Date Published: April 12, 2018
Author(s): Hanneke Brits, Jeanie Adendorff, Dyanti Huisamen, Dahne Beukes, Kristian Botha, Hanre Herbst, Gina Joubert.
Neonatal 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.
The main aim of this article was to determine the prevalence of neonatal jaundice and secondly to explore its risk factors in healthy term neonates.
Maternity ward, National District Hospital, Bloemfontein, South Africa.
In 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.
A 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.
More 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.
The term ‘jaundice’ is used to describe the yellow-orange discoloration of the skin and sclera because of excessive bilirubin in the skin and mucous membranes.1,2 Jaundice itself is not a disease but rather a symptom or sign of a disease. Bilirubin is mainly formed when the haem component of red blood cells are broken down in the spleen to biliverdin and then unconjugated bilirubin.3 As bilirubin is not water soluble, it is transferred via the bloodstream from the spleen to the liver, bound to the plasma protein albumin. In this form, it is known as conjugated bilirubin, which is then secreted into the gall. In the gut it is further metabolised to other gall pigments and then excreted in the faeces.3
A total of 96 mother-infant pairs were included in the study. As per inclusion criteria, all babies were term and healthy. The age of the mothers varied between 18 and 36 years, with a mean age of 26.5 years. The mean weight of the babies was 3.15 kg, ranging from 2.1 kg to 4.39 kg, and the mean gestation was 38.5 weeks.
The baseline characteristics regarding age (26.5 years vs. 25 years) and race (black 77.1% vs. 80%) of the mothers, as well as the mean birth weight (3.25 kg vs. 3.07 kg) of the neonates, compared well with that of national statistics for mothers attending and delivering at public health facilities in South Africa.18,19,20
The prevalence of neonatal jaundice in healthy term babies at National District Hospital in Bloemfontein was 55.2%. Although 52% of sampled infants had jaundice on the Bilicheck® meter, only 17% appeared clinically jaundiced. The consequence of a missed diagnosis and delayed treatment may cause serious morbidity (kernicterus). The Bilicheck® meter is reliable, non-invasive, easy to use and cost-effective and should be available in all maternity units and clinics for screening of all infants before discharge and again on day 3. Although babies 72 h and older had a greater chance of neonatal jaundice, it cannot be considered as a risk factor, as it is in accordance with the normal course for the development of neonatal jaundice. The only risk factor identified in this study that could contribute to neonatal jaundice was normal vaginal delivery.