Prevalence of Bilirubin Encephalopathy in Calabar, South-South Nigeria: A Five-year Review Study

Document Type : Original Article


1 Department of Pediatrics, University of Calabar, Calabar, Nigeria

2 Department of Pediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria


Background: Bilirubin encephalopathy is a clinical syndrome, associated with bilirubin toxicity in the central nervous system, resulting in chronic and permanent sequelae. It has been estimated that approximately 60% and 80% of term and preterm newborns develop jaundice in the first week of life, respectively. In the present study, we aimed to determine the prevalence, morbidity, and mortality of bilirubin encephalopathy in the neonatal unit of the University of Calabar Teaching Hospital, Calabar, Nigeria.
Methods: In this retrospective, descriptive review, medical records of all newborns, diagnosed with bilirubin encephalopathy over the past five years (from January 2010 to December 2014), were studied. Information retrieved from the medical records included age, sex, presence of fever, duration of disease, place of delivery, causes of the disease, and selected treatments. Variables such as hospital discharge, discharge against medical advice, and mortality were also evaluated.
Results: Out of 2,820 newborns, 21 (0.74%) cases were admitted on account of bilirubin encephalopathy. Among these affected cases, 17 (81%) were male and 4 (19%) were female (male-to-female ratio of 5:1). Based on the findings, 18 newborns (85.7%) had pyrexia, while 8 (38.1%) and 6 (28.6%) cases were hypertonic and hypotonic, respectively upon admission. Only 33.3% of deliveries took place in healthcare facilities. The established factors responsible for jaundice included infection, i.e., septicemia (n=15, 71.4%), ABO incompatibility (n=4, 19.1%), and glucose-6-phosphate-dehydrogenase (G6PD) deficiency (n=2, 9.5%). The mean maximum total bilirubin level in subjects was 321.3 μmol/L (range: 242.5–440.3 μmol/L). Also, mortality was reported in 4 (19%) out of 21 cases.
Conclusion: Based on the findings, neonatal septicemia is associated with bilirubin encephalopathy. Therefore, identification and prompt treatment are of utmost importance in preventing the associated morbidity and mortality.


  1. Rennie J, Burman-Roy S, Murphy MS. Neonatal jaundice: summary of NICE guidance. London: National Institute for Health and Clinical Excellence; 2010.
  2. Slusher TM, Olusaniya BO. Neonatal jaundice in low-and middle-income countries. Care of the jaundiced neonate. New York: McGraw-Hill; 2012. P. 263-73.
  3. Sgro M, Campbell DM, Kandasamy S, Shah V. Incidence of chronic bilirubin encephalopathy in Canada, 2007-2008. Pediatrics. 2012; 130(4):e886-90.
  4. Brooks JC, Fisher-Owens SA, Wu YW, Strauss DJ, Newman TB. Evidence suggests there was not a “resurgence” of kernicterus in the 1990s. Pediatrics. 2011; 127(4):672–9.
  5. Ebbesen F, Andersson C, Verder H, Grytter C, Pedersen-Bjergaard L, Petersen JR, et al. Extreme hyperbilirubinaemia in term and near-term infants in Denmark. Acta Paediatr. 2005; 94(1):59–64.
  6. Owa JA, Ogunlesi TA. Why we are still doing so many exchange blood transfusion for neonatal jaundice in Nigeria. World J Pediatr. 2009; 5(1):51-5.
  7. Manning D, Todd P, Maxwell M, Jane Platt M. Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland. Arch Dis Child Fetal Neonatal Ed. 2007; 92(5):F342–6.
  8. Udo JJ, Anah MU, Ochigbo SO, Etuk IS, Ekanem AD. Neonatal morbidity and mortality in Calabar, Nigeria: a hospital-based study. Niger J Clin Pract. 2008; 11(3):285-9.
  9. Ogunlesi TA, Dedeke IO, Adekanmi AF, Fetuga MB, Ogunfowora OB. The incidence and outcome of bilirubin encephalopathy in Nigeria: a bi-centre study. Niger J Med. 2007; 16(4):354-9.

10. Christensen RD, Lambert DK, Henry E, Eggert LD, Yaish HM, Reading NS, et al. Unexplained extreme hyperbilirubinemia among neonates in a multihospital healthcare system. Blood Cells Mol Dis. 2013; 50(2):105–9.

11. Johnson L, Bhutani VK, Karp K, Sivieri EM, Shapiro SM. Clinical report from the pilot USA Kernicterus Registry (1992 to 2004). J Perinatol. 2009; 29(Suppl 1):S25-45.

12. Gamaleldin R, Iskander I, Seoud I, Aboraya H, Aravkin A, Sampson PD, et al. Risk factors for neurotoxicity in newborns with severe neonatal hyperbilirubinemia. Pediatrics. 2011; 128(4):e925-31.

13. Chan GJ, Lee AC, Baqui AH, Tan J, Black RE. Prevalence of early-onset neonatal infection among newborns of mothers with bacterial infection or colonization: a systematic review and meta-analysis. BMC Infect Dis. 2015; 15:118.

14. Onyearugha CN, Onyire BN, Ugboma HA. Neonatal jaundice: prevalence and associated factors as seen in Federal Medical Centre Abakaliki, Southeast Nigeria. J Clin Med Res. 2011; 3(3):40-5.

15. Owa JA, Taiwo O, Adebiyi JA, Dogunduro SA. Neonatal Jaundice at Wesley Guild hospital Ilesa and Ife state hospital, Ile-Ife. Nig J Paediatr. 1989; 16:23-30.

16. Israel-Aina YT, Omoigberale AI. Risk factors for neonatal jaundice in babies presenting at the university of benin teaching hospital, Benin City. Niger J Paediatr. 2012; 39(4):159-63.

17. Kuzniewicz MW, Wickremasinghe AC, Wu YW, McCulloch CE, Walsh EM, Wi S, et al. Incidence, etiology and outcomes of hazardous hyperbilirubinaemia in Newborns. Pediatrics. 2014; 134(3):504-9.

18. Ogunlesi TA, Abdul AR. Maternal knowledge and care-seeking behavior for newborn jaundice in Sagamu, Southwest Nigeria. Niger J Clin Pract. 2015; 18(1):33-40.

19. Maimburg RD, Bech BH, Bjerre JV, Olsen J, Møller-Madsen B. Obstetric outcome in Danish children with validated diagnosis of kernicterus. Acta Obstet Gynecol Scand. 2009; 88(9):1011-6.

20. Hansen TW, Nietsch L, Norman E, Bjerre JV, Hascoet JM, Mreihil K, et al. Reversibility of acute intermediate phase bilirubin encephalopathy. Acta Paediatr. 2009; 98(10):1689-94.