title: Supra-treatment threshold neonatal jaundice: Incidence in HIV-exposed compared to non-exposed neonates at Queen Elizabeth Central Hospital in Blantyre, Malawi.
abstract: BACKGROUND
  Jaundice is the yellowish pigmentation of the skin, sclera, and mucous membranes resulting from bilirubin deposition. Children born to mothers with HIV are more likely to be born premature, with low birth weight, and to become septic-all risk factors for neonatal jaundice. Further, there has been a change in the prevention of mother-to-child transmission (PMTCT) of HIV guidelines from single-dose nevirapine to a six-week course, all of which theoretically put HIV-exposed newborns at greater risk of developing neonatal jaundice.
  
  
  OBJECTIVE
  We carried out a study to determine the incidence of severe and clinical neonatal jaundice in HIV-exposed neonates admitted to the Chatinkha Nursery (CN) neonatal unit at Queen Elizabeth Central Hospital (QECH) in Blantyre.
  
  
  METHODS
  Over a period of four weeks, the incidence among non-exposed neonates was also determined for comparison between the two groups of infants. Clinical jaundice was defined as transcutaneous bilirubin levels greater than 5 mg/dL and severe jaundice as bilirubin levels above the age-specific treatment threshold according the QECH guidelines. Case notes of babies admitted were retrieved and information on birth date, gestational age, birth weight, HIV status of mother, type of feeding, mode of delivery, VDRL status of mother, serum bilirubin, duration of stay in CN, and outcome were extracted.
  
  
  RESULTS
  Of the 149 neonates who were recruited, 17 (11.4%) were HIV-exposed. One (5.88%) of the 17 HIV-exposed and 19 (14.4%) of 132 HIV-non-exposed infants developed severe jaundice requiring therapeutic intervention (p = 0.378). Eight (47%) of the HIV-exposed and 107 (81%) of the non-exposed neonates had clinical jaundice of bilirubin levels greater than 5 mg/dL (p < 0.001).
  
  
  CONCLUSIONS
  The study showed a significant difference in the incidence of clinical jaundice between the HIV-exposed and HIV-non-exposed neonates. Contrary to our hypothesis, however, the incidence was greater in HIV-non-exposed than in HIV-exposed infants.
authors.affiliation: Department of Paediatrics & Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: W
authors.initials: W
authors.lastname: Nakanga
authors.affiliation: Department of Paediatrics & Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Paediatrics & Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: S
authors.initials: S
authors.lastname: Panjwani
authors.affiliation: Department of Paediatrics & Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: N
authors.initials: N
authors.lastname: Kennedy
authors.affiliation: Department of Paediatrics & Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: K
authors.initials: K
authors.lastname: Kawaza
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D001942:Breast Feeding; D015897:Comorbidity; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D007567:Jaundice, Neonatal / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008295:Malawi / Q000453:epidemiology; D008297:Male; D019829:Nevirapine / Q000627:therapeutic use; D010789:Phototherapy; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine; D001663:Bilirubin