Hindawi Publishing Corporation BioMed Research International Volume 2013, Article ID 316430, 6 pages http://dx.doi.org/10.1155/2013/316430 Clinical Study Factors Affecting Bilirubin Levels during First 48 Hours of Life in Healthy Infants Betul Siyah Bilgin, 1 Ozge Altun Koroglu, 1 Mehmet Yalaz, 1 Semra Karaman, 2 and Nilgun Kultursay 1 1 Division of Neonatology, Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey 2 Department of Anesthesiology and Reanimation, Ege University Faculty of Medicine, Izmir, Turkey Correspondence should be addressed to Mehmet Yalaz; mehmet.yalaz@ege.edu.tr Received 19 April 2013; Revised 18 May 2013; Accepted 20 May 2013 Academic Editor: Sohinee Bhattacharya Copyright © 2013 Betul Siyah Bilgin et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To investigate the relationship of delivery type, maternal anesthesia, feeding modalities, and first feeding and meconium passage times with early bilirubin levels of healthy infants. Methods. Cord, 24 hours’ and 48 hours’ total bilirubin levels were measured in 388 study infants. Results. Infants born with cesarean section were fed later and more oſten had mixed feeding. First meconium passage was delayed with general anesthesia. Cord, 24 and 48 hours’ bilirubin levels were not correlated with first feeding time, meconium passage time, mode of delivery, existence and type of anesthesia, and feeding modalities. Being in high intermediate risk zone at 72 hours of Bhutani’s nomogram was only related to first feeding time and high cord bilirubin level. Late preterm infants were more frequently born with cesarean section and offered supplementary formula. erefore, first meconium passage times and bilirubin levels were similar in the late preterm and term infants. Conclusions. Type of delivery or anesthesia, late prematurity, feeding modalities, and first meconium passage time were not related to early bilirubin levels in healthy neonates, but delayed first feeding and high cord bilirubin levels were related to be in higher risk zone for later hyperbilirubinemia. 1. Introduction Despite being a temporary condition, neonatal jaundice is still the most common cause of hospitalization in the first week of life. Physiological jaundice is due to the developmen- tal insufficiency of bilirubin uptake, transport, and conjuga- tion in the newborn liver. Decreased gut motility, delayed passage of bilirubin rich meconium, and absence of intestinal bacteria that degrades bilirubin to urobilinogen may all con- tribute to hyperbilirubinemia by increasing enterohepatic circulation [1, 2]. Delayed initiation of breastfeeding and technical problems in nursing may cause maternal milk insufficiency and increase the risk of hyperbilirubinemia [2]. In recent years, increased cesarean section (c/s) rates and promotion of breastfeeding and earlier hospital discharge caused an increased frequency of neonatal hyperbilirubine- mia [3, 4]. Jaundice is more prominent and lasts longer in breastfed infants [1]. Type of the anesthesia used for c/s may also affect the risk for hyperbilirubinemia [5]. Understanding the major contributing factors of early neonatal hyperbilirubinemia may help clinicians to identify the infants at highest risk of hyperbilirubinemia since earlier discharge is a new cost reducing strategy in most clinics. Fur- thermore, identifying infants with risk of hyperbilirubinemia and observing closely before discharge might reduce both morbidity and readmission rates [3]. erefore, the relation of gestational age, delivery type, existence and type of maternal anesthesia, feeding modalities, and first meconium passage time with early bilirubin levels of healthy infants was investigated in this study. As a secondary aim we planned to analyze the complex relationship among these parameters. 2. Methods is prospective study was carried out in Ege University Faculty of Medicine, Department of Obstetrics and Gyne- cology, between November 2011–February 2012 in infants