Clinical characteristics and outcomes of newborn infants admitted with jaundice at Kawempe National Referral Hospital

Abstract

Background: Neonatal jaundice affects one in two infants globally and is a major contributor to neonatal mortality and paediatric population morbidity in developing countries. There are several risk factors for the development of neonatal jaundice, including infections, birth weight, gestational age, genetics, and familial factors. Although neonatal jaundice occurs in a significant proportion of neonates in sub-Saharan Africa, there is a paucity of data on the outcome following treatment of these children. About 10–22% of infants with severe neonatal jaundice die. Although the prevalence of neonatal jaundice in Uganda has been studied, there is limited data regarding the clinical characteristics and outcomes of these children. Bridging this critical knowledge gap could provide guidance on strategies to improve the care of neonates admitted with jaundice. Objectives: To describe the clinical characteristics and outcomes and to determine the risk factors for mortality among newborn infants admitted with jaundice at Kawempe National Referral Hospital. Methods: This was a prospective cohort study of neonates admitted with jaundice at Kawempe National Referral Hospital. The study was conducted at the Special Care Unit and the Paediatric ward of Kawempe National Referral Hospital. The study included neonates who were admitted with neonatal jaundice at Kawempe National Referral Hospital and whose primary caregiver provided informed consent. A structured questionnaire was administered after obtaining informed consent from the parents of the neonates. A total of 340 participants were enrolled in the study. Socio-demographic, anthropometric, clinical, and laboratory variables were collected from all the children. Continuous variables were summarized using measures of central tendency, while categorical variables were summarized using proportions and frequencies. Cox regression analysis Hazard ratios were used to assess the risk factors for mortality among neonates with jaundice at bivariate and multivariate levels. Survival analysis was also carried out. Results: A total of 340 neonates were studied; the median age was 3 days, IQR (2-4). The males were 211 (62.1%), and 129 (37.5%) were females. The commonest clinical features were fevers, inability to breastfeed, difficulty breathing, lethargy, and hypotonia. The mean transcutaneous bilirubin was 206.5 µmol/L with a standard deviation of ±57.8. Physiological jaundice was estimated at 65.6% and pathological jaundice at 34.4%.The most common diagnosis at admission was neonatal sepsis. Anemia (Hb<12g/dl) was seen in 7.7%, probable sepsis was 45.3%, with neutropenia (neutrophil count<2x10^3 at 17.9%) and neutrophilia (neutrophil count>6x10^3) at 27.4%. The majority of the neonates were blood group O positive (42.8%), ABO incompatibility was 18.8%, and Rh-D incompatibility was 2.9%, whereas 3.5% had a positive direct Coombs test. The overall mortality was 4.4%, 95% CI (2.6–7.2), and 21 participants were lost to follow-up. Low birth weight (<2.5 kg) [AHR: 4.97, 95% CI (1.47, 16.83) P value 0.010], a positive direct Coombs test [AHR: 10.7, 95% CI (1.25, 86.85) P value 0.030], and the Rh-D negative blood group of the mother [AHR: 43.45, 95% CI (3.10, 608.14) P value 0.005] were risk factors for mortality at multivariate Cox regression analysis. Conclusion and Recommendation: The mortality rate was lower than that observed in previous studies, with the risk factors being low birth weight, a positive direct Coombs test, and the Rh-D negative blood group of the mother. There is a need to strengthen the follow-up of neonates with hyperbilirubinemia at 1 week of life so as to manage the possible causes of death at an early stage. More studies are needed to follow up on these neonates to assess the long-term outcomes of neonatal jaundice.