Study of hematological indices in neonates admitted with non-obstructive jaundice and its outcome in a tertiary care hospital

Vikram R., C. S. Balachandran


Background: To study non-obstructive causes and laboratory profile of neonatal hyperbilirubinemia. Design: prospective study.

Methods: Selection of cases were done from routine cases reporting to newborn unit in the department of paediatrics, with clinical evidence of jaundice in neonates. Blood group of the mother and baby, Serum bilirubin estimation, Complete blood count with peripheral smear examination, Reticulocyte count, Direct coomb’s test and C-reactive protein of the baby were done.

Results: Study includes 89 cases of newborn admitted in our tertiary care institute. Out of 89 neonates, 52 (58.42%) were male while 37 (41.57%) were females. Total number of Pre-term babies was 35 (39.32%). Neonates having low birth weight were 30 (33.7%) and very low birth were 10 (11.23%). Physiological jaundice constituted majority cases. Septicemia was the commonest cause of pathological jaundice and ABO incompatibility is second commonest cause of pathological jaundice. Pre-term and low birth weight babies were having higher levels of serum total bilirubin but the difference was not significant (P >0.05). The rise in serum bilirubin level was found to be more in pathological jaundice as compare to physiological jaundice. Difference was significant statistically with p value of <0.05.

Conclusions: Most of the cases were having physiological jaundice although septicemia and ABO-Rh incompatibility were not exceptional. Peak serum bilirubin levels were found to be more among the pathological jaundice. Also, prematurity and low birth weight were having higher levels of serum bilirubin. Special care must be given to them in order to avoid future complications of hyperbilirubinemia.


Jaundice, Non-obstructive, Physiological, Sepsis

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Bhutani VK, Johnson LH, Keren R. Diagnosis and management of hyperbilirubinemia in the term neonate: for a safer first week. Pediatr Clin North Am. 2004;51:843-61.

Ives NK. Management of neonatal jaundice. Pediatr Child Health. 2015;25(6):276-81.

Christensen RD, Nussenzveig RH, Yaish HM, Henry E, Eggert LD, Agarwal AM. Causes of hemolysis in neonates with extreme hyperbilirubinemia. J Perinatol. 2014;34(8):616.

Meijer EJ, Kudavelly SR, Koninklijke Philip NV. Apparatus and method for measuring an analyte such as bilirubin, using light. United States patent US 9,279,763. 2016 Mar 8.

Kuzniewicz MW, Greene DN, Walsh EM, McCulloch CE, Newman TB. Association between laboratory calibration of a serum bilirubin assay, neonatal bilirubin levels, and phototherapy use. JAMA Pediatr. 2016;170(6):557-61.

Kabat EA. Blood group substances: their chemistry and immunochemistry. Elsevier; 2013.

Karafin MS, Denomme GA, Schanen M, Gottschall JL. Clinical and reference lab characteristics of patients with suspected direct antiglobulin test (DAT)-negative immune hemolytic anemia. Immunohematology. 2015;31(3):108-15.

Phillips JJ, Phillips PP. Handbook of training evaluation and measurement methods. Routledge;2016.

Maisels MJ. Jaundice. In MacDonald MG, Seshia MMK, Mullett MD (eds). Avery’s Neonatology: Pathophysiology and Management of the Newborn. Philadelphia, JB Lippincott. 2005; p 768-846.

Bhutani VK, Gourley GR, Adler S, et al. Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics. 2000;106:e17.

American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316

Mesić I, Milas V, Međimurec M, Rimar Ž. Unconjugated pathological jaundice in newborns. Collegium Antropologicum. 2014;38(1):173-8.

Krishna GD, Babu KS, Arun R, Jothibai DS. A study on Rh incompatibility and frequency of weak D among blood donors and patients at a tertiary care referral teaching hospital in Tirupati, Andhra Pradesh. J Clinic Sci Res. 2015;4(4):281-4.

Watchko JF. Bilirubin-induced neurotoxicity in the preterm neonate. Clin Perinatol. 2016;43(2):297-311.

Kuzniewicz MW, Wickremasinghe AC, Wu YW, McCulloch CE, Walsh EM, Wi S, Newman TB. Incidence, etiology, and outcomes of hazardous hyperbilirubinemia in newborns. Pediatr. 2014;134(3):504-9.