Relationship between Neonatal Skin Bilirubin Level and Severe Jaundice with Maternal, Childbirth, and Neonatal Characteristics

Document Type: Original Article


1 Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

2 Department of Midwifery, Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

3 Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

4 Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

5 Road Traffic Injury Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran


Background: Neonatal jaundice is the most common cause of newborns' hospitalization. This study aimed to examine various maternal, childbirth, and neonatal factors affecting the neonatal skin bilirubin level and severe jaundice.
Methods: This cross-sectional study was conducted on 1066 healthy neonates with a gestational age of 35 weeks or over and birth weight of ≥2000 g at teaching hospitals of Alzahra and Taleghani in Tabriz, Iran, during 2016-2017. The participants were selected using convenience sampling. Data were collected using a three-part researcher-made questionnaire assessing maternal, childbirth, and neonatal characteristics based on the medical histories of mothers and newborns as well as interviews with mothers. Neonatal jaundice was measured utilizing the Kj-8000 device on days 3-6 after birth by measuring the skin bilirubin level. Moreover, the need to phototherapy (severe jaundice) was determined based on the American Academy of Pediatrics guideline. The generalized linear model and multivariate logistic regression were employed for data analysis.
Results: Out of the followed-up neonates, 94 (9.96%) cases developed severe jaundice and 850 (90.04%) newborns did not show any symptoms of this complication. The results of the adjusted generalized linear model showed that infant’s bilirubin level correlated significantly with a history of jaundice in previous children, infant’s age at first meconium excretion, frequency of feeding, gestational age, mother’s blood type, and a number of maternal ultrasound during pregnancy. Moreover, the results of adjusted logistic regression revealed an association between severe jaundice and variables, such as the place of residence, history of jaundice in previous children, feeding the infant with water or sugar water during breastfeeding intervals, frequency of feeding the infant, gestational age, mother’s blood type, time of discharge from the hospital, and number of pregnancies.
Conclusion: Some factors related to neonatal jaundice were identified to raise the awareness of healthcare personnel for the early identification and treatment of neonatal jaundice in order to prevent its complications.


1. Paul IM, Lehman EB, Hollenbeak CS, Maisels MJ. Preventable newborn readmissions since passage of the Newborns’ and Mothers’ Health Protection Act. Pediatrics. 2006; 118(6):2349-58.

 2. Boskabadi H, Maamouri G, Mafinejad S. The effect of traditional remedies (Camel's Thorn, Flixweed and Sugar Water) on idiopathic neonatal jaundice. Iran J Pediatr. 2011; 21(3):325-30.

3. el-Beshbishi SN, Shattuck KE, Mohammad AA, Petersen JR. Hyperbilirubinemia and transcutaneous bilirubinometry. Clin Chem. 2009; 55(7):1280-7.

 4. Newman TB, Xiong B, Gonzales VM, Escobar GJ. Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization. Arch Pediatr Adolesc Med. 2000; 154(11):1140-7.

 5. Gale R, Seidman DS, Dollberg S, Stevenson DK. Epidemiology of neonatal jaundice in the Jerusalem population. J Pediatr Gastroenterol Nutr. 1990; 10(1):82-6.

 6. Marcdante K, Kliegman RM. Nelson essentials of pediatrics. 7th ed. New York: Elsevier Health Sciences; 2015.

 7. Peevy KJ, Landaw SA, Gross SJ. Hyperbilirubinemia in infants of diabetic mothers. Pediatrics. 1980; 66(3):417-9.

8. Alizadeh Taheri P, Sepahran M, Shariat M. Maternal factors in newborns breast feeding jaundice: a case control study. Tehran Univ Med J. 2013; 70(12): 798-73.

9. Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001; 344(8): 581-90.

10. Mercier CE, Barry SE, Paul K, Delaney TV, Horbar JD, Wasserman RC, et al. Improving newborn preventive services at the birth hospitalization: a collaborative, hospital-based quality-improvement project. Pediatrics. 2007; 120(3):481-8.

11. Siyah Bilgin B, Altun Koroglu O, Yalaz M, Karaman S, Kultursay N. Factors affecting bilirubin levels during first 48 hours of life in healthy infants. Biomed Res Int. 2013; 2013:316430.

12. Mansouri A, Ghaderpanahi M, Kazemi GM, Moradzadeh R, Tolide IH, Akbarpour S, et al. A casecontrol study on prenatal factors of newborns’mild jaundice. J Nurse Phys War. 2014; 23-24:17-23.

 13. Saber A, Ferdowsi S, Askari F, Farsi L. Epidemiology of pathological jaundice and its association with demographic factors in infants born in the 22 Bahman Hospital in Gonabad, 2011. Razi J Med Sci. 2013; 20(114):42-8.

 14. Boskabadi H, Khakshour A, Khorashadi Zadeh F, Taherpur M, Esmaily H. Prenatal complications causing neonatal jaundice in Ghaem Hospital, Mashhad- Iran. J North Khorasan Univ Med Sci. 2011; 3(2):7-12.

 15. Sajjadian N, Shajari H, Mofid R, Jahadi R, Alizadeh Taheri P. Therelation of increasing serum bilirubin during 24-48 hours of birth and birth season. Tehran Univ Med J. 2013; 70(12):788-92.

 16. Seyedi R, Mirghafourvand M, Dost AJ, MohammadAlizadeh-Charandabi S, Asghari Jafarabadi M, Tabrizi SO. Tanscutaneous bilirubin nomogram for evaluating the risk of hyperbilirubinemia in Iranian healthy newborns. World J Pediatr. 2018; 15(1):72-7.

 17. Zahed PY, Baleqi M, Kalantar M. Association between time of neonatal discharge with mode of delivery. J Babol Univ Med Sci. 2016; 18(2):14-8.

 18. De Carvalho M, Hall M, Harvey D. Effects of water supplementation on physiological jaundice in breast-fed babies. Arch Dis Child. 1981; 56(7): 568-9.

19. Okwundu CI, Uthman OA, Smith J. Transcutaneous screening for hyperbilirubinemia in neonates. Cochrane Database Syst Rev. 2014; 4:CD011060.

 20. Behjaty S, Shajary H, Isfahany KW, Gholozar A. The prevalence of breast feeding jaundice. Iran J Pediatr. 2004; 14(2):108-14.