Udochukwu M Diala1, Richard P Wennberg2, Isa Abdulkadir3, Zubaida L Farouk4, Carlos D Coda Zabetta5, Efe Omoyibo6, Abieyuwa Emokpae7, Aleksandr Aravkin8, Bose Toma9, Stephen Oguche9, Tina Slusher10. 1. University of Jos, Jos, Nigeria. dialaum@yahoo.com. 2. Department of Pediatrics, University of Washington, Seattle, WA, USA. 3. Ahmadu Bello University, Zaria, Nigeria. 4. Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria. 5. Bilimetrix s.r.l., Trieste, Italy. 6. Federal Medical Centre, Asaba, Nigeria. 7. Massey Street Children's Hospital, Lagos, Nigeria. 8. Department of Applied Mathematics, University of Washington, Seattle, WA, USA. 9. University of Jos, Jos, Nigeria. 10. University of Minnesota and Hennepin County Medical Center, Minneapolis, MN, USA.
Abstract
BACKGROUND: Acute bilirubin encephalopathy (ABE) is an important cause of neonatal morbidity in Nigeria, accounting for 5-14% of neonatal deaths. Most newborns with severe ABE have irreversible damage before receiving treatment emphasizing the need for timely pre-admission monitoring and referral. There is limited evidence that educational interventions targeting mothers and health care providers will reduce delayed care. OBJECTIVE: To provide baseline data on the incidence of ABE and associated pre-admission risk factors in five centers of Nigeria in order to evaluate the effect of subsequent educational interventions on outcome. STUDY DESIGN: The incidence of ABE among newborns treated for hyperbilirubinemia was documented prospectively. Bivariate analysis and multivariate logistic regression were used to evaluate risk factors for acute bilirubin encephalopathy and reasons for regional differences in its occurrence. RESULTS: Of 1040 infants, 159 treated for hyperbilirubinemia (15.3%) had mild to severe bilirubin encephalopathy (including 35 deaths), but the incidence ranged from 7 to 22% between centers. Logistic regression identified four common predictors: total serum bilirubin (odds ratio 1.007 per mg/dl rise), out-of-hospital births (OR 2.6), non-alloimmune hemolytic anemia (OR 2.8), and delayed care seeking (OR 4.3). CONCLUSION: The high occurrence of bilirubin encephalopathy in Nigeria is due in large part to a delay in seeking care. A planned intervention strategy will target conditions leading to severe hyperbilirubinemia and delay.
BACKGROUND: Acute bilirubinencephalopathy (ABE) is an important cause of neonatal morbidity in Nigeria, accounting for 5-14% of neonatal deaths. Most newborns with severe ABE have irreversible damage before receiving treatment emphasizing the need for timely pre-admission monitoring and referral. There is limited evidence that educational interventions targeting mothers and health care providers will reduce delayed care. OBJECTIVE: To provide baseline data on the incidence of ABE and associated pre-admission risk factors in five centers of Nigeria in order to evaluate the effect of subsequent educational interventions on outcome. STUDY DESIGN: The incidence of ABE among newborns treated for hyperbilirubinemia was documented prospectively. Bivariate analysis and multivariate logistic regression were used to evaluate risk factors for acute bilirubinencephalopathy and reasons for regional differences in its occurrence. RESULTS: Of 1040 infants, 159 treated for hyperbilirubinemia (15.3%) had mild to severe bilirubinencephalopathy (including 35 deaths), but the incidence ranged from 7 to 22% between centers. Logistic regression identified four common predictors: total serum bilirubin (odds ratio 1.007 per mg/dl rise), out-of-hospital births (OR 2.6), non-alloimmune hemolytic anemia (OR 2.8), and delayed care seeking (OR 4.3). CONCLUSION: The high occurrence of bilirubinencephalopathy in Nigeria is due in large part to a delay in seeking care. A planned intervention strategy will target conditions leading to severe hyperbilirubinemia and delay.
Authors: Giulia Bortolussi; Xiaoxia Shi; Lysbeth Ten Bloemendaal; Bhaswati Banerjee; Dirk R De Waart; Gabriele Baj; Weiyu Chen; Ronald P Oude Elferink; Ulrich Beuers; Coen C Paulusma; Roland Stocker; Andrés F Muro; Piter J Bosma Journal: Antioxidants (Basel) Date: 2021-12-20