Incidence, aetiology and short term outcomes of extreme hyperbilirubinaemia, in term infants born in the West Metro area of Cape Town, South Africa between 2019 and 2020
Introduction: Extreme levels of bilirubin in the newborn is a major cause of lifelong neurodevelopmental impairment, which places a financial burden on healthcare resources and caregivers. Objective: To determine the incidence, aetiology and short term outcomes of extreme hyperbilirubinaemia in term infants born in a resource-limited setting. Methods: This is a retrospective observational study looking at term neonates with a birth weight ≥ 2500g, born in the Western health subdistrict of Cape Town, South Africa, between 1 January 2019 and 31 December 2020, who were exposed to a serum bilirubin level of ≥ 430 μmol/L in the first week of life and received care in the public health system. Results: Extreme hyperbilirubinaemia occurred in 59 term infants. The incidence was 74 cases per 100 000 (<0.01%) live births equating to 1 case in every 1345 live births. The cause of hyperbilirubinaemia was identified in 51 of the cases (86%), the most common being ABO incompatibility (31/51, 61%), followed by glucose-6-phosphate dehydrogenase deficiency (11/51, 22%). Twelve infants (20 %) underwent an exchange transfusion. Six infants were encephalopathic. Forty-seven infants (80%) were readmitted after initial post-natal discharge, with a mean age of readmission of 113 hours old (SD 31 hours). Conclusion: The incidence of extreme hyperbilirubinaemia in the Western health subdistrict of Cape Town is higher than in high-income settings. Further work should focus on training of healthcare workers and education of caregivers, for the early detection of significant hyperbilirubinaemia to prevent neurological complications caused by bilirubin toxicity.
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Department of Paediatrics and Child Health