Epidemiology, risk factors, and clinical outcomes of neonatal jaundice: a prospective observational study
Abstract
Neonatal jaundice is a highly common condition affecting over 80% of full-term and preterm infants, usually appearing within 2–4 days of birth due to increased total serum bilirubin (TSB) caused by heightened red blood cell breakdown and immature liver clearance. While most cases resolve spontaneously within 1–2 weeks, severe unconjugated hyperbilirubinaemia can lead to bilirubin encephalopathy, seizures, developmental delays, or even death, making early detection and treatment essential. This prospective six-month study was carried out in the Department of Paediatrics at SVS Medical College and Hospital, Mahabubnagar, involving 80 neonates to assess diagnosis, treatment approaches, and outcomes. Data collected included demographic details, bilirubin levels, type and severity of jaundice, and therapeutic responses. Results indicated a slight male predominance (53%) with the highest incidence in infants aged 1–10 days, while preterm infants were most affected (38%), highlighting their increased vulnerability due to immature liver function. The distribution of causes showed physiological jaundice and breast milk jaundice (25% each), pathological jaundice (20%), Rh incompatibility (17%), and ABO incompatibility (13%). Clinical presentation ranged from facial to generalised involvement, reflecting severity. Phototherapy was the main treatment (49%), followed by observation (31%), intravenous immunoglobulin (IVIG) (15%), and exchange transfusion (5%), emphasising its crucial role in preventing kernicterus. In conclusion, the study underscores that neonatal jaundice, although common, necessitates vigilant monitoring, early screening, and prompt intervention to minimise morbidity, especially in high-risk preterm infants.
Keywords:
Neonatal jaundice, hyperbilirubinemia, bilirubin encephalopathy, phototherapy, exchange transfusion, preterm infants, neonatal outcomesDOI
https://doi.org/10.70604/learnint.v2i3.85References
1. Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice. N Engl J Med. 2008;358(9):920-8.
2. Bhutani VK, Wong RJ. Bilirubin neurotoxicity in preterm infants: risk and prevention. Clin Perinatol. 2016;43(2):341-55.
3. Watchko JF. Hyperbilirubinemia and bilirubin toxicity in the late preterm infant. Clin Perinatol. 2006;33(4):839-52.
4. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297-316.
5. Rennie JM, Burman-Roy S, Murphy MS. Neonatal jaundice: summary of NICE guidance. BMJ. 2010;340:c2409.
6. Christensen RD, Yaish HM. Hemolytic disorders causing severe neonatal hyperbilirubinemia. Clin Perinatol. 2016;43(2):341-54.
7. Valaes T. Severe neonatal jaundice associated with glucose-6-phosphate dehydrogenase deficiency: pathogenesis and global epidemiology. Acta Paediatr Suppl. 1994;394:58-76.
8. Kaplan M, Hammerman C. Bilirubin and the genome: the hereditary basis of unconjugated neonatal hyperbilirubinemia. Curr Pharm Des. 2009;15(25):3032-42.
9. Newman TB, Maisels MJ. Evaluation and treatment of jaundice in the term newborn: a kinder, gentler approach. Pediatrics. 1992;89(5 Pt 1):809-18.
10. Olusanya BO, Teeple S, Kassebaum NJ. The global burden of neonatal jaundice: a systematic review. BMC Pediatr. 2018;18(1):47.
11. Kaplan M, Hammerman C. Glucose-6-phosphate dehydrogenase deficiency: a hidden risk for kernicterus. Semin Perinatol. 2004;28(5):356-64.
12. Slusher TM, Zamora TG, Appiah D, Stanke JU, Strand MA, Lee BW, et al. Burden of severe neonatal jaundice: a systematic review and meta-analysis. BMJ Paediatr Open. 2017;1(1):e000105.
13. Watchko JF, Tiribelli C. Bilirubin-induced neurologic damage—mechanisms and management approaches. N Engl J Med. 2013;369(21):2021-30.
14. Bhutani VK, Johnson LH. Kernicterus in late preterm infants cared for as term healthy infants. Semin Perinatol. 2006;30(2):89-97.
15. Papachristou GI, Muddana V, Yadav D, O’Connell M, Sanders MK, Slivka A, et al. Comparison of BISAP, Ranson’s, APACHE-II, and CTSI scores in predicting complications and mortality. Am J Gastroenterol. 2010;105(2):435-41.
16. Pérez-Nombela S, Álvarez-Bueno C, Hidalgo-Robles Á, Ruiz-Becerro I, Fernández-Rego FJ. Neonatal hyperbilirubinemia and repercussions on neurodevelopment: a systematic review. Child Care Health Dev. 2022;48(6):935-45. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/cch.13183
17. Zahed Pasha Y, Alizadeh-Tabari S, Zahed Pasha E, Zamani M. Etiology and therapeutic management of neonatal jaundice in Iran: a systematic review and meta-analysis. World J Pediatr. 2020;16(6):586-95.
18. Kirk JM. Neonatal jaundice: a critical review of the role and practice of bilirubin analysis. Ann Clin Biochem. 2008;45(Pt 5):452-62.
19. Gottimukkala SB, Lobo L, Gautham KS, Bolisetty S, Fiander M, Schindler T. Neonatal jaundice. Lancet Child Adolesc Health. 2023;7(4):241-56. PMID: 36867730.
20. Abbey P, Kandasamy D, Naranje P. Neonatal jaundice. Indian J Pediatr. 2019;86(2):171-8. PMID: 30790186.
21. Shahbazi M, Khazaei S, Moslehi S, Shahbazi F. Effect of massage therapy for the treatment of neonatal jaundice: a systematic review and dose-response meta-analysis. Iran J Pediatr. 2022;32(2):e114641.
22. Zhang M, Tang J, He Y, Li W, Chen Z, Xiong T, et al. Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia. BMC Pediatr. 2021;21(1):56. PMID: 7817798.
23. Olusanya BO, Teeple S, Kassebaum NJ. Burden of severe neonatal jaundice: a systematic review and meta-analysis. BMC Pediatr. 2018;18(1):44. PMID: 5862199.
24. Westenberg LEH, Been JV, Willemsen SP, Vis JY, Tintu AN, Bramer WM, et al. Diagnostic accuracy of portable, handheld point-of-care tests vs laboratory-based bilirubin quantification in neonates: a systematic review and meta-analysis. JAMA Pediatr. 2023;177(4):366-75.
25. Iqbal J, Sharma S, Naaz B. Study of aetiological factors and clinical profiles of neonatal jaundice in the special newborn care unit of a tertiary care hospital in Jammu and Kashmir. Int J Res Med Sci. 2023;11(5):11738.
26. Olusanya BO, Kaplan M, Hansen TWR. Neonatal hyperbilirubinemia: a global perspective. Lancet Child Adolesc Health. 2018;2(8):610-20.
27. Chang YS, Hwang JH, Kwon HN, Choi CW, Ko SY, Park WS, et al. In vitro and in vivo efficacy of new blue light emitting diode phototherapy compared to conventional halogen quartz phototherapy for neonatal jaundice. J Korean Med Sci. 2005;20(1):61-8.
28. Seidman DS, Moise J, Ergaz Z, Laor A, Vreman HJ, Stevenson DK, et al. A prospective randomized controlled study of phototherapy using blue and blue-green light-emitting devices, and conventional halogen-quartz phototherapy. Acta Paediatr. 2003;92(3):327-31.
29. Kaplan M, Hammerman C. American Academy of Pediatrics guidelines for detecting neonatal hyperbilirubinaemia and preventing kernicterus. Arch Dis Child Fetal Neonatal Ed. 2005;90(6):F448-9. PMID: 16244203.
30. Tan KL. The nature of the dose-response relationship of phototherapy for neonatal hyperbilirubinemia. J Pediatr. 1977;90(3):448-52. PMID: 839123.
31. Maisels MJ. Why use homeopathic doses of phototherapy? Pediatrics. 1996;98(2 Pt 1):283-7. PMID: 8701749.
Published
Abstract Display: 460 
PDF Downloads: 266 How to Cite
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Deprecated: json_decode(): Passing null to parameter #1 ($json) of type string is deprecated in /home/lapinjournals/domains/lapinjournals.com/public_html/plugins/generic/citations/CitationsPlugin.php on line 68
.