Severe Neonatal Hyperbilirubinemia And Acute Bilirubin Encephalopathy


Introduction: Neonatal jaundice is a common condition with 60% of newborns being clinically affected in the first days of life. Severe hyperbilirubinemia makes infants at considerable risk of potentially dangerous bilirubin encephalopathy with subsequent kernicterus.Aim of study : To evaluate importance of clinical and laboratory factors affecting occurrence of acute bilirubin encephalopathy in neonates with severe neonatal hyperbilirubinemia.Patients and methods: A cross sectional study was conducted in the central child teaching hospital/ neonatal ward/ Baghdad/ Iraq, over the period of 9.5 months(from 1st of October 2015 to 15th of July 2016), including neonates presented with severe hyperbilirubinemia, whom required phototherapy ± exchange transfusion. Neonates were less than 14 days of life, and were term and near term. Full history and physical examination was conducted, and features of acute bilirubin encephalopathy by using the BIND score were assessed. Relevant laboratory tests were performed.Results: A 120 neonates with severe hyperbilirubinemia were studied. Mean age of admission was 7.4±2.97 days. Males:female ratio was 2.16:1, mean gestational age was 37.5±1.1 weeks. Term neonates were 100, while preterms were 20. Hemolytic diseases were commonest causes of jaundice (Rh isoimmunization and ABO incompatibility), then followed by sepsis. Fifty one neonates were affected with acute bilirubin encephalopathy according to BIND score. Neonates of BIND positive group were significantly younger (P <0.01), yet gender and weight were indifferent. Also neonates of BIND positive group were significantlynear terms (P 0.00), low body weight (P 0.024), caesarean delivered (P 0.04), and those needed exchange transfusion (P 0.00). Laboratory investigation in BIND positive group showed significantly higher total serum bilirubin, higher bilirubin/albumin ratio, and lower albumin (P <0.01, <0.01, <0.01 respectively).ROC analysis identified a total serum bilirubin cut off value of 19.5mg/dl, and bilirubin/albumin ratio was 6.337mg/g, with bilirubin/albumin ratio was more sensitive than total serum bilirubin as a predictor of acute bilirubin encephalopathy.Conclusion and Recommendations; Near term, low weight, and caesarean section deliveries carry risk for acute bilirubin encephalopathy. Bilirubin cut off value of 19.5mg/dl is critical in evaluating neonatal jaundice, while initial bilirubin/albumin ratio is a predictor of acute bilirubin encephalopathy in severe hyperbilirubinemia. So we recommend early checkup of serum bilirubin and albumin of neonates with jaundice. Also, encourage term deliveries, and early feeding in cesarean deliveries, and encourage public educational programs about risks of developing neurological dysfunction in newborns with neonatal jaundice and the importance of early seeking medical advice.