Can anesthesiologic strategies for caesarean section influence newborn jaundice? A retrospective and prospective study.
OBJECTIVE
Neonatal jaundice is a frequent problem in neonatology and can be influenced by many factors. Our study arose from the clinical observation that among all newborns delivered by caesarean section in our center, some had a more intense physiological jaundice. We began by reviewing clinical anesthesiological case-sheets to ascertain whether this difference was linked to the use of different anesthesiologic strategies. We then performed a prospective study on healthy preterm and term newborns to verify this hypothesis.


METHODS
We retrospectively considered all healthy term newborns with weight > 2,400 g delivered by caesarean section from January 1998 to May 1999. In the prospective studies we included healthy term and preterm newborns consecutively delivered by caesarean section from May 1999 to December 1999. We excluded preterm newborns with gestational age < 31 weeks and with weight < 1,400 g.


RESULTS
Both in retrospective and in prospective studies anesthetic agents employed were isoflurane (A), sevoflurane (B), or bupivacaine (C). The statistical comparison of the three groups in retrospective study confirmed the clinical observation: the total bilirubin levels were significantly higher in the isoflurane group than in the sevoflurane group (p = 0.0000) and bupivacaine group (p = 0.0002). Analysis of data from the prospective study on term newborns confirmed our previous results. In preterm infants total bilirubin is statistically higher in group A starting from 96 h postdelivery.


CONCLUSIONS
It is likely that anesthetic technique can be included among factors with possible influence on neonatal jaundice.
Department of Clinical Epidemiology and Biometry-Scientific Direction, Pavia, Italy. ddeamici@smatteo.pv.it
D
D
De Amici
P
P
Delmonte
L
L
Martinotti
A
A
Gasparoni
S
S
Zizzi
I
I
Ramajoli
F
F
Ramajoli
D000776:Anesthesiology / Q000379:methods*; D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D001663:Bilirubin / Q000097:blood; D002045:Bupivacaine; D002585:Cesarean Section; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007530:Isoflurane; D007567:Jaundice, Neonatal / Q000097:blood*; D008738:Methyl Ethers; D011446:Prospective Studies; D012189:Retrospective Studies; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane; D001663:Bilirubin; D002045:Bupivacaine