Management of hyperbilirubinemia in preterm infants in Turkey

Abstract

IntroductionBilirubin levels increase soon after birth, and neonatal hyperbilirubinemia is common in newborns. However, high levels of unconjugated bilirubin can enter the central nervous system and cause kernicterus. Because early identification can prevent severe hyperbilirubinemia, in 2004, the American Academy of Pediatrics (AAP) Subcommittee on Hyperbilirubinemia published guidelines for managing hyperbilirubinemia in newborn infants of ≥35 weeks gestational age (1).Premature infants develop more significant jaundice due to poor bowel motility, decreased oral intake, and immaturity of the hepatic conjugating system. Consequently, prematurity is a significant risk factor for developing hyperbilirubinemia, requiring therapy (2,3).This study investigated the current approach to managing hyperbilirubinemia among preterm newborns in Turkey. The results may contribute to national guidelines for better management and prevention of hyperbilirubinemia among preterm newborns.Background/aim: Prematurity is a significant risk factor for developing unconjugated hyperbilirubinemia. This study investigated the current approach to managing hyperbilirubinemia in preterm newborns in Turkey. Materials and methods:A study-specific questionnaire on the management of jaundice in preterm infants was sent to 100 level III neonatal intensive care units in Turkey.Results: Responses were obtained from 84 centers from all regions of Turkey. Of the centers, 75.3% used the Turkish Neonatology Society guidelines for deciding to start phototherapy, and 24.7% used different guidelines. The monitoring of bilirubin varied among the participants. Of the participants, 53.6% believed that prophylactic phototherapy was necessary if the infant's birth weight was below 1000 g. The participants reported 6 cases of kernicterus in preterm infants in recent years. Conclusion:There is no single standard approach for managing neonatal hyperbilirubinemia in preterm infants in Turkey. Prophylactic phototherapy for extremely low birth-weight infants might be added to the guidelines for Turkey.