Oral

BACKGROUND:
Prolonged unconjugated jaundice (PUJ) is a common problem in infants and defined as a jaundice lasting more than 14 days of life in the full-term and 21 days in preterm infants. Published literature are scarce¹.

OBJECTIVES:
To investigate the etiological profile, predictors and outcome of infants with PUJ

METHODS:
This prospective study was conducted on all infants diagnosed with PUJ during 2018-2019 at a tertiary care referral hospital of Northe India. A detailed history, clinical examination and investigations were performed in all. Enrolled infants were followed till the normalization of clinical jaundice or up to 8 weeks of age, whichever was earlier. Risk factors for PUJ were analysed by comparing with matched controls, selected from concurrent newbos having unconjugated jaundice requiring treatment but improved within 14 days and did not recur. Regression analysis was computed for independent risk factors of PUJ.

RESULTS:
76 infants (mean age 19.7±4.3 days, 57 male) with PUJ and 80 controls (mean age 5.5±2.9 days, 47 male) were analysed. Breast milk jaundice was the most commonly identified cause of PUJ (39.5%) followed by haemolytic conditions (Rh-D and ABO blood group incompatibility in 11.8% and 7.9%), sepsis (11.8%), cephalhematoma (9.2%), hypothyroidism (6.6%), and glucose-6-phosphate dehydrogenase deficiency (1.3%). No cause could be identified in 11.8 % infants. The median duration of jaundice in infants with PUJ was 5 weeks (range: 2-8) and mean bilirubin level of 11.22.2 g/dl. Poor weight gain (OR: 14.8, 95% CI: 3.1-71.2), cephalhematoma (OR: 12.2, 95% CI: 1.2-121.3), ABO and RhD incompatibility [(OR: 4.0, 95% CI: 1.1-13.1) and (OR: 4.4, 95% CI: 1.1-10.4)], Stool frequency <4 times in a day (OR: 7.1, 95% CI: 1.3–39.1) and reticulocytosis (OR: 9.4, 95% CI: 3.2-27.6) were independent predictors of PUJ. At 8 weeks of follow up PUJ disappeared in all infants.

CONCLUSIONS:
Breast milk was the most common cause of PUJ. Outcome of infants with PUJ is excellent. Further studies with a larger patient population and long-term follow-up are needed.

REFERENCE:
1. Gundur NM, Kumar P, Sundaram V, et al. Natural history and predictive risk factors of prolonged unconjugated jaundice in the newbo. Pediatr Int. 2010 Oct;52:769-72.

Table: Logistic regression analysis for prolonged unconjugated jaundice
 

Predictor variables	OR (95% CI)	p-value
Poor weight gain	14.82 (3.09 – 71.19)	0.001
Exclusive breast feeding	2.27 (0.89 to 5.76)	0.085
ABO incompatibility	0.09 (0.03-0.36)	0.097
Rh incompatibility	0.16 (0.04-0.66)	0.012
Stool frequency <4 times/day	7.10 (1.29-39.06)	0.024
Cephalohematoma	12.22 (1.23-121.33)	0.033
Hypothyroidism	10.18 (0.25-407.32)	0.218
Reticulocytosis	9.36 (3.17-27.63)	<0.005