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

Abstract

Introduction: prolonged neonatal jaundice (pnnj) is jaundice persisting beyond fourteen days in term and twenty-one days in pre-term babies. Globally, the incidence of cholestatic neonatal jaundice (nnj) is one in two thousand five hundred live births, and prolonged neonatal jaundice is reported in up-to 15% of all new-born babies. The most commonly identifiable causes of prolonged neonatal jaundice globally, are biliary atresia, metabolic causes and other inherited syndromes, among others. Nonetheless, several studies in developing countries reveal neonatal infections to be playing a major role in the aetiology. In kenya, nnj is a common reason of morbidity and mortality in the neonatal period. Since the differential diagnosis of prolonged nnj is extensive, a step-wise approach will be useful to identify the underlying pathology, based on the initial history and physical examination. A well-planned protocol can prevent us from having premature and expensive tests to establish cause. Also prevents time wastage and thus worsening clinical condition and outcomes of neonates. Study objectives: Primary: to determine the prevalence of prolonged neonatal jaundice among neonates with jaundice admitted to kenyatta national hospital. Secondary: to describe the laboratory and radiological investigations done, with results recorded, recorded aetiology and outcomes for babies admitted with prolonged neonatal jaundice in knh. Methodology: a retrospective cross-sectional study was carried out, aimed at determining the prevalence of prolonged neonatal jaundice in patients admitted to new born unit and paediatric wards, from 1st january 2016 – 31st december 2018, at kenyatta national hospital. A total of 368 files of patients with neonatal jaundice were randomly selected, with most recent files preferred to minimize missing data. 8files were excluded due to neonates reported to have total parenteral nutrition (tpn) administration. 360 files were analyzed manually to collect data as per the paper-based data collection tool. Data was then exported to stata version 15.1 for statistical analysis. Categorical data was presented as proportions and comparison of patients with or without neonatal jaundice. Continuous data was analyzed using means or medians depending with underlying probability distribution. Results: During study period, records from 360 eligible neonates were retrieved and analysed. Sixty-seven (19%) were born preterm while 293 (81%) were term babies. Fifty-six neonates had prolonged jaundice; prevalence of 16%. Fifty-three (95%) had liver function tests done, of which 91% had conjugated hyperbilirubinemia. Fifty-two (93%) had full blood count done and the remaining first tier tests done in less than 50% of patients. The most common

Causes were noted to be viral (25%) and bacterial (23%) sepsis. Other causes included biliary atresia (4%), breastfeeding jaundice and cholecystitis among others. 21% had no known diagnosis. As for the outcome, 1 out of 7 pre-terms and 4 out of 44 term neonates died during the first admission, thus, neonates admitted at earlier gestation were more likely to die than near term neonates. Conclusion: The prevalence of prolonged neonatal jaundice was noted to be high (16%) among jaundiced neonates admitted to kenyatta national hospital with no difference in gestational age at presentation. Patients with prolonged neonatal jaundice were not fully evaluated even for first tier as per espghan guidelines, but from the evaluation done, infections noted to top the list of possible aetiology, especially viral hepatitis. The outcome of neonates with prolonged jaundice could improve as 1 in every 10 admissions would die during the first admission. Recommendations: Neonates with prolonged jaundice should be evaluated fully at-least from the first tier of investigations to be done. We need to come up with a written protocol on evaluation and management of neonates with prolonged neonatal jaundice.