Management Of Neonatal Hyperbilirubinemia Research Articles

Implementation of a Neonatal Hyperbilirubinemia Clinical Pathway in a Pediatric Emergency Department

<h3>Category/Date</h3> Practice Innovation Poster presented at NAPNAP's 42nd National Conference on Pediatric Health Care, March 24th, 2021. https://napnap21.org/community/#/home <h3>Problem Statement</h3> Within the Pediatric Emergency Department, no protocol exists for the management of neonatal hyperbilirubinemia. Currently the management of infants with hyperbilirubinemia varies widely between providers. This practice gap leads to inconsistent delivery of care in the ED and variations in treatment timing with phototherapy. Within the department the median time from arrival to initiation of phototherapy is 103 minutes and the goal is to start phototherapy within 60 minutes of arrival. <h3>Purpose of Project & Goals</h3> The purpose of this QI project is to implement an evidenced based neonatal hyperbilirubinemia clinical pathway in pediatric ED. The goal is to decrease the time from arrival to initiation of phototherapy and thus decrease length of stay in the emergency department. <h3>Methods</h3> Development of a nurse-initiated Hyperbilirubinemia Clinical Pathway and associated nursing order set allows nursing staff to obtain a neonatal bilirubin blood panel and initiate phototherapy. This allows for the evaluation and treatment of infants with known or suspected hyperbilirubinemia to begin prior to provider assessment. The Clinical Pathway was approved by the hospital's medical executive committee and department of nursing. <h3>Results</h3> After pathway implementation time to phototherapy decreased from an average of 103 minutes to 27 minutes. There was also an associated decrease in the number of patients who received an intravenous catheter in the ED. <h3>Discussion</h3> After implementation of a nurse-initiated hyperbilirubinemia clinical pathway, the time from arrival to phototherapy was reduced by 74%, ED length of stay decreased from 240 minutes to 179 minutes and IV catheter placement was reduced by 27%. Based upon the literature these results were expected because early initiation of phototherapy and standardization of hyperbilirubinemia management is associated with improved outcomes. <h3>Conclusions</h3> The pathway can be modified and implemented in community EDs in order to improve care of neonates with hyperbilirubinemia. Further research is needed regarding the use of transcutaneous bilirubin meter in the ED setting and the utility of its addition to the clinical pathway <h3>IRB Approval</h3> The project was reviewed by the hospitals and the university IRB committee and demeaned non research, quality improvement <h3>Funding</h3> No funding was obtained for this project

Effects of Different Types of Phototherapy Units on Neonatal Jaundice: A Cross-sectional Study

Introduction: Phototherapy is the mainstay of treatment of neonates who develop significant jaundice. Light-emitting diode and compact florescent lamp phototherapy units are the newer devices in the management of neonatal hyperbilirubinaemia. The advantage of light-emitting diode phototherapy includes portability, energy efficiency, less heat production, and durability. Blue and white phototherapy devices are more economical but generate more heat leading to hyperthermia and dehydration more often. Aim: To determine the efficacy and side effects of three modes of phototherapy units viz conventional blue and white light phototherapy, Compact Fluorescent Lamp (CFL) phototherapy, and Light-emitting Diode (LED) phototherapy on neonates having jaundice. Materials and Methods: This cross-sectional study was conducted in Department of Paediatrics at SRM Medical college Hospital and Research Centre (tertiary care teaching hospital), Kattankulathur, Tamil Nadu, India, from February 2021 to January 2022. A total of 150 neonates with hyperbilirubinaemia in the phototherapy range, American Academy of Paediatrics (AAP), were included in this study. Study subjects were divided into three groups of 50 neonates each to receive phototherapy using one of the three phototherapy devices, i.e., Blue and white light, CFL, LED phototherapy groups. Data of serum bilirubin levels were recorded at the beginning and end of phototherapy. The number of babies who required exchange transfusion and other clinical side effects among the study groups was recorded. Descriptive statistics were reported as Mean±SD for continuous variables, frequencies (percentage) for categorical variables. The One-way Analysis of Variance (ANOVA) test was used to determine the statistically significant differences between the means of three independent groups. Results: All the three type of phototherapy units generated statistically non significant mean flux (p-value=0.754). Mean difference (from the baseline bilirubin) at end of phototherapy for blue and white light group was 5.77±1.72 mg%, for CFL group was 5.48±1.32 mg%, and for LED group was 6.34±1.48 mg%. The difference was statistically significant in all three groups (p-value=&lt;0.001). The reduction in serum bilirubin at the end of phototherapy was lesser in CFL group compared to blue and white light group and LED group. Conclusion: Light-emitting diode and blue and white light phototherapy units are more effective than compact fluorescent lamp phototherapy in treating neonatal hyperbilirubinaemia.

A study on effect of phototherapy in term new-born in a tertiary care centre in south Rajasthan

Background: Phototherapy is a safe and effective method for management of neonatal hyperbilirubinemia with no serious untoward side effects. Hypocalcemia is a common and lesser observed adverse effect of phototherapy.Methods: This study was a prospective observational study done in department of pediatrics, RNT Medical College, Udaipur (Rajasthan). Serum calcium level was observed in term neonates admitted for phototherapy.Results: Out of total 80 neonates included in study 40 received phototherapy and 40 were control. Neonates receiving phototherapy had significantly lower level of serum calcium. Other complication were rashes, loose stool, fever and dehydration.Conclusions: We can conclude from this study that hypocalcemia is a significant complication of phototherapy in newborn and probably monitoring of serum calcium level in babies under phototherapy is warranted.

The Outcome of Photo-Therapy on Serum Calcium Values in Term Neonates: A Cross Sectional Study

Background: In the management of hyperbilirubinemia in neonates, phototherapy is an important treatment modality. Photo-therapy can cause skin rashes, diarrhoea, increase in body temperature, retinal damage and bronze baby syndrome. Photo-therapy is thought to influence serum calcium levels by inhibiting pineal melatonin secretion.&#x0D; Aims and Objectives: The aim of this research was to see how photo-therapy affected serum calcium values in a term neonate.&#x0D; Materials and Methods: Over the course of six months, 74 neonates were studied in the neonatology department of a tertiary healthcare centre in Central India.&#x0D; Results: Calcium values fell in 77 % of the neonates in our sample, but only one case fell into significant symptomatic hypocalcemic range (1 percent).&#x0D; Conclusion: According to the findings, neonates who are receiving photo-therapy have a higher risk of falling into the hypocalemic range. As a result, neonates should be strictly observed for calcium shifts and treated appropriately.

50 Years Ago in TheJournalofPediatrics: Management of Neonatal Hyperbilirubinemia—Has Much Changed?

Valdes OS, Maurer HM, Shumway CN, Draper DA, Hossaini AA. Controlled clinical trial of phenobarbital and-or light in reducing neonatal hyperbilirubinemia in a predominantly Negro population. J Pediatr 1971;79:1015-7.

Efficacy and safety of probiotics in neonatal hyperbilirubinemia: Randomized controlled trial

IntroductionThere have been many studies evaluating the role of probiotics in the management of necrotizing enterocolitis (NEC), yet few studies related to the role of probiotics in the management of neonatal jaundice. The purpose of this study was to determine the efficacy and safety of utilizing probiotics in the management of neonatal hyperbilirubinemia. MethodsThis study was a single blinded randomized clinical trial conducted on 2–28 day old term and near-term infants (35–42 weeks gestational age) that were hospitalized with neonatal jaundice in Bandar Abbas, Iran in 2016. The primary outcome of this study was to evaluate the duration of hospitalization in neonates with neonatal jaundice. Secondary outcomes were to determine the percentage of infants who needed phototherapy on the 2nd, 3rd, 4th, and 5th days of admission. Data were analyzed by SPSS software and descriptive statistics and Chi-square and independent samples t-test. ResultsOne hundred and twenty-six (126) breastfed infants were enrolled in this study and randomly assigned to one of two groups. The non-probiotic group included 61 (48.4%) patients and the probiotic group included 65 (51.6%) patients. Duration of hospitalization was 3.10 ± 0.569 days in the non-probiotic group versus 3 ± 0.901 in the probiotic group (p = 0.469). The percentage of patients discharged in the probiotic group was significantly higher in comparison to the non-probiotic group on the 3rd day of admission (p = 0.008) and Discharged early. The percentage of patients discharged were similar between the two groups on the 2nd, 4th, and 5th days of admission (p > 0.05). ConclusionProbiotics are not effective in lowering the duration of phototherapy in infants with hyperbilirubinemia. Although probiotics can increase the rate of discharge on the 3rd day of admission in infants with neonatal hyperbilirubinemia, the rate of hospital discharge was not different in the probiotic and non-probiotic groups on the 2nd, 4 th, and 5 th days of admission. ClinicalTrials.gov Identifier: NCT03266913.

The Efficacy of Phototherapy in the Treatment of Neonatal Jaundice

Phototherapy is safe and effective in the management of neonatal hyperbilirubinemia; its efficacy has been demonstrated in several studies.A prospective study done on 100 cases of newborns with jaundice admitted to the pediatric ward at Tikrit Teaching Hospital during January to July 2009 were selected randomly, aim to evaluate the efficacy of phototherapy used in the treatment of significant indirect hyperbilirubinemia. The total serum bilirubin determinations were performed on newborns with jaundice. The current study demonstrated a statistically significant positive relation between the rate of TSB decrement and supplementary feeding, B.Wt. and type of light ,and a statistically non-significant negative relation between the rate of TSB decrement and gestational age, type of jaundice and receiving IVF. Conclusion: the efficacy of phototherapy in neonates with mixed feeding more than the bottle feeding and breast feeding, also the response to phototherapy in VLBW newborns was significantly slower than that of NBW and LBW. neonates under blue light phototherapy showed faster response than those under white light.

Neonatal hemoglobin affects the accuracy of whole blood bilirubin measurement on GEM Premier 4000 blood gas analyzers

ObjectivesWhole blood bilirubin measured on blood gas analyzers is accepted by physicians in neonatal hyperbilirubinemia management since it requires a small sample volume. The accuracy of bilirubin measurement on blood gas analyzers is instrument dependent and remains controversial. Design and MethodsBilirubin in adult and umbilical cord whole blood samples, spiked with an unconjugated bilirubin standard, and non-spiked adult plasma samples was measured on a blood gas analyzer (GEM 4000) and a Core Laboratory Chemistry analyzer (Architect c16000) respectively. We also investigated the linear regression for neonatal and adult hemoglobin measured on the blood gas analyzer and the Core Laboratory hematology analyzer (Alinity h-Series). ResultsPlasma bilirubin measured on the blood gas analyzer and the chemistry analyzer was statistically identical. Adult whole blood bilirubin showed slightly increased proportional bias. When umbilical cord whole blood samples were used, the Deming regression showed GEM bilirubin =1.233(Architect) (95% CI 1.199 ~ 1.266)-44.43 ​μmol/L (95% CI -53.6 ​~ ​−35.2). The regression was significantly different from that in plasma (p ​< ​0.001) or adult whole blood (p ​< ​0.001) samples. 36.1% neonatal samples with bilirubin levels >50 ​μmol/L showed that the bias% was above laboratory standards. In addition, the regression of neonatal hemoglobin measurement between the GEM and the Alinity was significantly different from adult hemoglobin (p ​< ​0.01). ConclusionsNeonatal whole blood bilirubin measurement on blood gas analyzers may be affected by neonatal hemoglobin. The method should be validated using neonatal whole blood samples or samples with a similar matrix before the analyzers are implemented into neonatal hyperbilirubinemia management.

Efficacy of early IV Immunoglobulin in management of neonatal hyperbilirubinemia due to Rh incompatibility and ABO incompatibility: A hospital based study

Efficacy of early IV Immunoglobulin in management of neonatal hyperbilirubinemia due to Rh incompatibility and ABO incompatibility: A hospital based study

Can bilirubin/albumin ratio predict neurodevelopmental outcome in severe neonatal hyperbilirubinemia? A 3-month follow up study

BackgroundThe risk of kernicterus and BIND may be in part determined by total serum bilirubin (TSB) and by the level of non-albumin bound free bilirubin, which can easily pass the blood–brain barrier. Free bilirubin (Bf) seems a more reliable predictor for bilirubin neurotoxicity. Bilirubin/albumin ratio (B/A) is considered a surrogate parameter for Bf and has been more useful than TSB. The aim of the study is to determine whether B/A ratio correlates with BIND in newborns with severe hyperbilirubinemia and if it can predict poor neurologic outcome at 3 months follow up.ResultsThis prospective study included one hundred seventeen outborn neonates ≥ 35 weeks admitted in a tertiary care neonatal intensive care unit, between May and December 2012, with TSB ≥ 20 mg/dl or necessitating exchange transfusion. Total serum bilirubin and serum albumin were done on admission and bilirubin/albumin ratio was calculated. BIND score was calculated. At the age of 3 months, 112 neonates were followed up with a detailed neurological assessment. Babies who depicted any abnormal motor examination were subjected to brain stem auditory evoked response and MRI examination. Seven infants (6.2%) presented with kernicterus on follow up. BIND scores on admission, mean TSB, and bilirubin/albumin ratio was significantly higher in kernicteric infants compared with those having normal neurological outcome at 3 months of age (P 0.001). The lowest TSB level at which kernicterus occurred in our study was 31 mg/dl. Receiver operation characteristics analysis identified B/A ratio cut off value for predicting kernicterus of 9.6 with sensitivity of 100% and specificity of 91.4%, whereas TSB cut off value of 30 mg/dl showed sensitivity of 100% and specificity of 83%.ConclusionB/A ratio is a strong indicator for the risk of kernicterus. B/A is more specific than TSB and should be used in the early management of neonatal hyperbilirubinemia.

Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia

ObjectiveHyperbilirubinemia is one of the most common clinical symptoms in newborns. To improve patient outcomes, evidence-based and implementable guidelines are required. However, clinical guidelines may vary in quality, criteria and...

Neonatal hyperbilirubinemia management: Clinical assessment of bilirubin production

The predominant cause of elevated total/plasma bilirubin (TB) levels is from an increase in bilirubin production primarily because of ongoing hemolysis. If undiagnosed or untreated, the risk for developing extreme neonatal hyperbilirubinemia and possibly bilirubin-induced neurological dysfunction (BIND) is increased. Since carbon monoxide (CO) and bilirubin are produced in equimolar amounts during the heme catabolic process, measurements of end-tidal CO levels, corrected for ambient CO (ETCOc) can be used as a direct indicator of ongoing hemolysis. A newly developed point-of-care ETCOc device has been shown to be a useful for identifying hemolysis-associated hyperbilirubinemia in newborns. This review summarizes the biology of bilirubin production, the clinical utility of a novel device to identify neonates undergoing hemolysis, and a brief introduction on the use of ETCOc measurements in a cohort of neonates in China.

Cotoneaster manna oral drop for the management of neonatal hyperbilirubinemia; a randomized, double-blinded and placebo controlled clinical trial

Introduction: Neonatal hyperbilirubinemia is a common physiologic condition, which is occurred in early days after birth with an estimated incidence of about 50% in term neonates. Objectives: The aim of this study was to evaluate the effect of Cotoneaster nummularioides manna on reducing neonatal total serum bilirubin (TSB) levels, and shortening hospitalization period. Patients and Methods: One hundred breast-fed term neonates with hyperbilirubinemia were randomly assigned to the intervention group or control group. The Newborns of the intervention group were received Cotoneaster manna drop in the dosage of 1 g/d divided into three doses every 8 hours for at least 3 days and the control group received placebo drops. Total serum bilirubin levels were measured at baseline, at 12, 24 hours and then daily through hospitalization days (day 9). Secondary outcome (discharge from hospital, TSB &lt;10 mg/dL) was also documented with risk ratio calculation. Results: TSB levels were declined in both groups; however, this was more prominent in the manna group than the placebo group. The greatest difference of mean TSB levels between the intervention and control groups was seen on days two (10.01 versus 13.04 mg/dL; mean difference [95% CI]: - 3.03 [-3.60 to -2.46]; P&lt;0.001). On day four, significantly more newborns in the intervention group versus the control group were discharged (70% versus 6.1%; risk ratio = 11.43, 95% CI= 3.76, 34.74). No major side effects were recorded in both groups. Conclusion:Cotoneaster nummularioides manna drop combined with phototherapy was superior to the control group in reducing TSB levels and reaching this observation more rapidly and shortening hospitalization period with no major side effects. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical trials (identifier: IRCT20160531028188N4; https://en.irct.ir/trial/27765, ethical code #IR.MAZUMS.REC.1394.1316).

Screening, Prevention, and Management of Neonatal Hyperbilirubinemia

Screening, Prevention, and Management of Neonatal Hyperbilirubinemia

Electrolyte changes in the neonates receiving phototherapy

Background: Neonatal jaundice is the most commonly observed clinical condition of early neonatal period. It remains a common cause of readmission and important cause of concern for the parents and clinicians. Therefore, appropriate management of neonatal hyperbilirubinemia is of paramount importance. Phototherapy plays a significant role in its management but this modality is not devoid of complications. Authors studied electrolyte changes in the neonates, who received phototherapy.Methods: This perspective hospital based observational study conducted over the period of one year on 90 eligible admitted neonates who received phototherapy as per AAP guideline. Serum bilirubin, sodium, potassium and calcium were determined before and after termination of phototherapy. The first samples were considered as controls and compared with the samples collected after termination of phototherapy.Results: The incidence of LBW babies in this study was 21.9%, while mean birth weight and gestational age was2.76±0.38 kg and 38.34±0.88 weeks respectively. Mean duration of phototherapy was 38.48±09.34 hours. The mean sodium, potassium and calcium level before therapy were 146.6±6.2 mg/dl, 4.7±0.47 mg/dl and 9.4±0.73 mg/dl respectively. Authors found statistically significant changes in the electrolyte’s levels (Na+ 141.3±6.1, K+ 4.2±0.51 and Ca+2 8.4±0.68 respectively), after phototherapy however none of any neonate shown any clinical signs of dyselectolytemia.Conclusions: Neonates undergoing phototherapy are at greater risk of dyselectrolytemia especially in preterm babies therefore close clinical and biochemical monitoring is required for the prompt management of any significant electrolyte imbalance.

Role of Kangaroo Mother Care in the Management of Neonatal Hyperbilirubinemia in Both Term and Preterm Neonates: A Systematic Review.

Neonatal hyperbilirubinemia (NNH) is the most common clinical sign seen in neonatal practice. Kangaroo mother care (KMC), a new strategy has been tried for the management of hyperbilirubinemia. To evaluate the role of KMC for reduction of bilirubin and duration of phototherapy in term and preterm neonates. The literature search was done for various randomized control trials by searching the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, ongoing clinical trials and abstracts of conferences. This review included five RCTs that fulfilled inclusion criteria. Out of five trials, two trials reported a significant reduction in bilirubin and three trials reported a significant reduction in duration of phototherapy. KMC may be a novel strategy in the management of NNH. However, due to small sample size and heterogeneity between the trials, the current evidence is not sufficient. Hence, large trials with adequate sample sizes are needed.

Assessment of adherence level for neonatal hyperbilirubinemia management by various physicians in ‎Iraq: a multi-clinic study

Background: Neonatal jaundice is a physiological process that occurs normally ‎for every infant to a varying degree. In some cases, this process becomes pathological ‎and imposes an increased risk of morbidity and mortality for the infant. The aim of this study was to assess the adherence level of various physicians to different guidelines ‎of management of neonatal hyperbilirubinemia in Iraq. Methods: An observational cross-sectional study was conducted in ‎multiple outpatient clinics in various Iraqi provinces, from February ‎‎2018 to ‎February 2019. ‎The study involved 130 physicians, who were divided into emergency physicians (EPs), general practitioners (GPs), and pediatricians (PDs), and assessed their compliance to guidelines for management of neonatal hyperbilirubinemia using a questionnaire, which included providing the correct management for a test case scenario. Results: PDs had significantly longer discharge times compared to EPs and GPs. In total, ‎91.7‎% of PDs always tested the neonate for bilirubin levels ‎before discharge, while 5.5‎% of GPs and 0% of EP did so. Regarding follow-up visits, 16.7‎%, 4.8% and 45.2% of PDs, EPs and GPs, respectively, scheduled a follow-up between 49-72 hours; ‎47.6‎% and 38.1% of EPs scheduled a follow-up at ≤24 hours and 25-48 hours, respectively‎‏. In addition, 91.7% of PDs gave the correct answer for the management of the test ‎case scenario, followed by 58.9% of GPs, and 38.1% of ‎EPs‎‏.‏ About half of ‎PDs extended neonates length of stay beyond 48 ‎hours. Conclusion: GPs and EPs show lower adherence levels for the management of neonatal jaundice than PDs, which indicates that these physicians adhere well to current management guidelines from the WHO, ‎AAP, and NICE.

Assessment of adherence level for neonatal hyperbilirubinemia management by various physicians in ‎Iraq: a multi-clinic study.

Background: Neonatal jaundice is a physiological process that occurs normally ‎for every infant to a varying degree. In some cases, this process becomes pathological ‎and imposes an increased risk of morbidity and mortality for the infant. The aim of this study was to assess the adherence level of various physicians to different guidelines ‎of management of neonatal hyperbilirubinemia in Iraq. Methods: An observational cross-sectional study was conducted in ‎multiple outpatient clinics in various Iraqi provinces, from February ‎‎2018 to ‎February 2019. ‎The study involved 130 physicians, who were divided into emergency physicians (EPs), general practitioners (GPs), and pediatricians (PDs), and assessed their compliance to guidelines for management of neonatal hyperbilirubinemia using a questionnaire, which included providing the correct management for a test case scenario. Results: PDs had significantly longer discharge times compared to EPs and GPs. In total, ‎91.7‎% of PDs always tested the neonate for bilirubin levels ‎before discharge, while 5.5‎% of GPs and 0% of EP did so. Regarding follow-up visits, 16.7‎%, 4.8% and 45.2% of PDs, EPs and GPs, respectively, scheduled a follow-up between 49-72 hours; ‎47.6‎% and 38.1% of EPs scheduled a follow-up at ≤24 hours and 25-48 hours, respectively‎‏. In addition, 91.7% of PDs gave the correct answer for the management of the test ‎case scenario, followed by 58.9% of GPs, and 38.1% of ‎EPs‎‏.‏ About half of ‎PDs extended neonates length of stay beyond 48 ‎hours. Conclusion: GPs and EPs show lower adherence levels for the management of neonatal jaundice than PDs, which indicates that these physicians adhere well to current management guidelines from the WHO, ‎AAP, and NICE.

Comparison of end-tidal carbon monoxide measurements with direct antiglobulin tests in the management of neonatal hyperbilirubinemia.

Determine whether management of neonatal hyperbilirubinemia differs if one used end-tidal carbon monoxide (CO) corrected for ambient CO (ETCOc) measurements instead of direct antiglobulin test (DAT) results to assess the severity of hemolysis. Retrospective chart review of infants with total bilirubin and ETCOc levels measured from July 2016 to August 2018. The reported treatment is the hypothetical management infants might have received had there been strict adherence to American Academy of Pediatrics guidelines, rather than the actual management they received. Only 27.2% of 191 DAT(+) infants were hemolyzing based on ETCOc, while 29.1% of DAT (-) infants were hemolyzing based on ETCOc. Management of 18 (9.4%) infants differed depending if ETCOc or DAT were used to determine hemolysis. Eight fewer infants would have received phototherapy if ETCOc was used. ETCOc is a more accurate determinant of hemolysis in the newborn, and its use can lead to less phototherapy.

Prevalence, factors associated and treatment outcome of hyperbilirubinaemia in neonates admitted to St Francis hospital, Nsambya, Uganda: a descriptive study.

With targeted management of neonatal hyperbilirubinaemia in high-income countries, there has been a drastic drop in both the prevalence and mortality. On the contrary, over two-thirds of the global burden of neonatal hyperbilirubinaemia is in Sub-saharan Africa and South East Asia with a high mortality risk of 16-35%. Neonatal hyperbilirubinaemia is not a leading global cause of neonatal mortality, however leads to irreversible neurological damage and death when managed poorly. Three-quarters of the babies admitted to the national referral hospital in Uganda had significant hyperbilirubinaremia; 16.6% of these babies died. We aimed at determining the prevalence, treatment outcome and describing factors associated with hyperbilirubinaemia in neonates admitted to St Francis hospital, Nsambya. A cross sectional study was carried out. A total of 242 files of babies with a preliminary diagnosis of hyperbilirubinaemia were retrieved retrospectively. Relevant data was extracted from the files and analysed using STATA version 14.0. The prevalence of significant hyperbillirubinaemia was 22.7% (55/242). Seventy-seven percent of the babies admitted did not require treatment for hyperbilirubinaemia. No factors were found to be significantly associated with significant hyperbilirubinaemia. The case fatality for severe hyperbilirubinaemia was 20% (6/30); half of these babies had haemolytic disease of the newborn. Establishment of local guidelines will prevent unnecessary admissions and ensure timely treatment is administered. Longitudinal studies are required to discover factors associated with neonatal hyperbilirubinaemia in this region.