Infants at risk of significant hyperbilirubinemia in poorly-resourced countries: evidence from a scoping review

Abstract

Background: Neonatal hyperbilirubinemia is frequently associated with disproportionately high rates of bilirubin-induced mortality and long-term morbidities in low- and middle-income countries (LMICs). This scoping review aimed to identify possible etiological/risk factors for clinically significant hyperbilirubinemia in LMICs so as to guide intervention and future research priorities.

Data sources: We systematically searched PubMed, Scopus, Excerpt Medica Database, Cumulative Index to Nursing and Allied Health Literature, WHO Library Database, African Index Medicus, African Journals Online, Latin American and Caribbean Health Sciences Literature, and Indian Medical Journals for reports published between January 1990 and August 2014 in LMICs with per capita income of ≤ US$ 6000. We included studies on the etiology of neonatal hyperbilirubinemia or hyperbilirubinemia as significant morbidity for relevant maternal, perinatal and neonatal disorders without restriction on study design.

Results: A total of 131 studies were identified in 23 LMICs from different regions of the world. The factors most frequently associated with neonatal hyperbilirubinemia (in approximately 10% of all studies) were ABO and Rhesus incompatibilities, diabetes mellitus, glucose-6-phosphate dehydrogenase deficiency, prematurity/low birth weight, infection, birth trauma, and drug-induced labor. The role of exclusive breast-feeding and genetic factors was sparsely explored.

Conclusions: Several maternal, perinatal and neonatal factors are associated with neonatal hyperbilirubinemia in LMICs. Improved research efforts and strategies to address these factors are warranted to curtail the disease burden in these countries.

Keywords: bilirubin-encephalopathy; developing countries; kernicterus; perinatal outcomes; risk factors.