Risk factors and outcome of neonatal jaundice in a tertiary hospital

Abstract

Neonatal jaundice is a common cause of newborn hospital admission. The risk factors, the characteristics and outcomes related to neonatal jaundice in Bangladesh has not been studied so far. This study addressed the outcomes, characteristics and risks of the jaundiced newborn admitted into hospital. The babies who had significant jaundice and required phototherapy and /or exchange transfusion were investigated. A detailed history of delivery with gestational age was noted and clinical examination of the admitted newborn was done. Birth weight was recorded. The investigations included complete blood count, ABO and Rh compatibility, serum bilirubin, glucose 6 phosphate dehydrogenase (G6PD), thyroid stimulating hormone (TSH) and ultrasonography (USG) of brain. The newborns were closely monitored for the prognosis. The requirement of individualized phototherapy and exchange transfusion were also noted. Finally, the outcomes were recorded. Overall, 60 (m v. f = 58.3 v. 41.7%) newborns were found who developed significant jaundice and were investigated. Of them, 35% had gestational age less than 32wks and only 32% had equal to or greater than 35wks. Regarding delivery, 83.3 % had the history of caesarean section. ABO-and Rh-incompatibilities were found in 13.3% and 3.3%, respectively. Septicemia was diagnosed among 26.7% though blood culture yielded growth only in 20%. Compared with the higher gestational age-group (≥ 35 wks) the lower group (<32 wks) showed significantly higher rate of septicemia (12.5 v. 68.8%, p<0.005). G6PD deficiency was found in only one (1.7%) case. Birth asphyxia was found as a concomitant factor in three patients. Exchange transfusion was done only in 2 (3.3%) babies. Among them one was preterm IDM with septicemia and other had G6PD deficiency. None of these babies developed kernicterus. Five (8.3%) babies died, all of them had septicemia and one baby also had intraventricular hemorrhage (IVH) with PDA. The study revealed that a substantial number of neonatal jaundice had the history of lower gestational age in Bangladeshi newborns; and the lower gestational age is significantly associated with septicemia and possibly with hyperbilirubinemia. More study is needed to establish the study findings.Ibrahim Med. Coll.

Evaluation of attributes to hyperbilirubinaemia in neonates in a tertiary care hospital in the Dhaka city

“…Prematurity is one of the major causes of neonatal jaundice. In this study 77.3% (88 out of 120) neonates were premature which is almost similar to the findings of Dawodu and his group 7 . The study reconfirmed the prematurity as prominent cause of hyperbilirubinemia in neonates.…”

“…As a global problem, preventive and control strategies of hyperbilirubinaemia should be based on adequate knowledge and information regarding the incidence and risk factors, which are not available in the developing countries where the vast majority of births occur at home. Identifying infants at risk of severe hyperbilirubinaemia and early intervention may reduce the levels of morbidity and mortality associated with bilirubin encephalopathy 7 . This study was designed to access neonatal and maternal risk factors related to the hyperbilirubinaemia among the neonates.…”

Etiological study of jaundice in neonates

“…14 11,15 In the study by Bedowra et al, Bangladesh (n=60), physiological jaundice contributes to 53.3% as the most common cause in their study. 16 It was comparatively higher too as compared to our study. These higher incidence of physiologic jaundice may be due to increased enterohepatic circulation, decreased intestinal bacteria and decreased gut motility with poor evacuation of bilirubin-laden meconium, defective up take of bilirubin from plasma caused by decreased ligandin and binding of ligandin by other anions and defective conjugation due to decreased UGT activity and decreased hepatic excretion of bilirubin.…”

“…9 Onyearugha et al, prematurity was the second leading cause of NNJ both in inborn and outborn babies. 10 Singhal et al, had given an incidence of 16.7% (Prematurity) as a cause of neonatal jaundice probably more because of physiological handicaps in premature, LBW babies. 11 Hussain et al, Karachi, too had shown that prematurity and LBW was an important risk factor for development of severe hyperbiliru-binemia.…”

Clinico-etiological profile of neonates admitted with jaundice in a tertiary care NICU of Central India

“…It was marginally higher as compared to our study. 13 Most common etiological factor for pathological neonatal hyperbilirubinemia was found to be septicaemia (33.68%) followed by ABO incompatibility (13.36%). This result were not similar with Jamir et al, who reported that the most common etiological factor for pathological neonatal hyperbilirubinemia was due to deficiency of enzyme G6PD (12%) followed by prematurity (8.7%) and sepsis (5.3%).…”