Neonatal Hyperbilirubinemia

Neonatal Hyperbilirubinemia, Kernicterus, and Subsequent

Neurological Sequelae in Developing Countries

 

Tina M. Slusher, Associate Professor of Pediatrics at the University of Louisville, Louisville, U.S.A. presented the distressing problem of hyperbilirubinemia resulting in kernicterus. This disorder, completely preventable and rarely seen in high income countries, appears to be a major cause of death and developmental disability in low income countries. This was noted more than 20 years ago. (Figure 6.1)

 

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Figures 6.2 and 6.3 detail the diagnosis and outcome for infants admitted to the Kilifi Hospital in Kenya. This data demonstrates the significance of jaundice as a cause of neonatal morbidity and mortality.

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High incidences of severe neonatal hyperbilirubinemia have been reported from
Turkey (Figure 6.4), Nepal (Figure 6.5), Papua New Guinea (Figure 6.6) and from several centres in Nigeria (Figures 6.7, 6.8, 6.9, 6.10, 6.11, 6.12, 6.13, 6.14, 6.15). Many of these reports show severe neonatal hyperbilirubinemia as a likely cause of death and of kernicterus.


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Dr. Slusher discussed the causes of jaundice, suggesting that in some communities G6PD deficiency may play a role (Figure 6.16), whereas in others it is of minor importance (Figure 6.17).

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The sequelae of neonatal jaundice were then discussed (
Figure 6.18). There is evidence from many countries (Nigeria, Turkey, Spain, Zimbabwe and Kenya) that neonatal jaundice is an important cause of developmental disorders (Figures 6.19. 6.20, 6.21, 6.22, 6.23, 6.24).

 

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Dr. Slusher emphasized the impact of neonatal jaundice in low income countries and stated that this serious problem has been grossly underestimated. (
Figure 6.25). This is partially due to a lack of diagnostic and therapy resources (Figures 6.26, 6.27, 6.28) and, presumably, to an under appreciation of the significance of the problem.

 

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Dr. Slusher also presented recommendations for research (
Figures 6.29 and 6.30). 

 

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Dr. Slusher concluded that neonatal jaundice is a major, yet preventable, cause of neonatal deaths and developmental impairment in low income countries.