JHSM
Journal of Health Sciences and Medicine

Journal of Health Sciences and Medicine (JHSM) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

eISSN: 2636-8579
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Submit Manuscript

Index
Original Article
Evaluation of factors affecting hospital stay in newborns with hyperbilirubinemia
Abstract
Aims: This study aimed to investigate the etiology and risk factors associated with indirect neonatal hyperbilirubinemia (INH) and their effects on the duration of hospital stay.
Methods: A total of 400 term newborns with INH were included in the study. Demographic characteristics, feeding practices, total serum bilirubin levels, phototherapy duration, and length of hospital stay were recorded. Risk zones for hyperbilirubinemia were determined using the Bhutani nomogram, and the significance of associated factors was assessed using Chi-square and Fisher’s exact tests.
Results: Of the 400 newborns, 51.5% were male, with a mean gestational age of 38.67±1.11 weeks and a mean birth weight of 3286.6±450.4 g. Twenty-five percent of the infants were classified in the high-risk zone for hyperbilirubinemia. Infants in the high-risk group were admitted at a significantly older postnatal age and required longer phototherapy duration compared with those in the intermediate-high risk group. Positive direct Coombs (DC) test and mixed feeding were significantly associated with prolonged phototherapy duration (>2 days). Furthermore, early-term infants were found to have a higher risk of developing severe hyperbilirubinemia. Gestational age, feeding method, DC positivity, parity, and phototherapy duration were identified as significant determinants of hospital stay.
Conclusion: This study identified key risk factors associated with prolonged hospital stay in term newborns with INH, including DC positivity and mixed feeding practices. These findings highlight the importance of early identification and appropriate management of at-risk infants to reduce the severity of hyperbilirubinemia and associated hospitalization duration.

Keywords : Breastfeeding, early term infant, hyperbilirubinemia, hospital stay

Download Article


1. Hansen TWH, Bratlid D. Physiology of neonatal unconjugated hyperbilirubinemia. In: Stevenson DK, Maisels MJ, Watchko JF, eds. Care of Jaundiced Neonate. New York: McGraw-Hill, 2012: 65-95.
2. Memon N, Weinberger BI, Hegyi T, Aleksunes LM. Inherited disorders of bilirubin clearance. Pediatr Res. 2016;79(3):378-386. doi:10.1038/pr. 2015.247
3. Cohen RS, Wong RJ, Stevenson DK. Understanding neonatal jaundice: a perspective on causation. Pediatr Neonatol. 2010;51(3):143-148. doi:10. 1016/S1875-9572(10)60027-7
4. Ullah S, Rahman K, Hedayati M. Hyperbilirubinemia in neonates: types, causes, clinical examinations, preventive measures and treatments: a narrative review article. Iran J Public Health. 2016;45(5):558-568.
5. Bhutani VK, Zipursky A, Blencowe H, et al. Neonatal hyperbilirubinemia and rhesus disease of the newborn: Incidence and impairment estimates for 2010 at regional and global levels. Pediatr Res. 2013;74(Suppl 1):86-100. doi:10.1038/pr.2013.208
6. Porter ML, Dennis BL. Hyperbilirubinemia in the term newborn. Am Fam Physician. 2002;65(4):599-606.
7. Woodgate P, Jardine LA. Neonatal jaundice. BMJ Clin Evid. 2011;2011: 0319.
8. Woodgate P, Jardine LA. Neonatal jaundice: phototherapy. BMJ Clin Evid. 2015;2015:0319.
9. Smitherman H, Stark AR, Bhutani VK. Early recognition of neonatal hyperbilirubinemia and its emergent management. Semin Fetal Neonatal Med. 2006;11(3):214-224. doi:10.1016/j.siny.2006.02.002
10. Shapiro SM. Chronic bilirubin encephalopathy: diagnosis and outcome. Semin Fetal Neonatal Med. 2010;15(3):157-163. doi:10.1016/j.siny.2009. 12.004
11. Radmacher PG, Groves FD, Owa JA, et al. A modified bilirubin-induced neurologic dysfunction (BIND-M) algorithm is useful in evaluating severity of jaundice in a resource-limited setting. BMC Pediatr. 2015;15: 28. doi:10.1186/s12887-015-0355-2
12. Johnson L, Bhutani VK, Karp K, Sivieri EM, Shapiro SM. Clinical report from the pilot USA kernicterus registry (1992 to 2004). J Perinatol. 2009; 29(Suppl 1):S25-S45. doi:10.1038/jp.2008.211
13. Le Pichon JB, Riordan SM, Watchko J, Shapiro SM. The neurological sequelae of neonatal hyperbilirubinemia: definitions, diagnosis and treatment of the Kernicterus Spectrum Disorders (KSDs). Curr Pediatr Rev. 2017;13(3):199-209. doi:10.2174/1573396313666170815100214
14. Kemper AR, Newman TB, Slaughter JL, et al. Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2022;150(3):e2022058859. doi:10. 1542/peds.2022-058859
15. Okulu E. Neonatal jaundice: recommendations for follow-up and treatment. Glob Pediatr. 2024;7(3):100131. doi:10.1016/j.gpeds.2023.100 131
16. Tan TJ, Chiu N, Lee H, Lai Y. Early-term neonates demonstrate a higher likelihood of neonatal jaundice and phototherapy than full-term neonates. Children (Basel). 2023;10(7):907.
17. Keren R, Luan X, Friedman S, Saddlemire S, Cnaan A, Bhutani VK. A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics. 2008;121(1):e170-e179. doi:10.1542/peds.2006-3499
18. Morris JM, Algert CS, Falster MO, et al. Trends in planned early birth: a population-based study. Am J Obstet Gynecol. 2012;207(3):186.e1-186.e1868. doi:10.1016/j.ajog.2012.06.082
19. Lain SJ, Nassar N, Bowen JR, Roberts CL. Risk factors and costs of hospital admissions in first year of life: a population-based study. J Pediatr. 2013;163(4):1014-1019. doi:10.1016/j.jpeds.2013.04.051
20. Murray NA, Roberts IA. Haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed. 2007;92(2):F83-F88. doi:10.1136/adc.2005. 076794
21. Zhou S, Wu X, Ma A, Zhang M, Liu Y. Analysis of therapeutic effect of intermittent and continuous phototherapy on neonatal hemolytic jaundice. Exp Ther Med. 2019;17(5):4007-4012. doi:10.3892/etm.2019. 7432
22. Boskabadi H, Hamidi MZ, Goudarzi M. Investigating the effect of maternal risk factors in incidence of neonatal jaundice. Iran J Obstetr Gynecol Infertil. 2013;15(34):1-6.
23. Boskabadi H, Rakhshanizadeh F, Zakerihamidi M. Evaluation of maternal risk factors in neonatal hyperbilirubinemia. Arch Iran Med. 2020;23(2):128-140.
24. Yang WC, Zhao LL, Li YC, et al. Bodyweight loss in predicting neonatal hyperbilirubinemia 72 hours after birth in term newborn infants. BMC Pediatr. 2013;13:145. doi:10.1186/1471-2431-13-145
25. Scrafford CG, Mullany LC, Katz J, et al. Incidence of and risk factors for neonatal jaundice among newborns in southern Nepal. Trop Med Int Health. 2013;18(11):1317-1328. doi:10.1111/tmi.12189
26. Sharma N, Oberoi S, Moses PM. Positive influencers for early initiation of breastfeeding. J Family Med Prim Care. 2023;12(5):990-995. doi:10. 4103/jfmpc.jfmpc_1671_22
27. Lin Q, Zhu D, Chen C, Feng Y, Shen F, Wu Z. Risk factors for neonatal hyperbilirubinemia: a systematic review and meta-analysis. Transl Pediatr. 2022;11(6):1001-1009. doi:10.21037/tp-22-229
28. Chen YJ, Yeh TF, Chen CM. Effect of breast-feeding frequency on hyperbilirubinemia in breast-fed term neonate. Pediatr Int. 2015;57(6): 1121-1125. doi:10.1111/ped.12667
29. Salas AA, Salazar J, Burgoa CV, De-Villegas CA, Quevedo V, Soliz A. Significant weight loss in breastfed term infants readmitted for hyperbilirubinemia. BMC Pediatr. 2009; 9:82. doi:10.1186/1471-2431-9-82
30. Kemper AR, Newman TB, Slaughter JL, et al. Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2022;150(3):e2022058859. doi:10. 1542/peds.2022-058859
31. Chen CF, Hsu MC, Shen CH, et al. Influence of breast-feeding on weight loss, jaundice, and waste elimination in neonates. Pediatr Neonatol. 2011;52(2):85-92. doi:10.1016/j.pedneo.2011.02.010
32. Brown SB, King RF. The mechanism of haem catabolism. Bilirubin formation in living rats by [18O] oxygen labelling. Biochem J. 1978; 170(2):297-311. doi:10.1042/bj1700297
33. Scrafford CG, Mullany LC, Katz J, et al. Incidence of and risk factors for neonatal jaundice among newborns in southern Nepal. Trop Med Int Health. 2013;18(11):1317-1328. doi:10.1111/tmi.12189
34. Huang HC, Wang SY, Chen CH. Body image, maternal fetal attachment, and choice of infant feeding method: a study in Taiwan. Birth. 2004;31(3): 183-188. doi:10.1111/j.0730-7659.2004.00303.x
35. Manganaro R, Mami C, Marrone T, Marseglia L, Gemelli M. Incidence of dehydration and hypernatremia in exclusively breast-fed infants. J Pediatr. 2001;139(5):673-675. doi:10.1067/mpd.2001.118880
Article available in :
Volume 9, Issue 3, 2026
Page : 576-582
https://doi.org/10.32322/jhsm.1851747
Article Information
Received : 03 Oca 2026
Accepted : 14 Nis 2026
Published : 19 May 2026
Corresponding Author :

Dilek Kurnaz: Department of Neonatology, İstanbul Haseki Training and Research Hospital, İstanbul, Turkiye

[email protected]
Citation : Kurnaz D, Cebeci B, Pirdal BZ, Büyükkayhan D. Evaluation of factors affecting hospital stay in newborns with hyperbilirubinemia. J Health Sci Med. 2026;9(3):576-582. doi:10.32322/jhsm.1851747

Read: 234
Download : 91
Cited: 0
_Footer