Author(s): Harischandra Venkata Yanamandala1, Seshagiri Koripadu2
Neonatal jaundice or neonatal hyperbilirubinemia or neonatal icterus has originated from the Greek word iκτερος, icteric is yellowing of the skin and other tissues of a newborn infant. A bilirubin level of more than 85 μmol/L (5 mg/dL) leads to a jaundiced appearance in neonates, whereas in adults, a level of 34 μmol/L (2 mg/dL) is needed for this to occur. In newborns, jaundice is detected by blanching the skin with pressure applied by a finger, so that it reveals underlying skin and subcutaneous tissue. Jaundiced newborns have yellow discoloration of the white part of the eye and yellowing of the face extending down onto the chest.
The aim of the study is to evaluate the relation of various factors such as gestational age, type of delivery, feeding modalities, existence and type of maternal anaesthesia and first meconium passage time with early bilirubin levels during first 48 hours of healthy infants.
MATERIALS AND METHODS
This study was a prospective study, which was carried out in the Department of Paediatrics in Gitam Institute of Medical Sciences and Research, Rushikonda, Visakhapatnam, during the period of October 2015 to November 2016.
In the present study, 200 infants were involved. Foetal growth was small for gestational age in 8 infants (3%) appropriate for gestational age in 189 infants (95%) and large for gestational age in 3 infants (2%). Delivery mode was through vaginal mode in 82 infants (41%) and through caesarean section in 118 infants (59%). Anaesthesia type was general in 25 (12%), epidural anaesthesia in 19 (10%) and spinal anaesthesia in 156 (78%). Feeding type was breastfed in 162 (81%), mixed in 36 (18%) and formula in 2 (1%). Apgar score at 1 minute was 7 and at 5 minutes was 8. Gestational age was 36 weeks. Birth weight was 3125 grams, length was 52 cm and head circumference was 37 cm. The meconium passage time in vaginal delivery and caesarean delivery was 5 hours. Cord bilirubin was 1.5 mg/dL in both the delivery modes, 24 hrs. bilirubin levels were 4 g/dL in both the delivery modes and 48 hrs. bilirubin levels were 6.25 mg/dL in vaginal delivery and 6.3 mg/dL in caesarean delivery. The meconium passage time (11 hours) and cord bilirubin was highest (1.8 mg/dL) in general anaesthesia, 24 hrs. bilirubin was highest (4.4 mg/dL) in epidural anaesthesia and 48 hrs. bilirubin was highest (6.75 mg/dL) in spinal anaesthesia.
High cord bilirubin levels were associated to be in high-risk zone for later hyperbilirubinemia. Early bilirubin levels in healthy neonates were not associated to type of delivery or anaesthesia, late prematurity, feeding type and first meconium passage times.