Abstract

Basim A. Alabdely* MBChB, DCH, CABP; Batool J. A. Zalzala MBChB, MPH and Ziad T. A. Al-Rubaie MBChB, MPH, PhDc

ABSTRACT

Background: The current practice of the management of neonatal hyperbilirubinemia varied among doctors in Iraq. There is no national guideline and most of the decision making by doctors depend either on evidence-based practices or on the published criteria of other national guidelines such as the American Academy of Pediatrics (AAP) guidelines for the management of neonatal hyperbilirubinemia. Objectives: The objectives of this study are to estimate the incidence of neonatal hyperbilirubinemia in Al-Fallujah city; to identify the risk factors that can predict severe hyperbilirubinemia in newborns; and to compare the doctors’ practice in management of neonatal hyperbilirubinemia in Al-Fallujah teaching hospital for maternity and childhood with the AAP guidelines for the management of neonatal hyperbilirubinemia. Methods: This was a cross sectional study design. All the newborns admitted to the neonatal unit at Al-Fallujah teaching hospital for maternity and childhood suffering from neonatal hyperbilirubinemia and received phototherapy from 1st January 2017 to 31st December 2017 were included in the study. The data was de-identified. The demographic characteristics and the established risk factors were collected. The outcomes were newborns met AAP criteria for phototherapy, underwent exchange transfusion and met AAP criteria for exchange transfusion. The distribution of demographic characteristics and neonatal factors was presented in number and percentages. The continuous variables were presented as mean and standard deviation (SD) and range. We calculated the incidence of neonatal hyperbilirubinemia. We used univariable and multivariable analyses to estimate the association of the risk factors with each outcome by calculating the odds ratio (OR) and 95% confidence interval (CI). We used kappa statistical test to compare the level of agreement of the current practice in the management of neonatal hyperbilirubinemia with the AAP criteria for phototherapy and exchange transfusion. Results: 426 newborns with neonatal hyperbilirubinemia were included in the study. The incidence of neonatal hyperbilirubinemia was 419 per 10,000 live births and of exchange transfusion was 21 per 10,000 live births. The mean age of newborns at admission was 5.3 days (SD 2.9). Rh and ABO incompatibilities were the main risk factors of severe hyperbilirubinemia that needed exchange transfusion and complementary phototherapy (AOR 16.10, 95% CI 2.52-102.95, AOR 6.02 (0.97-37.24) respectively). Out of 22 newborns underwent exchange transfusion, only 5 newborns (22.7%) did not met the AAP criteria for exchange transfusion with kappa test of 0.87 indicating acceptable level of agreement between the doctors’ decisions and the AAP guidelines criteria for exchange transfusion. Conclusion: Neonatal hyperbilirubinemia is highly incident in Iraq due to unnecessary hospital admissions. The current practice in the management of neonatal hyperbilirubinemia is consistent with the AAP guidelines recommendation for exchange transfusion but not for phototherapy. Newborns with Rh or ABO incompatibilities are at higher risk of severe hyperbilirubinemia and exchange transfusion. Further researches and development are needed.