Title OBILJEŽJA INTENZIVIRANE I PROLONGIRANE HIPERBILIRUBINEMIJE TERMINSKE NOVOROĐENČADI
Title (english) FEATURES OF INTENSIFIED AND PROLONGED HYPERBILIRUBINEMIA IN TERM NEONATES
Author Tea Gamberažić
Mentor Orjena Žaja (mentor)
Committee member Marijan Saraga (predsjednik povjerenstva)
Committee member Branka Polić (član povjerenstva)
Committee member Ivana Pavlinac Dodig (član povjerenstva)
Granter University of Split School of Medicine (Pediatrics) Split
Defense date and country 2019, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Pediatrics
Abstract Cilj istraživanja: Cilj istraživanja bio je istražiti obilježja intenzivirane i prolongirane hiperbilirubinemije terminske novorođenčadi.
Ispitanici i metode: Ovo retrospektivno istraživanje obuhvatilo je 100 novorođenčadi, od kojih je 42 s dijagnozom novorođenačke hiperbilirubinemije hospitalizirano na Odjelu za gastroenterologiju Klinike za pedijatriju KBC-a "Sestre Milosrdnice" u Zagrebu, a 58 na Klinici za pedijatriju KBC-a Split, u razdoblju od 1. siječnja 2017. do 10. svibnja 2019. godine.
Rezultati: U ovo istraživanje uključeno je 100 novorođenčadi i mlađe dojenčadi s dijagnosticiranom intenziviranom (68%) i prolongiranom hiperbilirubinemijom (32%) u dobi od 2 do 45 dana. U obje skupine dob majke bila je u prosjeku 30 godina. Većina je djece rođena u 39. gestacijskom tjednu, a 63% djece rođeno je vaginalnim putem poroda. Novorođenčad u skupini intenzivirane hiperbilirubinemije češće je rođena u toplijim mjesecima, od ožujka do rujna, a novorođenčad s produljenom hiperbilirubinemijom u hladnijem dijelu godine, tijekom jeseni i zime. Većina djece liječena je intravenskom hidracijom, njih 89%, a 56% djece liječeno je i fototerapijom. Utjecaj infekcije urinarnog trakta na hiperbilirubinemiju novorođenčadi nije dokazan. Laboratorijski nalazi eritrocita, hemoglobina i hemtokrita bili su unutar referentnih vrijednosti, a mali broj djece imao je nesignifikantno povišene vrijednosti jetrenih enzima. Najveća vrijednost bilirubina bila je izmjerena u skupini djece s intenziviranom hiperbilirubinemijom i iznosila je 472 µmol / l. Tjelesna masa djece s intenziviranom hiperbilirubinemijom bila je značajno niža pri prijemu u usporedbi s porodnom masom, dok su u skupini s prolongiranom hiperbilirubinemijom djeca imala veću tjelesnu masu u trenutku hospitalizacije u odnosu na porodnu masu. 42 od 100 novorođenčadi imalo je učinjenu DNA-UGT analizu za UGT1A1*28 genotip. Učestalost nositelja polimorfizma za
Gilbertov sindrom u ispitivanoj populaciji bila je veća od učestalosti u kontrolnoj skupini.
Zaključak: Novorođenačka hiperbilirubinemija značajan je klinički entitet na koji mogu utjecati brojni nasljedni, okolišni i drugi čimbenici. Od svih ispitivanih obilježja hiperbilirubinemije novorođenčadi u ovom je istraživanju najjača povezanost utvrđena u razlici tjelesne mase pri prijemu i porodne mase, koja je bila negativna u skupini intenzivirane hiperbilirubinemije, a pozitivna u novorođenčadi s prolongiranom hiperbilirubinemijom. Polimorfizam GS je važan utjecajni čimbenik na pojavnost i trajanje hiperbilirubinemije novorođenčeta. Sva ispitivana obilježja trebalo bi uzeti u obzir pri procjeni ozbiljnosti novorođenačke hiperbilirubinemije prilikom otpusta iz rodilišta, kako se ne bi propustila klinički značajna hiperbilirubinemija koja zahtijeva daljnju obradu i praćenje.
Abstract (english) Objectives: The aim of this study was to investigate the features of newborns on the occurrence of intensified and prolonged hyperbilirubinemia in term neonates.
Patients and methods: The retrospective research study included 100 term neonates, out of which 42 diagnosed with neonatal hyperbilirubinemia were hospitalized in the Department of Gastroenterology of the “Sestre Milosrdnice” University Hospital in Zagreb and 58 in the Department of Gastroenterology of the University Hospital in Split, in the period between the 1st January 2017 and 10th May 2019.
Results: This study included 100 neonates and younger infants with diagnosed intensified (68%) and prolonged hyperbilirubinemia (32%) in the age of 2 to 45 days. In both groups the age of the mother was in the average 30 years. All the children were born in the 39th gestation week and 63% of children were born vaginal delivery. Newborns in the group of intensified hyperbilirubinemia were more often born during the warmer months, March – September, and newborns with prolonged hyperbilirubinemia in the colder part of the year. Most children were treated with intravenous fluid supplements, 89% of them, and 56% children were also treated with phototherapy. The influence of urinary infection on newborn hyperbilirubinemia is not proven. Laboratory findings of erythrocytes, hemoglobin and hemtocrit were within the refining values, and a small number of children had insignificantly elevated liver enzymes. The highest value of bilirubin was measured in the group of intensified hyperbilirubinemia and it was 472 µmol/l. The body mass of the newborns and infants with intensified
hyperbilirubinemia was significantly lower on admission compared to the birth weight, whereas in the group of prolonged hyperbilirubinemia children had higher body mass at the time of hospitalization than the birth weight. 42 out of 100 newborns and infants had DNA-UGT analysis at UGT1A1*28 genotype done. The frequency of the polymorphism carrier for Gilbert syndrome in the examined population was higher than the frequency in the control group.
Conclusion: Newborn hyperbilirubinemia is a significant clinical entity to which many hereditary, environmental and other factors can be affected. Of all the examined features of newborn hyperbilirubinemia, the strongest correlation was found in the difference in body weight at admission and birth weight, which is negative in the group of intensified hyperbilirubinemia and positive in newborns with prolonged hyperbilirubinemia. GS polymorphism is an important factor influencing the appearance and duration of newborn hyperbilirubinemia. All tested features should be taken into account when assessing the severity of newborn hyperbilirubinemia when discharged from the maternity clinic, in order not to miss a clinically significant hyperbilirubinemia that requires further processing and monitoring.
Keywords
Novorođenačka hiperbilirubinemija
Keywords (english)
Hyperbilirubinemia Neonatal
Language croatian
URN:NBN urn:nbn:hr:171:050048
Study programme Title: Medicine Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2019-07-10 12:59:53