Frequency of Neonatal Jaundice in Polycythemic Infants Admitted to the Intensive Care Unit: A Cross-Sectional Study
DOI:
https://doi.org/10.52206/jsmc.2025.15.4.1037Abstract
Background: Neonatal jaundice, characterized by yellow discoloration of the skin and sclera due to bilirubin deposition, remains one of the most common neonatal problems. Polycythemia in neonates increases red blood cell mass, leading to accelerated breakdown and hyperbilirubinemia, which can progress to severe complications such as kernicterus.
Objective: To determine the frequency of neonatal jaundice among polycythemic infants admitted to the neonatal intensive care unit (NICU).
Methodology: A cross-sectional study was conducted at the Department of Pediatrics, Hayatabad Medical Complex, Peshawar, from July 2020 to January 2021. A non-probability consecutive sampling technique was used, and a total of 167 neonates were enrolled based on WHO sample size calculation. Inclusion criteria were neonates less than one month old, gestational age between 31–40 weeks, weight 1500–4600 g, and diagnosed with polycythemia. Neonates with blood disorders, syndromic features, or jaundice developing after three weeks were excluded. Data were collected through structured questionnaires, clinical assessment, and laboratory investigations. Analysis was done using SPSS v20.
Results: Among 167 neonates, 108 (65.7%) were male and 59 (35.3%) female, with a mean age of 14.5 ± 7.22 days. Neonatal jaundice was present in 78 (46.7%) infants, and 45 (26.9%) developed kernicterus. Jaundice was significantly associated with male gender, neonatal age <15 days, high hemoglobin levels (>22 g/dL), elevated serum bilirubin, obstetric complications, birth asphyxia, and cephalohematoma (p < 0.05), but not with gestational age.
Conclusion: Nearly half of the polycythemic neonates admitted to the NICU developed jaundice, with a considerable proportion progressing to kernicterus. Male gender, higher hemoglobin concentration, and perinatal complications emerged as major risk factors. These findings highlight the importance of early screening and timely intervention in polycythemic infants to prevent severe neurological outcomes.
Keywords: Bilirubin, Birth asphyxia, Kernicterus, Neonatal jaundice, Polycythemia.
References
Johnston M, Ravindran RR. Jaundice. Surgery (Oxford). 2023 Jun 1;41(6):334-41. https://doi.org/10.1016/j.mpsur.2023.02.019
Slusher TM, Angyo IA, Bode-Thomas F, Akor F, Pam SD, Adetunji AA, et al. Transcutaneous bilirubin measurements and serum total bilirubin levels in indigenous African infants. Pediatrics. 2004;113(6):1636-41. https://doi.org/10.1542/peds.113.6.1636.
Hansen TW. The epidemiology of neonatal jaundice. Pediatr Med. 2021;5(18):18. https://doi.org/10.21037/pm-21-4.
Obeagu EI, Katya MC. A systematic review on physiological jaundice: diagnosis and management of the affected neonates. Madonna Univ J Med Health Sci. 2022 Sep 26;2(3):25-41.
Owaymir ADA, Aseeri RMA, Albariqi MAA, Alalyani MS, Almansaf JAA, Albalwi ABK, et al. An overview on diagnosis and management of neonatal jaundice. Arch Pharm Pract. 2021;12(2):99-102. https://doi.org/10.51847/1TWl2LWtPn.
Kamal AN, Hassan AF. Comparative study of liver function and Rh blood group between physiological and pathological neonatal jaundice. Iraqi J Pharm Sci. 2021 Jun 15;30(1):101-9. https://doi.org/10.31351/vol30iss1pp101-109.
Liu Y, Sun X, Wang Y, Xing C, Li L, Zhou S. Evaluation of associated markers of neonatal pathological jaundice due to bacterial infection. Iran J Public Health. 2021 Feb;50(2):333-40. https://doi.org/10.18502/ijph.v50i2.5394
Alkén J, Håkansson S, Ekéus C, Gustafson P, Norman M. Rates of Extreme Neonatal Hyperbilirubinemia and Kernicterus in Children and Adherence to National Guidelines for Screening, Diagnosis, and Treatment in Sweden. JAMA Netw Open. 2019;2(3):e190858. https://doi.org/10.1001/jamanetworkopen.2019.0858
Bashir BA, Othman SA. Neonatal polycythaemia. Sudan J Paediatr. 2019;19(2):81-83. https://doi.org/10.24911/SJP.106-1566075225.
Barros TM, Gavilanes ER, Barros JM. Polycythemia in the newborn: Prevalence and associated factors. Rev Cubana Pediatr. 2021;1:1-6. https://doi.org/10.52011/0090
Mostefa AM. A Study of Prevalence and Risk Factors of Polycythemia in Neonatal Nursery in Duhok. Methodology. 2015.
Chaudhari AR, Phalak AM, Chauhan PG, Goriya AN, Prajapati BS. Neonatal polycythemia: incidence and associated factors. International Journal of Contemporary Pediatrics. 2023 Feb;10(2):168–73. https://doi.org/10.18203/2349-3291.ijcp20230115
Al-Zahiri J, Kumar A, Nair A, Watts T. Prevalence of neonatal polycythemia and an assessment of its related risk factors. J Pediatr Rev. 2022;10(4):297-304. https://doi.org/10.32598/jpr.10.4.1053.1.
Barros TM, Gavilanes ER, Barros JM. Polycythemia in the newborn: Prevalence and associated factors. Rev Cubana Pediatr. 2021;1:1-6. https://doi.org/10.52011/0090
Asefa GG, Gebrewahid TG, Nuguse H, Gebremichael MW, Birhane M, Zereabruk K, et al. Determinants of neonatal jaundice among neonates admitted to neonatal intensive care unit in public general hospitals of Central Zone, Tigray, Northern Ethiopia, 2019: a case-control study. Biomed Res Int. 2020;2020:4743974. https://doi.org/10.1155/2020/4743974.
Bizuneh AD, Alemnew B, Getie A, Wondmieneh A, Gedefaw G. Determinants of neonatal jaundice among neonates admitted to five referral hospitals in Amhara region, Northern Ethiopia: an unmatched case-control study. BMJ Paediatr Open. 2020;4(1). https://doi.org/10.1136/bmjpo-2020-000830
Tavakolizadeh R, Izadi A, Seirafi G, Khedmat L, Mojtahedi SY. Maternal risk factors for neonatal jaundice: a hospital-based cross-sectional study in Tehran. Eur J Transl Myol. 2018 Jul 10;28(3):7618. https://doi.org/10.4081/ejtm.2018.7618.
Awang H, Ja'afar SM, Ishak NA, Dollah Z. Determinants of neonatal jaundice among newborns in Pasir Puteh district, Kelantan. International Journal of Public Health and Clinical Sciences. 2020 Jan 3;6(6):109-22.
Kassa RT, Gudeta H, Assen ZM. Neonatal hyperbilirubinemia: magnitude and associated etiologic factors among neonates admitted at Tikur Anbessa Specialized Hospital, Ethiopia. J Pregnancy Child Health. 2018;5:1000384. https://doi.org/10.4172/2376-127X.1000384.
Devi DS, Vijaykumar B. Risk factors for neonatal hyperbilirubinemia: a case-control study. Int J Reprod Contracept Obstet Gynecol. 2017;6:198-202. https://doi.org/10.18203/2320-1770.ijrcog20164657.
Kolawole SE, Obueh HO, Okandeji Barry OR. Prevalence of neonatal jaundice in Eku Baptist community hospital in Delta State, Nigeria. J Public Health Epidemiol. 2016;8:87-90. https://doi.org/10.5897/JPHE2015.0779.
Omekwe DE, Duke GM, Kennis BT. Survey and management outcome of neonatal jaundice from a developing tertiary health centre, Southern Nigeria. IOSR J Dent Med Sci. 2014;13:35-9. https://doi.org/10.9790/0853-13413539.
Rai S, Sood M, Kaur A. Is perinatal asphyxia associated with an increase in serum bilirubin in neonates? A case-control study. J Family Med Prim Care. 2022 Jul 1;11(7):3840-3. https://doi.org/10.4103/jfmpc.jfmpc_1018_21
Liawat FH, Andriyanti A, Utomo B. The association between asphyxia and neonatal pathological jaundice incidence in Umbu Rara Meha Hospital, East Sumba Regency. Blantika Multidiscip J. 2024 Jun 25;2(8). https://doi.org/10.57096/blantika.v2i8.188.
Imoudu IA, Yusuf MO, Aro AT, Akpabio PE, Waziri ZM. Severe perinatal asphyxia and risk of neonatal jaundice at a tertiary hospital in Northern Nigeria. Asian J Pediatr Res. 2021 Mar 23;5(3):17-22. https://doi.org/10.9734/ajpr/2021/v5i330176.
Boskabadi H, Sezavar M, Zakerihamidi M. Evaluation of neonatal jaundice based on the severity of hyperbilirubinemia. J Clin Neonatol. 2020 Jan-Mar;9(1):46-51. https://doi.org/10.4103/jcn.JCN_81_19
2Zeleke BA, Ersado TL, Hanjelo HW, Zeleke GA. Determinants of neonatal jaundice among neonates admitted to neonatal intensive care unit in hospitals of Gurage zone, Southern Ethiopia. BMC pediatrics. 2025 May 28;25(1):427. https://doi.org/10.1186/s12887-025-05772-9
Selvam S, Taksande A. Risk factors of hyperbilirubinemia—a case-control study in a tertiary level hospital in rural central India. Journal of Evolution of Medical and Dental Sciences. 2021;10(25):1904–9. https://doi.org/10.14260/jemds/2021/395
Asaye S, Bekele M, Getachew A, Fufa D, Adugna T, Tadese E. Hyperbilirubinemia and associated factors among neonates admitted to neonatal care unit in Jimma Medical Center. https://doi.org/10.21203/rs.3.rs-1805402/v1
Warsame HA, Theuri C, Abdullahi NM, Keynan AM, Ahmed MA. Prevalence and risk factors for neonatal jaundice: a multicentre analytical cross-sectional study at neonatal intensive care units, Mogadishu, Somalia. BMJ open. 2025 Mar 1;15(3). https://doi.org/10.1136/bmjopen-2024-096692
Sisay BD, Abebe RF, Kassie AA, Wondimu MG, Kassie GA. Determinants of neonatal jaundice among neonates admitted to neonatal intensive care unit in public hospitals of Sidama Region, Sidama, Ethiopia, 2022: an unmatched case-control study. Pan African Medical Journal. 2023;45(1):33. https://doi.org/10.11604/pamj.2023.45.33.39373
Abiti H, Dedefo A, Lemma L. Prevalence and associated factors of hyperbilirubinemia among neonates admitted to neonatal intensive care unit of Saint Peter Specialized Hospital, Addis Ababa, Ethiopia. Science. 2023;11(3):56-63. https://doi.org/10.11648/j.sjph.20231103.12
Adugna A, Ado D. Determinants of jaundice among neonates admitted to neonatal intensive care unit of Mizan Tepi University Teaching Hospital, Southwest Ethiopia, 2021: unmatched case control study. Global Pediatric Health. 2023 Dec;10: https://doi.org/10.1177/2333794X231218193
Dahat A, Turkhede J, Korde S. Etiological profile of neonatal hyperbilirubinemia in neonates in nicu at tertiary care centre in india–a cross-sectional study. Int j acad med pharm. 2025;7(3):540-4. https://doi.org/10.47009/jamp.2025.7.3.101
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 The authors retain the copyrights. Authors are permitted and encouraged to post their work online (e.g. in institutional repositories or on their website), as it can lead to productive exchanges, as well as greater citation of published work.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
