Clinical and Aetiological Profile of Neonates and Infants with Conjugated Hyperbilirubinaemia- A Cross-sectional Study

Introduction: Neonatal Conjugated Hyperbilirubinaemia (CHB) poses a significant diagnostic challenge in day to day practice because of its varied aetiologies with non-specific clinical presentations. The rationale of the present study is to better understand the underlying causes, clinical manifestations, and outcomes of CHB in this age group, with the goal of improving early diagnosis, management strategies, and ultimately reducing associated morbidity and mortality.

Aim: To describe the hospital prevalence, clinical and aetiological profile of neonates and infants presenting with CHB.

Materials and Methods: The present cross-sectional study was conducted at Maharana Yeshwantrao Hospital and Sri Aurobindo Institute of Medical sciences, Indore, Madhya Pradesh, India from May 2021 to May 2022. Seventy neonates and infants up to three months of age presenting with CHB, defined as direct bilirubin >1 mg/dL in the presence of elevated total bilirubin, were included in the study. Age at presentation, early (<14 days of life) and late onset (>14 days of life) CHB, clinical findings including syndromic features, were noted, and investigations were done accordingly to find the aetiology. Data was analysed in Microsoft excel sheet and Open Sources Software.

Results: The existing clinical records of 70 neonates were analysed during ongoing admission; the mean age at presentation with CHB was 24.1 days (range 3 to 90 days), and 37 (53%) of the patients had early onset CHB. Male: female ratio was 2.9:1. The clinical features were jaundice in all 70 (100%), pale stools in 21 (30%), failure to thrive in 18 (25%), hepatomegaly in 6 (9%) and liver failure in 8 (11%) neonates. The most common aetiology was sepsis in 24 (34%), followed by blood group incompatibility in 13 (19%), prematurity related factors in 7 (10%), dehydration in 6 (8%) and biliary atresia in 6 (8%) neonates. All patients with CHB due to blood group incompatibilities, dehydration and 13 infants in the sepsis aetiology had early onset disease.

Conclusion: The hospital prevalence of CHB in present study was around 4.6% with almost equal distribution between early and late CHB. Sepsis was the most common aetiology of CHB, with a higher frequency among premature and small-for-gestational-age neonates. This reinforces the importance of early identification and management of infections in at-risk neonates to prevent complications such as cholestasis.