Assessments at week 2 and 3 in Term Newborns Diagnoses with Prolonged Jaundice

Abstract

Introduction: Jaundice is one of the most common problems at neonatal period and seen in 60-70% of all newborns at first days of life. Prolonged jaundice is defined as hyperbilirubinemia persisting at the end of week 2 in term newborns. In this study, we reviewed term newborns diagnosed with prolonged jaundice. It was aimed to demonstrate delaying laboratory evaluations for a week in infants with favorable clinical presentation can prevent unnecessary tests in majority of newborns. Materials and methods: The study included full-term newborns who presented after day 14 of life and diagnosed with prolonged jaundice at neonatology outpatient clinic of Health Sciences University, Keçiören Teaching and Research Hospital in 2016. Overall, 336 infants with prolonged jaundice were screened. The infants with congenital anomaly, those with findings of sepsis or severe infection, those with history of intrauterine infection, those with history of acholic stool and those with no available data were excluded. In 180 patients included, clinical evaluations, bilirubin levels and advanced test results were assessed at baseline and weekly follow-up. Findings: Of the infants included, 51.7% were boys while 48.3% were girls. The most common blood type was A Rh (+). There was ABO incompatibility alone in 24 infants (14.2%), Rh incompatibility alone in 6 infants (3.5%) and ABO plus Rh incompatibility in 3 infants (1.2%). In 130 infants, total bilirubin was studied on both week 2 and 3. At week 3, total bilirubin value was ≥10 mg/dl in only 36 infants (27.7%) while it was decreased below 10 mg/dL in 94 infants (72.3%). Urinary tract infection (UTI) was detected in 7 of 38 infants with available tests at week 2. Two of 6 infants with UTI had other clinical signs of UTI. Mean total bilirubin value was 17.9 mg/dL in 5 infants. A significant correlation was found between UTI and vomiting, breastfeeding and feeding pattern (p<0.05). Congenital hypothyroidism was detected in 6 of 38 infants with available tests at week 2. It was seen that 2 infants had suspected congenital hypothyroidism in neonatal heel prick test and underwent further evaluations while mean total bilirubin value was 17.5 mg/dL at week 2 in remaining 4 infants. Given the vast majority of cases are breast milk jaundice, a novel cut-off value was defined for total bilirubin measurement at week 2 to distinguish the cases in which total bilirubin decreases below 10 mg/dL at week 3. Conclusions: Although several disorders that may lead prolonged jaundice at neonatal period have been identified, it is well-known that prolonged jaundice can be seen without any pathological condition in majority of infants fed by breast milk. Delaying laboratory evaluations recommended at week for prolonged jaundice is an approach that may prevent unnecessary testing in most infants.