Supra-treatment threshold neonatal jaundice: Incidence in HIV-exposed compared to non-exposed neonates at Queen Elizabeth Central Hospital in Blantyre, Malawi|
Nakanga, W.; Patel, P.; Panjwani, S.; Kennedy, N. & Kawaza, K.
Jaundice is the yellowish pigmentation of the skin, sclera, and mucous
membranes resulting from bilirubin deposition. Children born to mothers
with HIV are more likely to be born premature, with low birth weight, and
to become septic—all risk factors for neonatal jaundice. Further, there
has been a change in the prevention of mother-to-child transmission
(PMTCT) of HIV guidelines from single-dose nevirapine to a six-week
course, all of which theoretically put HIV-exposed newborns at greater
risk of developing neonatal jaundice.
We carried out a study to determine the incidence of severe and clinical
neonatal jaundice in HIV-exposed neonates admitted to the Chatinkha
Nursery (CN) neonatal unit at Queen Elizabeth Central Hospital (QECH)
Over a period of four weeks, the incidence among non-exposed neonates
was also determined for comparison between the two groups of infants.
Clinical jaundice was defined as transcutaneous bilirubin levels greater
than 5 mg/dL and severe jaundice as bilirubin levels above the age-specific
treatment threshold according the QECH guidelines. Case notes of babies
admitted were retrieved and information on birth date, gestational age,
birth weight, HIV status of mother, type of feeding, mode of delivery,
VDRL status of mother, serum bilirubin, duration of stay in CN, and
outcome were extracted.
Of the 149 neonates who were recruited, 17 (11.4%) were HIV-exposed.
One (5.88%) of the 17 HIV-exposed and 19 (14.4%) of 132 HIVnon-
exposed infants developed severe jaundice requiring therapeutic
intervention (p = 0.378). Eight (47%) of the HIV-exposed and 107 (81%)
of the non-exposed neonates had clinical jaundice of bilirubin levels
greater than 5 mg/dL (p < 0.001).
The study showed a significant difference in the incidence of clinical
jaundice between the HIV-exposed and HIV-non-exposed neonates.
Contrary to our hypothesis, however, the incidence was greater in HIVnon-
exposed than in HIV-exposed infants.