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Factors that influence hyperbilirubinaemia and kernicterus






                     Table 3.1  Comparative studies evaluating risk factors for hyperbilirubinaemia
                     Study details  Study                                                   Risk factor
                              population
                                         Family history of   GA < 38 weeks or  Sex   Race   Exclusive   Early clinical  Severity of  Bruising or cephalo- Delivery   Maternal
                                         jaundice      early gestation           breastfeeding   jaundice   jaundice   haematoma   characteristics   characteristics
                     Newman et al.  BW ≥ 2000 g   OR 6.0 (1.0–36.0)   GA per week: OR 0.6  Male   Asian   OR 6.9 (2.7–17.5)   OR 7.3 (2.8–     Bruising: OR 3.5 (1.7–  Vacuum delivery:  Maternal age
                     (2000)   9  and GA                (0.4–0.7)     sex: NS  race:           19.0)             7.4)          NS          ≥ 25 years: OR 2.6
                     [EL II]   ≥ 36 weeks                                 OR 3.1                                Cephalohaematoma:         (1.1–9.2)
                                                                          (1.5–6.3)                             OR 3.2 (1.1–9.2)
                     Newman et al.  BW ≥ 2000 g                                               RR 2.9 (1.6–
                        10
                     (2002)    and GA                                                         5.2)
                     [EL II]   ≥ 36 weeks

                     Kuzniewicz et  GA ≥ 34 weeks  OR 3.8 (0.9–15.7)   For 34–37 weeks:   Male   Asian and  OR 2.0 (1.03–4.0)      Serum   Bruising: OR 2.4 (1.2–
                          11
                     al. (2008)    and BW   NS         OR 3.7 (0.6–22.7)   sex: NS  African   Risk after reaching   bilirubin   4.8)
                     [EL II]   ≥ 2000 g with           For 38–39 weeks:   American   qualifying serum   increase of   Cephalohaematoma:
                              serum bilirubin          OR 3.1 (1.2–8.0)   race: NS   bilirubin levels   ≥ 102 micr  NS
                              levels of 291–           40 weeks as reference                           omol/litre
                              392 micromol/litr                                                        per day:
                              e at ≥ 48 hours                                                          OR 2.5 (1.2–
                              of age                                                                   5.5)
                     Keren et al.   BW ≥ 2000 g if     GA < 38 weeks:   Male   Asian,   OR 2.6 (1.5–4.5   Analysed   Analysed   Bruising: NS   Vacuum delivery:  Maternal age,
                        12
                     (2005)    GA ≥ 36 weeks,          OR 2.6 (1.5–4.5)   sex: NS  Hispanic,   separately as   separately as   Cephalohaematoma:   OR 2.2 (1.5–3.6)   parity,
                     [EL II]   and BW                                     black: NS           pre-discharge   pre-  NS        Oxytocin use:   hypertension,
                              ≥ 2500 g if GA                                                  risk zones   discharge          OR 2.0 (1.2–3.4)   diabetes: NS
                              ≥ 35 weeks                                                               risk zones
                     Seidman et al.  Healthy term   Jaundice in sibling: NS    Male   Jewish   Full breastfeeding:   Day 1 serum   Change in   Cephalohaematoma:   Vacuum delivery:  Maternal age per
                     (1999)    babies (GA                            sex: NS  ethnicities:  NS   bilirubin level  serum   NS   NS         year: OR 1.1 (1.0–
                        13
                     [EL II]   ≥ 37 weeks)                                NS                  > 85 micromo bilirubin                      1.2)
                                                                                              l/litre: OR 36.5  from day 1                Maternal blood
                                                                                              (15.9–83.6)   to day 2 per                  type O: OR 2.9
                                                                                                       17 micromol                        (1.5–5.8)
                                                                                                       /litre: OR 2.4
                                                                                                       (1.9–3.0)                          Maternal education
                                                                                                                                          per year: OR 0.8
                                                                                                                                          (0.7–0.9)
                     Keren et al.   GA ≥ 36 weeks      GA < 38 weeks:   Female  Black   Mother’s plan of   Analysed   Clinical      Vacuum delivery:  Maternal smoking,
                        14
                     (2008)    and BW                  OR 19 (6.3–56)   sex:   race:   exclusive   separately as   jaundice   NS          ethnicity: NS
                     [EL II]   ≥ 2000 g, or GA                       OR 3.2  OR 0.22   breastfeeding:   pre-discharge   grade 4 or
                              ≥ 35 weeks and                         (1.2–  (0.08–  OR 3.7 (1.1–13)   risk zones   higher:
                              BW ≥ 2500 g                            8.4)   0.61)                      OR 1.7 (1.2–
                                                                                                       2.6)





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