Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia and Neurotoxicity in Neonates from Hilly Terrain of India

BACKGROUND AND AIM: Neonatal hyperbilirubinemia continues to be the most common cause of hospital admissions and readmissions in the neonatal population worldwide and this pattern continues despite attempts to identify neonates at risk of pathological hyperbilirubinemia. Therefore, this study aimed to study the risk factors for severe hyperbilirubinemia in neonates. MATERIALS AND METHODS: An observational prospective study was undertaken for 1 year in neonates with hyperbilirubinemia requiring double volume exchange transfusion in neonatology unit of a tertiary rural health care hospital. RESULTS: Risk factors included ABO incompatibility in 14 (28.5%), Rh incompatibility in 14 (28%). Other risk factors for hyperbilirubinemia were, jaundice in elder sibling, oxytocin use, birth asphyxia, hypothyroidism, ABO along with Rh incompatibility, Glucose-6 phosphate Dehydrogenase deficiency, cephalhematoma, and sepsis in neonates. Ten (20%) neonates were neurologically abnormal with signs of encephalopathy. Significant association of risk factors with neurotoxicity were also found. All neurologically abnormal neonates were small for date and none was appropriate for date (P = 0.05). There were no neurologically abnormal neonates with A+ and O− mothers (P = 0.04). CONCLUSION: The high rate of exchange transfusion warrants aggressive management of neonatal hyperbilirubinemia by health-care providers by adequate dissemination of information, strict following of hour-based normograms, performing total serum bilirubin assessment in all icteric neonates, and stratification into risk groups thereafter.