Burden of severe neonatal jaundice: a systematic review and meta-analysis

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Abstract

Context

To assess the global burden of late and/or poor management of severe neonatal jaundice (SNJ), a common problem worldwide, which may result in death or irreversible brain damage with disabilities in survivors. Population-based data establishing the global burden of SNJ has not been previously reported.

Objective

Determine the burden of SNJ in all WHO regions, as defined by clinical jaundice associated with clinical outcomes including acute bilirubin encephalopathy/kernicterus and/or exchange transfusion (ET) and/or jaundice-related death.

Data sources

PubMed, Scopus and other health databases were searched, without language restrictions, from 1990 to 2017 for studies reporting the incidence of SNJ.

Study selection/data extraction

Stratification was performed for WHO regions and results were pooled using random effects model and meta-regression.

Results

Of 416 articles including at least one marker of SNJ, only 21 reported estimates from population-based studies, with 76% (16/21) of them conducted in high-income countries. The African region has the highest incidence of SNJ per 10 000 live births at 667.8 (95% CI 603.4 to 738.5), followed by Southeast Asian, Eastern Mediterranean, Western Pacific, Americas and European regions at 251.3 (132.0 to 473.2), 165.7 (114.6 to 238.9), 9.4 (0.1 to 755.9), 4.4 (1.8 to 10.5) and 3.7 (1.7 to 8.0), respectively. The incidence of ET per 10 000 live births was significantly higher for Africa and Southeast Asian regions at 186.5 (153.2 to 226.8) and 107.1 (102.0 to 112.5) and lower in Eastern Mediterranean (17.8 (5.7 to 54.9)), Americas (0.38 (0.21 to 0.67)), European (0.35 (0.20 to 0.60)) and Western Pacific regions (0.19 (0.12 to 0.31). Only 2 studies provided estimates of clear jaundice-related deaths in infants with significant jaundice [UK (2.8%) and India (30.8%).

Conclusions

Limited but compelling evidence demonstrates that SNJ is associated with a significant health burden especially in low-income and middle-income countries.

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Most cited references 63

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Status of implementation of Framework Convention on Tobacco Control (FCTC) in Ghana: a qualitative study

Ellis Owusu-Dabo, Ann McNeill, Sarah Lewis … (2010)

Background The Framework Convention on Tobacco Control (FCTC), a World Health Organization treaty, has now been ratified by over 165 countries. However there are concerns that implementing the Articles of the treaty may prove difficult, particularly in the developing world. In this study we have used qualitative methods to explore the extent to which the FCTC has been implemented in Ghana, a developing country that was 39th to ratify the FCTC, and identify barriers to effective FCTC implementation in low income countries. Methods Semi-structured interviews with 20 members of the national steering committee for tobacco control in Ghana, the official multi-disciplinary team with responsibility for tobacco control advocacy and policy formulation, were conducted. The Framework method for analysis and NVivo software were used to identify key issues relating to the awareness of the FCTC and the key challenges and achievements in Ghana to date. Results Interviewees had good knowledge of the content of the FCTC, and reported that although Ghana had no explicitly written policy on tobacco control, the Ministry of Health had issued several tobacco control directives before and since ratification. A national tobacco control bill has been drafted but has not been implemented. Challenges identified included the absence of a legal framework for implementing the FCTC, and a lack of adequate resources and prioritisation of tobacco control efforts, leading to slow implementation of the treaty. Conclusion Whilst Ghana has ratified the FCTC, there is an urgent need for action to pass a national tobacco control bill into law to enable it to implement the treaty, sustain tobacco control efforts and prevent Ghana's further involvement in the global tobacco epidemic.

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Incidence and causes of severe neonatal hyperbilirubinemia in Canada.

Douglas Campbell, Michael Sgro, Vibhuti Shah (2006)

Severe hyperbilirubinemia is the most common cause of neonatal readmission to hospital in Canada even though, in the majority of cases, risk factors can be identified before discharge. Severe neonatal hyperbilirubinemia and kernicterus continue to be reported worldwide in otherwise healthy term infants. We conducted this study to estimate the incidence of severe neonatal hyperbilirubinemia in Canada and to determine underlying causes, improved knowledge of which would be valuable to help identify strategies for risk reduction. Data on term infants 60 days of age and younger with unconjugated hyperbilirubinemia were collected prospectively through the Canadian Paediatric Surveillance Program from 2002 to 2004. Infants were included if they had a peak serum total bilirubin level of more than 425 micromol/L or underwent an exchange transfusion. Infants with rhesus iso-immunization or who were born at less than 36 weeks' gestation were excluded. Of 367 cases reported, 258 were confirmed to be severe neonatal hyperbilirubinemia, for an estimated incidence of 1 in 2480 live births. Causes were identified in 93 cases and included ABO incompatibility (n = 48), glucose-6-phosphate dehydrogenase deficiency (n = 20), other antibody incompatibility (n = 12) and hereditary spherocytosis (n = 7). The mean peak bilirubin level reported was 471 micromol/L (standard deviation [SD] 76 micromol/L, range 156-841 micromol/L). Fifty-seven infants (22.1%) underwent an exchange transfusion. A total of 185 infants (71.7%) were readmitted to hospital, 121 (65.4%) of them within 5 days of age. Severe neonatal hyperbilirubinemia continues to occur frequently in Canada. In the majority of cases, the underlying cause was not identified. The high readmission rate within days after initial discharge indicates a need for a more thorough assessment of newborn infants and consideration of strategies to identify at-risk newborns, such as predischarge measurement of serum bilirubin levels.

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Bilirubin toxicity in the developing nervous system.

M. Shapiro (2003)

Bilirubin toxicity remains a significant problem despite recent advances in the care of jaundiced (hyperbilirubinemic) neonates. A recent surge in reported cases of classical kernicterus, due in part to earlier hospital discharge and relaxation of treatment criteria for hyperbilirubinemia, and new reports of hyperbilirubinemia-induced auditory dysfunction using evoked potential based infant testing and hearing screening, underscore the need to better understand how hyperbilirubinemia causes brain damage in some infants, especially because the damage is preventable. Recent progress in understanding bilirubin binding and neurotoxicity resulting from unbound or "free" unconjugated bilirubin, how bilirubin affects the central nervous system in vivo and in vitro, and the use of new clinical tools in neonates, for example magnetic resonance imaging revealing bilateral lesions in globus pallidus and subthalamus, and abnormal brainstem auditory evoked potentials with normal inner ear function, may lead to improved detection and prevention of neurologic dysfunction and damage from bilirubin. Finally, the concern is raised that partial or isolated neurologic sequelae, for example auditory neuropathy and other central auditory processing disorders, may result from excessive amount and duration of exposure to free, unconjugated bilirubin at different stages of neurodevelopment.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Paediatr Open

Journal ID (iso-abbrev): BMJ Paediatr Open

Journal ID (hwp): bmjpo

Journal ID (publisher-id): bmjpo

Title: BMJ Paediatrics Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2399-9772

Publication date Collection: 2017

Publication date (Electronic): 25 November 2017

Volume: 1

Issue: 1

Electronic Location Identifier: e000105

Affiliations

[1 ]departmentDepartment of Pediatrics , University of Minnesota , Minneapolis, Minnesota, USA

[2 ]Hennepin County Medical Center , Minneapolis, Minnesota, USA

[3 ]Texas Tech University Health Science Center , Abilene, Texas, USA

[4 ]departmentBiomedical Library , University of Minnesota , Minneapolis, Minnesota, USA

[5 ]departmentDepartment of Pharmacy , North Dakota State University , Fargo, North Dakota, USA

[6 ]departmentDepartment of Medicine , University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA

[7 ]departmentDepartment of Family Medicine , University of Arizona , Tucson, Arizona, USA

[8 ]departmentDepartment of Pediatrics , Baylor College of Medicine , Houston, Texas, USA

[9 ]Center for Healthy Start Initiative , Lagos, Nigeria

Author notes

[Correspondence to ] Dr Tina M Slusher; tslusher@ 123456umn.edu

Author information

Bolajoko O Olusanya http://orcid.org/0000-0002-3826-0583

Article

Publisher ID: bmjpo-2017-000105

DOI: 10.1136/bmjpo-2017-000105

PMC ID: 5862199

PubMed ID: 29637134

SO-VID: 79cc3fb5-a775-4999-a745-71c549961a94

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date received : 26 May 2017

Date revision received : 25 September 2017

Date accepted : 01 October 2017

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Keywords: neonatology,jaundice

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Keywords: neonatology, jaundice

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Burden of severe neonatal jaundice: a systematic review and meta-analysis

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Abstract

Context

Objective

Data sources

Study selection/data extraction

Results

Conclusions

Related collections

Road 2 Open Meta

Most cited references 63

Status of implementation of Framework Convention on Tobacco Control (FCTC) in Ghana: a qualitative study

Incidence and causes of severe neonatal hyperbilirubinemia in Canada.

Bilirubin toxicity in the developing nervous system.

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Cited by 61

Most referenced authors 2,247