الفهرس 
Chapter 1: Neonatal hyperbilirubinemiaOnly 14 pages are availabe for public view
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Abstract
Jaundice is the most common condition requiring medical attention in newborns. In most newborn, unconjugated hyperbilirubinemia reflects a normal transitional phenomenon. However, in some newborn, serum bilirubin levels may raise exclusively, which can be a cause for concern because unconjugated bilirubin is neurotoxic and can cause death in newborns and lifelong neurologic sequelae in infants who survive (kernicterus). For these reasons, the presence of neonatal jaundice frequently results in diagnostic evaluation. Risk factors are namely late preterm gestational age and exclusive breast feeding . These two contributors are reviewed first, followed by six others of notable clinical impact: glucose 6 phosphate dehydrogenase (G6PD) deficiency, ABO and Rh hemolytic diseases, East Asian ethnicity, jaundice observed in the first 24 hours of life, cephalohematoma or significant bruising, and history of a previous sibling treated with phototherapy One of the common risk factors for pathologic hyperbilirubinemia in newborn infants is deficiency of Glucose 6 phosphatase dehydrogenase (G6PD) enzyme. Deficiency of this enzyme is the most prevalent enzymopathy in red blood cells that causes hemolysis and hyperbilirubinemia. A common complication is that of severe neonatal hyperbilirubinemia with the potential of bilirubin encephalopathy or kernicterus .
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Summary & Conclusion
The aim of this work is to study the importance of some hematological parameters used in diagnosis and differentiation between physiologic and pathological jaundice very early to give appropriate treatment and avoid complications in neonates. This study was conducted on 101 neonates with hyperbilirubinemia was collected from NICU at Menoufia University Hospital. Neonates included were those with indirect hyperbilirubinemia in preterm or full term , Newborns who were excluded were those with direct hyperbilirubinemia (direct to total bilirubin ratio more than 20%) in full term or preterm, newborns with sepsis , neonates with inborn error of metabolism , neonates with congenital anomalies . All were subjected to full history, detailed clinical examination and investigations as serum bilirubin (with direct fraction), complete blood picture (including reticulocytic count), Coomb’s test, maternal & neonatal blood group & Rh, serum C - reactive protein (CRP) and G6PD enzyme assay. The age of neonates ranged from 1st day after birth to day 13. Candidates were 72 males (71.3 %) and 29 were females (28.7 %). 22.8 % of the studied cases (23 neonates) were delivered by N.V.D., while 59.4 % (60 neonates) were delivered by elective C.S. ,17.8 % of studied cases(18neonates) were delivered by emergency C.S. In present study, percentage of Pre-term (<37 weeks) babies was 16 (15.8 %) and neonates having low birth weight (<2.5 kg) were 8 (7.9%).
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Summary & Conclusion
In current study out of 101, 22 (21.8 %) cases were diagnosed as having physiological jaundice, 16 cases (15.8 %) as ABO incompatibility, 7 cases (6.9 %) as Rh incompatibility, and 9 cases (8.9 %) as G6PD deficiency and it is level range from 1.5to 4.5 U/gHb and all +ve cases were males , 8 cases as G6PD only and one as G6PD with Rh incompatibility ,one case as ABO with Rh incompatibility and one case as polycythemia while 45cases (44.6 %) were having undermined cause ABO incompatibility was the commonest cause of pathological jaundice and G6PD is second commonest cause of pathological jaundice. The rise in serum bilirubin level was found to be more in pathological jaundice as compare to physiological jaundice. Difference was significant statistically with p value of <0.05, Mean serum bilirubin of pathological jaundice was 16.4 ±3.7 mg/dl, ranged between 9.4 - 27 mg/dl Serum bilirubin was highest in Rh incompatibility with G6PD (bilirubin level was 25.3 mg/dl), followed by Rh Incompatibility (15.8 mg/dl) then ABO incompatibility (15.7 mg/dl). Mean Hb level was 15.4 ± 3.05 gm/dl with ranged of 8.2 - 23.1 gm/dl. With lowest level of Hb in cases of G6PD especially with RH incompatibility it was 10.6 mg/dl followed by G6PD deficiency cases was( 12.6 ± 1.6 mg /dl) and highest was in polycythemia it was 23.1 mg/dl while highest level of reticlocytic count in G6PD with RH incompatibility was (9 %) and RH with ABO incompatibility cases was (8 %)followed by G6PD cases was (7.5 %) . Direct Coomb’s test was found to be positive in all case in Rh incompatibility while they it was positive in 75% of cases in ABO incompatibility.
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Summary & Conclusion
Peak serum bilirubin levels were found to be more among the pathological jaundice. Also prematurity and low birth weight were having higher levels of s. bilirubin. In conclusion, Neonatal hyperbilirubinemia is associated with various other clinical morbidities. Causes of hyperbilirubinemia should be investigated comprehensively. ABO and Rh typing should be done along with Coombs Test, reticulocyte count and G6PD screening.