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Jaundice: a 10 year review of 41,000 live born infants
Insights
Hyperbilirubinemia affected over 10% of newborns, with prematurity as the leading cause. Phototherapy was a safe treatment, while exchange transfusion carried risks, including two deaths from necrotizing enterocolitis.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Clinical Research
Background:
- Jaundice is common in newborns, with hyperbilirubinemia defined as serum bilirubin levels of 154 mumol/l or more.
- A 10-year review (up to 1980) analyzed jaundiced newborn infants to understand causes and treatment outcomes.
Purpose of the Study:
- To review the etiological factors and treatment modalities for hyperbilirubinemia in a large cohort of newborn infants.
- To assess the safety and efficacy of phototherapy and exchange transfusion in managing neonatal jaundice.
Main Methods:
- Retrospective review of 41,057 live births over a 10-year period.
- Analysis of etiological factors including prematurity, ABO and Rhesus erythroblastosis, sepsis, bruising, and glucose-6-phosphate dehydrogenase deficiency.
- Categorization of treatment interventions: no treatment, phototherapy alone, exchange transfusion with phototherapy, and exchange transfusion alone.
Main Results:
- 10.7% of infants (4,406) presented with hyperbilirubinemia.
- Prematurity (19.9%) was the most frequent cause, followed by ABO erythroblastosis (7.1%) and sepsis (3.4%).
- Phototherapy was used in 32.2% of infants, while exchange transfusion was reserved for severe cases, often linked to Rhesus or ABO erythroblastosis.
Conclusions:
- Phototherapy was a safe treatment for neonatal hyperbilirubinemia with no attributable deaths.
- Exchange transfusion, though necessary for severe cases, was associated with significant risks, including mortality from complications like necrotizing enterocolitis.
Abstract:
A review is presented of jaundiced newborn infants during the 10-year period to 1980. Included are those whose serum bilirubin level was 154 mumol/l or more. Of 41,057 live births, 4,406 (10.7%) infants had hyperbilirubinaemia. The most common (19.9;%) aetiological factor was prematurity, followed by ABO erythroblastosis 7.1%; sepsis 3.4%; Rhesus erythroblastosis 2.7%; bruising 2.2%; multifactorial 1.0% and glucose-6-phosphate dehydrogenase deficiency 0.5%. Treatment was not undertaken in 2,855 (64.7%) infants, but 1,419 (32.2%) received phototherapy alone, 122 (2.7%) infants received both exchange transfusion and phototherapy and 10 (0.2%) infants received exchange transfusion alone. Of the infants requiring exchange transfusion 50.0% had Rhesus erythroblastosis, 28.0% ABO erythroblastosis, 10.6% jaundice of prematurity and the remainder were due to a variety of causes. Sixty-three (1.4%) infants died, with two deaths being related to the hyperbilirubinaemia, as their death was due to necrotizing enterocolitis following exchange transfusion. Phototherapy proved safe with no deaths directly attributable to its use.