Effect of anesthesiological strategies on neonatal bilirubin levels during cesarean section: a prospective and randomized trial.
OBJECTIVE
Neonatal jaundice, a frequent problem in neonatology, can be influenced by many factors. Here, we sought to clarify the role of anesthesia and to compare the effects of various anesthesiological strategies on neonatal bilirubin levels during cesarean section.


METHODS
We prospectively enrolled 167 ASA I-II status uncomplicated pregnant women who delivered by cesarean section as the study group. The patients were randomized based on anesthesiological strategy: inhalation (IA), spinal (SA), total intravenous (TIVA), and epidural anesthesia (EA) groups. Neonatal total (TB) and direct bilirubin (DB) levels at the 24th hour and 5th day of life and the need for phototherapy were compared between the groups.


RESULTS
Direct bilirubin levels at 24th hour of SA group and EA group were higher compared to IA group (p = 0.008). When DB levels at fifth day were compared, levels in group TIVA were significantly higher than group SA (p = 0.019). TB levels at fifth day in group TIVA were higher than SA and EA groups (p = 0.05). The percentage of newborns needing phototherapy did not differ significantly among groups, but was highest in the TIVA group (25%), followed by the IA (15%), EA (10%) and SA (7%) groups (p = 0.08).


CONCLUSIONS
EA and SA at cesarean section seem to be better among the four anesthesia techniques considering neonatal hyperbilirubinemia. Our findings are consistent with the idea that anesthesia may be a risk factor for hyperbilirubinemia. Although anesthesia may not significantly increase the need for interventions such as phototherapy, it may increase the burden of time, labor and cost.
Departments of Anesthesiology and Reanimation, Duzce University School of Medicine, Duzce, Turkey.
Yavuz
Y
Demiraran
Mustafa
M
Albayrak
Ilknur Suidiye
IS
Seker
Gursel
G
Kaynak
Abdulkadir
A
Iskender
Gulbin Yalcin
GY
Sezen
Ismail
I
Ozdemir
D000280:Administration, Inhalation; D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects; D000777:Anesthetics / Q000008:administration & dosage / Q000009:adverse effects*; D001663:Bilirubin / Q000097:blood*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000209:etiology* / Q000628:therapy; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood; D008297:Male; D010789:Phototherapy; D011247:Pregnancy; D055815:Young Adult
D000777:Anesthetics; D001663:Bilirubin