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Updated: Jun 13, 2026
Biochemical Measurement of Neonatal Hypoxia
Published on: August 24, 2011
Incidence of neonatal hyperbilirubinemia: a population-based prospective study in Pakistan
Shiyam Sundar Tikmani1, Haider Javed Warraich, Farrukh Abbasi
1Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
Insights
Neonatal jaundice and hyperbilirubinemia are common in urban Pakistan, with over 39 cases per 1000 live births. Early detection and management are crucial to prevent potential neurological damage in newborns.
Area of Science:
- Neonatal health
- Public health
- Pediatrics
Background:
- Neonatal jaundice is a common condition, but its incidence and severity in developing countries remain understudied.
- Home births are prevalent in many urban poor communities, posing challenges for timely medical intervention.
Purpose of the Study:
- To determine the incidence of neonatal jaundice and hyperbilirubinemia in a low-income urban setting in Karachi, Pakistan.
- To highlight the need for improved screening and management guidelines for neonatal jaundice in developing nations.
Main Methods:
- A prospective study involving home-based surveillance of newborns from September 2004 to July 2006.
- Clinical jaundice assessment using the Kramer scale, with bilirubin levels measured in a subset of infants.
- Referral of jaundiced infants to a local clinic for physician assessment.
Main Results:
- A total of 1690 infants were monitored; 27.6% were referred for jaundice.
- The overall incidence of hyperbilirubinemia (bilirubin >5 mg/dl) was 39.7 per 1000 live births.
- Severe hyperbilirubinemia (bilirubin >15 mg/dl) was observed in 16.5 per 1000 live births, with higher rates in infants showing significant clinical jaundice (Kramer score 4-5).
Conclusions:
- A substantial burden of untreated severe neonatal jaundice exists in urban Pakistan, potentially leading to neurological complications.
- There is an urgent need for World Health Organization (WHO) guidelines tailored for screening and managing neonatal jaundice in developing countries.
Objective:
To estimate the incidence of neonatal jaundice and hyperbilirubinemia in a poor urban community in Karachi, where 70% of births occur at home.
Methods:
Home-based pregnancy and newborn surveillance were conducted from September 2004 to July 2006 in a multi-ethnic population by trained community health workers. Newborns were visited several times at scheduled intervals until 59 days of life; any baby with jaundice was referred to the local clinic. Clinical assessments of jaundice were assigned by a physician and recorded using an adapted Kramer scale. Blood for plasma bilirubin was obtained if parents consented.
Results:
Of a birth cohort of 1690 young infants during the study period, 466 infants (27.6%) were referred to our centre with jaundice. Of these, 64% were 0-6 days old. Bilirubin was measured in 125 of 466 (27%) jaundiced newborns. Overall detected rate of hyperbilirubinemia (bilirubin >5 mg/dl) among 1690 newborns was 39.7/1000 live births (95% CI 29.3-47.6). Rate of plasma bilirubin levels in the range of 15-20 mg/dl was 13/1000 live births (95% CI 7.6-18.4); levels >20 mg/dl were observed in 3.5/1000 live births (95% CI 0.4-5.5). The proportion of newborns with bilirubin > or =15 mg/dl was significantly higher among those assigned a Kramer score of 4-5 compared to those receiving a score of 1-3 (P-value 0.00004).
Conclusion:
A significant burden of untreated severe neonatal jaundice, causing potential neurological sequelae, exists in developing countries such as Pakistan. WHO guidelines are needed for screening and appropriate management of neonatal jaundice in developing countries.
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