Incidence and causes of severe neonatal hyperbilirubinemia in Canada

Sgro, Michael; Campbell, Douglas M.; Shah, Vibhuti

doi:10.1503/cmaj.060328

Cited by 277 publications

(279 citation statements)

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“…In developed countries, the incidence of severe jaundice and associated bilirubin encephalopathy is low. However, in developing countries, this preventable disease s ll occurs in a signifi cant propor on of neonates 5 . Several clinical factors have been associated in causa on of severe jaundice including breast milk feeding, ABO incompa bly, G6PD defi ciency, East Asian Ethnicity and cephalhematoma 6 .…”

Section: Introductionmentioning

confidence: 99%

Adverse Events of Exchange Transfusion in Neonatal Hyperbilirubinemia

Chitlangia

Shah

Poudel

et al. 2014

J. Nepal Paedtr. Soc.

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Introduction: Jaundice is an important problem during neonatal period. When total serum bilirubin (TSB) level exceeds a critical limit, it crosses the blood brain barrier and results into bilirubin encephalopathy. The main aim of therapy for neonatal hyperbilirubinemia is prevention of bilirubin encephalopathy by phototherapy and/or exchange transfusion. The aims of this study were to evaluate the efficacy of exchange transfusion (ET) and observe the adverse events during and following three days of ET in neonates with hyperbilirubinemia. Materials and Method: Hospital based cross-sectional descriptive study. All neonates admitted to neonatal intensive care unit and /or paediatric wards of a tertiary-care centre between September 2010 to March 2012, requiring ET were enrolled. Results: A total of 139 ETs were performed in 120 neonates. The common causes were ABO incompatibility (30.8%), prematurity (30.8%), idiopathic (27.5%), Rh isoimmunization (6.7%) and cephalhematoma (4.2%). Mean pre-ET total serum bilirubin (TSB) was 24.2 mg% dL. There was 58% reduction in TSB in post ET and 31% net reduction in 6 hr post ET. Term and preterm neonates showed equal percentage of TSB reduction. Respiratory distress (10.8%) and bradycardia (6.7%) were the common adverse events during, and hypocalcemia (98.3%) and thrombocytopenia (34.2%) in 3 days following ET. The sick neonates had significantly higher incidence of thrombocytopenia (p= 0.031), respiratory distress (p=0.009), apnea (p<0.001) and cardiorespiratory arrest (p<0.001). Overall mortality was 4.2%, and non-survivors were mostly low birth weight, born outside the present hospital and had higher incidence of adverse events. Conclusion: Exchange transfusion is an effective intervention in reducing the serum bilirubin level. However, these neonates require monitoring of ionised calcium and thrombocytopenia. Sick neonates had higher incidence of adverse events than healthy and close clinical monitoring is needed to improve the outcome.

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Section: Introductionmentioning

confidence: 99%

Adverse Events of Exchange Transfusion in Neonatal Hyperbilirubinemia

Chitlangia

Shah

Poudel

et al. 2014

J. Nepal Paedtr. Soc.

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“…28 In a survey of the Canadian Paediatric Surveillance Program, of 93 newborns in whom a cause could be found for their severe hyperbilirubinemia, 20 were G-6-PD deficient. 29 Thus, the high incidence of G-6-PD deficiency in the neonatal population with severe hyperbilirubinemia or kernicterus contrasts sharply with the background incidence in these countries (Figure 1). In a study of an African American cohort, exclusive breast feeding, G-6-PD deficiency and predischarge plasma total bilirubin X75th percentile were found to be significant risk factors for developing hyperbilirubinemia, whereas prematurity, mixed breast-formula feeding, cephalhematoma or bruising, or birth weight X4.0 kg, were not significant factors.…”

Section: Distribution and Frequency Of G-6-pd Deficiencymentioning

confidence: 97%