Risk Factors of Hyperbilirubinemia - A Case-Control Study in a Tertiary Level Hospital in Rural Central India

Abstract

BACKGROUND Hyperbilirubinemia is the most common cause of hospital readmission in neonates affecting about 60 % of term and 85 % of preterm neonates. Often, it is a benign condition but may result in neurological sequelae like bilirubin induced encephalopathy and kernicterus spectrum of disorders. We wanted to evaluate the foetal and maternal risk factors of hyperbilirubinemia and also identify the modifiable risk factors of it in neonates. METHODS An observational case - control study was carried out from July 2018 to July 2020. Neonates with hyperbilirubinemia levels in the range of phototherapy as described by the age and gestation by the American Academy of Paediatrics were taken as cases and neonates without hyperbilirubinemia were taken as controls. Detailed demographic-, prenatal-, perinatal-, family-history and physical-examination was undertaken for all the neonates included in the study and various risk factors were assessed such as the presence of maternal illness, intrauterine growth retardation (IUGR), premature rupture of membranes (PROM), prematurity, ABO and Rh incompatibility, previous history of phototherapy in siblings, breast feeding problems and birth asphyxia. RESULTS Multivariate logistic regression studies of data collected has shown a significant association between IUGR (P value 0.01), prematurity (P value 0.002), ABO incompatibility (P value 0.009), breast feeding problems (P value 0.001), birth asphyxia (P value 0.05) and presence of PROM (P value 0.05) with neonatal hyperbilirubinemia. CONCLUSIONS Early identification of neonatal hyperbilirubinemia and prompt intervention reduces the morbidity and mortality associated with this common condition. KEY WORDS Jaundice of Neonate, Neonatal Jaundice, Icterus Neonatorum