Abstract:

Background: Neonatal hyperbilirubinemia is a common newborn problem encountered in medical practice. If not detected and managed early, it can results into a clinical jaundice, particularly during the first week of life and progress to acute bilirubin encephalopathy or kernicterus that significantly increase the risk of morbidity and mortality among newborns. Total serum bilirubin is the gold standard for measuring bilirubin level in the blood. Transcutaneous bilirubin (TcB) is new non-invasive technique developed for estimating serum bilirubin in newborn with high risk of hyperbilirubinemia. Hence it serves as a guide to prompt initiation of treatment. It is quick and can be performed easily and cheap compared to conventional blood serum measurement for bilirubin. However TcB has not been extensively used in LMICs.

Methods: This was a hospital based cross sectional study conducted from December 2018 to April 2019 with the objective of determining the prevalence, factors associated with hyperbilirubinemia and utility of transcutaneous bilirubin among newborn admitted at Bugando Medical Center, Mwanza-Tanzania. Pre-tested questionnaire was used to catch up basic maternal and neonate information. Blood sample was drawn from neonates for Total serum bilirubin measurement, blood culture, Complete blood count, and blood grouping. Transcutaneous bilirubin measurements were done using JM105 Dragger machine. Data were analyzed using STATA software version 13.

Results: Out of 389 neonates studied 153(39.3%) had neonatal hyperbilirubinemia. Neonates aged 2 – 7 days had higher odds of hyperbilirubinemia compared with children aged 1 day of life (OR: 2; 95%CI: 1.1 – 3.7; p-value 0.031). Hyperbilirubinemia in newborn had a significant positive correlation with prolonged labor (OR: 5.5; 95%CI: 0.9 – 22.5; p-value 0.029) and herbal medication use prior delivery (OR: 3.2; 95%CI: 1.6 – 6.7; p-value 0.002). The transcutaneous bilirubin had the sensitivity of 87.6% and specificity of 95.7% in detecting neonatal hyperbilirubinemia. Also had positive and negative predictive value of 93.0% (134/144) and 92.2% (226/245) respectively. There was high positive linear correlation between Total serum bilirubin test and Transcutaneous bilirubin test and the relationship was statistically significant (r=0.89; p-value<0.001).

Conclusion: The observed high prevalence of hyperbilirubinemia is alarming and it was significantly associated with herbal medicine use during pregnancy, prolonged labour and it occurred mostly after 14hrs of life. Transcutaneous bilirubin machine showed a high sensitivity and specificity in detecting neonatal hyperbilirubinemia.

Recommendation: We recommend that all neonates should be screened for neonatal hyperbilirubinemia, using TcB test, before discharge and close follow up to make sure that they cannot develop severe hyperbilirubinemia, especially among those born from mothers who had prolonged labour and those whose mothers consumed local herbs during pregnancy.