Prevalence, Natural History and Risk Factors of Neonatal Prolonged Icterus of Newborns in a Preventive Setting in Flanders.

Abstract

Background

Prolonged jaundice is a symptom that requires further investigation. Early diagnosis of severe underlying causes can prevent harm and improve outcomes. Currently, there are no known data on the prevalence, risk factors, outcomes, and prognosis of children with prolonged jaundice in Flanders. This study aimed to provide more information on the natural history, prevalence and risk factors of prolonged icterus in order to optimize newborn screening.

Methods

We reviewed the records of 65497 newborns who consulted Kind & Gezin, a preventive public health service in Flanders. Neonates from the Brussels-Capital region and one with an error in gestational age were excluded. Jaundice was assessed visually by care providers. Prolonged jaundice was defined as jaundice persisting beyond the fourteenth day of life. Stool colour was assessed using a stool colour card.

Results

On day 15, 21.1% of the children were found to have jaundice, with a progressively decreasing frequency thereafter. A significant association was found between prolonged jaundice and male sex (p<0.001), prematurity (p<0.001), breastfeeding (p<0.001), maternal country of origin (p<0.001), lower socioeconomic status (p<0.001), and the province of residence (p<0.001). Logistic regression revealed a significant effect of gender, prematurity, breastfeeding at 2 weeks, and socioeconomic status on prolonged jaundice (p<0.001).

Conclusions

Prolonged jaundice in neonates born in Flanders is prevalent and is mainly linked to established risk factors for neonatal jaundice. However, only 5.4% of the variance in prolonged jaundice could be explained by the studied variables. Therefore, population screening is recommended regardless of the presence of underlying characteristics.