Biliruhn-related mortality and morbidity in nigerian neonates

T. M. Slusher, H. J. Vreman, D. W. McLaren, C. W. Clardy, D. K. Stevenson

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Blood carboxyhemoglobin (COHb) is an index of the rate of bilirubin production. In addition elevated COHb has been shown to correlate with bilirubin related morbidity and mortality in Nigerian infants with neonatal jaundice. To determine the natural course of jaundice in Nigerian infants and to compare these infants to infants admitted with neonatal jaundice, we followed 213 infants admitted to Eku Baptist Mission hospital in Nigeria. Data are presented as mean ± SD (range). Of these 141 were enrolled in the study on days 1-3 of life. In this group the peak serum total bilirubin (STB) was 10.1±6.7 mg/dl (1.5-43.2). Forty-four percent of the infants had a peak STB of <10mg/dl. Peak STB occurred on day 4.2±2 (2-10). Two percent had clinical kernicterus, 8% had exchange blood transfusion (EBT) indicated, and 3% died. G6PO deficiency, determined by G6PD screen, was detected in 20% and in these infants 81% had a STB of <10 mg/dl. An additional 59 infants were admitted at <3 days of age with neonatal jaundice. The average maximum STB was 24.9±12.1 mg/dl (7.3-54.0). As expected, the incidence of clinical kernicterus (54%), need for EBT (56%), and death (19%) was much higher in this older group. The incidence of G6PD deficiency was slightly higher 31% (n=47). The maximum STB correlated with COHb (R=0.64, p<0.01). Furthermore, COHb correlated strongly (p<0.01) with: 1) the incidence of clinical kernicterus; 2) the need for EBT; and 3) death. These data confirm that an elevated COHb in the context of jaundice is strongly associated with morbidity and mortality in Nigerian infants.

Original languageEnglish (US)
JournalJournal of Investigative Medicine
Issue number1
StatePublished - Jan 1 1996


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