Pathological jaundice in late preterm neonates admitted in a tertiary hospital, Imphal: a prospective COHORT study

Abstract

Background: Approximately 85% of all term and most preterms develop clinical jaundice. Hyperbilirubinrmia is defined as a total bilirubin (TB) >95th percentile on the hour-specific Bhutani normogram. Pathological jaundice implies the onset of jaundice before 24 hours of age, rate of rise in TSB of >0.2 mg/dl/hour and jaundice persisting after 14 days in term and 21 days in late-preterms. The aim of this study was to determine the incidence, progression and the predictors of pathological jaundice among the late preterm infants admitted in Paediatrics ward of a tertiary care centre, Imphal.Methods: A hospital based prospective cohort study was carried out in paediatrics department, RIMS during a period of 2 years (September 2019 to August 2022) with approval from research ethics board. Sample size was 100 based on consecutive sampling.Results: Pathological jaundice developed among 65.0% (95% CI: 54.7-74.1%) neonates. The median duration of onset was 47.0 hours. The mean bilirubin at the time of diagnosis of jaundice was 15.5 mg/dl. Three neonates underwent exchange transfusion. Of these 3, one had pre-exchange bilirubin encephalopathy. Male gender, breast feeding, sepsis, infants blood group (B +ve), jaundice among the siblings and birth trauma (birth asphyxia/cephalhematoma) were significantly associated with the development of neonatal hyperbilirubinemia.Conclusions: Jaundice is condition that is often present and constitutes one of the major risks for neurodevelopmental issues in later life and the risk is further compounded by prematurity. Hence further studies with a larger sample size on a multicentric level could add robustness to our study thereby helping in better understanding and management of the condition.