RISK FACTORS FOR SEVERE HYPERBILIRUBINEMIA (JAUNDICE) AMONG NEONATES IN ACCRA

ABSTRACT

Introduction

Hyperbilirubinemia (jaundice) is the yellowish coloration of the skin, sclera of the eyes and the mucosa due to excess bilirubin in the blood. All age groups are susceptible to jaundice, but neonates are particularly at risk. Annually, neonatal jaundice affects about 60% of the 130 million babies born worldwide. Severe Neonatal hyperbilirubinemia (SNHB) and Chronic Bilirubin Encephalopathy (CBE) are complications with neonatal jaundice that can have fatal outcome.

About 900,000 babies are delivered each year in Ghana with 14% and 11% born prematurely and as low birth weight babies respectively. About a third (33%) of all annual neonatal deaths in Ghana is attributable to prematurity. ABO and Rhesus incompatibility, prematurity, low birth weight and mother ever having a jaundiced baby are among key risk factors of SNHB. To assess the role played by these factors in the life of the neonate, we investigated the risk factors of SNHB among neonates in Accra.

Method

The research was a case control study involving 224 mothers and their neonates who were screened and found to have met the inclusion criteria for cases and controls. Participants were recruited from the GARH in Accra over a period of 41 days. An interview-structured questionnaire was used to collect data from neonate-mother pair. Data was entered into Microsoft Excel software (version 2013) using identifiers. Data was imported into Stata (14) for student t-test, Pearson chi2 and logistic regression analysis. Results were presented

in tables and graphs. A case of severe neonatal hyperbilirubinemia (SNHB) for this research was defined as any neonate whose mother had been resident in Accra for the past six months preceding the delivery at the GARH or referred to the GARH and diagnosed as having SNHB with a total serum bilirubin (TSB) > 14 mg/dl or 240 μmol/l. Ethical clearance was obtained from Ghana Health Service (GHS).

Results

A total of 112 cases and 112 controls were recruited into the study. Over 96% of mothers were Ghanaians with a few Togolese and Nigerians. Mean ages of neonates, mothers and gestation age were 5.05 (±3.94) days, 30.55 (±5.68) years and 38.42 (±2.91) weeks respectively. The mean TSB and time onset of jaundice were 319.50 (±68.35) μmol/l and 2.36 (±0.89) days respectively. About 18% of the cases were pathological whilst 33% were very severe (TSB > 340 μmol/l). Age of neonate, type of delivery, mother’s educational level and mother ever having a jaundiced baby were shown to be significantly associated with SNHB (p < 0.05). Cephalohematoma, sepsis, maternal blood group and gestational age were not significantly associated with SNHB.

Conclusion

Age of neonate, type of delivery, educational level of mother and mother ever having a jaundiced baby were predictive of SNHB among neonates in Accra. It was recommended to the GHS to intensify education of all mothers and would-be mothers on SNHB during Antenatal clinics.