ID Design Press, Skopje, Republic of Macedonia

Open Access Macedonian Journal of Medical Sciences. 2018 Aug 20; 6(8):1387-1393.
https://doi.org/10.3889/oamjms.2018.319
eISSN: 1857-9655
Clinical Science

Risk Factors Associated with Neonatal Jaundice: A Cross-

Sectional Study from Iran

1 2 3 4,5 6*
Sayed Yousef Mojtahedi , Anahita Izadi , Golnar Seirafi , Leila Khedmat , Reza Tavakolizadeh

1 2
Department of Pediatrics, Ziyaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Pediatric
3
Infection Disease, Tehran University of Medical Science, Tehran, Iran; School of Medicine, Ziyaeian Hospital, Tehran
4
University of Medical Sciences, Tehran, Iran; Department of Community Medicine, School of Medicine,Tehran University of
5
Medical Science, Tehran, Iran; Health Management Research Center and Department of Community Medicine, Faculty of
6
Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran; Department of Pediatrics, Tehran University of Medical
Sciences, Tehran, Iran

Abstract
Citation: Mojtahedi SY, Izadi A, Seirafi G, Khedmat L, BACKGROUND: Neonatal jaundice is one of the main causes of the patient's admission in the neonatal period
Tavakolizadeh R. Risk Factors Associated With Neonatal
Jaundice; a Cross-Sectional Study from Iran. Open
and is potentially linked to morbidity.
Access Maced J Med Sci. 2018 Aug 20; 6(8):1387-1393.
https://doi.org/10.3889/oamjms.2018.319 AIM: This study aimed to determine the possible risk factors for neonatal jaundice.
Keywords: Neonatal Jaundice; Predisposing factors;
Jaundice METHODS: We investigated the case of infants who were admitted to the neonatal department of Ziyaeian
*Correspondence: Reza Tavakolizadeh. Department of hospital and Imam Khomeini Hospital for jaundice. Simple random sampling was used to evaluate variables
Pediatrics, Tehran University of Medical Sciences, related to maternal and neonatal predisposing factors based on the medical records and clinical profiles. All
Tehran, Iran. E-mail: rezatavakolizadeh@yahoo.com
variables in this study were analysed using SPSS software.
Received: 06-Jul-2018; Revised: 23-Jul-2018;
Accepted: 07-Jul-2018; Online first: 11-Aug-2018 RESULTS: In this study, about 200 mothers and neonates were examined. Our findings depicted that mother's
Copyright: © 2018 Sayed Yousef Mojtahedi, Anahita WBC, Hb, PLT, and gestational age were associated with jaundice (P < 0.05). Furthermore, there were significant
Izadi, Golnar Seirafi, Leila khedmat, Reza Tavakolizadeh.
This is an open-access article distributed under the terms relationships between different degrees of bilirubin with TSH, T4 levels and G6PD (P < 0.05). In fact, TSH, T4
of the Creative Commons Attribution-NonCommercial 4.0 levels and G6PD were found to be linked to neonatal hyperbilirubinemia. The risk factors for jaundice in our study
International License (CC BY-NC 4.0)
population comprise some predisposing factors such as WBC, Hb, PLT, gestational age, TSH, and T4 levels, as
Funding: This research did not receive any financial well as G6PD. Neonates at risk of jaundice are linked to some maternal and neonatal factors that can provide
support
necessary interventions to reduce the burden of the disease. Therefore, identification of associated factors can
Competing Interests: The authors have declared that no
competing interests exist facilitate early diagnosis, and reduce subsequent complications.

CONCLUSION: Neonatal jaundice should be considered as the main policy in all health care settings of the
country. Therefore, identification of factors affecting the incidence of jaundice can be effective in preventing
susceptible predisposing factors in newborns and high-risk mothers.

Introduction day of birth and is not usually harmful, and a self-

limiting condition, where disease usually improves
without treatment after reaching the normal amount of
Neonatal jaundice is a common event that bilirubin [6] [7], but very high levels of bilirubin may
occurs especially in the first week of birth [1] [2] [3] lead to kernicterus as permanent brain damage.
and is one of the most common causes of Nevertheless, diagnosis of newborn jaundice and its
hospitalisation of the term and preterm neonates in management will play an important role in the health
neonatal wards [1]. Based on the present evidence, of newborns [8]. If jaundice lasts more than 14 days, it
80% of premature infants have clinical symptoms, is called to be prolonged neonatal jaundice [6].
including yellowish skin and sclera, caused by serum An imbalance between bilirubin production
bilirubin levels [4] [5]. Hyperbilirubinemia is a common and conjugation is the main mechanism of jaundice,
disease that occurs especially in the first week of birth which leads to an increase in bilirubin levels. This
[1] [2] [3] and is one of the most common causes of imbalance often occurs due to the immature liver and
hospitalisation of the term and preterm infants in the rapid breakdown of red blood cells, which may be
neonatal hospitals [1]. It usually occurs on the second involved with several factors [9] [10] [11] [12].
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Clinical Science
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The indirect bilirubin value in the physiologic Material and Methods

jaundice of the term neonates does not exceed 12
mg/dL on the third day, and, this maximum increase
reaches 15 mg/dL in preterm infants on the fifth day This cross-sectional study was conducted on
[13]. 207 neonates (<15 days) with hyperbilirubinemia (>
In physiologic jaundice, the maximum indirect 15 mg/dL) admitted to Ziaeean and Imam Khomeini
bilirubin of infants who fed breast milk may be higher hospitals in Tehran from April 2010 to May 2016.
than those fed with skimmed milk (15-17 mg/dL All neonates were examined for neonatal
versus 12 mg/dL); this higher level is probably due to jaundice risk factors. Neonates born with jaundice
the lower consumption of fluid by infants who are were selected based on the clinical outcomes of the
breastfeeding [14]. neonates. Furthermore, data from medical records
Jaundice on the first day of life is always and interviews with mothers were collected by survey
pathologic, and urgent attention is needed to find its staff. A checklist including demographic information
cause. Early jaundice is often due to hemolysis and and other information was also provided.
internal haemorrhage (cephalohematoma, liver or Maternal variables including blood group, RH,
spleen hematoma) or infection. Furthermore, jaundice Gestational diabetes mellitus (GDM), familial history of
is considered to be pathologic after two weeks and diabetes, history of anemia and thalassemia minor,
suggests direct hyperbilirubinemia [13] history of thyroid disease during and before
Jaundice is usually seen in newborns when the pregnancy, history of birth of a newborn with jaundice,
concentration of bilirubin reaches 5-10 mg/dl; history of smoking during pregnancy, use of herbal
however, it is seen as 2-3 mg/dl in adults. If the medicines during pregnancy, history of perinatal
jaundice is observed, the total bilirubin should be infections (TORCH: syphilis, rubella, toxoplasmosis),
measured to determine its severity. On the other CMV, CBC were evaluated in the current study.
hand, If the concentration in the newborn is more than Neonatal variables included gender, the age of birth,
5 in the first day of life or higher than 13 mg/dl in the birth season, birth weight, blood group and Rh.
following days, further studies are needed to
determine the direct and indirect bilirubin value, blood Hyperbilirubinemia was the criteria for
group, Coombs test, CBC, Peripheral blood smear entering this study. Also, exclusion criteria included
and reticulocytes count [13]. incomplete medical records. However, 20% of the
sample size was considered as additional samples in
Identification of predisposing factors in the the current study.
management of the disease is important [15] [16],
there are a number of predisposing factors in the Finally, data were collected from medical
occurrence of this disease, including maternal records and questionnaires. All data were then
diabetes, race, prematurity, height, polycythemia, analysed by using SPSS software version 19. In this
male sex, cephalohematoma, medications, Trisomy study, all principles of the Helsinki Statement were
21, weight loss, breastfeeding, delayed meconium considered as a statement of ethical principles for
passage and family history of jaundice [17] [18] [19] medical studies. It is worth noting that parents were
[20] [21]. The most common cause of jaundice can be informed about the study.
ABO incompatibility. Rh incompatibility and type of 20% of the extra sample size was added to
delivery can be among the controversial factors. prevent loss and withdrawal (N = 200). P is
Furthermore, some factors may contribute to jaundice, considered to be the first pregnancy in the formula, as
such as congenital infections (Syphilis, CMV, rubella, reported previously (24 and 25). Thus, the sample
toxoplasmosis), and age more than 25 years [22]. To size was calculated as 200 individuals: alfa = 0.05, Z1-
the best of our knowledge, there were not many a/2= 1.961150776, d= 0.03, p= 0.96, n= 165.
studies on the epidemiology of jaundice in Iran.
Data were collected by a questionnaire that
On the other hand, there has also been no was asked by the researcher from the patient.
program for the prevention and management of Moreover, a set of data was collected from medical
jaundice. Regarding the importance of irreversible records. Then, the data were analysed by SPSS
complications of hyperbilirubinemia and the software. Frequency was calculated for qualitative
prevention of these complications, the present study variables, while the mean, range and standard
was aimed to investigate the predisposing factors deviation were calculated for quantitative variables.
(maternal and neonatal risk factors) in the incidence of The chi-square test was used to examine qualitative
jaundice in newborn infants admitted to Ziaeean data, and t-test for non-dependent samples was used
medical centre. Identifying predisposing factors in to study quantitative data. It should be noted that the
predicting the occurrence and prevention of such risks P-value of < 0.05 was considered significant.
in neonates is important to reduce the morbidity and
mortality of hyperbilirubinemia.

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 Mojtahedi et al. Risk Factors Associated With Neonatal Jaundice
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Results Also, there was no significant difference in the

maternal blood group in the neonates with different
levels of bilirubin (P = 0.1; Table 2).
The mean age of the pregnancy (weekly) Our findings have revealed that there was no
based on the level of bilirubin was shown in Table 1. significant difference in maternal hematologic Rh
The result of statistical analysis indicated that the among neonates with different levels of bilirubin (P =
gestational age was significantly related to jaundice (P 0.8; Table 3).
= 0.003).
Table 3: Evaluation of RH Blood Groups in Maternal Different
Table 1: Evaluation of Blood Factors and Other Neonatal Ages of Bilirubin (Rh/m)
Factors in Different Levels of Bilirubin
Total Bilirubin P = 0.8
t4/n tsh/n hct/n plt/n mcv/n hb/n wbc/n Retic bili/d bili/ b/w g/age Bilirubin 20-24.9 15-19.9 10-14.9
total
0.105 0.003 0.704 0.192 0.107 0.389 0.370 0.079 0.740 0.000 0.105 0.003 p-value 154 4 24 126 Number Positive Rh/m
8.98 4.96 40.22 290.59 98.44 15.14 11.82 0.03 0.50 9.75 2727.84 36.01 Average 10- 77.0% 66.7% 77.4% 77.3% Percent
2.72 3.52 9.27 95.97 7.92 3.23 4.03 0.02 0.38 2.55 715.43 3.29 Deviation 14.9
standard 46 2 7 37 Number Negative
8.74 3.88 40.85 299.48 99.61 15.67 10.70 0.03 0.50 16.24 2896.29 37.94 Average 15- 23.0% 33.3% 22.6% 22.7% Percent
3.08 1.62 8.38 64.59 8.58 2.45 3.02 0.02 0.21 0.82 572.05 1.59 Deviation 19.9
standard 200 6 31 163 Number Total
10.45 1.80 48.24 341.33 102.58 16.83 8.90 0.03 0.38 19.25 3250.00 38.00 Average 20- 100.0% 100.0% 100.0% 100.0% Percent
1.34 0.71 8.59 115.11 4.30 3.43 2.51 0.01 0.16 1.29 388.59 1.10 Deviation 24.9
standard
8.97 4.75 40.56 293.49 98.75 15.28 11.56 0.03 0.49 11.04 2769.62 36.37 Average Total
2.75 3.31 9.18 92.42 7.96 3.13 3.89 0.02 0.35 3.61 693.32 3.13 Deviation
standard

Based on Table 4, out of 163 patients, 41

neonates (25.2%), who their mothers suffered from
Moreover, as shown in Table, the findings of GDM, exhibited a serum bilirubin level of 10-14.9,
the statistical analysis revealed that the birth weight of followed by a bilirubin level of 20-24.9 (16.7%) and a
the infant was not significantly associated with the bilirubin level of 15-19.9 (16.1%). Neonates with
incidence of jaundice based on the bilirubin levels (P = different levels of bilirubin exhibited no significant
0.105). difference regarding gestational diabetes mellitus (P =
Assessment of neonatal bilirubin based on the 0.5).
different bilirubin level revealed that total bilirubin had
Table 4: Evaluation of Gestational Diabetes Mellitus in Different
a significant relationship with jaundice (P = 0.000). Ages of Bilirubin
Furthermore, there was no significant correlation
Bilirubin
between direct bilirubin with jaundice (P = 0.740). Total
20-24.9 15-19.9 10-14.9
P = 0.5
47 1 5 41 Number Gestational
Yes
The average reticulocyte count of the infant 23.5% 16.7% 16.1% 25.2% Percent diabetes
153 5 26 122 Number mellitus
indicated that the reticulocyte was not significantly 76.5% 83.3% 83.9% 74.8% Percent
No
(GDM)
200 6 31 163 Number
associated with the incidence of jaundice at the 100.0% 100.0% 100.0% 100.0% Percent
Total

different levels of bilirubin (P = 0.079). The mean of

Hb regarding bilirubin level exhibited that Hb of
neonate was strongly associated with jaundice (P = In the present study, out of 163 neonates, 72
0.389). Evaluation of the mean of mcv by the level of patients (44.2%) with a history of familial diabetes
bilirubin depicted that there was no significant revealed bilirubin levels of 10 to 14.9, following a
difference in infant mcv in different levels of bilirubin bilirubin level of 15-19.9 (54.8%) and a bilirubin level
(P = 0.107). of 20-24.9 (16.7%), (Table 5). No significant difference
The mean of PLT and WBC were markedly was found in the familiar history of diabetes among
associated with jaundice (P = 0.192; (P = 0.370). The neonates with different levels of bilirubin (P = 0.2). As
results of our study showed that the mean of Hct a matter of fact, familial history of diabetes was not
neonates had a significant correlation with found to be correlated with hyperbilirubinemia.
hyperbilirubinemia (P = 0.704).
Table 5: Evaluation of Familiar Diabetes Mellitus in Different
Based on the findings, it was revealed that the Ages of Bilirubin
TSH and T4 were significantly associated with Total
Bilirubin
P=0.2
jaundice (P = 0.003; P = 0.105). 20-24.9 15-19.9 10-14.9
90 1 17 72 Number
Yes
45.0% 16.7% 54.8% 44.2% Percent
Familiar/dm
110 5 14 91 Number
Table 2: Evaluation of Maternal Blood Groups in Different Ages 55.0% 83.3% 45.2% 55.8% Percent
No
of Bilirubin (bg/m) 200 6
31 163 Number Total
Total Bilirubin P = 0.1
20-24.9 15-19.9 10-14.9
54 1 9 44 Number A Bg/m
27.0% 16.7% 29.0% 27.0% Percent Table 6 indicated that out of 163 neonates 35
20 0 7 13 Number Ab
10.0% 0% 22.6% 8.0% Percent newborns (21.5%) with a maternal history of anaemia
45 1 8 36 Number B
22.5% 16.7% 25.8% 22.1% Percent
showed the bilirubin level of 10-14.9, following a
81 4 7 70 Number O bilirubin level of 15-19.9 (32.3%) and a bilirubin level
40.5% 66.7% 22.6% 42.9% Percent
200 6 31 163 Number Total of 20-24.9 (33.3%). There was no significant
100.0% 100.0% 100.0% 100.0% Percent
difference in the maternal history of anaemia between
neonates with different levels of bilirubin (P = 0.3).
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Table 6: Evaluation of Maternal Anemia in Different Ages of associated with hyperbilirubinemia.

Bilirubin

Total
Bilirubin
P = 0.3
Table 10: Evaluation of Asphyxia in Neonatal Different Ages of
20-24.9 15-19.9 10-14.9 Bilirubin
47 2 10 35 Number
Yes
23.5% 33.3% 32.3% 21.5% Percent Bilirubin
Anaemia Total P=0.002
153 4 21 128 Number 20-24.9 15-19.9 10-14.9
No
76.5% 66.7% 67.7% 78.5% Percent 51 0 1 50 Number
200 6 31 163 Number Yes
Total 25.5% 0% 3.2% 30.7% Percent
100.0% 100.0% 100.0% 100.0% Percent Asphyxia
149 6 30 113 Number
No
74.5% 100.0% 96.8% 69.3% Percent
200 6 31 163 Number
Total
100.0% 100.0% 100.0% 100.0% Percent
Bilirubin levels of 10-14.9% were seen in
9.2% of neonates with maternal thalassemia, followed
by a bilirubin level of 15-19.9 (22.6%) and a bilirubin According to Table 11, 15.5% of neonates
level of 20-24.9 (0%), (Table 7). The maternal showed cephalohematoma, while 84.5% of them did
thalassemia was not associated with different levels of not show this complication. Of the total number of 163
bilirubin (P = 0.06). neonates, 13.5% of neonates with hematoma showed
a bilirubin level of 10-14.9, while bilirubin levels of 19-
Table 7: Evaluation of Maternal Thalcemia in Different Ages of 15 and 20-24.9 were found in 25.8% and 16.7% of
Bilirubin
neonates, respectively. Findings demonstrated that
Total
Bilirubin
P = 0.06 there was no significant relationship between
20-24.9 15-19.9 10-14.9
22 0 7 15 Number cephalohematoma and disease (P = 0.2, Table 10). In
Yes
11.0% 0% 22.6% 9.2% Percent
178 6 24 148 Number
Thalassemia the present study, G6PD was also related to the
No
89.0% 100.0% 77.4% 90.8% Percent disease (P = 0.02).
200 6 31 163 Number
Total
100.0% 100.0% 100.0% 100.0% Percent
Table 11: Evaluation of Cephalohematoma in Neonatal
Different Ages of Bilirubin
Bilirubin
We also found that the baby's blood group Total
20-24.9 15-19.9 10-14.9
P = 0.2
was not significantly related to Hyperbilirubinemia 31 1 8 22 Number
Yes
15.5% 16.7% 25.8% 13.5% Percent
(P=0.3l Table 8), followed by a bilirubin level of 15- 169 5 23 141 Number
Cephalohematoma
+ No
19.9 in 80.6% of RH infants and bilirubin levels of 20- 84.5% 83.3% 74.2% 86.5% Percent
+ 200 6 31 163 Number
Total
24.9 in 66.7% of Rh infants. 100.0% 100.0% 100.0% 100.0% Percent

Table 8: Evaluation of Neonatal Blood Groups in Different

Ages of Bilirubin
Bilirubin
Total P = 0.3
20-24.9 15-19.9 10-14.9
66 1 7 58 Number
A
33.0% 16.7% 22.6% 35.6% Percent
27 0 7 20 Number
AB
Discussion
13.5% 0% 22.6% 12.3% Percent
49 2 6 41 Number
B
24.5% 33.3% 19.4% 25.2% Percent
58 3 11 44 Number
O
29.0% 50.0% 35.5% 27.0% Percent Recent studies have demonstrated neonatal
200 6 31 163 Number
100.0% 100.0% 100.0% 100.0% Percent
Total jaundice occurrence in more than 60% of term and
80% of premature neonates in the first week, where
bilirubin is non-conjugate, lipid-soluble, and non-polar
Based on the data presented in Table 9, it pigment. Bilirubin is one of the final products of
was found that the RH blood group was not related to haemoglobin catabolism and its clinical significance in
hyperbilirubinemia (P = 0.7). the neonates is due to sedimentation in the skin and
mucous membrane and the formation of jaundice.
Table 9: Evaluation of RH Blood Groups in Neonatal Different
Ages of Bilirubin (Rh/m)
This complication is also the most common
cause of hospitalisation of the neonates in the first
Bilirubin
Total
20-24.9 15-19.9 10-14.9
P = 0.7 month after birth (about 19%). In most cases, jaundice
157 4 25 128 Number
Positive can be transient, usually resolved by the end of the
78.5% 66.7% 80.6% 78.5% Percent
43 2 6 35 Number
Negative
Rh/n first week after birth, when the total serum bilirubin
21.5% 33.3% 19.4% 21.5% Percent
200 6 31 163 Number
concentration is not considered to be a harmful
Total
100.0% 100.0% 100.0% 100.0% Percent condition. Severe hyperbilirubinemia has been
described to develop with a potential risk for acute
As shown in Table 10, out of 163 patients, 50 bilirubin encephalopathy and kernicterus [23] [24] [25]
neonates (30.7%) with asphyxia showed a bilirubin [26] [27] [28] [32] [33] [34] [35] [36] [37]. Neonatal
level of 10-14.9, following a bilirubin level of 15-19.9 jaundice usually starts from the face and progresses
(3.2%). There was no significant difference in with the increase in the serum level to the abdomen
asphyxia among newborns with different levels of and legs. Based data described before, Jaundice is
bilirubin (P = 0.002). In other words, asphyxia was not one of the most common neonatal problems [23] [24]
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 Mojtahedi et al. Risk Factors Associated With Neonatal Jaundice
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[25] [26] [27] [28] [29]. study. However, our findings have revealed that
maternal and neonatal blood group and RH were not
This complication may lead to death in the first
significantly associated with hyperbilirubinemia
months, and infants who are still alive often suffer from
mental retardation, movement and balance disorders, A previous study indicated that blood type and
seizures, hearing loss at high frequencies, and speech Rh incompatibilities had been the important causes of
impairment. Therefore, the timely diagnosis and kernicterus [45]. It has been depicted that ABO
treatment of neonatal jaundice are very important in incompatibility, idiopathic jaundice, G6PD deficiency
preventing its complications. Identifying the and Rh incompatibility be the most important
predisposing factors of neonatal jaundice is still a predisposing factors for acute kernicterus [45].
serious discussion and can be effective in controlling
Based on the data presented in the current
jaundice and controlling the primary problem. In the
study, G6PD was also related to the disease. While
natural state, since liver enzymes have not evolved
the exact mechanism for linking G6PD deficiency to
enough, some icterus appears on the second to third
hyperbilirubinemia is still not fully understood, early
day, reaching its maximum on the second to fourth day
diagnosis of G6PD deficiency in infants can
and decreasing on the fifth to seventh days. This type
adequately reduce the risk of hyperbilirubinemia in
of jaundice is called physiologic jaundice. Factors such
affected neonates [40] [46], indicating the importance
as maternal diabetes, race, premature infant,
of prevention and timely treatment due to the
medication use of mother, male gender,
incompatibility of ABO and Rh. According to the
cephalohaematoma, breastfeeding, weight loss,
recommendations of the WHO Working Group,
delayed stools in the baby may be correlated with
screening for all neonates should be performed in
physiologic jaundice [23] [24] [25] [26] [27] [28] [29]
areas with a prevalence of 3-5% for G6PD deficiency
[30]. We also evaluated neonates for jaundice -specific
[47]. It is worth noting that the incompatibility of the
risk association such as gestational age, birth weight
blood group can be managed through daily care and
gestational diabetes, familial history of diabetes, low
the diagnosis of mothers whose neonates are at risk
birth weight, maternal history of anemia, maternal
for these disorders [40][48].
thalassemia, asphyxia, cephalohematoma, TSH and T4
and related blood factors including, blood count (Hb, A study indicated that the main causes of the
Hct. MCV. WBC and PLT) maternal-fetal blood group high prevalence of Jaundice complications in icteric
and their Rh for potential risks. newborns include incomplete follow-up in acrylic
babies due to ABO incompatibility, physician
The result of our study indicated that the
insensitivity, lack of routine examination of neonatal
gestational age was significantly linked to jaundice.
babies born to mothers with type O (Rh+) and
Consist of our study; It has been described that the
parental insensitivity [49].
risk of hyperbilirubinemia significantly increases with
decreasing gestational age [31] [32] [33] [34] [35]. Our data demonstrated that gestational
Furthermore, weight loss in the neonatal period is diabetes mellitus was not linked to hyperbilirubinemia.
considered as another risk factor for jaundice [35] Also family history of diabetes was not observed to be
[36]. Low-calorie intake has been indicated to be associated with hyperbilirubinemia.
associated with increased hepatic circulation of
A study has reported that gestational diabetes
bilirubin and often occurs within the first few days
has various and dangerous side effects on the baby,
before milk comes in [35] [36] [37]; however, we didn’t
the most common being neonatal jaundice (3.7%),
find a significant association of birth weight with the
incidence of jaundice. Based on the evidence present [50]. It is also described that the incidence of neonatal
in literature, neonates with low gestational age (less jaundice in diabetic mothers is three times higher than
that in the control group. Perhaps the reason for the
than 37 weeks) and increased level of bilirubin in the
difference in the prevalence of maternal diabetes
first hours of life should be evaluated to confirm and
associated- jaundice in different studies could be due
monitor them adequately. Also, rapid diagnosis of low
birth weight infants with or without visual evidence of to differences in study type and sample size [51]. In
weight loss at admission is needed to be included into the current study, the maternal thalassemia and
anaemia were not found to be associated with
clinical guideline for the control of neonatal
neonatal jaundice. However, further studies are
hyperbilirubinemia [38]. Another known risk factors
needed to clarify the role of maternal thalassemia and
identified in different investigations for the
anaemia in the development of hyperbilirubinemia. It
development of jaundice in neonates such as Asian
race, birth weight, exclusive breastfeeding, difficulty is worth noting that anaemia may range from
feeding, male sex, labour with oxytocin, primiparity, asymptomatic to life-threatening and reported to
potentially be linked to severe hyperbilirubinemia [52].
etc., [39] [40] [41] [42] [43] [44].
Patients with haemoglobin H has been indicated to
Risk factors identified in different usually born with hypochromic anaemia, where may
investigations for the development of jaundice in be at high risk for neonatal hyperbilirubinemia [53]
neonates among blood count variables, the mean of [54]. Also, Based on our findings, cephalohematoma
Hb, Hct, PLT and WBC were found to be markedly and asphyxia were not observed to be significantly
associated with hyperbilirubinemia in the present linked to hyperbilirubinemia.
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