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Risk factors for severe neonatal hyperbilirubinemia in low and middle-income countries: a systematic review and
Bolajoko O Olusanya1, Folasade B Osibanjo2, Tina M Slusher3
1Director, Centre for Healthy Start Initiative, Ikoyi, Lagos, Nigeria.
Insights
Severe neonatal hyperbilirubinemia disproportionately affects low- and middle-income countries (LMICs). Key risk factors include primiparity, delivery outside hospitals, ABO incompatibility, Rhesus hemolytic disease, G6PD deficiency, and low gestational age.
Area of Science:
- Neonatal Medicine
- Public Health
- Genetics
Background:
- Severe neonatal hyperbilirubinemia poses a significant health burden in low- and middle-income countries (LMICs).
- This condition leads to disproportionately high rates of morbidity, mortality, and neurodevelopmental disorders in LMICs compared to high-income countries.
- Identifying risk factors is crucial for targeted interventions and further research.
Purpose of the Study:
- To identify maternal and infant risk factors associated with severe neonatal hyperbilirubinemia in LMICs.
- To inform targeted interventions and highlight areas for future research to reduce the disease burden.
Main Methods:
- Systematic literature search of multiple databases (PubMed, Scopus, EMBASE, CINAHL, WHOLIS, AIM, AJOL, LILACS, IndMed) from January 1990 to June 2014.
- Inclusion of studies controlling for confounding variables in risk factor analysis.
- Meta-analysis of eligible studies using random effects models to compute summary risk estimates.
Main Results:
- Analysis of 13 studies with 1,951 subjects and 32,208 controls from India, Nigeria, Pakistan, Nepal, and Egypt.
- Identified risk factors include primiparity, delivery outside public hospitals, ABO incompatibility, Rhesus hemolytic disease, G6PD deficiency, UGT1A1 polymorphisms, low gestational age, underweight/weight loss, sepsis, and high bilirubin levels.
- Low social class was not found to be associated with an increased risk.
Conclusions:
- Infants in LMICs are at increased risk of severe hyperbilirubinemia due to identifiable maternal and neonatal factors.
- Available interventions can effectively address these risk factors to reduce the disease burden.
- Further research and targeted actions are needed to mitigate the impact of severe hyperbilirubinemia in LMICs.
Background:
Available evidence suggests that low- and middle-income countries (LMICs) bear the greatest burden of severe neonatal hyperbilirubinemia characterized by disproportionately high rates of morbidity, mortality and neurodevelopmental disorders compared to high-income countries. We set out to identify the risk factors that contribute to the burden of severe hyperbilirubinemia in the most developmentally disadvantaged LMICs to highlight areas for action and further research.
Methods:
We systematically searched PubMed, Scopus, Ovid EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), WHO Library Database (WHOLIS), African Index Medicus (AIM), African Journals Online (AJOL), LILACS, and IndMed for reports published between January 1990 and June 2014. We included only studies that controlled for the effects of confounding variables in determining maternal and infant risk factors for severe hyperbilirubinemia. We conducted meta-analysis of the eligible studies and computed the summary risk estimates with random effects models.
Results:
A total of 13 studies with 1,951 subjects and 32,208 controls from India, Nigeria, Pakistan, Nepal and Egypt were identified and analyzed. The pooled data showed that primiparity (OR, 1.59; 95% CI:1.26-2.00), delivery outside public hospitals (OR, 6.42; 95% CI:1.76-23.36), ABO incompatibility (OR, 4.01; 95% CI:2.44-6.61), Rhesus hemolytic disease (OR, 20.63; 95% CI:3.95-107.65), G6PD deficiency (OR, 8.01; 95% CI:2.09-30.69), UGT1A1 polymorphisms (OR, 4.92; 95% CI:1.30-18.62), low gestational age (OR, 1.71; 95% CI:1.40-2.11), underweight/weight loss (OR, 6.26; 95% CI:1.23-31.86), sepsis (OR, 9.15; 95% CI:2.78-30.10) and high transcutaneous/total serum bilirubin levels (OR, 1.46; 95% CI:1.10-1.92) placed infants at increased risk of severe hyperbilirubinemia or bilirubin induced neurologic dysfunctions. Low social class was not associated with an increased risk of severe hyperbilirubinemia.
Conclusions:
Infants at risk of severe hyperbilirubinemia in LMICs are associated with maternal and neonatal factors that can be effectively addressed by available interventions to curtail the disease burden prevailing in the affected countries.
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