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Severe neonatal hyperbilirubinemia and adverse short-term consequences in Baghdad, Iraq
Numan Nafie Hameed1, Alaa' Muhamed Na' Ma, Rohan Vilms
1Division of Pediatrics, College of Medicine, Baghdad University and Children Welfare Teaching Hospital Medical City Complex, Bab Al-Muadham, Baghdad, Iraq. numanalhamdani@yahoo.com
Insights
Severe neonatal jaundice can lead to acute bilirubin encephalopathy (ABE) and mortality. Early detection and treatment of ABE are crucial to prevent irreversible brain injury and death in newborns.
Area of Science:
- Neonatology
- Pediatric Neurology
- Public Health
Background:
- Severe neonatal hyperbilirubinemia poses a risk of acute bilirubin encephalopathy (ABE) and kernicterus.
- Preventive strategies aim for timely interventions to manage high bilirubin levels.
Purpose of the Study:
- To identify clinical risk factors for severe neonatal jaundice.
- To determine short-term outcomes in infants admitted for jaundice management.
Main Methods:
- Observational study using post-discharge medical chart review.
- Cohort of infants admitted for newborn jaundice management over a 4-month period.
- Assessment of hyperbilirubinemia severity, ABE, exchange transfusion, survival, and post-icteric sequelae.
Main Results:
- 22% incidence of advanced ABE, 12% neonatal mortality, and 21% post-icteric sequelae.
- Admission with advanced ABE significantly increased the risk of kernicterus/death (OR 8.03).
- Absence of ABE signs on admission and prompt treatment were associated with no adverse outcomes (OR 0.34).
Conclusions:
- High rates of mortality and brain injury underscore the need for community and healthcare provider education.
- Advanced ABE at admission was a dominant factor overriding other known risk factors for adverse outcomes.
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.
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