Etiological Analyses of Marked Neonatal Hyperbilirubinemia in A Single Institution in Taiwan

Background: Hyperbilirubinemia is a common disorder during the neonatal period. Severeneonatal hyperbilirubinemia (NH) carries a potential for permanent neurological impairment. The current study analyzed possible etiologies leading toNH.Methods: A retrospective cohort of neonates with total serum bilirubin (TSB) ≥ 20mg/dL was surveyed from 1995 to 2007. Subjects with gestational ages < 34weeks were excluded, leaving a total of 413 enrolled neonates.Results: The most common etiology in relation to marked NH was breast milk feeding (38.5%), followed by glucose-6-phospahate dehydrogenase (G6PD) deficiency (24.0%), ABO incompatibility (21.8%), extravascular hemorrhage(6.5%), Rh incompatibility (2.9%), bacterial infection (2.2%), hereditaryspherocytosis (1.2%), dehydration (1.2%), diabetic mother (1.0%), polycythemia (0.7%), and gastrointestinal obstruction (0.7%). Other rare etiologies included Down syndrome, Chinese herb intake, asphyxia, galactosemiaand congenital hypothyroidism. We did not identify any known cause in 63neonates (15.3%). Neonates with more than one etiology tended to havehigher TSB than subjects without a known etiology (p < 0.05). Anemia wasmore common in those with G6PD deficiency, blood group incompatibility,hereditary spherocytosis, and gastrointestinal obstruction. Neonates fedbreast milk tended to have prolonged NH.Conclusion: This study depicts the clinical features of marked NH. Breast milk feeding,G6PD de f i c i ency and ABO incompa t ibi l i ty a r e common e t iologi e s inTaiwan. Prolonged NH is more common in neonates fed breast milk thanthose who were given formula.