnicity, male gender, reticulocytosis, and IVIG use.
- Screening for these risk factors enables timely management to prevent complications.
Results:
Out of 555 records, 404 neonates were included. Among those, 209 (51%) were males and 275 (68.1%) were Bahraini. The median indirect bilirubin level at presentation was 218 (interquartile range, 174-270) μmol/L. ABO incompatibility was the commonest risk factor for neonatal indirect hyperbilirubinemia (n = 152, 37.6%) followed by glucose-6-phosphate dehydrogenase (G6PD) deficiency (n = 130/400, 32.5%). Age (>25 years) was the commonest maternal risk factor (n = 331, 81.9%) followed by cesarean delivery (n = 137, 33.9%). Neonates with ABO incompatibility had a significantly higher mean indirect bilirubin level compared to those with other risk factors (234.9 ± 68.5 versus 225 ± 82.2 mmol/L, respectively) (P = 0.04). Phototherapy use significantly increased along with the rise of bilirubin level (P < 0.0001). Intravenous immunoglobulins (IVIG) and exchange transfusion were used in 44 (10.9%) and 14 (3.5%) patients, respectively. Neonates who received IVIG had significantly higher bilirubin levels than those who did not (P = 0.005). Male newborns (P = 0.008), Bahrainis (P = 0.001), those with reticulocytosis (P = 0.001), and those who received IVIG (P = 0.001) were more prone to have associated risk factors.
Conclusion:
ABO incompatibility, G6PD deficiency, and older maternal age were the commonest neonatal and maternal risk factors for developing neonatal indirect hyperbilirubinemia. Bahraini, male newborns, reticulocytosis, and IVIG use were associated with these factors. Early detection of such factors through screening can aid in immediate management to prevent serious complications of this common condition.
