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Comparison of prognosis between hyperbilirubinemic infants with and without hypernatremia
M Zakerihamidi1, A Moradi2,3, A Ramazani4
1Department of Midwifery, School of Medical Sciences, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran.
Insights
Jaundice and hypernatremia in infants can worsen developmental outcomes. While both conditions independently affect prognosis, their combined presence intensifies problems, though hyperbilirubinemia plays a larger role in complications.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Clinical Pediatrics
Background:
- Hypernatremia may increase bilirubin diffusion across the blood-brain barrier, elevating the risk of bilirubin encephalopathy.
- Understanding the combined impact of jaundice and hypernatremia on infant neurodevelopment is crucial for early intervention.
Purpose of the Study:
- To compare the prognosis of infants with jaundice versus those with both jaundice and hypernatremia.
- To investigate the long-term developmental outcomes in term infants with idiopathic jaundice.
Main Methods:
- A cohort study of 615 term infants with idiopathic jaundice, with or without hypernatremia, was conducted over 12 years.
- Data collected via questionnaire included laboratory results and neonatal characteristics; developmental status assessed using the Denver test II at 6, 12, 18, and 24 months.
Main Results:
- 90.2% of infants had normal outcomes; 9.8% had abnormal outcomes.
- Significant differences were observed in serum sodium, bilirubin, urea, and creatinine levels, as well as hyperthermia and unconsciousness between groups.
- Infants with both jaundice and hypernatremia had a higher rate of unfavorable prognoses (16%) compared to those with jaundice alone (9%).
Conclusions:
- Both hypernatremia and jaundice, individually, can impact infant prognosis up to age 2.
- The combination of jaundice and hypernatremia exacerbates developmental problems in infants.
- Hyperbilirubinemia appears to be a more significant factor in complication incidence than hypernatremia.
Objectives:
Hypernatremia may facilitate the diffusion of bilirubin through the blood-brain barrier and increase the risk of bilirubin encephalopathy. This study was conducted to compare the prognosis of jaundice infants with those with jaundice and hypernatremia.
Methods:
A total of 615 term infants with idiopathic jaundice with or without hypernatremia were enrolled in this cohort study with 24-months follow-up at Ghaem Hospital, Mashhad, Iran, between 2010 and 2022. An in-house questionnaire including the laboratory evaluation and neonatal characteristics was used as the data collection tool. The follow-up of neonatal development status was performed using the Denver test II at 6, 12, 18, and 24 months after discharging from hospital.
Results:
Normal outcomes were seen in 555 (90.2%) out of 615 studied infants, while 60 cases (9.8%) showed abnormal outcomes. Serum levels of sodium (P = 0.017), bilirubin (P = 0.001), urea (P = 0.024), and creatinine (P = 0.011) as well as hyperthermia (P = 0.046) and unconsciousness (P = 0.005) showed significant differences between the two groups. Approximately 16% of the newborns with both jaundice and hypernatremia, and 9% of those with only jaundice had unfavorable prognoses. Also, bilirubin level had the most predictive power (91.3%).
Conclusions:
Our results suggest that hypernatremia or jaundice alone, may affect the prognosis of infants aged 2 years; but jaundice and hypernatremia together, will intensify the developmental problems in jaundice infants. However, the role of hyperbilirubinemia in the incidence of complications is more than hypernatremia.
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