الفهرس 
Neonatal JaundiceOnly 14 pages are availabe for public view
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Abstract
Neonatal jaundice, the yellow discoloration of the sclera and skin caused by hyperbilirubinemia, is one of the most common conditions confronting neonatologists daily. Approximately 60 % of term and 80% of pre-term babies develop jaundice in the first week of life.
In most infants with jaundice there is no underlying disease, and the jaundice is termed physiological. Physiological jaundice typically presents on the second or third day of life and results from the increased production of bilirubin and the decreased excretion of bilirubin that normally occur in newborn babies. Breastfed infants are more likely to develop jaundice within the first week of life; this is thought to be an exacerbated physiological jaundice caused by a lower caloric intake and increased enterohepatic circulation of bilirubin.
Prolonged unconjugated jaundice, persisting beyond the second week, is also seen in breastfed infants. The mechanism for this later ’breast milk jaundice syndrome’ is still not completely understood. Non-physiological causes include blood group incompatibility (rhesus or ABO problems), other causes of haemolysis, sepsis, bruising, and metabolic disorders. Gilbert’s and Crigler-Najjar syndromes are rare causes of neonatal jaundice.
Phototherapy plays a significant role in the treatment and prevention of hyperbilirubinemia in neonates. However, exchange transfusion is still the gold standard of treatment for severe hyperbilirubinaemia. The efficacy of phototherapy in the treatment of unconjugated hyperbilirubinaemia may be influenced by the wavelength of the light used, the intensity of the light source, the total
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dose of light received (time under phototherapy and amount of skin exposed), and/or the threshold at which phototherapy is commenced.
In vitro number of studies reported that hemoglobin competes the bilirubin for absorbing light during phototherapy . It has been suggested that high level of hemoglobin or hematocrit interfered in the effectiveness of phototherapy We aimed by this study to assess the effect of hemoglobin level on the efficacy of phototherapy.
The study included 100 full term neonate admitted with a diagnosis of jaundice into the NICU of Menoufia University Hospital. With median GA 38 week, age at admissiom 4 days, 57% are male, 79% delivered by Cs. Inclusion criteria was full term and near term neonate with indirect hyperbilirubinemia treated by phototherapy. Exclusion criteria was gestational age <34 weeks, direct hyperbilirubinemia, presence of a neonatal illness other than jaundice such as sepsis, previous treatment with phtotherapy and infants requiring exchange transfusion. For all neonates studied, investigations were done at admission [CBC, CRP, Reticulocytic count, total and direct bilirubin and blood group and RH (to the neonates and the mother)]. The infants were treated by phototherapy, total serm bilirubin and hemoglobin levels were measured upon admission and 24-hr after phototherapy.
Studied neonates were categorized according to the median delta total serum bilirubin into two groups: the first one with delta bilirubin above the median; the second group with delta bilirubin equal to or less than the median.
There was no significant difference between patients with higher delta total bilirubin and those with lower delta bilirubin level regarding the admission, 24-hour, and mean hemoglobin levels.
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Patients with higher delta total bilirubin had significantly higher platelet and white blood cell count. The frequency of double phototherapy was significantly higher among patients with higher delta total serum bilirubin
Multivariate logistic regression analysis confirmed the independent association of delta bilirubin level with platelet count and proved that double photherapy was the best independent variable associated with reduction of bilirubin level.