Abstract
Neonatal jaundice a common condition which affects about 60-80% of newborn and if severe can lead serious neurological sequelae. Determinants include neonatal and maternal factors. A prospective case control descriptive study in a tertiary care centre was done in 62 consecutive cases with neonatal jaundice and 124 consecutive newborns without jaundice served as controls. The major determinants for neonatal jaundice were low birth weight <2.5 kg (OR 24.54 95% CI 10.98 – 54.84 : P<0.0001), birth asphyxia (OR 16.5; 95% CI 4.63- 58.76, P<0.0001), Low APGAR score <7( OR 26.1; 95% CI 3.28- 207.47, P =0.0002), prematurity <37weeks ( OR 28.92 95% CI 12.15-68.82 P=0.0001) Preterm premature rupture of membranes (OR 58.57 95% CI 7.67 -449.87 P<0.0001) and malpresentation (OR 14.64 95% CI 3.16 -67.792 tailed p =0.00004).The factors which evolved significant on logistic regression were Preterm premature rupture of membranes , gestational age <37 weeks , APGAR score below 7, Birth weight below 2500grams , Birth asphyxia and multiple pregnancy. The association was less strong for ABO incompatibility, antepartum hemorrhage and intrauterine growth retardation (IUGR). Meticulous antenatal care of these high risk pregnancies and intrapartum and post partum care will help in reducing the occurrence of neonatal jaundice.
Keywords: Neonatal jaundice, Determinants, Preterm Premature Rrupture of Membranes, APGAR.
References
1. Burke BL, Robbins JM, Bird TM, Hobbs CA, Nesmith C, et al. (2009) Trends in hospitalizations for neonatal jaundice and kernicterus in the United States, 1988–2005. Pediatrics 123:524–5320
2. Hameed NN, Na’ Ma AM, Vilms R, Bhutani VK. (2011) Severe neonatal hyperbilirubinemia and adverse short-term consequences in Baghdad, Iraq. Neonatology 100:57–63.
3. English M, Ngama M, Musumba C, Wamola B, Bwika J, et al. (2003) Causes and outcome of young infant admissions to a Kenyan district hospital. Arch Dis Child 88:438–443.
4. Mwaniki MK, Atieno M, Lawn JE, Newton CR. (2012) Long-term neurodeve-lopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet 379:445–452.
5. American Academy of Pediatrics (AAP). (2004) Management of hyperbilirubin-aemia in the newborn infant 35 or more weeks of gestation. Pediatrics 114:297–316
6. Bhutani VK, Zipursky A, Blencowe H, Khanna R, Sgro M, et al. (2013) Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatr Res 74 Suppl 1:86–100.
7. Najib KS, Saki F, Hemmati F, Inaloo S. Incidence, Risk Factors and Causes of Severe Neonatal Hyperbilirubinemia in the South of Iran (Fars Province). Iran Red Cres Med J. 2013; 15(3): 260-3. DOI: 10.5812/ircmj.3337.
8. Huang MJ, Kua KE, Teng HC, Tang KS, Weng HW, Huang CS Risk Factors for Severe Hyperbilirubinemia in Neonates, Pediatr Res 56: 682–689, 2004
9. Garosi E , Mohammedi F, Ranjkesh F, The Relationship between Neonatal jaundice and Neonatal factors and Maternal factors , Iranian Journal of Neonatology, 2016; 7(1); open access; http:/ ijn.mums.ac.j
10. Olusanya BO, Osibanjo FB, Slusher TM, (2015) Risk Factors for Severe Neonatal Hyperbilirubinemia in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis. PLoS ONE 10(2): 0117229.
11. doi:10.1371/journal. pone.0117229
12. Murki S, Kumar P, Majumdar S, Marwaha N, Narang A. (2001) Risk factors for kernicterus in term babies with non-hemolytic jaundice. Indian Pediatr 38:757–762
13. Porter ML, Dennis BL, Hyperbiliru-binemia in the Term Newborn: Am Fam Physician 2002;65:599-606,613-4
14. Chawla D, Jain S, Dhir S, Rani S. (2012) Risk assessment strategy for prediction of pathological hyperbilirubinemia in neonates. Indian J Pediatr 79:198–201.
15. Scrafford CG, Mullany LC, Katz J, Khatry SK, Leclerq SC, et al. (2013) Incidence of and risk factors for neonatal jaundice among newborns in southern Nepal. Trop Med Int Health 18:1317–1328
16. Arif K, Bhutta ZA. (1999) Risk factors and spectrum of neonatal jaundice in a birth cohort in Karachi. Indian Pediatr 36:487–493
17. Kalakheti BK, Singh R, Bhatta NK, Karki A, Baral N. (2009) Risk of neonatal hyperbilirubinemia in babies born to ‘O’ positive mothers: A prospective cohort study. Kathmandu Univ Med J 7:11–15