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Jaundice: Clinical Practice in 88,000 Liveborn Infants
Author(s) -
Guaran Robert L.,
Drew John H.,
Watkins Andrew M.
Publication year - 1992
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1992.tb01942.x
Subject(s) - jaundice , medicine , exchange transfusion , abo incompatibility , pediatrics , abo blood group system , necrotizing enterocolitis , sepsis , etiology , erythroblastosis fetalis , bilirubin , pregnancy , gastroenterology , surgery , fetus , genetics , biology
EDITORIAL COMMENT: This paper by paediatricians was written mainly for obstetricians and those medical practitioners and nurses who care for the ‘normal’ newborn infant, more than 50% of whom develop at least a tinge of jaundice in the first few days of life. This paper considers only cases of bone‐fide jaundice (≥154 umol/l) which however occurs in about 1 in 8 liveborn infants. This paper will give the reader a valuable overview of the causes of significant jaundice in the newborn and the management and mortality rates according to the cause, and the necessary method of treatment. We asked the authors to provide copies of the 4 charts which detail management of jaundiced infants according to birth‐weight (< 1,500 g, 1,500‐2,000 g, 2,001–2,500 g and > 2,500 g), age in days and level of plasma bilirubin since they will be of practical assistance to readers. These charts are reproduced with permission from Beischer NA, Mackay EV. Obstetrics and the Newborn. Holt‐Saunders 1986; p661 and are available in colour from the authors on request. Summary: We reviewed jaundiced infants born between 1971 and 1989. Jaundice was diagnosed in infants whose serum bilirubin level was found to be 154 umol/l or greater. Of 88,137 livebirths, 10,944 (12.4%) were jaundiced. The most common aetiological factor was prematurity (20.3%), followed by ABO erythroblastosis (5.5%), sepsis (1.8%), Rh erythroblastosis (1.8%), bruising (1.3%), multifactorial (1.0%) and glucose‐6‐phosphate dehydrogenase deficiency (0.5%). In the remainder (67.8%) no cause was found or inadequate investigations were performed to determine a cause. During the period under review there was a significant increase (r = 0.91) in the proportion of newborn infants with jaundice of prematurity, in those not investigated (r = 0.92) and a decrease in the proportion with bruising (r = ‐0.90) as the cause. Phototherapy was used on 4,126 (37.7%) infants and exchange transfusion performed on 248 (2.3%). Causes of jaundice in infants requiring exchange transfusion were Rh erythroblastosis (108, 43.6%), ABO erythroblastosis (58, 23.4%), jaundice of prematurity (44, 17.7%) and a variety of causes in the remaining 38 (15.3%). Death occurred in 164 (1.5%) infants. In only 7 (4.3%), however, was the death possibly related to hyperbilirubinaemia or its treatment (Rh erythroblastosis (4), necrotizing enterocolitis following exchange transfusion (2) and pulmonary haemorrhage following exchange transfusion (1)). Phototherapy proved safe with no deaths attributable to its use.