Prevalence and clinical correlates of prolonged neonatal jaundice among neonates with jaundice at Kenyatta national hospital, Nairobi

Abstract

Background: Prolonged neonatal jaundice is jaundice beyond fourteen days in term and twenty-one days in pre-term babies. The common causes are biliary atresia, metabolic conditions and infections. Work up for neonates with jaundice as per international guidelines is extensive and may not be available in developing countries. In Kenya, the prevalence and aetiology of prolonged jaundice has not been published.
Objectives: Primary: To determine the prevalence of prolonged neonatal jaundice among neonates admitted with jaundice.
Secondary: To describe laboratory and radiological investigations, aetiology and short-term outcomes for babies admitted with prolonged neonatal jaundice.
Design: A retrospective, cross-sectional study
Setting: Children’s wards and newborn unit, Kenyatta National Hospital.
Subjects: A total of 360 files of neonates with jaundice were analyzed manually using a data collection tool.
Results: Of 360 eligible neonates, fifty-six (16%) neonates had prolonged jaundice. There were sixty-seven preterm and 293 term babies and 91% had conjugated hyperbilirubinemia. Fifty-two (93%) had full blood count done and the remaining first tier tests were done in less than 50% of patients. The most common causes were viral hepatitis (25%), bacterial sepsis (23%), biliary atresia (4%) and cholecystitis. One out of 8 pre-terms and 4 out of 48 term neonates died during the first admission.
Conclusion: The prevalence of prolonged neonatal jaundice amongst infants admitted with jaundice was 16%. Patients with prolonged neonatal jaundice were not fully evaluated even for first tier as per international guidelines, but infections were the most common cause. The short-term mortality of prolonged neonatal jaundice was 10%.