Neonatal hyperbilirubinemia in Eastern India: A comprehensive analysis of risk factors

Background: Neonatal hyperbilirubinemia is a widespread neonatal concern that, if not addressed promptly, may result in irreversible neurological damage. Delayed recognition and intervention remain significant challenges in Eastern India, particularly in resource-limited regions. Aims and Objectives: This study aimed to quantify the burden of neonatal jaundice and delineate its associated risk factors among infants admitted to the special newborn care unit/neonatal intensive care unit at Malda Medical College. Materials and Methods: In this 1-year observational descriptive study, 100 neonates with clinically identified jaundice were enrolled. Data collection involved standardized forms capturing demographic, clinical, and laboratory parameters, including total serum bilirubin (TSB), direct Coombs test, G6PD status, liver function tests, and sepsis evaluations. Univariate and multivariate logistic regression analyses were performed to determine independent predictors of severe hyperbilirubinemia (TSB ≥20 mg/dL). Results: The cohort’s mean gestational age and birth weight were 37.2±2.1 weeks and 2.85±0.52 kg, respectively; 58% were male. Severe hyperbilirubinemia occurred in 40%. Univariate analysis identified sepsis (odds ratios [OR]=8.78; P=0.039) as a significant risk factor; hypoalbuminemia and hypocalcemia showed non-significant trends (ORs=3.93 and 3.68; P=0.081 and 0.096). G6PD deficiency, rhesus incompatibility, positive Coombs test, and acidosis exclusively occurred in severe cases, precluding OR estimation. Multivariate adjustment confirmed sepsis as the strongest predictor (adjusted OR=7.74; P=0.066). Conclusion: Sepsis is the primary driver of extreme bilirubin elevations in this population, with metabolic derangements also contributing. Early infection control, hemolysis screening, and metabolic optimization are vital for preventing severe neonatal jaundice.