Comparison of Bilirubin Levels in Neonates with Hyperbilirubinemia according to De livery Methods

Gwang Yeon Lee; Jong Woon Choi

doi:10.14734/PN.2019.30.3.134

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Lee and Choi: Comparison of Bilirubin Levels in Neonates with Hyperbilirubinemia according to De livery Methods

Original Article

Perinatology 2019;30(3):134-139.

Published online: 20 September 2019

DOI: https://doi.org/10.14734/PN.2019.30.3.134

Comparison of Bilirubin Levels in Neonates with Hyperbilirubinemia according to De livery Methods

Gwang Yeon Lee, MD, Jong Woon Choi, MD, PhD

Department of Pediatrics, Bundang Jesaeng General Hospital, Seongnam, Korea

Correspondence to Jong Woon Choi, MD, PhD Department of Pediatrics, Bundang Jesaeng General Hospital, 20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 13590, Korea Tel: +82-31-779-0275 Fax: +82-31-779-0894 E-mail: cjw@dmc.or.kr

Received 8 March 2019 Revised 22 April 2019 Accepted 14 June 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

This study aimed to find out the correlation between bilirubin levels and delivery methods in term babies with neonatal hyperbilirubinemia.

Methods

This retrospective study was performed in a single center. The subjects were full-term neo nates (37–41 weeks of gestational age) with a chief complaint of hyperbilirubinemia (serum total bilirubin ≥12 mg/dL) admitted to the Bundang Jesaeng General Hospital from May 2015 to July 2018. The subjects were divided into two groups according to delivery methods (vaginal delivery [VD] and cesarean section [CS]). Total bilirubin levels were compared between the two groups, and the correlation between severe hyperbilirubinemia (serum total bilirubin ≥25 mg/dL) and delivery methods was analyzed.

Results

A total of 87 neonates were enrolled. Of 87 neonates, 59 (67.8%) were born by VD and 28 (32.2%) by CS. The mean serum total bilirubin level of the VD group was significantly higher than that of the CS group (21.5±4.0 mg/dL and 17.5±3.4 mg/dL, respectively; P<0.001). There were also signi ficant differences in bilirubin levels according to delivery methods in subgroups based on demographic characteristics, except in cases when the age of neonates exceeded 7 days on admission and in breast-feeding neonates. In addition, VD was significantly correlated with an increased risk of severe hyperbilirubinemia (relative risk 1.5; 95% confidence interval 1.2–1.9; P=0.031).

Conclusion

This study showed that term neonates with hyperbilirubinemia born by VD had significantly higher bilirubin levels than those born by CS, and were also significantly correlated with severe hyperbilirubinemia.

Keywords: Hyperbilirubinemia, neonatal, Delivery, obstetric

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Table 1.

Clinical Characteristics of Patients with Neonatal Hyperbilirubinemia (n=87)

Characteristics	Values
Postnatal age at the time of admission (day)	7.2±2.8
<7 days	45 (51.7)
≥7 days	42 (48.3)
Birth weight (kg)	3.3±0.4
Total bilirubin (mg/dL)	20.2±4.3
Direct bilirubin (mg/dL)	0.4±0.1
Sex
Male	53 (60.9)
Female	34 (39.1)
Delivery methods
Vaginal delivery	59 (67.8)
Cesarean section	28 (32.2)
Mother's age
Mean age (year)	31.8±3.9
<35 years	67 (77.0)
≥35 years	20 (23.0)
Birth order
First child	36 (41.4)
Second child or after	51 (58.6)
Feeding type
Breast feeding	22 (25.3)
Formula feeding	25 (28.7)
Mixed feeding (breast+formula)	40 (46.0)

Values are presented as mean±standard deviation or number (%).

Table 2.

Comparison of the Mean Serum Total Bilirubin Levels according to Delivery Methods (by Independent Samples t-test)

	Total bilirubin level (mg/dL)	P-value
Vaginal delivery	21.5±4.0	<0.001
Cesarean section	17.5±3.4

Values are presented as mean±standard deviation.

Table 3.

Comparison of the Mean Serum Total Bilirubin Levels according to Delivery Methods in Subgroups based on Demographic Characteristics of Neonates (by Independent Samples t-test or Mann-Whitney U-test)

Characteristics	Total bilirubin level (mg/dL)		P-value
Characteristics	Vaginal delivery	Cesarean section	P-value
Postnatal age <7 days	21.4±3.3	16.3±3.0	<0.001
Postnatal age ≥7 days	21.5±4.7	18.8±3.3	0.071
Male	22.5±4.1	18.0±3.5	<0.001
Female	19.9±3.6	16.4±3.0	0.010
Mother's age <35 years	20.5 (11.1–35.9)	16.2 (13.5–22.9)	<0.001
Mother's age ≥35 years	21.7 (15.2–29.9)	19.3 (12.0–25.1)	0.037
First child	21.4±3.1	17.4±3.1	0.001
Second child or after	21.5±4.6	17.5±3.6	0.004
Breast feeding	22.8 (11.1–26.7)	21.6 (20.6–25.1)	1.000
Formula feeding	20.0±2.3	16.9±3.1	0.009
Mixed feeding	20.7 (16.6–35.9)	16.5 (12.0–22.3)	<0.001

Values are presented as mean±standard deviation or median (minimum-maximum).

Table 4.

Comparison of the Mean Serum Total Bilirubin Levels according to Characteristics of Neonates

Characteristics	Total bilirubin level (mg/dL)	P-value
Postnatal age∗
<7 days	19.7±4.0	0.274
≥7 days	20.7±4.5
Sex∗
Male	21.0±4.4	0.025
Female	18.9±3.7
Mother's age∗
<35 years	20.0±4.2	0.614
≥35 years	20.6±4.5
Birth order∗
First	20.1±3.6	0.873
Second or after	20.2±4.7
† Feeding type
Breast feeding	21.7±4.0	0.059
Formula feeding	18.8±3.0
Mixed feeding	20.2±4.8

Values are presented as mean±standard deviation. ∗Independent samples t-test.

^† One-way ANOVA.

Table 5.

Comparison of the Mean Serum Total Bilirubin Levels according to Feeding Types (by Post-hoc Analysis)

Feeding type	Total bilirubin level (mg/dL)	P-value
Breast feeding	21.7±4.0	0.046
Formula feeding	18.8±3.0
Breast feeding	21.7±4.0	0.368
Mixed feeding	20.2±4.8
Formula feeding	18.8±3.0	0.367
Mixed feeding	20.2±4.8

Values are presented as mean±standard deviation.

Table 6.

The Correlation between Severe Hyperbilirubinemia (Total Bilirubin ≥25 mg/dL) and Delivery Methods (by Fisher's exact test; Relative Risk 1.5; 95% Confidence Interval 1.2–1.9; P=0.031)

V	Delivery method		Total n
V	Vaginal delivery	Cesarean section	Total n
Total bilirubin ≥25 mg/dL	13 (22.0)	1 (3.6)	14 (16.1)
Total bilirubin <25 mg/dL	46 (78.0)	27 (96.4)	73 (83.9)
Total	59 (100)	28 (100)	87 (100)

Values are presented as number (%).

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