Etiology and risk factors for severe indirect neonatal hyperbilirubinemia

Abstract

Background: The aim of this study was to evaluate the etiology and risk factors for severe indirect hyperbilirubinemia in neonates treated at the tertiary level Pediatric Clinic, in a five-year period

Methods: A retrospective single-center, observational study included all consecutive neonates admitted at the tertiary level Pediatric Clinic, with a diagnosis of severe indirect hyperbilirubinemia. Relevant data from the anamnesis, clinical data, laboratory findings and types of treatment, were obtained from the Admission Protocols and electronic database of treated neonates. Statistical analysis applied standard methods, and the research was approved by the Ethics Committee of the institution.

Results: In a five-year period, 996 neonates with severe indirect hyperbilirubinemia were identified, which accounted for almost a third of all hospitalized neonates, and 6.85% of all live births. The most common perinatal risk factors were male gender (59.2%), prematurity (42.0%) and perinatal asphyxia (17.0%). In 13.5% of neonates, severe indirect hyperbilirubinemia had hemolytic causes. Sepsis (42.3%) and extravascular blood collections (47.2%) were significant causes, and the rarest cause of severe neonatal hyperbilirubinemia were hereditary metabolic disorders (0.4%). As part of the treatment, 24 of these neonates required exchange transfusion, and this study group significantly most often had isoimmunization as the cause, with significantly higher mean values of bilirubin, along with significantly lower values of hemoglobin, erythrocytes and hematocrit.

Conclusion: Hyperbilirubinemia is one of the most common clinical problems in neonatology, which remains a permanent challenge in terms of prevention, improvement of treatment and outcome.