Evaluation of Inflammatory Markers in Full Term Neonates With Unconjugated Hyperbilirubinemia

Abstract

Neonatal jaundice or hyperbilirubinemia is one of the most common problems encountered in newborn unconjugated bilirubin (UCB) is the principal end product of heme catabolism. Increased level of UCB are responsible for the clinical manifestation of jaundice. Unconjugated bilirubin injury to glial cells leads to the secretion of glutamate and elicits a typical inflammatory response. Release of proinflammatory cytokines may influence gliogenesis and neurogenesis, and lead to deficits in learning and memory and even moderate levels of UCB have been associated with developmental delay. The aim of the current study was to evaluate the inflammatory markers TNF- and IL- in full term neonates with unconjugated hyperbilirubinemia which helps in diagnosis, treatment and follow up. The study was done in El-Galaa Teaching Hospital pediatric department screening clinic during the period from October 2012 to June 2014. The cases were classified into 3 groups: Group A: 25 neonates with unconjugated bilirubin ranged from 12-18 mg/dl. SUMMARY 193 Group B: 25 neonates with unconjugated bilirubin above 18 mg/dl Group C: 25 Healthy neonates as control group with matched age and sex. For all neonates the following were performed: History taking, clinical examination, laboratory investigations including CBC, CRP, total and direct bilirubin. Serum interleukin -1β (IL-1), and tumor necrosis factor-  (TNF-) by ELISA kit. From each neonate met the inclusion criteria of the present study, three milliliters of blood were collected. Each sample was divided in two tubes; the first tube was EDT tube for CBC, the second tube was a plain tube into which blood was left to clot and serum was separated and divided into 2 parts, one was used for CRP and bilirubin determination; while the other was stored at – 20oC till assay of tumor necrosis factor- and interleukin -1. Regarding total and unconjugated bilirubin showed statistically significant positive correlation with neurological examination (lethargy or irritability). Also we found that increased unconjugated bilirubin level showed statistically significant positive correlation with relatively increased inflammatory markers IL-1  and TNF- levels. SUMMARY 194 Additionally we found that both inflammatory markers (IL-1 and TNF-) levels showed statistically significant positive correlation with breast feeding. In the present study we also found that both inflammatory markers (IL-1 and TNF-) increasing levels showed statistically significant positive correlation with neurological examination (Lethargy or irritability). The results of this study revealed that neonates with unconjugated hyperbilirubinemia have high levels of inflammatory markers IL-1 and TNF- Also significant difference between neonates with unconjugated hyperbilirubinemia and control group persisted towards unconjugated bilirubin and inflammatory markers