Maternal and Neonatal Factors Associated with the Incidence of Acute Bilirubin Encephalopathy in Nigerian Population

Background: Acute bilirubin encephalopathy (ABE) is still a common cause of morbidity and mortality in developing countries despite the availability, and efficacy of phototherapy and exchange blood transfusion. The prevalence of kernicterus has not shown any significant reduction in low and middle-income countries (LMICs) because many neonates with jaundice present very late with overt features of ABE. Objective: The study was done to determine maternal and neonatal factors associated with ABE and factors responsible for the late presentation of neonatal jaundice among the patients presenting with this condition in our health facility. Methods: All newborns presenting with ABE at the special care baby unit of Sacred Heart Hospital, Abeokuta, Nigeria were prospectively studied over 3 years. ABE was diagnosed clinically based on a bilirubin-induced neurologic dysfunction score of ≥1. Results: One hundred and seventy-eight neonates with hyperbilirubinaemia of whom sixty-three (35.4%) had ABE were studied. Forty-two (56.7%) of the 63 babies with ABE were male, and the male-to-female ratio 2:1. Forty-eight (76.2%) of babies who had ABE at presentation were (outborns), while 15 (23.8%) were inborns. Eight (12.7%) of the inborn babies with ABE were readmitted following early discharge before 36 hours of life and 3 (4.8%) initially discharged against medical advice while the 4 (6.3%) were on admission before they developed ABE. Twenty –six (41.3%) of the mothers saw at least one health worker more than 24 hours before presentation. Leading causes of jaundice were septicaemia, G-6-PD and deficiency. while maternal factors associated with ABE were low socio-economic status and teenage deliveries. Multivariate analysis showed that outside delivery and weight < 2.5 kg were the only predictors of ABE in this cohort of neonates. Conclusion: The identified factors of ABE are modifiable, there is a need to increase the awareness in the community of the occurrence and dangers of neonatal jaundice and its appropriate treatment. Health workers themselves need education and training in the early recognition and treatment of neonatal jaundice. Key words: Acute bilirubin encephalopathy, kernicterus, late presentation, maternal factors, preventive measures, Nigeria