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HYPERBILIRUBINEMIA

Risk factors:

Preterm babies
Prematurity is consider to be a risk factor in developing hyperbilirubinemia,
premature babies have immature organs including lungs, and lungs plays a very important
rule in metabolism of bilirubin, it produces enzymes that convert indirect bilirubin which
is fat soluble into water soluble which is called direct bilirubin and readily excreted
through the feces. In this case, the immature lungs is not able to produce glucoronyl
tranferase an enzyme that convert indirect bilirubin to direct bilirubin. Preterm babies are
also experiencing feeding problem which is another risk factor in developing

hyperbilirubinemia.
Having parents of East Asian or Mediterranean descent
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common
enzyme deficiency in humans. It has a high prevalence in persons of African, Asian, and
Mediterranean descent. G6PD deficiency can present as neonatal hyperbilirubinemia.
G6PD helps RBC function normally, it protects the RBC from potential harmful byproducts that can accumulate when a person has some mediation in the body or when the
body is fighting infection. Persons with this disorder can experience episodes of brisk
hemolysis in response to oxidative stresses or, less commonly, have chronic hemolysis.
However, many individuals with G6PD deficiency are asymptomatic.

Newborns with feeding difficulties/poor feeding


Babies who have poor feeding causes slow bowel elimination, stools is not
evacuated for long period of time, so the normal flora inside the intestine then breaks
down bile into its basic component, one of which is indirect bilirubin, since indirect
bilirubin is lipid or fat soluble, it is not excreted instead of excreting bilirubin it will
reabsorb into the blood causing elevated bilirubin in the blood.

Rh Sensitization/ABO incompatibility
Newborn infants with maternal-fetal ABO incompatibility are at a greater risk for
developing subsequent significant hyperbilirubinemia, and therefore, prediction of

probable risk factors, such as the degree of hemolysis, gains importance.


Bruising
Bruising may lead to hemorrhage of blood into the subcutaneous tissue or skin,
and this blood is broken down so it can add to the amount of indirect bilirubin
accumulating in the blood.

LGA
A large fetus may experience difficulty of passing through the bony part of the
mother due to its size. So this can now result to bruises.

Breast Feeding
Breast-fed babies, particularly those who have difficulty nursing or getting
enough nutrition from breast-feeding, are at higher risk of jaundice. Dehydration or a low
calorie intake may contribute to the onset of jaundice. However, because of the benefits
of breast-feeding, experts still recommend it. It's important to make sure your baby gets
enough to eat and is adequately hydrated.

Breastfed babies
Compared with formula-fed babies, a small proportion of breastfed babies may have
more difficulty of converting indirect bilirubin o direct bilirubin because breast milk
contains a metabolite progesterone that depresses the action of pregnanediol.

An abnormality of your baby's red blood cells that causes them to break

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