Well Neonate Due For Discharge In Low Resource Setting Must Be Screened For Significant Hyperbilirubinemia

Introduction: Due to inadequacy of postnatal care in low resource settings, neonates with significant hyperbilirubinemia are likely to be discharged home only to develop complications of hyperbilirubinemia. Objective: To determine the prevalence of significant hyperbilirubinemia among well neonates due for discharged, factors associated with it and performance of transcutaneous bilirubin (TCB) compared to visual inspection in identifying these neonates.Methods: We conducted a cross sectional study involving 235 neonates in the postnatal ward of Mulago Hospital. Relevant data were captured. Neonates with significant hyperbilirubinemia were referred for treatment. Data was entered in to Epi-data version 3.0 then exported to STAT 14.0 software and analyzed. P-value of <0.05 was considered significant with confidence interval of 95%.Results: Thirty two (13.6%) participants had significant hyperbilirubinemia and 3 (1.3%) were above exchange transfusion threshold. Eleven (34.3%) of these neonates had ABO/Rhesus discordancy and eight (25%) had high CRP. Significant hyperbilirubinemia was independently associated with CRP ≥ 10mg/dl (AOR 3.96, CI 1.23-12.73, p 0.021), ABO discordance (AOR 3.67, CI 1.28-10.49, p 0.015), jaundice in previous baby (AOR 3.565, CI 1.10-11.51, p 0.034) and Time of initiation of feeds > 1 hour (AOR 2.74, CI 1.10-6.90, p 0.007). The sensitivity, specificity, positive and negative predictive values of TCB were 96.5%, 84.6%, 47.5% and 99.4% respectively compared to 31.2%, 98.5%, 76.9% and 90% respectively for visual assessment.Conclusions: Well neonates prior to discharge must be screened for significant hyperbilirubinemia preferably using transcutaneous bilirubinometer. Early initiation of feeding should be promoted. Screening for sepsis in neonates with significant hyperbilirubinemia should be emphasized.