title: Neurological and developmental outcome of neonatal jaundice and sepsis in rural Kenya.
abstract: Neonatal jaundice (NJ) and sepsis are common causes of neonatal mortality in sub-Saharan Africa, but little is known about the long-term morbidity in this setting. This study aimed to describe the neurological and developmental sequelae of severe neonatal hyperbilirubinaemia and neonatal sepsis (NS) in a district hospital in rural Kenya. Twenty-three term infants with NJ [total serum bilirubin (TSB) >300 mumol/l] and 24 infants with a history of NS were identified from hospital records. These children were compared to 40 children from the community (CC) without neonatal problems. At ages 18-32 months, the children's neurological, motor and developmental status were assessed, and blood groups of the NJ and NS subjects and their mothers were determined. Ten (43%) of the NJ subjects were unable to sit and/or stand independently. The NJ subjects had significantly more neurological, motor and developmental difficulties and caused greater maternal concern than the CCs. Five (21%) of the NJ subjects had possible blood group incompatibility. The NS subjects had significantly more motor and eye-hand difficulties and maternal concerns expressed than the CCs. Severe NJ in term infants (of mainly non-haemolytic origin) was associated with a high prevalence of neurological and developmental sequelae at ages 18-32 months. The NS is also associated with neuro-developmental sequelae, but the pattern is different to those seen in NJ. Since NS is common in resource poor countries, this may be an important cause of neuro-developmental impairment in children living in this setting.
authors.affiliation: Centre for Geographic Medicine Research--Coast, KEMRI/Wellcome Trust Research Laboratories, Kilifi, Kenya. gordonanne@yahoo.co.uk
authors.forename: Anne L
authors.initials: AL
authors.lastname: Gordon
authors.forename: Michael
authors.initials: M
authors.lastname: English
authors.forename: J
authors.initials: J
authors.lastname: Tumaini Dzombo
authors.forename: Mary
authors.initials: M
authors.lastname: Karisa
authors.forename: Charles R J C
authors.initials: CR
authors.lastname: Newton
mesh_terms: D001925:Brain Damage, Chronic / Q000209:etiology; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000209:etiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000150:complications*; D007630:Kenya; D009043:Motor Activity / Q000502:physiology; D009422:Nervous System Diseases / Q000209:etiology*; D009483:Neuropsychological Tests; D011379:Prognosis; D011596:Psychomotor Disorders / Q000209:etiology; D012423:Rural Health; D018805:Sepsis / Q000150:complications*; D012959:Socioeconomic Factors