Prevalence of Bilirubin Encephalopathy in Calabar, South-South, Nigeria (A 5-Year Review)

Authors

  • Sunday O. Ochigbo Department of Paediatrics, University of Calabar
  • Ifeoma Venn Department of Paediatrics, University of Calabar
  • Anachuna Kingsley Department of Paediatrics, University of Calabar

DOI:

https://doi.org/10.6000/1929-4247.2015.04.04.7

Keywords:

Bilirubin, Kernicterus, Exchange Blood Transfusion, infections

Abstract

Background: Bilirubin encephalopathy is the clinical syndrome associated with bilirubin toxicity to the central nervous system resulting in chronic and permanent sequelae. It has been estimated that approximately 60% of term babies and 80% of preterm babies develop jaundice within the first week of life.

Objective: To determine the prevalence, morbidity and mortality of bilirubin encephalopathy at our centre.

Methodology: A retrospective descriptive review of the case files of all babies diagnosed with bilirubin encephalopathy over the past 5 years from January 2010 to December 2014 was undertaken. Information retrieved from the case notes included age, sex, presence of fever, duration of illness, place of delivery, causes and treatment. The outcome measures such as discharged home, discharged against medical advice, and death were also noted.

Results: Out of a total of 2,820 babies, 21 (0.74%) were admitted on account of bilirubin encephalopathy. Of these 21, seventeen (81%) were males and four (19%) females giving M; F ratio of 5:1. Eighteen babies (85.7%) had pyrexia, 8(38.1%) and 6(28.6%) were hypertonic and hypotonic respectively on admission. Only 33.3% of the deliveries took place in the health facilities. The established factors responsible for jaundice included infections (septicaemia) (15/71.4%), ABO incompatibility (4/19.1%), and G6PDeficiency (2/9.5%). The mean maximum serum bilirubin of the subjects was 321.3μmol/l (242.5 – 440.3). The case fatality was 4/21(19%).

Conclusion: Neonatal septicaemia is associated with bilirubin encephalopathy. Therefore identification and prompt treatment is of utmost importance to avoid morbidity and mortality.

References

[1] NICE. Neonatal Jaundice. CG98. London: National Institute for Health and Clinical Excellence 2010.
[2] Slusher TM, Olusaniya BO. Neonatal jaundice in low- and middle-income countries. Care of the jaundiced neonate. New York: McGraw-Hill 2012: 263-73.
[3] Sgro M, Campbell DM, Kandasamy S, Shah V. Incidence of chronic bilirubin encephalopathy in Canada. Pediatrics 2012; 130: e886-90.
[4] Brooks JC, Fisher-Owens SA, Wu YW, Strauss DJ, Newman TB. Evidence suggests there was not a “resurgence” of kernicterus in the 1990s. Pediatrics 2011; 127: 672-9.
http://dx.doi.org/10.1542/peds.2010-2476
[5] Ebbesen F, Andersson C, Verder H, et al. Extreme hyperbilirubinaemia in term and near-term infants in Denmark. Acta Paediatr 2005; 94: 59-64.
http://dx.doi.org/10.1080/08035250410022170
[6] Owa JA, Ogunlesi TA. Why we are still doing so many exchange blood transfusion for neonatal jaundice in Nigeria. World J of Pediatr 2009; 5: 51-5.
http://dx.doi.org/10.1007/s12519-009-0009-2
[7] Manning D, Todd P, Maxwell M, Jane Platt M. Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland. Arch Dis Child Fetal Neonatal Ed 2007; 92: F342-6.
[8] Udo JJ, Anah MU, Ochigbo S O. Neonatal morbidity and mortality in Calabar. A hospital based study. Nig J Clin Pract 2008; 11: 285-9.
[9] Ogunlesi TA, Dedeke IO, Fetuga MB, Ogunfowora OB. The incidence and outcome of bilirubin encephalopathy in Nigeria; a bicentre study. Nig J Med 2007; 16: 354-9.
[10] Christensen RD, Lambert DK, Henry E, et al. Unexplained extreme hyperbilirubinemia among neonates in a multihospital healthcare system. Blood Cells Mol Dis 2013; 50: 105-9.
http://dx.doi.org/10.1016/j.bcmd.2012.10.004
[11] Johnson L, Bhutani VK, Karp K, Sivieri EM, Shapiro SM. Clinical report from the pilot USA. Kernicterus Registry (1992 -2004). J Perinat 2009; 29(Suppl 1): S25-45.
[12] Gamaleldin R, Iskander I, Seoud I, et al. Risk factors for neurotoxicity in newborns with severe neonatal hyperbilirubinemia. Pediatrics 2011; 128: e925-31.
http://dx.doi.org/10.1542/peds.2011-0760
[13] Grace JC, Ann CL, Abdullah HB, Jingwen T, Robert EB. Prevalence of early-onset neonatal infection among newborns of mothers with bacterial infection or colonization: a systematic review and meta-analysis. BMC Infect Dis 2015; 15: 118.
http://dx.doi.org/10.1186/s12879-015-0813-3
[14] Onyearugha CN, Onyire BN, Ugboma HA. Prevalence and associated factors as seen in Federal Medical Centre Abakaliki, South East Nigeria. J Clin Med Res 2011; 3: 40-5.

[15] Owa JA, Taiwo O, Adebiyi JA, Dogunduro SA. Neonatal jaundice at Wesley Guild hospital Ilesa and Ife state hospital Ile Ife. Nig J Pediatr 1989; 16: 23-30.
[16] Israel-Aina YI, Omoigberale AI. Risk factors for neonatal jaundice in babies presenting at UBTH, Benin City. Nig J Pediatr 2012: 39: 159-63.
http://dx.doi.org/10.4314/njp.v39i4.2
[17] Micheal WK, Andrea CW, Yvonne W, et al. Incidence, etiology and outcomes of hazardous hyperbilirubinaemia in Newborns. Pediatrics 2014; 134: 504-9.
http://dx.doi.org/10.1542/peds.2014-0987
[18] Ogunlesi TA, Abdul AR. Maternal knowledge and care seeking behavior for Newborn jaundice in Sagamu, South west Nigeria. Nig J Clin Pract 2015; 18: 33-40.
[19] Maimburg RI, Madsen B. Danish children with validated diagnosis of Kernicterus. Acta Obst Gyne Soc 2009; 88: 1011-6.
http://dx.doi.org/10.1080/00016340903124917
[20] Hansen TW, Nietsch L, Norman E, et al. Reversibility of acute intermediate phase bilirubin encephalopathy. Acta Paediatr 2009; 98: 1689-94.
http://dx.doi.org/10.1111/j.1651-2227.2009.01409.x

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Published

2015-12-11

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General Articles