الفهرس 
Magnitude of the problemOnly 14 pages are availabe for public view
 |  | from | 170 |  |  |
| | | from | 170 | | |
Abstract
Neonatal hyperbilirubinemia is a common clinical problem encountered during the neonatal period, especially in the first week of life, severe jaundice if not treated can cause kernicterus. The role of the primary care practitioner especially a family physician is to evaluate the jaundiced neonate to rule out pathological causes and to monitor physiological jaundice and refer the neonate to tertiary care if its bilirubin approaches dangerous levels. Aim of the study; is to determine the incidence of neonatal jaundice in Kafr El Sheikh City, Egypt, and to determine the potential risk factors of neonatal jaundice during period of study. Subjects and Methods: This study was a prospective cohort study carried out in the Main Central Health Office in Kafr El Sheikh City. The studied group included 410 infants, the sample size was calculated at N<374 provided that the power of this study is 80% and the confidence limit is at 95%.It is calculated by the epi-info version 7.2 program for statistical analysis. A predesigned questionnaire was the tool used. All mothers were interviewed with their babies during the first week of life during making their infant’s thyroid test in the center to see if they are jaundiced or not. All the neonates were subjected to history taking from their mothers, comprehensive general and local examination; Laboratory investigations for the mother to estimate anemia and blood group (ABO & RH) were taken from their health record in the center. The cases that were not recorded in the center did this lab investigation in the health center. Laboratory investigations for the babies who developed pathological jaundice did a Total and Direct Serum Bilirubin, blood type & RH and complete blood count in the health center and/or El Obour Insurance Hospital in the same city. All infants were followed up for 28 days after birth to trace the occurrence of pathological jaundice. The data was analyzed using SPSS version 21. The results of the current study can be summarized as follow: The incidence of neonatal jaundice in current study was high. (88.0%),(81.7%) from them were physiological and (6.3%) were pathological, only (2.5%) had sever jaundice, pathological causes were due to ABO incompatibility (77.0%) more than Rh incompatibility (11.6%) while other causes as bile duct obstruction, hematoma and infection had equal ratio of (3.8%) about half of cases did not need a treatment, (23.8%) of them treated conservatively, (25.2%) treated by phototherapy, only (1.6%) needed blood exchange, there was one case from 26 cases of pathological jaundice died making a case fatality rate (CFR) of (3.8%). In the current study several risk factors were associated with development of significant neonatal jaundice: Maternal risk factors, regarding sociodemographic characterestics, the results revealed that pathological jaundice appeared in a higher significant incidence among infants whom their mothers were less than 20 years old, with low and moderate education and non-working, they were (20.0& 9.7%, 9.7 and 7.0%) respectively, It was found that the risk of occurrence of neonatal pathological jaundice among mothers aged less than20y and those above 30y were triple and double the risk among mothers aged 20-30y, RR= (3.091and 2.870) respectively .And the risk of its occurrence among mothers with low and moderate education were double and one and half the risk among mothers with high education RR(2.151 and 1.524)respectively. As regards clinical characteristics of mothers; the results revealed the higher incidence of occurrence of jaundice among infants whom their mothers were suffering from diseases. All diabetic mothers had babies with jaundice, (57.1%) were physiological and (42.9%) were pathological with p value (0.001), also (90.0%) of hypertensive mothers had yellow babies. Mother with renal disease which was pyelonephritis had a baby with physiological jaundice (100%), (88.6%) of anemic mothers their babies were jaundiced, only (7.2%) of them had a pathological jaundice.2.5% of mothers received drugs during third trimester for about (4-6) months, their babies developed pathological jaundice. Perinatal risk factors included: Gestational age, and the results revealed that the occurrence of pathological jaundice was in a higher incidence in preterm infants than full-term (13.3%,6.1%).The mode of delivery showed higher incidence of pathological NNJ. with caesarian method and with mothers who took oxytocin drug during their normal labour (6.7 and 4.0) respectively. Neonates of mothers exposed to delivery complications were more risky to pathological jaundice three times than neonates of mothers not exposed to delivery complications, RR= (2.723). Neonatal risk factors: results revealed that the risk of occurrence of pathological jaundice among infants whom their siblings suffered jaundice was four times more than among infants whom their siblings did not have jaundice RR= (4.050). Also, pathological jaundice was more frequent among females, twins, large babies (>3500gm) and those fed artificially (6.6, 8.7, 12.5and 21.7) respectively. Also there was higher incidence of pathological jaundice among babies who had complications during labour than who did not have (8.8%and 5.9%) respectively. There was a significant association between some neonatal complications during delivery and neonatal jaundice as cephalohematoma, not feeding well and unconsciousness p values were (0.001, 0.001and 0.025) respectively. All babies with pathological jaundice were incubated (100.0%) while only about a quarter (23%) of physiological jaundice was incubated. In current study a significant high appearance of jaundice were associated with some maternal risk factors as; age < 20years, diabetes, complications during labour, Primiparity, taking drugs for long duration during pregnancy,previous sibling with jaundice, artificial lactation. Birth weight and trauma were significant neonatal risk factors. The decline of number of jaundiced babies taking treatment, put a spot light on the importance of follow-up of yellow infants so, these infants after discharge should be followed up at pre- decided time interval.