Factors associated with the incidence of acute bilirubin encephalopathy in Nigerian population

Acute bilirubin encephalopathy (ABE) is still a major and common health problem in developing countries in spite of the availability and efficacy of phototherapy and exchange blood transfusion. In developing countries, the prevalence of kernicterus has not shown any reduction because many babies with jaundice present very late in well established kernicterus. The study was done to determine the factors responsible for the late presentation of neonatal jaundice and development of ABE among the patients presenting with this condition in our health facility. All newborns presenting with ABE at the special care baby unit of the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria were prospectively studied. The diagnosis of ABE was made clinically if there were neurologic abnormalities associated with hyperbilirubinemia. Twenty-eight (3.2%) of 882 babies admitted over 3 yr had ABE. There were 21 males, 7 females, and the male: female ratio 3: 1. Twenty-two (78.6%) of the mothers saw at least one health worker more than 24 hr before presentation. Three (10.4%) other mothers who noticed the jaundice did not initiate any treatment while the remaining three (10.4%) mothers did not notice the jaundice in their babies until they presented at the health facility with the complaint of failure to suck. Prescribed medications before presentation were oral antibiotics, hematinics and gentamicin injections, a solution of Naphthalene balls in water and an extract of local herbs made from Pawpaw leaves. Causes of jaundice were septicemia, G6PD deficiency, ABO incompatibility, low birth weight and rhesus isoimmunization in decreasing order of frequency. Maternal factors include low socioeconomic status, teenage and low parity statuses of the mothers. Inappropriate treatment of neonatal jaundice by health workers was also one of the underlying reasons. Therefore, there is need to raise the level of 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.