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Direct hyperbilirubinemia in newborns with gastroschisis

  • Sarah B. Cairo
  • Alex H. Osak
  • Sara K. Berkelhamer
  • Cara McLaughlin
  • David H. Rothstein
Original Article
  • 1 Downloads

Abstract

Background

Patients with gastroschisis and prolonged total (or partial) parenteral nutrition (PN) commonly develop direct hyperbilirubinemia (DH).

Objective

To quantify the prevalence and severity of DH in newborns with gastroschisis and characterize the diagnostic work-up for DH in this patient population.

Design/Methods

Retrospective chart review of patients born with gastroschisis between 2005 and 2015 for the first 6 months of life.

Results

29 patients were identified with gastroschisis. Mean gestational age and birthweight were 36.4 (± 1.8) weeks and 2.5 (± 0.6) kg. 41% were treated with primary reduction versus staged closure. Peak total and direct bilirubin (DB) levels were 10.17 ± 6.21 mg/dL and 5.58 ± 3.94 mg/dL, respectively. 23 patients (79.3%) were diagnosed with DH and 78.2% underwent additional work-up for hyperbilirubinemia consisting of imaging and laboratory studies, none of which revealed a cause for DH other than the presumed PN-associated cholestasis. In all patients, DB began to decline within 1–10 days of initiation of enteral feeds.

Conclusion(s)

DH is common in patients with gastroschisis and is unlikely to be associated with pathology aside from PN. Additional work-up may lead to unnecessary resource utilization.

Levels of evidence

Case series with no comparison group, Level IV.

Keywords

Direct hyperbilirubinemia Gastroschisis Resource utilization Cholestasis Outcomes 

Abbreviations

PN

Parenteral nutrition

CH

Conjugated hyperbilirubinemia

DB

Direct bilirubin

PNALD

Parenteral nutrition associated liver disease

NASPGHAN

North American Society for pediatric gastroenterology, hepatology, and nutrition

DOL

Day of life

SD

Standard deviation

Notes

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The need for informed consent was waived by the Institutional Review Board as the study was felt to pose less than minimal risk by its nature as a retrospective review.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sarah B. Cairo
    • 1
  • Alex H. Osak
    • 2
  • Sara K. Berkelhamer
    • 2
    • 3
  • Cara McLaughlin
    • 4
  • David H. Rothstein
    • 1
    • 5
  1. 1.Department of Pediatric SurgeryJohn R. Oishei Children’s HospitalBuffaloUSA
  2. 2.Department of PediatricsJohn R. Oishei Children’s HospitalBuffaloUSA
  3. 3.Department of PediatricsUniversity at Buffalo Jacobs School of Medicine and Biomedical SciencesBuffaloUSA
  4. 4.Department of NutritionJohn R. Oishei Children’s HospitalBuffaloUSA
  5. 5.Department of SurgeryUniversity at Buffalo Jacobs School of Medicine and Biomedical SciencesBuffaloUSA

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