الفهرس 
NEONATAL HYPERBILIRUBINEMIAOnly 14 pages are availabe for public view
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Abstract
Jaundice is a frequently encountered problem during the newborn period. Although up to 60% of term newborns have clinical jaundice in the first week of life, few have a significant underlying disease. However, it can be associated with severe illnesses such as hemolytic disease, metabolic and endocrine disorders, enzymatic deficiencies of the liver and infections.
Urinary tract infection (UTIs) are a common clinical problem in febrile infants younger than 8 weeks old, with a prevalence between 5% and 11%. Previous studies have noted that jaundice may be one of the first signs of a bacterial infection in infants.
Although not statistically significant, yet a history of worsening jaundice, as reported by the parents, was more commonly observed in patients with positive urine cultures.
Our study was conducted on 120 full term neonates with neonatal jaundice, 73 males and 47 females. They were selected form the NICU in Benha Children Hospital and Kafr Shukr Hospital. Newborns were recruited during the study period from Mars 2011 January 2012.
Newborns who were excluded were those: above 2 weeks of age, jaundiced neonates with bilirubin levels < 15 mg %, neonates jaundiced in the first 24 hrs with signs of hemolysis and newborns with fever and signs of sepsis.
Complete obstetric history was taken, clinical examination was performed, and the following investigations were done:
C.B.C and reticulocytic count, maternal and neonatal blood group and RH, bilirubin (direct and total), and Coomb’s test were evaluated. Urine analysis and urine culture were performed on specimens obtained by bladder catheterization, if more than 100,000 bacteria were isolated the result was considered as positive. Pyuria was defined as > 5 white blood cells/blood cells/HPF.
The results of the present study showed that 9 of the 120 neonates had positive urine culture. There was no statistically significant difference between the positive and negative groups as regards gestational age, post conceptional age or mode of delivery.
Most of the cases with UTI (7 out of 9 neonates) (77.8%) were males. With no statistically significant difference between the positive and negative groups regarding male predominance.
In this study 87.5% of the studied subjects (105 neonates) had irrelevant family history but (12.5%) (15 neonate) had a positive family history of neonatal jaundice in a previous sibling.
The comparison between the positive & negative groups regarding history of maternal infections showed that (77.8%) had positive history of neglected maternal infections uncovered with antibiotics among the positive group. While only (34.2%) had positive history of neglected maternal infections among the negative group, with statistically significant difference between the two groups.
Regarding the causative organisms, 33,4% (3 neonates out of 9) had klebsiella pneumoniae infection while more than 66,7% (6 neonates out of 9) had Escherichia coli infection.
Pyuria in our study showed statistically significant difference between positive and negative groups as regards urinary pus cells. None of the neonates had significant microscopic hematuria.
Such findings should raise an important question about the value of testing for a UTI as a part of the diagnostic evaluation of asymptomatic jaundiced infants.
Also, another important question is raised here and should be evaluated in future related studies and that is whether jaundice is the result of UTI or UTI is the result of jaundice due to decreased bactericidal action in the sera of jaundiced neonates resulting from a functional defect in the complement system.
from the previous discussion, we can come to the conclusion that UTI may occur in jaundiced newborns. Points to be considered in such neonates are: maternal history of infections during pregnancy, Circumcision is considered as an important protective factor against UTI and should be performed as early so possible one should not rely on simple urine analysis only for detection UTI in a jaundiced newborns