Assistant Professor Weill Cornell Medicine Ithaca, New York, United States
Background: Extreme hyperbilirubinemia (EHB; Serum bili >25mg/dl) remains a significant cause of neonatal mortality and morbidity in South East Asia and sub-Saharan Africa including Nigeria. While multiple cohort studies provided EHB-related mortality estimates from different parts of the country, there is paucity of data regarding overall countrywide estimates of EHB-related infant mortality rates. Objective: To estimate the burden and assess the trends of infant mortality rate due to EHB (EHB-IMR) in Nigeria from 1990-2019. Design/Methods: We used Global Health Data Exchange tool to access data for annual deaths due to hemolysis and other perinatal jaundice from 1990 to 2019 by age (early: 0-6days, late: 7-27d, post neonatal: >28d-365d) and location in our analysis (https://ghdx.healthdata.org/). Mean estimates are reported with 95% uncertainty intervals (UIs). For annual birth cohorts, we extracted data from United Nations Population Prospects. We present EHB-IMR per 1000 live births and assessed changes in rates of early, late, post neonatal EHB-IMR by mean annual percent change (APC) using Joinpoint regression software version 4.9.1.0 (National Cancer Institute, USA) which accounts for non-linear trends by inflection points and by weighting for the trend segments. Statistical significance was set at p<.05. Results: In Nigeria, there were 87,059 (95% UI: 62,387, 123,971) infant deaths attributable to hemolytic and other perinatal jaundice from 1990-2019. The annual median number of deaths were 2951 (IQR: 2738, 3067) (Figure 1). We observed distinct joinpoint trends in EHB-IMR over the study period characterized by one joinpoint for early neonatal mortality and four joinpoints each for late and post neonatal mortality with different APCs (Figure 2). From 1990-2019, average APC rates for early, late and post neonatal EHB-IMR were -1.6 (95% CI: -2.0, -1.2; p< 0.1), -2.7 (95% CI: -3.1, -2.3; p< 0.1), and -2.8 (95% CI: -7.8, -5.3; p< 0.001), respectively. Overall, EHB-IMR changed from 0.60 (95%CI: 0.43, 0.85) in 1990 to 0.33 (95% CI: 0.24, 0.45) per 1000 live births in 2019, a 46% decrease (Figure 3), despite 45% increase in number of births between 1990-2019. We observed highest reductions during late neonatal period (-57.8%) compared to early neonatal period (-38.8%).
Conclusion(s): EHB is associated with significant fatal and chronic non-fatal sequelae in Nigerian newborns. These data suggest that early identification, parental awareness, timely access and availability of interventions are changing the national trends but should be prioritized to meet the needs of an expanding populace and their expectations.
