Evaluation of Neonatal Jaundice in the First Day of Life
Background: Jaundice in the first day of life is generally considered as pathologic. In this study we aimed to evaluate the etiologies of jaundice in the neonates who were admitted on the first day of life.
Materials and Methods: In this retrospective cross-sectional study, all the neonates with gestational age of more than 35 weeks with jaundice in the first day of life who were admitted in Vali-e-Asr Hospital, Tehran, Iran, during 2015-2018 were investigated. Data including gestational age, delivery type, birth weight, sex, neonatal age (hours), maternal disease, maternal age, parity, maternal and neonatal blood group, serum levels of bilirubin and haemoglobin, reticulocyte count, peripheral blood smear results, glucose-6-phosphate dehydrogenase (G6PD) activity and therapeutic interventions were evaluated.
Results: Of the 1512 neonates who were admitted for neonatal jaundice, 230 had first-day jaundice (15.6%). Of 230 neonates 46.1% were male, 73.9% were delivered by cesarean section, 40% of their mothers had an underlying disease. The mean birth weight and bilirubin level were 3040 ± 6.02 gr and 7.87± 2.73 mg/dl, respectively. Most common etiologies were ABO incompatibility 41%, Rh incompatibility 14.3%, simultaneous ABO and Rh incompatibility 3.4%, caput succidanum and cephalohematoma 4.9%, G6PD deficiency 2.6%, sepsis 2.1% and others 2%. All patients received phototherapy, 1.3% received intravenous immunoglobulin (IVIG), 1.7% underwent exchange transfusion and 2.6% received both IVIG and exchange transfusion.
Conclusions: In the present study, ABO incompatibility was the commonest etiology for the first day jaundice and the main reason for exchange transfusion in neonates. Blood type screening at the antenatal period and by cord blood sampling may result in early diagnosis and prompt treatment and can prevent the serious complications of jaundice in the neonates.