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. 2023 Sep 5;109(4):965-974.
doi: 10.4269/ajtmh.23-0293. Print 2023 Oct 4.

Prevalence and Risk Factors of Neonatal Hyperbilirubinemia in a Semi-Rural Area of the Democratic Republic of Congo: A Cohort Study

Caterina Fanello  1   2   3 , Sue Jean Lee  1   2 , Germana Bancone  1   4 , Daddy Kayembe  3   5 , Pauline Ndjowo  3   5 , Benjamen Badjanga  3   5 , Gornpan Gornsawun  4 , Paphapisa Chotthanawathit  2 , Naomi Waithira  1   2 , Nicholas John White  1   2 , Marie Onyamboko  3   5
Affiliations

Prevalence and Risk Factors of Neonatal Hyperbilirubinemia in a Semi-Rural Area of the Democratic Republic of Congo: A Cohort Study

Caterina Fanello et al. Am J Trop Med Hyg. .

Abstract

Neonatal hyperbilirubinemia (NH) is a frequent condition that, if left untreated, can lead to neurological disability and death. We assessed the prevalence of NH and associated neonatal and maternal risk factors in 362 mothers and 365 newborns in a semi-rural area of the Democratic Republic of Congo. In addition, we explored the knowledge and practices of mothers regarding this condition. We collected demographic data, anthropometric data, and obstetric and medical anamneses. We examined newborns at birth and at 24, 48, and 72 hours and measured bilirubin at birth in umbilical cord and capillary blood and thereafter in capillary blood. Hemoglobin, hematocrit, ABO group, Rhesus factor, glucose-6-phosphate dehydrogenase (G6PD) deficiency, Hemoglobin S (HbS), and malaria were assessed in mothers and newborns. Among 296 newborns (all time points available), 5.7% developed NH (95% CI: 3.4-9.0) between 24 and 72 hours according to National Institute for Health and Care Excellence (NICE) UK guidelines. There was a significantly higher risk in newborns with G6PD deficiency (homo- and hemizygous adjusted Odd Ratio [aOR]: 21.0, 95% CI: 4.1-105.9), preterm births (aOR: 6.1, 95% CI: 1.4-26.9), newborns with excessive birth weight loss (aOR: 5.8, 95% CI: 1.4-23.2), and hyperbilirubinemia at birth (aOR: 14.8, 95% CI: 2.7-79.6). Newborns with feto-maternal ABO incompatibility and G6PD deficiency had significantly higher bilirubin at birth than others. More than 60% of mothers had adequate knowledge of NH, but compliance with phototherapy in the absence of symptoms was low. Although risk factors for NH are common in this area, prevalence was not high, suggesting a need for better case definition. Implementation of point-of-care devices for diagnosis and awareness programs on risk prevention could help reduce neonatal morbidity and mortality associated with hyperbilirubinemia in these areas.

Trial registration: ClinicalTrials.gov NCT03880591.

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Conflict of interest statement

De-identified participant data are available from the Mahidol Oxford Tropical Medicine Data Access Committee upon request (https://www.tropmedres.ac/units/moru-bangkok/bioethics-engagement/data-sharing).

Figures

Figure 1.
Figure 1.
Flowchart. ANC = antenatal care; NH = neonatal hyperbilirubinemia.
Figure 2.
Figure 2.
Median interquartile range total bilirubin level over time in newborns without and with neonatal hyperbilirubinemia.
Figure 3.
Figure 3.
Median interquartile range total bilirubin level over time by glucose-6-phosphate dehydrogenase genotype.
See this image and copyright information in PMC

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