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

Journal List > Perinatology > v.30(3) > 1144118

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

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.

Go to :

Keywords: Hyperbilirubinemia, neonatal, Delivery, obstetric

References

1. Watchko JF. Hyperbilirubinemia and bilirubin toxicity in the late preterm infant. Clin Perinatol. 2006; 33:839–52.

2. Shapiro SM, Bhutani VK, Johnson L. Hyperbilirubinemia and kernicterus. Clin Perinatol. 2006; 33:387–410.

3. Tamouk A, Saleh Zadeh F, Amini Sani N, Moghadam Yeganeh ZH. Etiology of neonatal hyperbilirubinemia at Ardabil Sabalan Hospital, 2003. J Ardabil Univ Med Sci. 2005; 5:316–20.

4. Bhutani VK, Johnson LH. Urgent clinical need for accurate and precise bilirubin measurements in the United States to prevent kernicterus. Clin Chem. 2004; 50:477–80.

5. Bulbul A, Okan FF, Unsur EK, Nuhoglu A. Adverse events associated with exchange transfusion and etiology of severe hyperbilirubinemia in near-term and term newborns. Turk J Med Sci. 2011; 41:93–100.

6. Newman TB, Liljestrand P, Escobar GJ. Jaundice noted in the first 24 hours after birth in a managed care organization. Arch Pediatr Adolesc Med. 2002; 156:1244–50.

7. Newman TB, Xiong B, Gonzales VM, Escobar GJ. Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization. Arch Pediatr Adolesc Med. 2000; 154:1140–7.

8. Maisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. Pediatrics. 1998; 101:995–8.

9. Chang PF, Lin YC, Liu K, Yeh SJ, Ni YH. Risk of hyperbilirubinemia in breastfed infants. J Pediatr. 2011; 159:561–5.

10. Davies DP, Gomersall R, Robertson R, Gray OP, Turnbull AC. Neonatal jaundice and maternal oxytocin infusion. Br Med J. 1973; 3:476–7.

11. Boskabadi H, Navaei M. Relationship between delivery type and jaundice severity among newborns referred to Ghaem Hospital within a 6-year period in Mashhad. Iran J Obstet Gynecol Infertil. 2011; 14:15–21.

12. Osborn LM, Reiff MI, Bolus R. Jaundice in the fullterm neonate. Pediatrics. 1984; 73:520–5.

13. Linn S, Schoenbaum SC, Monson RR, Rosner B, Stubblefield PG, Ryan KJ. Epidemiology of neonatal hyperbilirubinemia. Pediatrics. 1985; 75:770–4.

14. Yamauchi Y, Yamanouchi I. Difference in TcB readings between full term newborn infants born vaginally and by cesarean section. Acta Paediatr Scand. 1989; 78:824–8.

15. Bulbul A, Cayonu N, Sanli ME, Uslu S. Evaluation of risk factors for development of severe hyperbilirubinemia in term and near term infants in Turkey. Pak J Med Sci. 2014; 30:1113–8.

16. Chew WC, Swann IL. Influence of simultaneous low amniotomy and oxytocin infusion and other maternal factors on neonatal jaundice: a prospective study. Br Med J. 1977; 1:72–3.

17. Calder AA, Ounsted MK, Moar VA, Turnbull AC. Increased bilirubin levels in neonates after induction of labour by intravenous prostaglandin E2 or oxytocin. Lancet. 1974; 2:1339–42.

18. Keren R, Bhutani VK, Luan X, Nihtianova S, Cnaan A, Schwartz JS. Identifying newborns at risk of significant hyperbilirubinaemia: a comparison of two recommended approaches. Arch Dis Child. 2005; 90:415–21.

19. Buchan PC. Pathogenesis of neonatal hyperbilirubinaemia after induction of labour with oxytocin. Br Med J. 1979; 2:1255–7.

20. Koh BH, Lee DK, Hwang HB, Kim SD, Ahn JY. Obstetric factors influencing the incidence rate of neonatal hyperbilirubinemia. Obstet Gynecol Sci. 1984; 27:2151–6.

21. Lee HS, Kwon GH, Kim JD. Clinical study on the oxytocin effect on neonate. Obstet Gynecol Sci. 1986; 29:942–9.

22. Jang HH, Kim YH, Ha YS, Park JS. Obstetric factors influencing the incidence rate of neonatal hyperbilirubinemia. Obstet Gynecol Sci. 1987; 30:506–13.

23. Jeong YA, Chung CW. Pregnant women's labor progress, childbirth outcome, and childbirth satisfaction according to the presence or absence of labor induction. Korean J Women Health Nurs. 2018; 24:58–70.

24. Punnoose AR, Schwartz LA, Golub RM. Neonatal hyperbilirubinemia. JAMA. 2012; 307:2115.

25. Carbonell X, Botet F, Figueras J, Riu-Godó A. Prediction of hyperbilirubinaemia in the healthy term newborn. Acta Paediatr. 2001; 90:166–70.

26. Gourley GR. Breast-feeding, neonatal jaundice and kernicterus. Semin Neonatol. 2002; 7:135–41.

27. Farhat AS, Hafizi L, Pourhoseini MT, Halimi F, Mohamadzadeh A, Saeidi R. Comparison of bilirubin level in term infants born by vaginal delivery and C/S. IJN. 2016; 7:45–9.

28. Alkan S, Tiraş U, Dallar Y, Sunay D. Effect of anaesthetic agents administered to the mothers on transcutaneous bilirubin levels in the neonates. Acta Paediatr. 2010; 99:993–6.

29. Saber A, Ferdowsi S, Askari F, Farsi L. Epidemiology of pathological jaundice and its association with demographic factors in infants born in the 22 Bahman Hospital in Gonabad, 2011. Razi J Med Sci. 2013; 20:42–8.

30. Boskabadi H, Zakerihamidi M, Bagheri F. Outcomes of vaginal delivery and cesarean in Mashhad Ghaem University Hospital. Tehran Univ Med J. 2014; 71:807–15.

31. Agrawal V, Singh V, Goel SP, Gupta B. Maternal and neonatal factors affecting physiological jaundice in Western U.P. Indian J Physiol Pharmacol. 2007; 51:203–6.

32. Gale R, Seidman DS, Dollberg S, Stevenson DK. Epidemiology of neonatal jaundice in the Jerusalem population. J Pediatr Gastroenterol Nutr. 1990; 10:82–6.

33. Maisels MJ, Newman TB. Kernicterus in otherwise healthy, breastfed term newborns. Pediatrics. 1995; 96(4 Pt 1):730–3.

34. Huang A, Tai BC, Wong LY, Lee J, Yong EL. Differential risk for early breastfeeding jaundice in a multiethnic Asian cohort. Ann Acad Med Singapore. 2009; 38:217–24.

Go to :

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 (%).

TOOLS

Similar articles