Outcome of neonates with severe hyperbilirubinemia in a tertiary level neonatal unit of North India

Objectives The primary objective was to determine the outcome, in terms of mortality and development of bilirubin encephalopathy, of neonates with severe hyperbilirubinemia. The secondary objective was to determine the possible risk factors for development of acute bilirubin encephalopathy (ABE). Methods Consecutive neonates of >35 weeks gestation admitted to Neonatal Intensive Care Unit (NICU) with a serum bilirubin >20mg% in first 72h of life or >25mg% later were enrolled in the study. The clinical and demographic characteristics of the neonates were recorded. Neonates were treated with phototherapy and exchange transfusion as required. Outcome in terms of mortality and development of bilirubin encephalopathy was noted. Discharged neonates were followed at 1, 3, and 6 months for chronic bilirubin encephalopathy (CBE). Results Out of 64 neonates enrolled, 28 (44%) were admitted with ABE. Four with ABE left against medical advice. Out of 60 neonates studied, 5 (8.3%) expired. A total of 17 (89.5%) neonates of ABE group and 25% of all neonates developed CBE on follow-up. A lower weight on admission (2254.68+417g vs 2481.75+369g; p=0.0195), ABO/Rh incompatibility (odds ratio 4.00; 95% CI: 1.13–14, p=0.030), a positive Coomb's test (odds ratio 5.7; 95% CI: 1.53–21.4, p=0.0096), culture-proven sepsis (odds ratio 16; 95% CI: 0.82–312, p=0.067), and normal vaginal delivery (odds ratio 5.5; 95% CI: 1.1–27.4, p=0.037) were found to be significant risk factors for development of ABE. Conclusion Nearly half of the neonates admitted in a tertiary care NICU with severe hyperbilirubinemia had features of ABE on admission. The risk was more if they were born vaginally, had a lower weight on admission, had blood group incompatibility with positive Coomb's test, and had sepsis.