Skip to main content

Infants at risk of significant hyperbilirubinemia in poorly-resourced countries: evidence from a scoping review

Abstract

Background

Neonatal hyperbilirubinemia is frequently associated with disproportionately high rates of bilirubin-induced mortality and long-term morbidities in low- and middle-income countries (LMICs). This scoping review aimed to identify possible etiological/risk factors for clinically significant hyperbilirubinemia in LMICs so as to guide intervention and future research priorities.

Data sources

We systematically searched PubMed, Scopus, Excerpt Medica Database, Cumulative Index to Nursing and Allied Health Literature, WHO Library Database, African Index Medicus, African Journals Online, Latin American and Caribbean Health Sciences Literature, and Indian Medical Journals for reports published between January 1990 and August 2014 in LMICs with per capita income of ≤US$ 6000. We included studies on the etiology of neonatal hyperbilirubinemia or hyperbilirubinemia as significant morbidity for relevant maternal, perinatal and neonatal disorders without restriction on study design.

Results

A total of 131 studies were identified in 23 LMICs from different regions of the world. The factors most frequently associated with neonatal hyperbilirubinemia (in approximately 10% of all studies) were ABO and Rhesus incompatibilities, diabetes mellitus, glucose-6-phosphate dehydrogenase deficiency, prematurity/low birth weight, infection, birth trauma, and drug-induced labor. The role of exclusive breast-feeding and genetic factors was sparsely explored.

Conclusions

Several maternal, perinatal and neonatal factors are associated with neonatal hyperbilirubinemia in LMICs. Improved research efforts and strategies to address these factors are warranted to curtail the disease burden in these countries.

This is a preview of subscription content, access via your institution.

References

  1. Stevenson DK, Dennery PA, Hintz SR. Understanding newborn jaundice. J Perinatol 2001;21 Suppl 1:S21–S24; discussion S35-S39.

    Article  PubMed  Google Scholar 

  2. National Institute for Health and Clinical Excellence. Neonatal jaundice (Clinical guideline 98). 2010. www.nice.org.uk/CG98 (accessed September 3, 2014).

  3. Lazarus C, Avchen RN. Neonatal hyperbilirubinemia management: a model for change. J Perinatol 2009;29 Suppl 1:S58–S60.

    Article  PubMed  Google Scholar 

  4. Olusanya BO, Ogunlesi TA, Slusher TM. Why is kernicterus still a major cause of death and disability in low-income and middleincome countries? Arch Dis Child 2014;99:1117–1121.

    Article  PubMed  Google Scholar 

  5. Ip S, Chung M, Kulig J, O’Brien R, Sege R, Glicken S, et al. An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics 2004;114:e130–e153.

    Article  PubMed  Google Scholar 

  6. Bhutani VK, Zipursky A, Blencowe H, Khanna R, Sgro M, Ebbesen F, et al. Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatr Res 2013;74 Suppl 1:86–100.

    PubMed Central  Article  PubMed  Google Scholar 

  7. Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, et al. Every Newborn: progress, priorities, and potential beyond survival. Lancet 2014;384:189–205.

    Article  PubMed  Google Scholar 

  8. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific allcause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;385:117–171.

    Article  Google Scholar 

  9. Olusanya BO. State of the world’s children: life beyond survival. Arch Dis Child 2005;90:317–318.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  10. Blencowe H, Vos T, Lee AC, Philips R, Lozano R, Alvarado MR, et al. Estimates of neonatal morbidities and disabilities at regional and global levels for 2010: introduction, methods overview, and relevant findings from the Global Burden of Disease study. Pediatr Res 2013;74 Suppl 1:4–16.

    PubMed Central  Article  PubMed  Google Scholar 

  11. Shiffman J. Issue attention in global health: the case of newborn survival. Lancet 2010;375:2045–2049.

    Article  PubMed  Google Scholar 

  12. Lavis J, Davies H, Oxman A, Denis JL, Golden-Biddle K, Ferlie E. Towards systematic reviews that inform health care management and policy-making. J Health Serv Res Policy 2005;10 Suppl 1:35–48.

    Article  PubMed  Google Scholar 

  13. Mwaniki MK, Atieno M, Lawn JE, Newton CR. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet 2012;379:445–452.

    PubMed Central  Article  PubMed  Google Scholar 

  14. Olusanya BO, Osibanjo FB, Slusher TM. Risk factors for severe hyperbilirubinemia in low and middle-income countries: a systematic review and meta-analysis. PLoS ONE 2015;10:e0117229.

    PubMed Central  Article  PubMed  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement. PLoS Med 2009;6:e1000097.

    PubMed Central  Article  PubMed  Google Scholar 

  16. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114:297–316.

    Article  Google Scholar 

  17. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Psychiatry Res Methodol 2005;8:19–32.

    Article  Google Scholar 

  18. Colquhoun HL, Levac D, O’Brien KK, Straus S, Tricco AC, Perrier L, et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol 2014;67:1291–1294.

    Article  PubMed  Google Scholar 

  19. Gough D, Thomas J, Oliver S. Clarifying differences between review designs and methods. Syst Rev 2012;1:28.

    PubMed Central  Article  PubMed  Google Scholar 

  20. Seale AC, Blencowe H, Zaidi A, Ganatra H, Syed S, Engmann C, et al. Neonatal severe bacterial infection impairment estimates in South Asia, sub-Saharan Africa, and Latin America for 2010. Pediatr Res 2013;74 Suppl 1:73–85.

    PubMed Central  Article  PubMed  Google Scholar 

  21. Watchko JF, Jeffrey Maisels M. Enduring controversies in the management of hyperbilirubinemia in preterm neonates. Semin Fetal Neonatal Med 2010;15:136–140.

    Article  PubMed  Google Scholar 

  22. Blencowe H, Lee AC, Cousens S, Bahalim A, Narwal R, Zhong N, et al. Preterm birth-associated neurodevelopmental impairment estimates at regional and global levels for 2010. Pediatr Res 2013;74 Suppl 1:17–34.

    PubMed Central  Article  PubMed  Google Scholar 

  23. Howes RE, Piel FB, Patil AP, Nyangiri OA, Gething PW, Dewi M, et al. G6PD defi ciency prevalence and estimates of affected populations in malaria endemic countries: a geostatistical modelbased map. PLoS Med 2012;9:e1001339.

    Article  Google Scholar 

  24. Nkhoma ET, Poole C, Vannappagari V, Hall SA, Beutler E. The global prevalence of glucose-6-phosphate dehydrogenase defi ciency: a systematic review and meta-analysis. Blood Cells Mol Dis 2009;42:267–278.

    CAS  Article  PubMed  Google Scholar 

  25. Olusanya BO, Emokpae AA, Zamora TG, Slusher TM. Severe neonatal hyperbilirubinaemia in low and middle-income countries with significant G6PD-deficiency. Acta Paediatr 2014;103:1102–1109.

    CAS  Article  PubMed  Google Scholar 

  26. Kaplan M, Slusher T, Renbaum P, Essiet DF, Pam S, Levy-Lahad E, et al. (TA)n UDP-glucuronosyltransferase 1A1 promoter polymorphism in Nigerian neonates. Pediatr Res 2008;63:109–111.

    CAS  Article  PubMed  Google Scholar 

  27. Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007–08. Lancet 2010;375:490–499.

    Article  PubMed  Google Scholar 

  28. Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, et al. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet 2006;367:1819–1829.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Bolajoko O. Olusanya.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Olusanya, B.O., Slusher, T.M. Infants at risk of significant hyperbilirubinemia in poorly-resourced countries: evidence from a scoping review. World J Pediatr 11, 293–299 (2015). https://doi.org/10.1007/s12519-015-0037-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-015-0037-z

Keywords

  • bilirubin-encephalopathy
  • developing countries
  • kernicterus
  • perinatal outcomes
  • risk factors