Prevalence, associated factors and immediate outcome of neonatal jaundice in special care unit, Mulago Hospital

Abstract

INTRODUCTION: Neonatal jaundice is one of the major contributors to childhood neurological impairments and neonatal mortality in developing countries. Although worldwide, most cases are benign, etiological and perpetuating factors, inadequate diagnostic and therapeutic facilities in developing countries contribute to a high prevalence and more severe disease that can result in bilirubin encephalopathy and kernicterus. This study was designed to determine the prevalence and associated factors of jaundice and to study outcomes of significant hyperbilirubinaemia and mortality in the neonatal ward of Mulago Hospital. This information is to be used to put in place preventive and management protocols that will reduce the neonatal jaundice and its complications. OBECTIVES: To determine the prevalence, associated factors and immediate outcomes of jaundice among neonates admitted to Special Care Unit (SCU) Mulago Hospital. STUDY DESIGN: A Cross sectional study of neonates admitted to SCU Mulago Hospital with a short follow up component for neonates with jaundice. STUDY PROCEDURE: Between 31st January and 20th February 2009, 200 neonates admitted to the SCU were consecutively enrolled into the study. Data on neonates included birth weight, gestation period, presence or absence of jaundice and septicaemia. Neonates with jaundice also had blood grouping, coombs tests and serial bilirubin estimation performed. Significant hyperbilirubinaemia was obtained from the serial bilirubin estimates. Mortality by day 7 was established for neonates for naundice with jaundice. Data was analyzed using SPSS Version 13. Chi-square test was performed for bivariate analysis and binary logistic regression independent association (p< 0.05) RESULTS: Forty two (21 percent 95% C1= 15.3-26.7 percent) of the 200 neonates had jaundice. Sixty percent jaundiced neonates were preterm and forty percent were term. Factors independently associated with neonates jaundice were septicaemia (AOR= 3.89:95% C1 1.40-10.83, P=0.009) and use ofoxytocin in the mother (A0R= 6.58; 95% C1 1.93-22.43, P= 0.003). Birth weight was weekly associated with neonatal jaundice (COR=1.99; 95%C1 0.93-4.28). Thirty three (78.6%) of 42 neonates with jaundice had significant hyperbilirubinaemia and seven (16.6%) of these 42 neonates died within seven days of jaundice onset. Prematurity (5), confirmed septicaemia (1) and birth asphyxia (1) were co-morbidities among neonates who died. CONCLUSIONS: Neonates jaundice was highly prevalent in the Mulago Hospital Special Care Unit with one out of every five neonates affected. The condition is not benign since over three quarters jaundiced neonates had significant hyperbilirubinaemia and one out of every six jaundiced neonates died. Septicaemia, use of oxytocin in the mother and low birth weight were factors associated with neonatal jaundice in this setting. RECOMMENDATIONS: Measures to reduce on the high prevalence rates of neonatal jaundice in Mulago Hospital Special Care unit should focus on prevention and early effective management of neonatal septicaemia and low birth weight. More phototherapy units and training on skills of exchange transfusion are required to manage the large proportion of neonates with significant jaunide. Studies on obstetric factors surrounding oxytocin use should be done to further examine the association with neonatal jaundice.