Severe Neonatal Hyperbilirubinaemia in the First 24 Hours of Life: Tertiary Center Experience in Oman

Abstract

Introduction: Neonatal jaundice is a common condition observed in approximately two-thirds of all newborns in the first postnatal week of life. In most cases it is benign and no treatment is required. However, in severe cases, pathological jaundice can lead to acute bilirubin encephalopathy and kernicterus. Aim: To characterise the main predisposing factors as well as the treatment modalities of babies with significant neonatal jaundice presenting in the first 24 hours of life. Materials and Methods: We conducted a retrospective, observational study of all babies admitted to the neonatal unit at the Royal hospital in Oman in the period between 1st January 2014 and 31st December 2014 and treated for significant hyperbilirubinaemia presenting in the first 24 hours of life. Patients were selected from the Royal Hospital neonatal admission registry. A total of 125 patients records were analysed for the sake of the study. Results: The mean gestational age was 34 weeks and the mean birth weight was 2070 grams. Male to female ratio was 1:1.2. About 30 (45%) of the males and 15 (26%) of the females had Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency. Blood group of the babies was A 42 (33.6%), B 34 (27.2%), AB 4 (3.2%) and O 45 (36%). About 4.8% were Rhesus negative. In all 27 (21.6%) of the babies tested positive for Direct Coombs Test. The maximum Total Serum Bilirubin (TSB) in the first 24 hours of life was 130±65 µmol/L and the maximum TSB anytime during the admission was 215±80 µmol/L. About 88 (70%) of the babies received standard phototherapy and 37 (30%) received intensive phototherapy. Intravenous Immunoglobulin (IVIG) in addition to phototherapy was administered in 21 (17%) of the babies. None of the babies required exchange transfusion. Conclusion: It was observed that the most common predisposing factors for significant neonatal jaundice presenting in the first 24 hours of life were prematurity, G6PD deficiency and isoimmune hemolytic disease. Phototherapy and IVIG was the treatment modalities used.

Keywords

• Encephalopathy
• Glucose 6 phosphate dehydrogenase deficiency
• Neonatal jaundice
• Rh isoimmunization