Background: Severe neonatal hyperbilirubinemia, when unmonitored or untreated, can progress to acute bilirubin encephalopathy (ABE). Initiatives to prevent and eliminate post-icteric sequelae (kernicterus) are being implemented to allow for timely interventions for bilirubin reduction. Objectives: We report an observational study to determine the clinical risk factors and short-term outcomes of infants admitted for severe neonatal jaundice. Methods: A post-discharge medical chart review was performed for a cohort of infants admitted for management of newborn jaundice to the Children Welfare Teaching Hospital during a 4-month period in 2007 and 2008. Immediate outcomes included severity of hyperbilirubinemia, association of ABE, need and impact of exchange transfusion, and survival. Short-term post-discharge follow-up assessed for post-icteric sequelae. Results: A total of 162 infants were admitted for management of severe jaundice. Incidences of severe sequelae were: advanced ABE (22%), neonatal mortality within 48 h of admission (12%) and post-icteric sequelae (21%). Among the cohort, 85% were <10 days of age (median 6 days, IQR 4–7 days). Readmission total serum bilirubin ranged from 197 to 770 µM; mean 386 ± 108 SD µM (mean 22.6 ± 6.3 SD mg/dl; median 360, IQR 310–445 µM). The major contributory risk factor for the adverse outcome of kernicterus/death was admission with advanced ABE (OR 8.03; 95% CI 3.44–18.7). Other contributory factors to this outcome, usually significant, but not so for this cohort, included home delivery, sepsis, ABO or Rh disease. Absence of any detectable signs of ABE on admission and treatment of severe hyperbilirubinemia was associated with no adverse outcome (OR 0.34; 95% CI 0.16–0.68). Conclusions: Risks of mortality and irreversible brain injury among healthy infants admitted for newborn jaundice are urgent reminders to promote education of communities, families and primary health care providers, especially in a fractured health system. Known risk factors for severe hyperbilirubinemia were overwhelmed by the effect of advanced ABE.

Gestational age, birth weight, whiteout chest X-ray, and FiO2 are important predictive values for success of CPAP therapy. A larger prospective multicenter controlled trial is needed to determine the benefits and risks of CPAP and predictors of its failure in our setting. Our results may be useful for others practicing in similar settings as us.

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Background: Transient tachypnea (TTN) is a common disorder of the newborn. It is characterized by the early onset of tachypnea sometimes with retractions or expiratory grunting and occasionally cyanosis that is relieved by minimal oxygen supplementation (<40%). Objectives: To identify the risk factors and describe the clinical characteristics, treatment and outcome of infants with TTN. Patients and methods: This study was carried out on 100 newborn babies with birth weight of 2500 to 4000 gm and gestational ages range from (completed 37-42 wks), who were admitted to the neonatal care unit of Children Welfare Teaching Hospital, Medical city, Baghdad, from 1st of September 2013 to the 31st of January 2014, and diagnosed as having TTN. Results: Males represented 68% and females were 32%, with a male to female ratio of 2.1:1. Fifty-three percent aged 38 weeks, compared to 38% aged < 38 weeks and 9% > 38 weeks, indicating that there was a significant inverse correlation between the incidence of TTN and the gestational age. There was a highly significant inverse correlation between the neonate's weight and the frequency of TTN. Cesarean section done in 80% compared to 20% delivered with spontaneous vaginal delivery (SVD) and neonates who were delivered by elective section were more likely to have TTN than those delivered with SVD or emergency section. The history of maternal diabetes in (17%), a statistically significant association was found between TTN and the maternal Diabetes Mellitus but not with other maternal diseases. Tachypnea and chest retraction were the most frequent clinical manifestations, 93% and 72% respectively. Chest X-ray revealed that 71% had increased pulmonary vascular markings, over aeration in 22%. Out of the 100 cases, 95% were discharged after they improved without complications, 5% complicated with Pneumothorax. No death in the studied group. Conclusions: There was a significant association between TTN and maternal diabetes, mode of delivery especially elective CS, lower gestational age (38 weeks and less), and lower body weight. The most frequent clinical manifestations of TTN are Tachypnea and chest retraction. Increased pulmonary vascular markings and over-aeration are the most frequent radiological manifestations. TTN is a self-limited disease in most of the cases.