Incidence and Risk Factors to Neonatal Jaundice in Jalingo, Taraba State

This cross-sectional study was aimed to determine the incidence and the significant risk factors to neonatal jaundice in FMC, Jalingo. Four hundred and thirty three neonates admitted to special baby care unit (SBCU) FMC, Jalingo with their mothers were surveyed. Data were collected through a data extraction format looking on the medical records of the neonates (from 1st January, 2021 to 31st August, 2021) and interviewing the mothers. Data were transferred to an Excel data sheet and results were summarized by frequencies and percentages (categorical variables). Logistic regression analysis was used to determine the strength of the risk factors to neonatal jaundice while the significance was tested at p-value ≤ 0.05. The findings revealed that the incidence of neonatal jaundice in FMC Jalingo was 40.18% while the significant risk factors were age group 41 - 50 years (I = 15.01%, OR: 2.970 at 95% CI: 1.566 - 5.634, p = 0.000), spontaneous vaginal delivery (I = 18.01%, OR: 1.382 at 95% CI: 0.940 - 2.033, p = 0.000), premature rupture of membrane (I = 24.94%, OR at: 2.252 at 95% CI: 1.520 - 3.337, p = 0.000), hypertension in pregnancy (I = 21.02%, OR: 1.831 at 95% CI: 1.240 - 2.703, p = 0.002). Others were breech fetal presentation (I = 23.33%, OR: 2.689 at 95% CI: 1.809 - 3.995, p = 0.000), birth asphyxia (I = 22.40%, OR: 3.469 at 95% CI: 2.3105.210, p = 0.000), significant bruising (I = 22.86%, OR: 1.705 at 95% CI: 1.157 - 2.513, p = 0.007), neonatal sepsis (I = 21.02%, OR: 1.688 at 95% CI: 1.145 - 2.488, p = 0.008) and congenital hemolytic anemia (I = 21.71%, OR: 1.723 at 95% CI: 1.169 - 2.540, p = 0.006). Therefore, the need for all concerned to ensure the incidence is reduced and the risk factors identified early and tackled.

Correlation between Transcutaneous Bilirubinemia and Blood Bilirubinemia in Screening Term Newborn for Neonatal Jaundice at the Essos Hospital Centre (EHC), Yaoundé, Cameroon

Background: Early and non-invasive diagnosis of neonatal hyperbilirubinemia remains critical in dark skinned babies of low resource settings. Objective: To assess correlation/agreement between transcutaneous bilirubin (Tcb) and serum bilirubin (Tsb) values in full term neonates with jaundice. Methodology: An analytical cross-sectional study was conducted at the neonatology unit of the Essos Hospital Centre (EHC) from January to June 2019. All full-term neonates aged 0 to 7 days with suspected jaundice who did not receive phototherapy were eligible for the study. The enrolled neonates in the study were assessed clinically, then with the MBJ20 transcutaneous bilirubinometer (TcB). The MBJ20 transcutaneous bilirubinometer highest measurement over the forehead and the sternum were compared to TsB. Data were entered and then analysed with the CsPro7.2 and R (version 3.6.0) software. Correlation was captured by Bland & Alman plots and Concordance Correlation Coefficient (CCC) estimates. The Pearson correlation coefficient and Student test for paired data were used for descriptions purposes, and the significance level was 5%. Results: We recruited 88 neonates. The sex ratio of the babies included was 1.25 favouring males. Median Post-natal age was 3 days with 62% aged 72 hours or more. The mean TcB corresponding to the maximum average between frontal and sternal measurement was 153 mg/dl ± 48 and the average Tsb was 123.80 mg/dl ± 50.48. A good linear correlation was found between TcB and total serum bilirubin level r = 0.86 [0.80;0.91]. Positive correlation was noted between both (forehead and sternum) TcB measurements sites, namely r = 0.78 and r = 0.86. The Bland & Altman plot measured the bias at -29.68 mg/l (confidence interval at 95%, 21.14 - 80.50). The CCC estimate was 0.2 varying from -0.22 to 0.76 according to TcB measurement threshold and post-natal age. The ROC area under the curve value for a threshold < 100 mg/l equals 90% proving to be a good predictor for this threshold. Conclusion: A good linear correlation was found despite a poor agreement between TcB and Tsb. TcB method systematically overestimated the value of TsB.

Determinants of neonatal jaundice in Ethiopia:a systematic review and meta-analysis

Background Neonatal jaundice is a common condition characterized by a yellowish discoloration of the skin,conjunctiva,and sclera caused by elevated serum or plasma bilirubin levels during the newborn period.The condition is usually not dangerous,but it can progress to severe hyperbilirubinemia,which can lead to acute bilirubin encephalopathy and kernicterus,a bilirubin-induced neurological damage.Therefore,this study aimed to assess the pooled prevalence of neonatal jaundice and its determinants in Ethiopia.Methods Scopus,PubMed,Google Scholar,Embase,and CINAHL databases were searched for studies published between January 1,2010 and July 30,2021.A weighted DerSimonian Laird random-effects model was used to estimate the pooled prevalence of neonatal jaundice and its associated factors.The I2 was used to calculate the degree of heterogeneity.The funnel plot and Egger's regression test were used to assess publication bias.Results Totally 697 articles were generated from various databases,and the review included a total of eight articles.The pooled prevalence of neonatal jaundice was 30.96%[95%confidence interval(CI)16.61%–45.31%)]in Ethiopia.This review showed that prolonged labor[adjusted odd ratio(AOR)=3.39;95%CI 2.41–4.77),low birth weight(AOR=5.12;95%CI 3.11–8.72),birth asphyxia(AOR=3.75;95%CI 2.11–6.66),cephalohematoma(AOR=7.07;95%CI 2.72–18.38),ABO incompatibility(AOR=6.05;95%CI 2.95–12.42),Rhesus(RH)incompatibility(AOR=3.77;95%CI 2.04–6.96),male sex(AOR=4.53;95%CI 3.39–6.07),and neonatal sepsis(AOR=2.47;95%CI 1.49–4.08)were identified as a determining factor for neonatal jaundice in Ethiopia.Conclusions In low-and middle-income countries,neonatal jaundice is a significant healthcare burden,accounting for a significant portion of global childhood mortality and morbidity.However,some low-cost,effective,practical,and dependable solutions have been implemented.Prolonged labor,ABO incompatibility,RH incompatibility,birth asphyxia,neonatal sepsis,low birth weight,cephalohematoma,and male sex were identified as risk factors for neonatal jaundice in Ethiopia.

The effect of traditional Chinesemedicine washing combined withmassage for neonataljaundice： a meta-analysis

Objective： To systematically assess the effect of traditional Chinese medicine washing （TCM washing） combined withmassage for the treatment of neonatal jaundice.Methods and analysis： Databases, including PubMed, the Cochrane Library, Embase, Web of Science, the ChineseBiomedical Literature Database （CBM）, CNKI, and Wanfang Data were electronically searched for randomizedcontrolled trials （from inception to July 2017）. The methodological qualities of included trials were evaluated by theCochrane risk of bias assessment tool. The meta-analysis was performed by using RevMan 5.3 software.Results： Overall, thirteen trials with a total of 1998 participants were included. The results of meta-analysis indicatedthat TCM washing combined with massage group was significantly superior to the control group in the first meconiumtime （MD, -16.67; 95% CI, -24.59 to -8.74; P〈0.001）, time for transformation of meconium （MD, -15.44; 95% CI,-23.59 to -7.28; P〈0.001）, transcutaneous bilirubin index changes [after treating three days （MD, -1.99; 95% CI, -2.57 to-1.40; P〈0.001）, after treating four days （MD, -1.86; 95% CI, -2.77 to -0.95; P〈0.001）, after treating five days （MD,-2.44; 95% CI, -3.47 to -1.42; P〈0.001）, after treating six days （MD, -2.23; 95% CI, -3.30 to -1.16; P〈0.001）, and thechanges of serum bilirubin levels [after treating five days （MD, -3.17; 95% CI, -5.83 to -0.50; P=0.02）, after treating sixdays （MD, -1.63; 95% CI, -3.10 to -0.16; P=0.03）, after treating fifteen days （MD,-1.20; 95% CI, -1.99 to -0.41; P=0.003）.Conclusions： TCM washing combined with massage may be an effective therapy for the treatment of neonatal jaundice.It can accelerate the excretion of meconium, shorten the time for transformation of meconium, and decreasetranscutaneous bilirubin index and the level of serum bilirubin. But it should be careful to interpreting these findings.Well-designed RCTs are needed to further clarify the conclusion.

Analysis of the histologic features in the differential diagnosis of intrahepatic neonatal cholestasis

AIM:To compare the histologic features of the liver in intrahepatic neonatal cholestasis(IHNC)with infectious,genetic-endocrine-metabolic,and idiopathic etiologies. METHODS:Liver biopsies from 86 infants with IHNC were evaluated.The inclusion criteria consisted of jaundice beginning at 3 mo of age and a hepatic biopsy during the 1st year of life.The following histologic features were evaluated:cholestasis,eosinophilia,giant cells,erythropoiesis,siderosis,portal fibrosis,and the presence of a septum. RESULTS:Based on the diagnosis,patients were classified into three groups:group 1(infectious;n=18),group 2(genetic-endocrine-metabolic;n=18),and group 3(idiopathic;n=50).There were no significant differences with respect to the following variables:cholestasis,eosinophilia,giant cells,siderosis,portalfibrosis,and presence of a septum.A significant difference was observed with respect to erythropoiesis,which was more severe in group 1(Fisher's exact test,P=0.016). CONCLUSION:A significant difference was observed in IHNC of infectious etiology,in which erythropoiesis was more severe than that in genetic-endocrine-metabolic and idiopathic etiologies,whereas there were no significant differences among cholestasis,eosinophilia,giant cells,siderosis,portal fibrosis,and the presence of a septum.

Correlation between Late Cord Clamping and Phototherapy and Other Neonatal Unfavorable Outcomes: A Randomized Clinical Trial

Background: Recently, late umbilical cord clamping is generally recommended, which decreases neonatal anemia;however, it may also increase neonatal jaundice and some other poor outcomes. Objectives: We here attempted to determine whether late clamping actually increases the incidence of phototherapy for jaundice and other poor outcomes of the term “low-risk newborns”. Methods: With the approval of the Brazilian Registry of Clinical Trials (REBEC), a total of 357 low-risk newborns (singleton, uncomplicated pregnancy/delivery, in a Brazilian public institution) were randomized into two groups: group I (n = 114): cord clamping 1 minute (early clamping) or group II (n = 243): cord clamping between 1 - 3 minutes (late clamping). Statistics were used appropriately (i.e., measures of central tendency, dispersion for continuous variables, Shapiro-Wilk, Mann-Whitney test, or Chi-square test). Results: Phototherapy was performed in 5.3% in both groups. Also, there were no statistical differences in the occurrence of secondary outcomes, such as sepsis, neonatal ICU admission, and transient tachypnea of the newborns: i.e., 0.9%, 15.8%, and 3.5%, respectively for group I versus 1.2%, 15.6%, and 5.8%, respectively for group II. Conclusion: Late umbilical cord clamping does not increase the need for phototherapy in low-risk neonates. This result corroborates the current recommendation of late cord clamping, whenever appropriate.

The diagnostic value of high-frequency ultrasonography in biliary atresia

BACKGROUND: It is a globally challenging problem to differentially diagnose biliary atresia (BA) from other disease processes causing infantile cholestatic jaundice. The high frequency ultrasonography (HUS) yields much improved spatial resolution and therefore, might show better image in BA diagnostic examination. The present study was to evaluate the HUS on the diagnosis of BA in infants with jaundice. METHODS: Fifty-one infants with neonatal jaundice were scanned with ultrasonography. Images included gallbladder, bile duct, right hepatic artery (RHA), portal vein (PV) and triangular cord (TC) sign, magnetic resonance imaging and additionally laboratory tests and histopathology reports were assessed. RESULTS: Twenty-three BA and 28 non-BA cases were con firmed. The sensitivity, specificity, and accuracy of HUS were 91.3%, 92.9%, and 92.2%, respectively. All of these indices were significantly higher than those of conventional ultrasonography (P【0.01) and MR cholangiopancreatography (P【0.05). The HUS features, included a positive TC sign, an increased RHA diameter and RHA-diameter to portal-vein-diameter ratio (RHA/PV) and abnormal gallbladder, were important in the diagnosis of BA. CONCLUSION: HUS provided better imaging of BA and should be considered as a primary modality in the differential diagnosis of infantile jaundice.

Biliary atresia: Where do we stand now?

The pathway from clinical suspicion to establishing the diagnosis of biliary atresia in a child with jaundice is a daunting task. However, investigations available help to point towards the correct diagnosis in reasonable time frame. Imaging by Sonography has identified several parameters which can be of utility in the diagnostic work up. Comparison of Sonography with imaging by Nuclear medicine can bring out the significant differences and also help in appropriate imaging. The battery of Biochemical tests, available currently, enable better understanding of the line-up of investigations in a given child with neonatal cholestasis. Management protocols enable standardized care with optimal outcome. The place of surgical management in biliary atresia is undisputed, although Kasai procedure and primary liver transplantation have been pitted against each other. This article functions as a platform to bring forth the various dimensions of biliary atresia.

Conjugated hyperbilirubinemia presenting in first fourteen days in term neonates

AIM To describe the etiology and characteristics of earlyonset conjugated hyperbilirubinemia(ECHB) presenting within 14 d of life in term neonates.METHODS Retrospective review was performed of term infants up to 28-d-old who presented with conjugated hyperbilirubinemia(CHB) at a tertiary center over a 5-year period from January 2010 to December 2014. CHB is defined as conjugated bilirubin(CB) fraction greater than 15% of total bilirubin and CB greater or equal to 25 μmol/L. ECHB is defined as CHB detected within 14 d of life. "Late-onset" CHB(LCHB) is detected at 15-28 d of life and served as the comparison group.RESULTS Total of 117 patients were recruited: 65 had ECHB, 52had LCHB. Neonates with ECHB were more likely to be clinically unwell(80.0% vs 42.3%, P < 0.001) and associated with non-hepatic causes(73.8% vs 44.2%, P = 0.001) compared to LCHB. Multifactorial liver injury(75.0%) and sepsis(17.3%) were the most common causes of ECHB in clinically unwell infants, majority(87.5%) had resolution of CHB with no progression to chronic liver disease. Inborn errors of metabolism were rare(5.8%) but associated with high mortality(100%) in our series. In the subgroup of clinically well infants(n = 13) with ECHB, biliary atresia(BA) was the most common diagnosis(61.5%), all presented initially with normal stools and decline in total bilirubin but with persistent CHB. CONCLUSION Secondary hepatic injury is the most common reason for ECHB. BA presents with ECHB in well infants without classical symptoms of pale stools and deep jaundice.

Severe hyperbilirubinemia in a neonate with hereditary spherocytosis due to a de novo ankyrin mutation: A case report

BACKGROUND Hereditary spherocytosis(HS)is a common type of hemolytic anemia caused by a red cell membrane disorder.HS type 1(HS1)is mostly caused by mutations in ankyrin(ANK1).Newborns with HS1 usually only exhibit anemia and mild jaundice.We herein report a case of HS1 and discuss its clinical characteristics.CASE SUMMARY A 2-d-old male full-term newborn was admitted to our hospital with severe,intractable neonatal jaundice.Laboratory investigations showed hemolytic anemia and hyperbilirubinemia and excluded immune-mediated hemolysis.The patient underwent two exchange transfusions and one plasmapheresis resulting in significantly reduced serum bilirubin.Hematologic analyses and genomic DNA sequencing studies were performed.The trio clinical exome sequencing revealed a de novo null heterozygous mutation in the patient's ANK1 gene:c.841C>T(p.Arg281Ter).This mutation results in the premature termination of the ANK1 protein.CONCLUSION Our case demonstrates that genetic analysis can be an essential method for diagnosing HS when a newborn has severe hyperbilirubinemia.

Early vs. Delayed Cord Clamping at Full-Term Planned Cesarean Section: A Randomized Study

Objective: In cesarean section (CS), which, early vs. delayed cord clamping is better for neonatal and maternal hematocrit/hemoglobin level is not yet completely determined. This randomized controlled study attempted to determine this issue. Methods: Study population consisted of 64 full-term pregnant women/neonates undergoing planned CS: 32 received early cord clamping (ECC: 15 seconds after birth) and 32 delayed cord clamping (DCC: 90 seconds). We measured and analyzed 1) neonatal hematocrit at the first 24 - 48 hours, and 2) maternal-hemoglobin-change before and after CS. Results: Infants with ECC and DCC showed hematocrit (24 - 48 hours) of 57.47 ± 8.65 vs. 59.54 ± 7.67, showing no significant difference. Also, no significant differences were observed in the change in maternal hemoglobin in two groups. Conclusions: Cord clamping at 15 vs. 90 seconds did not yield neonatal hematocrit change or maternal hemoglobin change. As far as the present data (neonatal and maternal anemia) was concerned, cord may be clamped at 15 seconds in planned term CS.

Kell Blood Group Maternal-Fetal Incompatibility in Lubumbashi （D. R. Congo）, Case Report

Introduction： The anti Kell is a major cause of hemolytic disease of the newborn; the third cause after ABO and Rhesus in frequency; and the second in terms of severity after rhesus type incompatibility. In Africa, 60% of the population is Kell negative. In Congo, Kell blood group determination is not systematically performed and almost non-existent in perinatology. We aimed to report a case of this immunization in routine practice. Method： This study is a clinical report of Kell immunization. Physical examination was performed and blood group determined. Clinical and biological follow up of the case： a review of the literature of Kell immtmizations is included. Result： A female newborn on day 4 of life with weight of 3,250 g born at term admitted to Sendwe＇s Hospital emergency for pallor and respiratory distress. History reveals jaundice at birth. The mother is P1G4A3D0, blood group Orh＋. Clinically the child is pale, jaundiced, present tachycardia, hepatomegaly, polypnea Brh＋. The diagnostic orientation is a maternal-fetal incompatibility. The realization of blood grouping Kell, Duffy and irregular antibodies research Kell type confirms the diagnosis of Kell hemolytic disease of the newborn. We discharged him after 14 days. Conclusions： The Kell type IFME is a purveyor of grave hemolytic disease of the newborn. His knowledge, prevention and proper care by a multidisciplinary team can prevent dramatic situations.