CLINICAL PROFILE OF PATIENT WITH PROLONGED NEONATAL JAUNDICE RESIDING IN ALMATY
Introduction. The prevalence and etiological factors of protracted neonatal jaundice depend on many reasons: the socio-economic situation of the country, national and gender, a burdened family history, ecology, etc. Prolonged neonatal jaundice is a multifactorial borderline disease with an unfavorable prognosis with a burdened history, children with this state need dynamic monitoring by a pediatrician and narrow specialists.
Purpose: To study the clinical portrait of a patient with chronic jaundice of the neonatal period using the example of the Children's City Clinical Infectious Diseases Hospital in Almaty city (CCCIDH).
Materials and research methods: The result of a cohort retrospective analysis of 405 case records of infants who were hospitalized in the Children's City Clinical Infectious Hospital from January to December 2018 with a diagnosis “Neonatal jaundice” is presented. The inclusion criteria were: full-term, residence in Almaty city, the age of the child over 14 days of life and the level of total serum bilirubin > 85 μmol /l. The exclusion criterions were used prematurity, the age up to 14 days of life, rural residency and the level of total serum bilirubin <85 μmol /l. Medical history data were studied: gender, nationality, age at the time of hospitalization, pregnancy and childbirth, family history, level of total serum bilirubin (TSB) at the time of hospitalization, fractions of total serum bilirubin, biochemical markers of cytolysis syndrome, results of neurosonography and ultrasonic scanning of abdominal cavity organs, conclusion of a neurologist. Quantitative data were processed by the method of variation statistics followed by establishment of criteria for the likelihood ratio and the Mann-Whitney criterion. The results were considered statistically significant at p = 0.045 p <0.05, respectively.
Results: Children with prolonged neonatal jaundice who was born by caesarean section often have abnormal abdominal cavity organs according to ultrasound data (likelihood ratio criterion (p = 0.017). Average values of total serum bilirubin (TSB) 215.1 ± 71.5 μmol/l, gamma-glutamyltransferase (GGT) 0.4 ± 0.9 μat /l, alanine aminotransferase (AAT) 0.7 ± 2.6 μat /l, aspartate aminotransferase (AcAT) 0.6 ± 0.5 μat /l cause pathological changes of abdominal cavity organs according to ultrasonic scanning (Mann-Whitney test, p <0.05). Children with prolonged neonatal jaundice with a range of mean total serum bilirubin (TSB) of 205.7 ± 82.0 μmol/l often have pathological changes in the brain according to neurosonography (Mann-Whitney test, p <0.05).
Conclusions: The clinical profile of a child with prolonged neonatal jaundice, a resident of Almaty city, is as follows: a full-term boy of Kazakh nationality who has reached 28.7 ± 10.2 days of life, with a debut of the disease from birth, with TSB of 177.2 ± 59.5 μmol / l, mainly due to indirect bilirubin, with a level of AlAT 0.3 ± 0.9 μkat / l, AcAt 0.5 ± 0.3 μkat / l, and a thymol breakdown of 1.7 ± 1.1; more often from 1 pregnancy and 1 birth (39% and 42%, respectively), with burdened antenatal and intrapartum anamnesis (60.1% and 21.2%, respectively). Of the risk factors leading to the development of pathological changes in the hepatobiliary system and the brain, we can attribute transferred intrauterine hypoxia and cesarean section. The inaccessibility of expensive laboratory and genetic studies in a hospital-wide network does not allow the etiology of chronic jaundice to be verified. Children with chronic neonatal jaundice require close attention both at the level of inpatient care and after discharge, especially the observation of a neurologist for early prevention of adverse outcomes of a central nervous system lesion.
Zhannat V.Rakisheva¹, https://orcid.org/0000-0001-6607-5345
Erzhan B. Seralin²
¹ Kazakh Medical University of Continuing Education, Almaty, Republic of Kazakhstan;
² Children’s City Clinical Infectious Diseases Hospital, Almaty, Republic of Kazakhstan.
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Rakisheva Zh.V., Seralin E.B. Clinical profile of patient with prolonged neonatal jaundice residing in Almaty // Nauka i Zdravookhranenie [Science & Healthcare]. 2020, (Vol.22) 2, pp. 118-127. doi:10.34689/SH.2020.22.2.014Related publications:
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