Risk Factors For Neonatal Jaundice Research Articles

Time of colostrum discharge of more than six hours as a risk factor for physiological jaundice in neonates

Background and purpose: Neonatal jaundice is both a physiological and pathological condition. Neonatal physiological jaundice occurs within 3-5 days after the baby is born. Publications about colostrum and neonatal jaundice are still limited. This study aims to determine the risk of the onset of colostrum discharge of more than 6 hours to physiological jaundice in neonates.Methods: A case control study was conducted at the Sanglah General Hospital in Denpasar from August to December 2017. The number of cases was 55 neonates with physiological jaundice and the number of controls was 55 neonates without physiological jaundice. Cases and controls were selected by consecutive sampling. The occurrence of physiological jaundice was obtained by direct observation and the degree of jaundice was determined based on the division of Kramer's body zone. Neonates with the Kramer grades I and II at the age of 3-5 days were classified as experiencing physiological jaundice (as cases) and neonates with a Kramer grade of 0 at the age of 3-5 days were classified as not jaundice (as controls). Cases were matched with controls by sex and age of the neonates. Data on maternal socio-demographic characteristics, onset of colostrum discharge, early breastfeeding initiation and 24-hour breastfeeding frequency were obtained by interview; data on jaundice was obtained by observation while mode of delivery, parity, history of pre-eclampsia, prematurity, neonatal birth weight, history of birth trauma (cephalic hematoma), history of asphyxia and major congenital abnormalities were obtained from medical records. Multivariate analysis with binary logistic regression was carried out to determine the adjusted odds ratio (AOR) of the onset of colostrum discharge.Results: The characteristics of cases and controls were found to be similar in terms of maternal education, neonatal age and sex, parity and pre-eclampsia history. Significant outset of colostrum >6 hours was found to be associated with physiological jaundice with AOR=2.57 (95%CI: 1.04-6.37). In this study, variables that were not found to be the risk factors of physiological jaundice in neonates were: cesarean delivery (AOR=0.36; 95%CI: 0.09-1.41; p=0.14), breastfeeding frequency within 24 hours (AOR=2.20; 95%CI: 0.47-10.23; p=0.31) and early breastfeeding initiation (AOR=0.71; 95%CI: 0.19-2.59; p=0.60)Conclusion: Onset of colostrum discharge >6 hours is a risk factor for neonatal jaundice. Efforts should be made to accelerate the release of colostrum in order to prevent neonatal jaundice.

A study of some risk factors of neonatal jaundice in the main health center in Kafr El Sheikh City, Egypt

Background Neonatal jaundice (NJ) is a common disorder worldwide and one of the important contributors to the high neonatal morbidity and mortality. Severe NJ may lead to brain damage or even death. Identification of risk factors of NJ can be effective in reducing morbidity and mortality. Aim The aim was to determine the incidence of NJ and some risk factors associated with it in Kafr El Sheikh City, Egypt. Participants and methods This study was a cohort study carried out in the main central health center in Kafr El Sheikh City. Its target included 410 infants examined in the first days of their life during sessions of thyroid screening test. A predesigned questionnaire was the tool used. Results The study revealed that the incidence of NJ was 88%, where 81.7% of them were physiological and 6.3% were pathological. The reported significant maternal risk factors included age less than 20 years, diabetes, labor complications, primiparity, taking drugs for a long duration during pregnancy, and artificial lactation. Conclusion and recommendations The study revealed a high incidence of physiological NJ, whereas pathological one constituted 6.3%. Infants at risk of severe jaundice were associated with maternal and neonatal factors that can be effectively prevented with good antenatal, natal, and postnatal care. Early detection and management of NJ cases is mandatory.

JAUNDICE OF NEONATAL PERIOD (REVIEW) CHAPTER I: CONCEPT’S DEFINTON. EPIDEMIOLOGY. ETIOPATHOGENESIS AND PATHOMORPHOLOGY. CLASSIFICATION

Researches results shows that countries with low and average incomes level have the highest frequency of complex type of jaundice in newborns, characteristic features of which are unproportionally high indicators of morbidity, mortality and disorders of neurological development on the following years of life compared to countries with high incomes level of population. Chapter I of this article disclose main conception and definitions, epidemiological data and risk factors of neonatal jaundice, also here enlightens the issues of etiology, pathogenesis and pathomorphology of hyperbilirubinemia. Jaundice it’s a syndrome of color changes of skin layers and mucous membrane which develops as a result of accumulation of excessive bilirubin quantity in blood, i.e. it is visual express of hyperbilirubinemia. Jaundice is one of the most common conditions, which demand a medical help in newborn. Neonatal jaundice is a highly common – almost each newborn has the increasing of unconjugated bilirubin in blood serum for more than 30 mmol/l during first week of life. Clinical signs of hyperbilirubinemia develop approximately in 60% of mature and 80% of prematurely newborns. The peculiarities of neonatal jaundice clinic are the fact that it can be physiological and can appear in healthy babies and be at the same time the sign of the whole series of diseases. That’s why, neonatal jaundice should be considered as a symptom of a potential danger. Getting of unconjugated bilirubin into the brain of newborn can cause both short terms and long terms neurological disorders, which is the cause of bilirubin encephalopathy. For indication of clinical signs of acute or chronic bilirubin encephalopathy of babies with very high bilirubin level and also jaundice tinge of brain related to suffered jaundice used the term “core jaundice”. The core jaundice can appear at lower bilirubin level in newborns with the presence of risk factors, in particular in prematurely newborns. According to the pathophysiological mechanisms of development of newborns hyperbilirubinemia can be hemolytic, conjugative, mechanical and parenchymal. Pathomorphological during the neonatal jaundice exist deposition of unconjugated bilirubin into a different organs and tissues – the condition which called bilirubin intoxication. The most dangerous is binding of unconjugated bilirubin by a brain lipids, which is confirmed by existence of yellow pigment in basal core of the central nervous system during the pathologoanatomical and histological research. Subcutaneous fatty tissue binds some part of bilirubin. It explains the lower level of expressiveness of physiological jaundice in mature newborns and even its absence in overmatured newborns, when its develops more frequenter in mature newborns with the consistence of bilirubin in their blood is much higher. Pathological changes, which exist during the pathoanatomical research of newborn’s brain can resemble in more cases the nonspecific damage than real core jaundice.

Maternal risk factors for neonatal jaundice: a hospital-based cross-sectional study in Tehran.

Diagnosis and timely treatment of neonatal jaundice is critical to preventing its dangerous side effects. Knowing the predisposing factors of neonatal jaundice is still a serious debate, which can be effective in controlling jaundice and the primary problem. The aim of this study was to evaluate maternal risk factors that contribute to the Hyperbilirubinemia among newborns admitted to Imam Khomeini and Ziaeean hospitals during 2015. We collected random samplings for the current study. Medical records for all newborns with jaundice were examined for risk factors associated with Hyperbilirubinemia. All variables were analyzed by SPSS software, version 19. Chi-square test and T-test were applied to evaluate qualitative and quantitative data, respectively. Our findings revealed that maternal age, weight, BMI, WBC, Hb, PLT, birth in the first pregnancy, numbers of pregnancies and prolonged delivery were significantly associated with bilirubin levels. Preventing the risk correlated with maternal factors or identifying neonates with these risk factors is important in effective management of infants. Therefore, the evaluation of neonatal jaundice in health care services should always be considered as a fundamental policy.

The prevalence of neonatal jaundice and risk factors in healthy term neonates at National District Hospital in Bloemfontein.

BackgroundNeonatal jaundice affects one in two infants globally. The jaundice is the result of an accumulation of bilirubin as foetal haemoglobin is metabolised by the immature liver. High serum levels of bilirubin result in lethargy, poor feeding and kernicterus of the infant.AimThe main aim of this article was to determine the prevalence of neonatal jaundice and secondly to explore its risk factors in healthy term neonates.SettingMaternity ward, National District Hospital, Bloemfontein, South Africa.MethodsIn this cross-sectional study, mothers and infants were conveniently sampled after delivery and before discharge. The mothers were interviewed and their case records were reviewed for risk factors for neonatal jaundice and the clinical appearance and bilirubin levels of the infants were measured with a non-invasive transcutaneous bilirubin meter.ResultsA total of 96 mother-infant pairs were included in the study. The prevalence of neonatal jaundice was 55.2%; however, only 10% of black babies who were diagnosed with jaundice appeared clinically jaundiced. Normal vaginal delivery was the only risk factor associated with neonatal jaundice. Black race and maternal smoking were not protective against neonatal jaundice as in some other studies.ConclusionMore than half (55.2%) of healthy term neonates developed neonatal jaundice. As it is difficult to clinically diagnose neonatal jaundice in darker pigmented babies, it is recommended that the bilirubin level of all babies should be checked with a non-invasive bilirubin meter before discharge from hospital or maternity unit as well as during the first clinic visit on day 3 after birth.

Jaundice: Newborn to Age 2 Months.

1. Debra H. Pan, MD* 2. Yolanda Rivas, MD* 1. *Division of Pediatric Gastroenterology and Nutrition, The Children’s Hospital at Montefiore, Bronx, NY * Abbreviations: AAP: : American Academy of Pediatrics ALT: : alanine aminotransferase AST: : aspartate aminotransferase BA: : biliary atresia BUGT: : bilirubin uridine diphosphate-glucuronosyltransferase GALD: : gestational alloimmune liver disease GGT: : γ-glutamyl transpeptidase G6PD: : glucose-6-phosphate dehydrogenase Ig: : immunoglobulin IVIg: : intravenous Ig MCT: : medium-chain triglyceride MR: : magnetic resonance MRCP: : MR cholangiopancreatography PFIC: : progressive familial intrahepatic cholestasis PN: : parenteral nutrition PT: : prothrombin time TORCH: : toxoplasmosis, other (syphilis, varicella-zoster, parvovirus B19), rubella, cytomegalovirus, and herpes simplex Neonatal jaundice is a common clinical sign that indicates hyperbilirubinemia. Clinicians should become familiar with the differential diagnoses of hyperbilirubinemia in newborns and young infants and the importance of early referral of all patients with cholestatic jaundice to a pediatric gastroenterologist or hepatologist. After completing this article, readers should be able to: 1. Recognize jaundice as a sign of hyperbilirubinemia and identify risk factors for neonatal jaundice. 2. Explain bilirubin metabolism. 3. Define hyperbilirubinemia and differentiate between the types of hyperbilirubinemia in newborns and young infants. 4. Explain the broad differential diagnoses of neonatal jaundice. 5. Recognize the importance of screening and postdischarge follow-up to prevent severe unconjugated hyperbilirubinemia. 6. Describe the management of neonatal jaundice, including cholestasis. The term jaundice, derived from the French word jaune , meaning yellow, is a yellowish discoloration of the skin, sclerae, and mucous membranes that is caused by tissue deposition of pigmented bilirubin. Jaundice is also known as icterus, from the ancient Greek word ikteros, signifying jaundice. Jaundice is a common clinical sign in newborns, especially during the first 2 weeks after birth. The first description of neonatal jaundice and bilirubin staining of the newborn brain goes back to the eighteenth century. The finding of jaundice on physical examination is an indicator of hyperbilirubinemia. This differs from carotenemia, which can also manifest as a pale yellow-red skin color and is caused by a high level of carotene in the blood. Older children and adults have a normal total serum bilirubin level less than 1.5 mg/dL (26 μmol/L), with the conjugated fraction accounting for less than 5%. (1) Hyperbilirubinemia is defined as a total serum bilirubin level greater than 1.5 …

Incidence and Risk Factors for Neonatal Jaundice among Neonates with Urinary Tract Infection in Abha, Saudi Arabia

Background: Hyperbilirubinemia is one of the presenting signs of bacterial infection in newborns, and the association of neonatal jaundice with urinary tract infection (UTI) has been particularly emphasized. The aim of this study was to determine the prevalence of UTI in asymptomatic jaundiced neonates younger than 4 weeks old. Method: A cross sectional survey has been conducted at Newborn Unit of Maternity & Pediatrics Hospital – Abha from January 2016 to August 2016. A total of 15 patients have been included in the study, who were diagnosed with hyperbilirubinemia due to urinary tract infection (UTI) after exclusion of unrelated criteria. Conclusion: It could be concluded that UTI should be routinely investigated in early (⩽10 days) idiopathic neonatal jaundice in which all other etiologic factors of neonatal hyperbilirubinemia are ruled out, and the presence of UTI should be considered in case of a poor phototherapy response in cases receiving phototherapy.

English

The prevalence of neonatal jaundice among newborn babies in Eku Baptist Community Hospital in Delta State was studied between January 2007 and May 2013. A total of 2,509 neonatal case folders were reviewed to determine the prevalence, pattern of occurrence, and associated risk factors of neonatal jaundice among the newborn babies aged between 1 and 28 days. Neonatal jaundice accounted for a total prevalence of 52. 6 in 1000 of the total number of cases reviewed. There was significant prevalence (p≤0.05) of neonatal jaundice in males (67.4) than in females (43.6). The risk factors of neonatal jaundice identified were sepsis (66.7%), prematurity (15.2%), lack of breast feeding (9.0%), ABO incompatibility (5.2%), and anaemia (3.8%). Two deaths were recorded from neonatal jaundice due to sepsis. Although the prevalence of neonatal jaundice was low, there is need to educate women on regular antenatal checks and delivery in appropriate health care facility in order to curb the incidence of neonatal jaundice. Key words: Prevalence, neonatal jaundice, newborn babies, Eku Baptist Community Hospital.

Causes, Management and Immediate Complications of Management of Neonatal Jaundice ? A Hospital-Based Study

Background: Jaundice is very common in the neonatal period of life. Although it is not a major cause of mortality, it is an important cause of morbidity. So, assessment of the causes and risk factors of neonatal jaundice is very important.Objectives: The objectives of the study were to find out the causes of jaundice, its clinical features, evaluation of the outcome of current management strategy and complications encountered by the participating subjects following treatment.Materials and Methods: This prospective study was conducted in the Neonatal Unit of Rangpur Medical College Hospital (RpMCH) during July to December 2006. A total of 100 neonates having jaundice on admission or who developed jaundice following admission were included in the study. A number of investigations were done for the purpose of assessment of neonates and their icteric condition. The test statistics used to analyse the data were descriptive statistics, Chi-square (?2) and correlation tests.Results: In the present study the median age of the jaundiced newborns on admission was 5 days, while the median age of appearance of jaundice was 3.5 days. Most of the newborns exhibited jaundice 24 hours after birth and peaked by 3–4 days. Majority of the subjects (77%) had pathological jaundice and only 23% had physiological jaundice. This study shows septicemia was in 28% cases followed by asphyxia (20%), prematurity (18%), Rh incompatibility (15%), IUGR (11%) etc. Half of the newborns (51%) had serum bilirubin (indirect) >10 mg/dL. Gestational age and serum bilirubin was found to exhibit a negative correlation. Preterm babies also tend to develop severe to very severe jaundice more than their term counterparts (p<0.001). Birth weight was also found to bear a negative correlation with serum bilirubin. Low birth weight (LBW) babies also had a significantly higher tendency to develop severe to very severe jaundice (p<0.001). Of the 77 patients who were treated, about 64% received phototherapy, 61% received antibiotics and very few (5.2%) received exchange transfusion. Majority of the patients developed some sorts of complications. The predominant complications of phototherapy were irritability (40.8%) followed by skin rashes (26.5%), loose motion (20.4%) and dehydration (16.3%). Very few newborns (4%) had hyperthermia. All four babies who received exchange transfusion suffered from hypovolaemia, one developed hypoglycaemia and one exhibited anaemia.Conclusion: Neonatal jaundice is a leading cause of hospitalisation in the first few weeks of life throughout the world. Though management of unconjugated hyperbilirubinaemia in newborns has undergone changes based on emerging evidences, phototherapy and exchange blood transfusion are still the most commonly used effective modalities for lowering serum bilirubin level.J Enam Med Col 2015; 5(2): 104-109

Incidence of and risk factors for neonatal jaundice among newborns in southern Nepal

To quantify the incidence of and risk factors for neonatal jaundice among infants referred for care from a rural, low-resource, population-based cohort in southern Nepal. Study participants were 18,985 newborn infants born in Sarlahi District in southern Nepal from May 2003 through January 2006 who participated in a cluster-randomised, placebo-controlled, community-based trial to evaluate the effect of newborn chlorhexidine cleansing on neonatal mortality and morbidity. Jaundice was assessed based on visual assessment of the infant by a study worker and referral for care. Adjusted relative risks (RR) were estimated to identify risk factors for referral for neonatal jaundice using Poisson regression. The incidence of referral for neonatal jaundice was 29.3 per 1000 live births (95% confidence interval: 26.9, 31.7). Male sex, high birth weight, breastfeeding patterns, warm air temperature, primiparity, skilled birth attendance, place of delivery, prolonged labour, oil massage, paternal education and ethnicity were significant risk factors (P-values < 0.01). After multivariable adjustment, sex, birth weight, difficulty feeding, prolonged labour, primiparity, oil massage, ambient air temperature and ethnicity remained important factors. Among infants with difficulty feeding, exclusive breastfeeding was a risk factor for neonatal jaundice, whereas exclusive breastfeeding was protective among infants with no report of difficulty feeding. Several known risk factors for neonatal jaundice in a low-resource setting were confirmed in this study. Unique observed associations of jaundice with ambient air temperature and oil massage may be explained by the opportunity for phototherapy based on the cultural practices of this study population. Future research should investigate the role of an infant's difficulty in feeding as a potential modifier in the association between exclusive breastfeeding and jaundice.

Risk factors for neonatal jaundice in babies presenting at the University of Benin Teaching Hospital, Benin City

Background: Jaundice is the yellowish discoloration of the skin, sclera and mucous membranes resulting from deposition of bilirubin. Neonatal jaundice is a leading cause of neonatal admissions in the first week of life and risk factors such as sepsis, prematurity, glucose-6-phosphate dehydrogenase enzyme deficiencies, use of native herbs and contact with naphthalene balls contaminated clothes have been identified for neonatal jaundice. Objective: To determine the risk factors for neonatal jaundice at University of Benin Teaching Hospital, Benin City. Methods: This retrospective study was conducted at the Special Care Baby Unit of the University of Benin Teaching Hospital, Benin City. Case notes of babies admitted from January 2006 to December 2008 were retrieved and information on biodata, gestational age, anthropometric values, potential risk factors, level of serum bilirubin at presentation and discharge, mode of treatment and outcome were extracted. Results: Of the 1784 babies admitted during the period, 472 (26.5%) were admitted for neonatal jaudice. Fifty seven percent of the babies with neonatal jaundice were delivered in UBTH (in-born babies), while 202 (42.8%) of the babies were born before arrival (out-born babies) in UBTH. The Male: Female ratio was 1.02:1. The mean age at presentation with jaundice was 3.43 ± 3.76 days of life. Outborn babies tended to present at an older age (6.08 ± 5.19 days) than in -born babies (2.47 ± 2.48 days). The mean serum bilirubin value in out-born babies (14.00 ± 4.58 mg/dL) was significantly higher than that observed among the in-born babies (9.35 ± 4.38 mg/dL: p = 0.000). The risk factors identified were use of mentholatum, naphthalene balls and native herbs in 40.0%, 16.7% and 7.0% respectively. ABO incompatibility was found in 7.6% of babies. No risk factor was identified in 36.3% of the babies. The case fatality rate in this study was relatively high particularly in association with sepsis, prematurity and asphyxia. Mortality was higher in out-born babies than in in-born babies (p= 0.00). Conclusion: Early presentation of babies and adequate management of sepsis and prematurity will reduce mortality associated with neonatal jaundice. Key words: In-born, jaundice, outborn, risk, sepsis.

A Polymorphic Mutation, c.-3279T&gt;G, in the UGT1A1 Promoter Is a Risk Factor for Neonatal Jaundice in the Malay Population

The uridine diphosphoglucuronate-glucuronosyltransferase 1A1 (UGT1A1) gene encodes the enzyme responsible for bilirubin glucuronidation. To evaluate the contribution of UGT1A1 promoter mutations to neonatal jaundice, we determined the genotypes of c.-3279T>G, c.-3156G>A, and A(TA)7TAA in Malay infants with neonatal jaundice (patients) and in infants without neonatal jaundice (controls). In our population study, only c.-3279T>G was associated with neonatal jaundice. The genotype distributions between both groups were significantly different (p = 0.003): the frequency of homozygosity for c.-3279G was much higher in patients than those in controls. Allele frequency of c.-3279G was significantly higher in patients than those in controls (p = 0.006). We then investigated changes in transcriptional activity because of c.-3279T>G. Luciferase reporter assay in HepG2 cells demonstrated that transcriptional activity of the c.-3279G allele was significantly lower than that of the c.-3279T allele in both the absence and presence of bilirubin. Luciferase reporter assay in COS-7 cells elucidated that c.-3279T>G modified the synergistic effects of the nuclear factors associated with transcriptional machinery. In conclusion, the c.-3279T>G mutation in the UGT1A1 promoter is a genetic risk factor for neonatal jaundice.

Antenatal phenobarbital for reducing neonatal jaundice after red cell isoimmunization

Neonates from isoimmunized pregnancies have increased morbidity from neonatal jaundice. The increased bilirubin from haemolysis often needs phototherapy, exchange transfusion or both after birth. Various trials in pregnant women who were not isoimmunized but had other risk factors for neonatal jaundice have shown a reduction in need for phototherapy and exchange transfusion by the use of antenatal phenobarbital. A recent retrospective case-controlled study showed reduction in the need for exchange transfusion for the neonates from isoimmunized pregnancies. To assess the effects of antenatal phenobarbital in red cell isoimmunized pregnancies in reducing the incidence of phototherapy and exchange transfusion for the neonate. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2006). Randomised and quasi-randomised controlled trials of pregnant women established to have red cell isoimmunization in the current pregnancy during their antenatal testing and given phenobarbital alone or in combination with other drugs before birth. All three review authors independently assessed study eligibility and quality. No trials met the inclusion criteria for this review. The use of antenatal phenobarbital to reduce neonatal jaundice in red cell isoimmunized pregnant women has not been evaluated in randomised controlled trials.

The Frequency of UDP-Glucuronosyltransferase 1A1 Promoter Region (TA)7 Polymorphism in Newborns and it's Relation with Jaundice

Increased bilirubin formation and decreased bilirubin conjugation play an important role in the pathogenesis of the newborn jaundice. Although physiologic jaundice is seen in most of the newborns, there are many risk factors that affect the severity and duration of hyperbilirubinemia. The latest studies showed that the frequency and severity of neonatal jaundice have been increased when mutations of the gene coding UDP-glucuronosyltransferase(UGT)1A1 coexist with other risk factors. Healthy term newborns weighing over 2500 g. were included in this study. The patient group consisted of 107 newborns either with total bilirubin level over 15 mg dl(-1) within 7 days or 5 mg dl(-1) after 15 days of age. The control group consisted of 55 newborns with bilirubin levels in physiological ranges. We investigated the frequency of promoter region [thymine-adenine(TA)]7 polymorphism in UGT1A1 gene. Factors which might cause pathologic and prolonged jaundice with coexisting polymorphism were also investigated. UGT1A1 6/7 genotype was found to be 11% in patient group and 13% in the control group. The difference between patient and control groups was not statistically significant. (TA)7 allele frequency was 0.069 and it is concluded that UGT1A1 promoter region polymorphism was not a risk factor for neonatal jaundice.

THE GILBERT SYNDROME ALLELE: A RISK FACTOR FOR JAUNDICE IN G-6-PD DEFICIENT AND NORMAL NEONATES. † 928

Jaundiced glucose-6-phosphate dehydrogenase deficient (G-6-PD def) neonates have deficient bilirubin conjugation, with a serum bilirubin profile akin to that of Gilbert Syndrome (GS). A variant promotor, (long TATAA element with an extra TA), has been identified in the gene for bilirubin UDP glucuronosyl transferase 1 (UDPGT) in GS. Aim: To determine whether the presence of GS allele is a risk factor for neonatal jaundice (NJ), in G-6-PD deficient and normal populations. Methods: Term, male neonates, screened for G-6-PD def, were observed for NJ, defined as peak serum total bilirubin ≥15mg/dL. DNA extracted from umbilical cord blood was analyzed by PCR for UDPGT promotor polymorphism associated with GS. Using G-6-PD normal with no GS allele as baseline, odds ratio (OR) for developing NJ was determined by logistic regression analysis, with jaundice as dependent, and GS genotype and G-6-PD status as independent variables. Results: GS allele frequency was similar in the G-6-PD defs and normals (30% vs. 29%, NS). 12/51 (23.5%) of the G-6-PD defs developed NJ, vs. 9/116 (7.8%) of normals(p=0.01). Table shows OR for NJ: Correction for ABO incompatibility, birthweight or gestational age did not change OR.

Neonatal jaundice, aflatoxins and naphthols: report of a study in Ibadan, Nigeria

This study set out to investigate the prevalence of naphthols and aflatoxins in the sera of babies with neonatal jaundice and their mothers in order to determine whether they contribute to the occurrence of unexplained neonatal jaundice in Ibadan. Blood was obtained from 327 jaundiced neonates and 80 of their mothers, and 60 non-jaundiced controls and seven of their mothers admitted to hospital between April 1989 and April 1991. Blood group, bilirubin concentration, erythrocyte G6PD status, aflatoxin and naphthol concentrations in blood were measured. Altogether, 30.9% of the jaundiced neonates were G6PD-deficient, compared with 13.3% of controls (chi 2 = 6.88; p = 0.009). Aflatoxins were detected in 27.4% of jaundiced neonates, 17% of their mothers, 16.6% of controls and 14.4% of control mothers. Naphthols were detected in 7.2% of jaundiced babies, 6.3% of their mothers, 6.25% of control babies and 14.4% of their mothers. Analysis of the data revealed that either G6PD deficiency or the presence of any serum aflatoxin is a risk factor for neonatal jaundice; odds ratio were 2.97 (95%) confidence intervals (CI): 1.31-6.74) and 2.68 (CI: 1.18-6.10), respectively. This study demonstrates that G6PD deficiency and/or the presence of serum aflatoxins are risk factors for neonatal jaundice in Nigeria. Aflatoxins are an additional risk factor not previously reported.

Association between glucose-6-phosphate dehydrogenase deficiency and neonatal jaundice: interaction with multiple risk factors.

This nonconcurrent cohort study was carried out to evaluate the association of neonatal jaundice with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency and its interactions with other risk factors. The G-6-PD enzyme activity of 12,379 neonates was screened by a semi-quantitative fluorometric assay and double-checked by a quantitative method to identify a G-6-PD deficient cohort of 333 neonates. Matched with these on birth date, sex and delivery hospital were a G-6-PD normal cohort of 653 neonates. Neonatal jaundice was defined by a peak serum bilirubin (PSB) level of > or = 15 mg/dl. A significant association between G-6-PD deficiency and neonatal jaundice was observed in male but not female neonates. There was an inverse dose-response relation between G-6-PD activity and neonatal jaundice among male neonates. Both hypoxia/asphyxia and maternal hepatitis B surface antigen (HBsAg) carrier status were associated with an increased risk of neonatal jaundice among G-6-PD deficient but not G-6-PD normal male neonates. Based on multiple regression analyses, an additively synergistic effect on PSB level and severe jaundice (PSB > or = 20 mg/dl) was observed for G-6-PD deficiency and maternal HBsAg carrier status.

Maternal smoking in relation to the incidence of early neonatal jaundice.

A case-control study was carried out to investigate the association between maternal smoking during pregnancy and the risk of early neonatal jaundice. A total of 1,569 cases of neonatal jaundice (2.7% of all singleton births) were identified from the 1984 Washington State birth certificates as having a bilirubin level greater than 10 mg/dl within the first 2 days of life. 2,336 nonjaundiced infants were randomly selected to serve as controls. Information regarding smoking during pregnancy was also obtained from the birth certificates. After excluding infants with known risk factors for neonatal jaundice, 912 cases and 1,752 controls were available for analyses. Infants whose mother smoked cigarettes during pregnancy were at lower risk of neonatal jaundice (odds ratio = 0.81; 95% confidence interval = 0.66-0.99) relative to infants of nonsmokers. This relative risk changed very little after adjusting separately for maternal age, infant's gender, number of prior pregnancies, number of prenatal visits, marital status and number of prior fetal deaths. There was suggestive evidence that this apparent protective effect may be operating only among normal and high-birth-weight infants.

Caution on Statistics

In Reply.— We appreciate the comments of Drs Malloy and Reed, and we agree (with some embarrassment) that our use of the term "risk-ratio" is inappropriate; we should have used "odds" and this term should be substituted for risk ratio throughout the paper.1 We also agree that one should be cautious in the interpretation of observational data subjected to multivariate logistic analysis. We were certainly aware of the variables considered biologically important in the modeling of risk factors for neonatal jaundice.

Glucose-6-phosphate dehydrogenase deficiency; the single most important cause of neonatal hyperbilirubinaemia in Kano, Nigeria

Introduction: Glucose- 6-phosphate dehydrogenase deficiency is the most common enzymatic disorder of the red cell and an important risk factor for neonatal jaundice.Methodology: The aim of the study was to determine the incidence of G-6-PD deficiency among jaundiced neonates, and describe the associated morbidity and mortality pattern in them. A prospective cross sectional study was conducted and we studied one hundred consecutive jaundiced neonates (55 males, 45 females) presenting at Aminu Kano Teaching Hospital from between 2004 and August 2005. G-6-PD activity was assayed by Quantitative spectrophotometric method of Kornberg; serum bilirubin and haemoglobin levels were estimated by standard techniques. Exposure to possible Icterogenic agents, clinical features of kernicterus and the outcome were noted.Results: The incidence of G-6-PD deficiency was found to be 46% with male to female ratio of 3:1 (Χ2 = 15, p = 0.001). A higher proportion (60.6%) of the inborn neonates had G-6-PD deficiency (X2 = 5.5, p = 0.06). Jaundice was noticed significantly earlier in the G-6-PD deficient neonates (mean = 2.0, SD = 1 days) compared to (mean = 2.7, SD = 1.6 days) in the sufficient neonates (t = 2.3, p = 0.02). Sixteen (16%) neonates developed kernicterus, of these 10 (63%) were G-6-PD deficient. The mortality rate among G-6-PD deficient neonates was 15% (7 of 46) twice as much as in the sufficient neonates 7% (4 of 54). Only six neonates 0.6% ware exposed to naphthalene of whom three were G -6PD deficient. Five babies were given traditional medicine two of which were G6-PD deficient.Conclusion: G-6-PD deficiency is an important risk factor for neonatal jaundice. Jaundice appeared early in the deficient neonates. There is high incidence of kernicterus and mortality among them. Low admission weight significantly contributed to the mortality.Key Words: G-6-PD deficiency; Neonatal Jaundice; Kernicterus