36 A Comprehensive Study of Neonatal Jaundice: Frequency, Risk Factors, Therapeutic Approaches and its Outcomes in District Mardan

Introduction/Objective Neonatal jaundice is a significant factor of infantile morbidity and mortality worldwide; reported as a leading cause of admission in the first week of life (1). Overall, about 60% of the full-term neonates and 80% of the preterm newborns encounter jaundice in the initial 3 days of life (2). Neonatal jaundice is mostly physiological. However, in premature infants, physiological jaundice may last for 3 weeks. Most neonatal jaundice cases do not have serious complications, but if left untreated, they can cause complications like acute brain encephalopathy, kernicterus, and long-term neurodevelopmental abnormalities such as hearing loss, athetosis, and, rarely, intellectual deficits (1, 3). According to the global burden of disease in 2016, neonatal jaundice accounted for 1306 deaths per 100,000 live births and ranked seventh in terms of mortality rate during the early neonatal period. In Pakistan, neonatal jaundice (NNJ) poses significant risks due to various factors including limited access to healthcare services and socioeconomic challenges (4). The complications associated with NNJ highlight the importance of early detection and management of NNJ in Pakistan to prevent long-term adverse outcomes. Methods/Case Report A descriptive longitudinal cross-sectional study conducted at District Headquarter Hospital, Shaheed Benazir Bhutto Children Hospital, and Mardan Medical Complex, Mardan, from 1st to 30th September 2023. All neonates (less than 28 days) seeking medical care in hospital and neonates whose parents give informed consent. Neonates already scheduled for medical interventions, or any planned medical treatments and neonates referred from another district were excluded from the study. A non-probability convenient sampling technique was used. After the Ethical approval data was collected using a structured questionnaire. All the data collected was entered and analyzed using IBM SPSS Statistics 26.0. The p-value <0.05 was considered significant. Descriptive statistics were employed to provide a comprehensive overview of the dataset. For categorical variables frequencies and percentages were calculated. Continuous variables were summarized using mean and standard deviation. Chi-square test was used to find association of neonatal jaundice with categorical variables. Post-Hoc was employed to evaluate the association of neonatal jaundice with gestational age. Binary logistic regression was employed to find the associations of neonatal age, birthweight, and maternal age with the occurrence of neonatal jaundice. Results A total of 485 neonates were enrolled in the study during the designated study duration of which 56.5% (n = 274) were male and 43.5% (n = 211) were females. Among the total neonates enrolled in the study, a significant portion (47.4%, n = 230) presented with neonatal jaundice (NNJ) with a mean bilirubin level of 12.41 mg/dl (SD ± 5.21). Among these, 136 neonates (59.1%) were male, while 94 neonates (40.9%) were female. The male-to-female ratio among neonates with jaundice was approximately 1.5:1. Among the 230 neonates identified with jaundice, 187 were admitted to the hospitals, and various therapeutic techniques were used for treatment. Phototherapy was used as an effective approach for majority of neonates (76.5%, n = 143) while a smaller fraction 3.7% (n = 7), required more comprehensive care such as exchange transfusions. The length of hospital stays for neonates with jaundice ranged from 1 to 9 days, with an average stay of 3.5 days (SD = ±1.424). Among neonatal factors, age of the neonate (p < 0.001) was significantly associated. Among admitted patient the mortality rate was 3.7%. Among the maternal characteristics, maternal medical condition (p = 0.011), medication (p = 0.001), passive-smoking (p = 0.004), and previous child with jaundice (p < 0.001) showed associations with NNJ. Conclusion A total of 485 neonates were enrolled in the study during the designated study duration of which 56.5% (n = 274) were male and 43.5% (n = 211) were females. Among the total neonates enrolled in the study, a significant portion (47.4%, n = 230) presented with neonatal jaundice (NNJ) with a mean bilirubin level of 12.41 mg/dl (SD ± 5.21). Among these, 136 neonates (59.1%) were male, while 94 neonates (40.9%) were female. The male-to-female ratio among neonates with jaundice was approximately 1.5:1. Among the 230 neonates identified with jaundice, 187 were admitted to the hospitals, and various therapeutic techniques were used for treatment. Phototherapy was used as an effective approach for majority of neonates (76.5%, n = 143) while a smaller fraction 3.7% (n = 7), required more comprehensive care such as exchange transfusions. The length of hospital stays for neonates with jaundice ranged from 1 to 9 days, with an average stay of 3.5 days (SD = ±1.424). Among neonatal factors, age of the neonate (p < 0.001) was significantly associated. Among admitted patient the mortality rate was 3.7%. Among the maternal characteristics, maternal medical condition (p = 0.011), medication (p = 0.001), passive-smoking (p = 0.004), and previous child with jaundice (p < 0.001) showed associations with NNJ.