Factors associated with neonatal hyperbilirubinemia in the first 2weeks of life in ola during children’s hospital in freetown, sierra leone

Abstract

Background: Jaundice which result from increased levels of bilirubin is a common and important condition that require medical attention in the newborn period. In most infants, unconjugated hyperbilirubinemia reflects a normal transitional phenomenon but when serum bilirubin levels excessively rise, death may occur and infants who survive may get lifelong neurologic sequelae. Knowledge of the contributing factors for neonatal jaundice in a given setting would be valuable to help identify strategies for risk reduction. Objectives: To describe the factors associated with neonatal hyperbilirubinemia in the first 2-weeks of life in Ola During Children’s Hospital in Freetown, Sierra Leone. Methods: This hospital based descriptive cross-sectional study was carried out on neonates less than 2weeks of age in Ola During Children’s Hospital (ODCH). Demographic, clinical and laboratory data: bilirubin levels, glucose-6 phosphate dehydrogenase (G-6PD) activity, blood group of both mother and baby, complete blood counts, VDRL, peripheral blood film and reticulocyte count, were collected to describe the factors associated with jaundice. A sample size of 95 neonates was studied. Results: Out of 95 neonates 68.4% were male and 31.6% female. The median age of neonates was 5.00 days (IQR 3.00 – 8.00). The associated factors in the 95 jaundiced babies were: prematurity 26 (27.4%), probable sepsis 24(26.7%), ABO incompatibility 11(11.6%), cephalohaematoma 9(9.5%), G6PD deficiency 7(7.6%) and Rhesus incompatibility 6(6.3%). Jaundice occurred in 24(25.2%) in whom no possible associated factor was found. Twenty one mothers (22.1%) knew their blood group and 15 (16.1%) was done during pregnancy, of 7 tested for syphilis, none was positive and 41 (43.2%) indicated they took herbal medicine during pregnancy. Conclusions: The prevalence of prematurity, sepsis, ABO incompatibility, Rhesus incompatibility, Cephalohaematoma and G6PD deficiency was high in neonates with jaudice. Only 5(5.2%) of the mothers had HIV, Urinalysis, VDRL and blood group tested during pregnancy. 12 Recommendations: screening of babies with jaundice should include blood group, direct coombs test, reticulocyte count, complete blood count and bilirubin levels. All women should be tested for ABO and RhD as early as possible during each pregnancy, preferably at their first trimester visit. RhD negative women should be administered prophylactic RhD immunoglobulin both during pregnancy and after delivery. ANC record that covers prenatal screening for blood group, HIV, VDRL, or bacteriuria, should be held by women to ensure that all essential information is readily available to the caregiver.