A Clinico-Pathological Study Of Unconjugated Hyperbilirubinemia In Neonates And Its Outcome In A Tertiary-Care Hospital

Authors

  • Sarbani Misra (Roy)
  • Sushama Sahoo
  • Shatadip Chakraborty

Keywords:

Neonatal jaundice, unconjugated hyperbilirubinemia, ABO incompatibility, exchange transfusion, kernicterus, neuro-developmental outcome

Abstract

Background: Unconjugated hyperbilirubinemia (UHB) affects 60-80 % of term and pre-term neonates worldwide and remains a leading, yet preventable, cause of kernicterus and long-term neuro-developmental disability [1, 2]. Local data identifying modifiable risk factors are essential to optimise guideline-driven care.

Methods: We conducted a prospective, descriptive study of 100 consecutive neonates (day 1–28) admitted with clinically apparent jaundice to the NICU/SNCU of Malda Medical College, India, over 12 months. Detailed maternal–infant histories, physical examinations, and targeted laboratory/radiologic investigations were performed. Total serum bilirubin (TSB) trajectories were plotted against the 2004 AAP nomogram. Management, including phototherapy and exchange transfusion (ET), followed institutional protocols. Outcomes (discharge, neurologic status, mortality) were documented at discharge and at 3-month follow-up.

Results: Seventy-two per cent of infants were inborn; 57 % were male; 21 % were pre-term. ABO incompatibility (65 %) and Rh iso-immunisation (16 %) were the dominant aetiologies, followed by G6PD deficiency (8 %). Mean (±SD) admission TSB was 21.3 ± 3.8 mg/dL; mean peak TSB 23.5 ± 5.0 mg/dL. Twenty-six per cent required ET. Higher admission TSB correlated significantly with sepsis, positive DCT, hypocalcaemia and metabolic acidosis (p < 0.05). Moderate/severe BIND scores predicted abnormal oto-acoustic emissions, BERA and neuro-imaging, and poorer neuro-developmental outcome (χ², p < 0.05). Overall mortality was 3 %.

Conclusion: In our setting, haemolytic disease (especially ABO incompatibility) remains the principal driver of hazardous UHB, compounded by sepsis and metabolic derangements. Adherence to the AAP 2004 threshold chart enabled timely ET and limited kernicterus; nevertheless, one-quarter of survivors showed early auditory or neuro-imaging abnormalities. Universal bilirubin screening, strengthened Rh/ABO-matching programmes, and routine G6PD testing could further reduce the burden.

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References

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Published

2025-05-16

How to Cite

1.
Misra (Roy) S, Sahoo S, Chakraborty S. A Clinico-Pathological Study Of Unconjugated Hyperbilirubinemia In Neonates And Its Outcome In A Tertiary-Care Hospital. J Neonatal Surg [Internet]. 2025May16 [cited 2025Sep.21];14(24S):468-73. Available from: https://jneonatalsurg.com/index.php/jns/article/view/5983

Issue

Vol. 14 No. 24S (2025): Journal of Neonatal Surgery

Section

Original Article

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