Background and objectives: Bilirubin encephalopathy is a preventable severe complication in neonates. Bhutani’s nomogram has been widely used for screening and deciding the optimal follow-up time based on the pre-discharge bilirubin level. However, there are many factors that may increase the risk of severe hyperbilirubinemia. This study aims to identify predisposing factors and prevalence of severe hyperbilirubinemia (total bilirubin > 20 mg/dL) in late preterm and term infants.
Methods: This is retrospective nested case-control study of newborn infants at 35-42 weeks’ gestation and birth body weight at least 2,000 grams who were readmitted due to neonatal jaundice at Sriphat Medical Center, Faculty of medicine, Chiang Mai University between January 1, 2014 and December 31, 2018.
Results: Eight hundred and five neonates were enrolled. The prevalence of severe hyperbilirubinemia was 26% of readmitted cases. No patient required exchange transfusion or developed symptoms of bilirubin encephalopathy. Gestational age, presence of cephalhematoma or subgaleal hematoma and weight loss at follow-up > 8% were significant predisposing factors of severe hyperbilirubinemia with adjusted OR (95%CI) of 2.24 (1.21 to 4.22), 2.18 (1.41 to 2.89), and 1.81 (1.06 to 2.45) respectively.
Conclusion: Gestational age of > 38 weeks, weight loss at follow-up date > 8% and history of cephalhematoma or subgalaeal hemorrhage were predisposing factors of severe hyperbilirubinemia in readmitted late preterm and term neonates.
