Infants with severe neonatal jaundice in Lagos, Nigeria: incidence, correlates and hearing screening outcomes

Abstract

Summaryobjectives To establish the incidence, correlates and hearing screening outcomes of infants with severe neonatal jaundice in Nigeria.methods Community-based study in which all infants attending Bacille Calmette-Guérin immunisation clinics in inner-city Lagos were enrolled into a universal hearing screening programme during which correlates of severe neonatal jaundice (requiring phototherapy and ⁄ or exchange blood transfusion) were explored with multivariable logistic regression.results Of the 5262 infants enrolled, only 48.7% were born in hospitals although almost all mothers (97.9%) attended antenatal clinics. 6.7% had a history of neonatal jaundice of whom 5.5% (95% CI:4.9-6.2) received phototherapy and 1.9% (95% CI:1.5-2.3) had an exchange blood transfusion. Factors independently associated with severe neonatal jaundice were maternal religion, occupation, use of herbal preparations during pregnancy, infant's gender, weight at screening, multiple gestation and place of birth. All but two infants with severe neonatal jaundice were exclusively breast-fed. Of those who failed the hearing tests, 17.3% were treated with phototherapy and 11.3% had an exchange blood transfusion. At least 8.9% of infants requiring phototherapy and 17.3% of those requiring exchange blood transfusion were at risk of sensorineural hearing loss.conclusions Severe neonatal jaundice is a significant condition associated with modifiable risk factors in this population. Policy initiatives for prevention, early detection followed by appropriate and timely intervention are urgently needed to reduce the disease burden.

The occurrence of high-risk factors for hearing loss in verylow- birth-weight neonates: A retrospective exploratory study of targeted hearing screening

“…The higher occurrence in females is contrary to findings which documented an observed higher risk of neonatal jaundice in males (Olusanya, Akande, Emokpae & Olowe, 2009). This finding may however be influenced by the fact that the current study sample comprised more females than males, and it therefore should be interpreted with caution.…”

“…This finding may however be influenced by the fact that the current study sample comprised more females than males, and it therefore should be interpreted with caution. The high percentage of neonates presenting with neonatal jaundice in the current study is also consistent with reports that state that the burden of neonatal jaundice is likely to be substantially higher in Africa compared with the developed world (Olusanya et al, 2009). Although hyperbilirubinaemia requiring exchange blood transfusion is listed as a risk factor for hearing loss, the frequency of neonatal jaundice necessitating phototherapy was greater than exchange blood transfusion.…”

“…Although hyperbilirubinaemia requiring exchange blood transfusion is listed as a risk factor for hearing loss, the frequency of neonatal jaundice necessitating phototherapy was greater than exchange blood transfusion. This is consistent with reports from another developing country, Nigeria, where the need for phototherapy reportedly exceeded exchange blood transfusion, with those who received phototherapy also being at significant risk for sensorineural hearing loss (Olusanya et al, 2009). These findings from the current study may have also been influenced by the unit policies at the hospital during this time period, whereby all neonates, irrespective of birth weight, were provided with standard neonatal care which included blood transfusions or phototherapy as needed .…”

Why is kernicterus still a major cause of death and disability in low-income and middle-income countries?

“…Whereas the inability to identify and manage at-risk infants prior to hospital discharge in a timely manner is often cited as the major root cause of adverse outcomes in developed countries,21 the high proportion of non-institutionalised delivery in residential or traditional maternity homes in the vast majority of LMICs suggests that the contributory factors are likely to transcend systems failure. For example, while phototherapy and/or exchange transfusion are proven treatments to prevent or treat ABE and kernicterus worldwide, high rates of adverse outcomes among infants treated with phototherapy and/or exchange transfusion are not uncommon,22 underscoring the potential role of appropriate timing for the effective treatment of the affected infants 11–14. We, therefore, set out to explore the available evidence in the literature on the care-seeking pathways for infants with neonatal jaundice in LMICs based on the conceptual framework proposed by Thaddeus and Maine23 which focuses on three phases of delay: the decision to seek appropriate care, reaching an appropriate health facility and receiving adequate/appropriate care.…”

Hiperbilirrubinemia neonatal: revisión de la situación actual

“…En un estudio realizado en Lagos (Nigeria), un 6'7% presentó ictericia neonatal, de los cuales un 5'5% recibió fototerapia y un 1'9% exanguinotransfusión 15 .…”