Page 123 - 16Neonatal Jaundice_compressed

Neonatal jaundice

399 micromol/litre and 33.7% serum bilirubin > 400 micromol/litre. Blood group
incompatibility was also implicated in 27.8% of cases of kernicterus.
A sensitivity analysis of these prevalence rates (Figure 6.1) shows the varying importance of
blood group incompatibility in different regions of the world. In Africa and Asia, it accounted for
over 20% of cases at each level of serum bilirubin and in cases of kernicterus. In studies from
the Middle East, it was found in 21.9% of cases of serum bilirubin between 255 and
399 micromol/litre, in 29.1% of cases of exchange transfusion or serum bilirubin
> 400 micromol/litre and in 27.8% of cases of kernicterus. In Europe/North America, blood
group incompatibility was implicated in 32.1% of cases of serum bilirubin
> 400 micromol/litre or exchange transfusions and 18.9% of kernicterus cases.
6.1.2 G6PD deficiency

Review findings

The pooled prevalence rates of G6PD deficiency increased as serum bilirubin levels rose. This
was identified as a cause of hyperbilirubinaemia in 6.8% of cases of serum bilirubin
< 254 micromol/litre, 11.8% at serum bilirubin between 255 micromol/litre and
399 micromol/litre and 16.5% serum bilirubin > 400 micromol/litre. G6PD deficiency was also
implicated in 30.6% of cases of kernicterus.
A sensitivity analysis of these prevalence rates (Figure 6.2) shows the varying importance of
G6PD deficiency in different world regions. In Africa it accounted for over 35% of cases at each
level of serum bilirubin and in cases of kernicterus. In Asia the prevalence rates rose from 8.8%
at serum bilirubin < 254 micromol/litre and 9.3% at serum bilirubin between 255 and
399 micromol/litre to 19.6% of cases of exchange transfusion or serum bilirubin
> 400 micromol/litre and reached a peak at 35.4% of kernicterus cases.

Likewise, in the Middle East the prevalence of G6PD deficiency rose from 8.0% in cases with
serum bilirubin between 255 and 399 micromol/litre to 27.8% in cases of kernicterus. In Europe
and North America it was implicated in 5.5% of babies with serum bilirubin
> 400 micromol/litre or receiving exchange transfusions, and 20.9% of kernicterus cases.

6.1.3 Infection
Review findings

The pooled prevalence rates of infection (as defined in each study; see the evidence tables)
varied as serum bilirubin levels rose. This was identified as a cause of hyperbilirubinaemia in
12.4% of cases at serum bilirubin < 254 micromol/litre, 9.7% at serum bilirubin between
255 micromol/litre and 399 micromol/litre and 8.9% at serum bilirubin > 400 micromol/litre.
Infection was also implicated in 15.4% of cases of kernicterus.
A sensitivity analysis of these prevalence rates (Figure 6.3) shows the varying importance of
infection in different world regions. In Africa infection was associated with over 13.9% of all
cases of hyperbilirubinaemia or kernicterus.
In Asia the prevalence rates ranged from 9.7% to 31.2% of all cases of hyperbilirubinaemia. In
the Middle East infection was found in 6.9% of cases of serum bilirubin between 255 and
399 micromol/litre and 50.0% of cases of kernicterus. In Europe and North America infection
was implicated in 1.9% of babies with serum bilirubin > 400 micromol/litre or receiving
exchange transfusions and in 14.3% of kernicterus cases.

6.1.4 No known cause

Review findings
Unsurprisingly, no cause for jaundice was found in a significant number of babies at all levels of
serum bilirubin. No cause was identified in 9.0% of babies who had serum bilirubin
< 254 micromol/litre, 28.8% at serum bilirubin between 255 micromol/litre and
399 micromol/litre and 31.2% at serum bilirubin > 400 micromol/litre. No cause could be
found for the hyperbilirubinaemia in 31.2% of cases of kernicterus.

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