Abstract
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Abstract; Background: Due to lack of comprehensive postnatal care; neonates in low resource settings are at high risk for significant hyperbilirubinemia (SHB) and its complications. We conducted a study to determine the prevalence of SHB, factors associated with it and performance of transcutaneous bilirubin (TCB) measurement compared to visual inspection in identifying these neonates.Methods: We conducted a cross sectional study over a one month period involving 235 neonates 24 to 72 hours of age who were due for discharge in the postnatal ward of Mulago Hospital. Relevant data was captured. Neonates with SHB were referred for treatment. Data was entered in to Epi-data version 3.0 then exported to STAT 14.0 software and analyzed. P-value of <0.05 was considered significant with confidence interval of 95%.Results: Thirty two (13.6%) of the participants had SHB and Three (1.3%) had bilirubin levels at/above exchange transfusion threshold. The means serum bilirubin level among neonates with SHB was 240µmol/l (range 132-481.4µmol/l). Possible causes for SHB included; ABO/Rhesus discordance 11 (34.4%), possible sepsis 8 (25%) due to high CRP without any explanation, significant weight loss 2 (6.25%), cephalohematoma 2 (6.25%) and twelve (37.5%) no immediate cause was identified. Significant hyperbilirubinemia was independently associated with CRP ≥ 10mg/l (AOR 3.96, CI 1.23-12.73, p 0.021), ABO discordance (AOR 3.67, CI 1.28-10.49, p 0.015), jaundice in a previous baby (AOR 3.565, CI 1.10-11.51, p 0.034) and time of initiation of feeds > 1 hour (AOR 2.74, CI 1.10-6.90, p 0.007). The sensitivity, specificity, positive and negative predictive values of TCB were 96.5%, 84.6%, 47.5% and 99.4% respectively compared to 31.2%, 98.5%, 76.9% and 90% respectively for visual assessment.Conclusions: Among well neonates in the post natal ward approximately 1 in 10 have SHB and 1 in 100 have bilirubin level at exchange transfusion threshold between 24 and 72 hours of age hence screening for SHB among such neonates should be emphasized. Transcutaneous bilirubinometry is a suitable screening tool since it identified majority of neonates with SHB. Early initiation of feeding should be promoted. Screening for possible sepsis in neonates with significant hyperbilirubinemia without identifiable reason should be considered.