Neonatal Conjugated Hyperbilirubinemia: Clinical Profile, Etiology, and Predictors of Adverse Outcomes in a NICU of a Tertiary Care Center

Background and objectives: Neonatal conjugated hyperbilirubinemia is a pathological condition reflecting cholestasis and hepatobiliary dysfunction, associated with significant morbidity and mortality if not detected early. Early recognition is critical, especially for surgically correctable or treatable causes such as biliary atresia and inherited metabolic liver diseases. Limited region-specific data exist from Northern India. This study aimed to characterize the clinical and biochemical profile, delineate the etiological spectrum, and identify predictors of adverse outcomes among neonates admitted to a tertiary care neonatal intensive care unit (NICU). Methodology: A prospective observational study was conducted over one year in the NICU of King George’s Medical University (KGMU), Lucknow. Neonates with conjugated hyperbilirubinemia (direct bilirubin >1 mg/dL if total bilirubin ≤5 mg/dL or >20% if total bilirubin >5 mg/dL) were consecutively enrolled. Clinical, laboratory, microbiological, and imaging evaluations were performed. Outcomes were classified as good (discharged) or adverse (expired/leave against medical advice), and multivariate logistic regression identified independent predictors of poor prognosis. Results: Seventy neonates were enrolled. Sepsis was the predominant etiology (41.4%), followed by intestinal pathology (27.1%). Multisystem involvement was frequent, with respiratory distress (91.4%), hepatomegaly (60%), encephalopathy (52.9%), and lactic acidosis (60%). Overall mortality was 50%, with 31.4% discharged. Adverse outcomes were significantly associated with elevated bilirubin, coagulopathy, hypoalbuminemia, and anemia. Independent predictors included neonatal acute liver failure (adjusted OR (aOR): 5.40; 95% CI: 2.10-11.20; p=0.0001), multiple organ dysfunction (aOR: 4.2; 95% CI:1.67-10.58; p= 0.003), metabolic disorders (aOR: 3.1; 95% CI:1.14-8.42; p=0.027), intestinal pathology (aOR:2.9; 95% CI:1.21-6.87; p=0.015), culture-positive sepsis (aOR: 2.6; 95% CI:1.14-5.98; p=0.02 ), and prolonged total parenteral nutrition (aOR: 2.3; 95% CI: 1.01-5.12; p=0.047 ). Conclusion: Neonatal conjugated hyperbilirubinemia in this tertiary NICU cohort was predominantly driven by sepsis and intestinal pathology, with high mortality. Early, structured evaluation and targeted management of high-risk neonates may improve outcomes.