Co esponding au ho : Sa a Abdelmoneim Ali Gasmelseed
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
P e alen causes and ou comes o unconjuga ed hype bili ubinemia in neona es
Sa a Abdelmoneim Ali Gasmelseed 1, *, Ome Saeed Magzoub 2 and Mohammed Awad Alka im Ahmed Aled esi 3
1 Senio Pedia ic Residen , Sudan Medical Specializa ion Boa d, Kha oum, Sudan.
2 Specialis Gene al Pedia ic, Ain Al-Khaleej Hospi al, UAE.
3 Assis an P o esso o Pedia ics and Child Heal h, Facul y o Medicine, Alzaeem Alazha i Uni e si y, Sudan.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1465-1473
Publica ion his o y: Recei ed on 10 July 2025; e ised on 17 Augus 2025; accep ed on 19 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2964
Abs ac
Backg ound: Ea ly de ec ion and p omp managemen o neona al jaundice a e c i ical in educing neona al mo bidi y
and mo ali y. E ec i e ea men s a egies include close moni o ing, pho o he apy, exchange ans usion, and
add essing unde lying causes. This s udy aimed o iden i y he p e alen causes o unconjuga ed hype bili ubinemia in
neona es and o assess hei immedia e clinical ou comes.
Me hodology: This p ospec i e hospi al-based s udy was conduc ed a Ahmed Gasim Teaching Hospi al om Janua y
o June 2022. A o al o 103 neona es who me he inclusion c i e ia we e en olled. Da a we e analyzed using SPSS
e sion 26.
Resul s: The s udy included 103 neona es, wi h a mean age o 7.6 ± 4.8 days ( ange: 1–28 days); 56 (54.4%) we e male.
The mean ges a ional age was 38.5 ± 1.9 weeks, wi h 91 (88.3%) being ull- e m and 12 (11.7%) being p e e m. The
mean age a onse o jaundice was 3.05 ± 1.8 days ( ange: 1–10 days). Mean o al bili ubin was 14.4 ± 13.9 mg/dL, and
mean di ec bili ubin was 0.97 ± 0.60 mg/dL. The mos common causes o unconjuga ed jaundice we e sepsis (86,
83.5%), ABO incompa ibili y (25, 24.3%), dehyd a ion (14, 13.6%), and Rh incompa ibili y (13, 12.6%). T ea men s
included pho o he apy (72, 69.9%), medica ions (68, 66.0%), conse a i e managemen (32, 31.1%), and exchange
ans usion (7, 6.8%). Mos neona es (91, 88.3%) we e discha ged in good condi ion, while 12 (11.7%) we e discha ged
agains medical ad ice. No cases o ke nic e us o mo ali y we e epo ed.
Conclusion: Sepsis and ABO incompa ibili y we e he leading causes o neona al unconjuga ed hype bili ubinemia.
Mos neona es esponded well o ea men and we e discha ged in good condi ion.
Keywo ds: Causes; Ou comes; Unconjuga ed Hype bili ubinemia; Neona es
1. In oduc ion
Neona al jaundice is a common clinical sign in newbo ns, cha ac e ized by yellow discolo a ion o he skin and scle ae
due o ele a ed se um bili ubin le els. This condi ion e lec s he accumula ion o bili ubin in issues, including he skin
and mucous memb anes. De ec ion can be challenging in in an s wi h da ke skin ones, making examina ion o he
scle ae a c ucial aspec o clinical assessmen [1].
Neona al jaundice is a global heal h conce n due o i s signi ican con ibu ion o neona al mo bidi y and mo ali y.
App oxima ely 60% o e m in an s and 80% o p e e m in an s de elop jaundice wi hin he i s week o li e, and up o
10% o b eas ed in an s may emain jaundiced o as long as one mon h. I accoun s o nea ly 70% o neona al
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mo bidi y and 10% o neona al mo ali y, wi h a subs an ial bu den obse ed in Sou h Asia and sub-Saha an A ica—
egions whe e app oxima ely 75% o neona al dea hs due o jaundice- ela ed complica ions occu [2].
Physiological jaundice is he mos common ype, esul ing om imma u e li e unc ion and ele a ed le els o
unconjuga ed bili ubin. In con as , pa hological jaundice is associa ed wi h condi ions ha ei he inc ease bili ubin
p oduc ion o impai i s exc e ion. Majo isk ac o s o neona al unconjuga ed jaundice include p ema u i y and
neona al sepsis [3]. O he causes o neona al bili ubinemia include b eas eeding o b eas milk- ela ed jaundice,
pe ina al in ec ions, and hemoly ic jaundice. The p e alence o hese causes a ies ac oss di e en popula ions and
egions. Hemoly ic jaundice is u he subdi ided in o Rh ac o incompa ibili y, ABO blood g oup incompa ibili y, and
jaundice due o glucose-6-phospha e dehyd ogenase (G6PD) de iciency [1,4].
Se e e unconjuga ed hype bili ubinemia—de ined as a o al se um bili ubin (TSB) le el exceeding 20 mg/dL (342.1
μmol/L)—a ec s less han 2% o e m in an s bu signi ican ly inc eases he isk o ke nic e us. Ke nic e us, a ch onic
o m o bili ubin encephalopa hy, esul s in pe manen neu ode elopmen al disabili ies. Due o i s hyd ophobic na u e,
bili ubin can c oss he blood-b ain ba ie , leading o bili ubin-induced neu ological dys unc ion (BIND). The se e i y
o BIND anges om mild language p ocessing delays o se e e encephalopa hy, ke nic e us, and e en dea h. Globally,
app oxima ely 24 million neona es a e a isk o complica ions om unconjuga ed hype bili ubinemia each yea .
Despi e being p e en able wi h imely in e en ion, he condi ion causes an es ima ed 114,000 in an dea hs annually
and lea es mo e han 63,000 child en wi h pe manen neu ological impai men [5,6].
Gi en i s po en ially se e e, li e- h ea ening consequences—pa icula ly in ol ing he ne ous sys em—neona al
hype bili ubinemia demands ho ough in es iga ion. This s udy aims o explo e he p e alen causes and sho - e m
ou comes o neona al jaundice among in an s admi ed o Ahmed Gasim Specialized Hospi al o Child en in Kha oum,
Sudan, be ween Janua y 2022 and June 2022. Speci ically, he s udy seeks o iden i y he common causes o neona al
unconjuga ed jaundice a his acili y and assess he sho - e m clinical ou comes among he a ec ed neona es.
2. Me hodology and ma e ials
A p ospec i e hospi al-based s udy was conduc ed om Janua y 2022 o June 2022 a Ahmed Gasim Teaching Hospi al
o Child en in Kha oum S a e, Sudan. This hospi al se es as a majo seconda y-le el e e al cen e o pedia ic ca e
and includes an in ensi e ca e uni wi h 7 beds, a high-dependency uni wi h 8 beds, and 7 long-s ay wa ds o aling 110
beds.
The s udy ocused on neona es aged ≤28 days who we e admi ed wi h ei he conjuga ed o unconjuga ed jaundice. A
o al o 103 pa icipan s we e en olled. Inclusion c i e ia included neona es diagnosed wi h jaundice whose ca egi e s
p o ided in o med consen . Neona es whose ca egi e s declined pa icipa ion we e excluded.
2.1. Sample Size
A con enience sampling me hod was used, and he inal sample size was 103 neona es.
2.2. Va iables
Dependen Va iable: Neona al unconjuga ed hype bili ubinemia
Independen Va iables: Demog aphic cha ac e is ics (age, ges a ional age, gende , esidence), admission de ails, causes
o jaundice, ea men me hods, and clinical ou comes
2.3. Da a Collec ion and Technique
Da a we e collec ed using a s uc u ed ques ionnai e adminis e ed h ough di ec in e iews wi h ca egi e s and
supplemen ed by in o ma ion ex ac ed om medical eco ds.
2.4. Da a Analysis and P esen a ion
Collec ed da a we e en e ed in o Mic oso Excel and analyzed using SPSS e sion 26. Desc ip i e s a is ics we e used:
con inuous a iables we e exp essed as mean ± s anda d de ia ion (SD), while ca ego ical a iables we e p esen ed as
equencies and pe cen ages [n (%)]. Resul s we e displayed using uni a ia e and bi a ia e ables (c oss- abula ions),
pie cha s, and his og ams. The Chi-squa e es was used o de e mine associa ions be ween a iables, wi h s a is ical
signi icance se a p < 0.05.
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2.5. E hical Clea ance
E hical app o al was ob ained om he Minis y o Heal h in Kha oum, Sudan, he hospi al’s adminis a i e au ho i y,
and ele an ins i u ional e hical commi ees. W i en in o med consen was ob ained om all ca egi e s. Anonymi y
and da a con iden iali y we e main ained h ough he use o coded se ial numbe s.
3. Resul s
103 neona es me he inclusion c i e ia and we e included in he s udy. Da a analysis was pe o med using SPSS e sion
26, and he ollowing indings we e ob ained:
3.1. Demog aphic and Clinical Cha ac e is ics
The mean age o he pa ien s was 7.6 ± 4.8 days, wi h a ange o 1 o 28 days. Mos neona es (n = 82, 63.1%) we e 7 days
old o younge , while 48 (35.9%) we e olde han 7 days. O he neona es, 56 (54.4%) we e male, and 47 (45.6%) we e
emale. The mean ges a ional age was 38.5 ± 1.9 weeks, wi h he majo i y being ull- e m (n = 91, 88.3%) and he
emainde p e e m (n = 12, 11.7%). A amily his o y o neona al jaundice was epo ed in 21 cases (20.4%) [Table 1].
The mos common ma e nal illness was in ec ion du ing p egnancy, a ec ing 25 cases (24.3%). O he ma e nal
condi ions included p ema u e up u e o memb anes (PROM) in 6 cases (5.8%), home aginal deli e y in 5 cases
(4.9%), and p eeclampsia in 3 cases (2.9%) [Table 2].
3.2. Clinical Fea u es and Causes o Jaundice
The mean age a onse o jaundice was 3.05 ± 1.8 days ( ange: 1–10 days). Mos cases (n = 49, 47.6%) de eloped jaundice
be ween days 2 and 3 o li e, while 34 cases (33%) de eloped jaundice a e day 3 [Table 3]. The mean bi h weigh was
2.8 ± 0.7 kg ( ange: 1–6 kg). A majo i y (n = 78, 75.7%) had a bi h weigh be ween 2.5 and 4 kg, and 23 (22.3%) weighed
less han 2.5 kg [Table 4].
Mo o e lex was p esen in 100 neona es (97.1%) and absen in 3 (2.9%) [Figu e 5]. Abdominal examina ion e ealed
abno mali ies in 8 neona es (7.8%); among hese, 5 (62.5%) had abdominal dis ension, and 3 (37.5%) had
hepa omegaly. Only one pa ien (1%) had an abno mal head examina ion, speci ically, cephalohema oma [Table 5].
3.3. Labo a o y Findings
The labo a o y esul s showed he ollowing mean alues: hemoglobin 14.3 ± 2.5 g/dL, o al whi e blood cell coun 12.3
± 4.5 × 10⁹/L, ed blood cell coun 4.33 ± 0.52 × 10¹²/L, mean co puscula olume 92.5 ± 15.5 L, pla ele coun 247.8 ±
99.8 × 10⁹/L, and e iculocy e coun 3.94 ± 2.6%. The mean o al bili ubin le el was 14.4 ± 13.9 mg/dL, and he mean
di ec bili ubin le el was 0.97 ± 0.60 mg/dL. The mean C- eac i e p o ein (CRP) le el was 23.93 mg/L [Table 6].
The mos common blood g oup was O+ (n = 52, 50.5%), ollowed by A+ (n = 29, 28.2%), B+ (n = 16, 15.5%), and AB+ (n
= 4, 3.9%) [Table 7]. The mos equen cause o unconjuga ed hype bili ubinemia was sepsis, p esen in 86 cases
(83.5%). O he causes included ABO incompa ibili y (n = 25, 24.3%), dehyd a ion (n = 14, 13.6%), and Rh
incompa ibili y (n = 13, 12.6%) [Table 8].
3.4. T ea men and Ou comes
The mean du a ion o hospi al admission was 4.67 ± 4.6 days ( ange: 1–24 days). Mos neona es (n = 48, 46.6%) we e
admi ed o ewe han 7 days, while 46 (44.7%) s ayed o 7 o 14 days [Table 9].
T ea men modali ies included pho o he apy (n = 72, 69.9%), medica ions (n = 68, 66.0%), conse a i e he apy (n =
32, 31.1%), and exchange ans usion (n = 7, 6.8%) [Table 10].
Rega ding ou comes, 91 neona es (88.3%) we e discha ged in good condi ion, while 12 (11.7%) we e discha ged
agains medical ad ice. No cases o ke nic e us o mo ali y we e epo ed [Table 11].
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Table 1 Demog aphic and Clinical Cha ac e is ics o neona es wi h unconjuga ed hype bili ubinemia
Pa ame e
Value
Mean Age (days)
7.6 ± 4.8 ( ange: 1–28 days)
Age Dis ibu ion
- Aged 7 days o younge
82 (63.1%)
- Olde han 7 days
48 (35.9%)
Sex Dis ibu ion
- Male
56 (54.4%)
- Female
47 (45.6%)
Mean Ges a ional Age (weeks)
38.5 ± 1.9
Ges a ional Age
- Full- e m
91 (88.3%)
- P e e m
12 (11.7%)
Family His o y o Jaundice
21 (20.4%)
Table 2 Ma e nal illness o neona es wi h unconjuga ed hype bili ubinemia
Ma e nal illness
F equency
Pe cen
In ec ion (du ing p egnancy)
25
24.3
PROM
6
5.8
NVD a home
5
4.9
p eeclampsia
3
2.9
Umbilical co d a ound baby's neck
3
2.9
Non
61
59.2
To al
103
100.0
Table 3 Day o jaundice onse among neona es wi h unconjuga ed hype bili ubinemia
Day o Jaundice Onse Mean ±SD (3.05±1.8 days)
F equency
Pe cen
1 day
20
19.4
2-3 days
49
47.6
>3 days
34
33.0
To al
103
100.0
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Table 4 Bi h weigh among neona es wi h unconjuga ed hype bili ubinemia
Bi h weigh
F equency
Pe cen
<2.5kg
23
22.3
2.5-4kg
78
75.7
>4kg
2
1.9
To al
103
100.0
Table 5 Clinical signs among neona es wi h unconjuga ed hype bili ubinemia
Clinical signs
Abdominal examina ion
F equency
Pe cen
No mal
95
92.2
Abno mal
8
7.8
To al
103
100.0
Abno mali y
Hepa omegaly
3
37.5
Abdominal dis ension
5
62.5
To al
8
100.0
Head examina ion
F equency
Pe cen
No mal
102
99.0
Abno mal (Cephalohema oma)
1
1.0
To al
103
100.0
Table 6 Hema ological pa ame e among neona es wi h unconjuga ed hype bili ubinemia
Hema ological pa ame e
Mean ±SD
Range
Hb g/dl
14.3±2.5
8-20
TWBCs
12.3±4.5
3-26
RBCs
4.33±0.52
2.8-5.5
MCV
92.5±15.5
8.6-116
Pla ele s
247.8±99.8
49-539
Re ics coun
3.94±2.6
1-14
CRP
23.93±13.3
0.4-200
To al bili ubin
14.4±13.9
1.9-42
Di ec bili ubin
0.97±0.60
0.1-15.7
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Table 7 Blood g oups o neona es wi h unconjuga ed hype bili ubinemia
Blood g oup
F equency
Pe cen
O posi i e
52
50.5
A posi i e
29
28.2
B Posi i e
16
15.5
AB posi i e
4
3.9
O nega i e
1
1.0
B nega i e
1
1.0
To al
103
100.0
Table 8 Causes o jaundice among neona es wi h unconjuga ed hype bili ubinemia
Causes o jaundice
F equency
Pe cen
Sepsis
86
83.5
ABO incompa ibili y
25
24.3
Dehyd a ion
14
13.6
Rhesus incompa ibili y
13
12.6
B uising
0
0.0
O he hemoly ic diso de
0
0.0
Polycy hemia
0
0.0
B eas milk
0
0.0
Unde e mined
7
6.8
No e: some pa ien s had mo e han one cause, and he equency exceeded he o al numbe o pa ien s.
Table 9 Admission du a ion among neona es wi h unconjuga ed hype bili ubinemia
Du a ion o admission
F equency
Pe cen
<7days
48
46.6
7-14 days
46
44.7
15-21days
7
6.8
>21 days
2
1.9
To al
103
100.0
Table 10 Unconjuga ed hype bili ubinemia ea men modali ies
T ea men
F equency
Pe cen
Pho o he apy
72
69.9
D ugs
68
66.0
Conse a i e
32
31.1
Exchange ans usion
7
6.8
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Table 11 Sho - e m ou come o neona es wi h unconjuga ed hype bili ubinemia
Ou come
F equency
Pe cen
Discha ge in good condi ion
91
88.3
Discha ge agains medical ad ice
12
11.7
Complica ed (ke nic e us)
0
0.0
Died
0
0.0
To al
103
100.0
4. Discussion
This s udy included 103 neona es who me all inclusion c i e ia. The sociodemog aphic cha ac e is ics e ealed ha 56
(54.4%) we e male, esul ing in a male- o- emale a io o app oxima ely 1.1:1. This inding aligns wi h s udies by Abd
Elmok ade e al. [7], Abbas SH e al. in I aq [8], and o he s, which also epo ed a male p edominance. This sugges s
ha male neona es may be mo e suscep ible o signi ican jaundice, al hough some s udies ha e epo ed di e ing
esul s.
The mean age a onse o jaundice was 3.05 ± 1.8 days, anging om 1 o 10 days. Mos cases (81.6%, n = 84) occu ed
be o e he i h day o li e, while 18.4% (n = 19) appea ed be ween he i h and en h days. These indings a e consis en
wi h Abbas SH e al. [8], who no ed ha mos neona es we e admi ed a ≥3 days o li e, and wi h Akgül e al. [9], who
epo ed a mean admission age o 4.4 ± 2.4 days. This iming may be explained by he physiological ise in bili ubin
le els ypically occu ing a e he i s 72 hou s o li e.
The mean ges a ional age was 38.5 ± 1.9 weeks, wi h 88.3% (n = 91) o neona es being ull- e m and 11.7% (n = 12)
p e e m. These esul s a e simila o hose o Ase a GG e al. [10], who ound ha 68.1% o hei pa ien s we e e m, and
Abbas SH e al. [8], who epo ed a p edominance o ull- e m neona es. In con as , Kali a D. e al. [11] epo ed a highe
p opo ion o p e e m neona es (51.8%). The mean bi h weigh was 2.8 ± 0.7 kg; 75.7% o neona es weighed be ween
2.5 and 4 kg, while 22.3% weighed less han 2.5 kg. These indings align wi h an Egyp ian s udy epo ing a mean bi h
weigh o 2.94 ± 0.39 kg. Ase a GG e al. [10], howe e , ound ha only 25% o jaundiced neona es had low bi h weigh .
Te m neona es wi h low bi h weigh o low ges a ional age emain a inc eased isk o jaundice and should be
moni o ed closely be o e discha ge.
Rega ding he e iology o jaundice, neona al sepsis was he mos common cause, a ec ing 83.5% (n = 86) o cases,
ollowed by ABO incompa ibili y (24.3%, n = 25), dehyd a ion (13.6%, n = 14), and Rh incompa ibili y (12.6%, n = 13).
These indings a e consis en wi h s udies om Egyp and o he egions [7]. Howe e , s udies by I shad e al. [12] and
Kali a D e al. [11] epo ed lowe a es o ABO incompa ibili y, likely due o di e ences in sample size and popula ion
cha ac e is ics. Some cases had unde e mined causes, po en ially due o me abolic o gene ic condi ions no ou inely
es ed a he s udy acili y.
The mean o al bili ubin le el was 14.4 ± 13.9 mg/dL, and he mean di ec bili ubin le el was 0.97 ± 0.60 mg/dL. These
esul s align wi h da a om I aq and Akgül e al. [9], who epo ed simila bili ubin p o iles. O he s udies, such as Ase a
GG e al. [10], obse ed sligh ly highe mean bili ubin le els. Va ia ions may be a ibu ed o di e ences in unde lying
e iologies, he iming o p esen a ion, and access o ea ly ea men .
Pho o he apy and exchange ans usion we e he p ima y ea men modali ies o neona al hype bili ubinemia.
T ea men h esholds a y ac oss s udies and se ings. In his s udy, 69.9% (n = 72) o neona es ecei ed pho o he apy,
66.0% (n = 68) we e ea ed wi h medica ions, 31.1% (n = 32) ecei ed conse a i e he apy, and 6.8% (n = 7)
unde wen exchange ans usion. These indings di e sligh ly om Egyp ian s udies and ha o Haq I e al. [13], whe e
pho o he apy was uni e sally he i s -line ea men and exchange ans usion a es a ied based on jaundice se e i y.
In e ms o ou comes, 88.3% (n = 91) o pa ien s we e discha ged in good condi ion, while 11.7% (n = 12) we e
discha ged agains medical ad ice. No ably, no dea hs we e eco ded du ing he s udy pe iod. This con as s wi h
s udies such as ha o Tsao PC e al., which epo ed a ke nic e us p e alence o 0.86% [14]. Globally, ke nic e us-
ela ed mo ali y declined signi ican ly be ween 1990 and 2019, wi h 2.8 million dea hs eco ded du ing his ime. By
2019, mo ali y a es we e as low as 4 pe million li e bi hs in high-income coun ies (HICs) compa ed o 293 pe
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million in low-income coun ies (LICs), wi h 82% o dea hs occu ing in LICs and lowe -middle-income coun ies.
Annual mo ali y declined by 6.2% in HICs and 3.0% in LICs [15].
4.1. S udy Limi a ions
This s udy was limi ed by a ela i ely small sample size and da a being es ic ed o a single hospi al, which may limi
he gene alizabili y o he indings.
5. Conclusion
The s udy ound ha mos neona es we e male, wi h a mean age a he onse o jaundice being 3.05 ± 1.8 days ( ange 1-
10 days). Sepsis eme ged as he mos common cause o neona al jaundice, ollowed by ABO incompa ibili y,
dehyd a ion, and hesus incompa ibili y. The a e age du a ion o hospi al admission was 4.67 ± 4.6 days. Mos neona es
ecei ed pho o he apy, wi h some also ea ed wi h medica ions, conse a i e he apy, o exchange ans usion. Mos
pa ien s we e discha ged in good condi ion, and he e we e no epo ed complica ions.
Recommenda ions
Ma e ni y hospi als should sc een all newbo ns o hype bili ubinemia be o e discha ge and schedule ollow-up
appoin men s. Ea ly b eas eeding and lac a ion suppo should be encou aged. Pa en s need o be educa ed on
jaundice and he impo ance o imely ollow-up. An i-D immunoglobulin should be adminis e ed o Rh-nega i e
mo he s, and e o s should ocus on p e en ing an ena al sepsis and ensu ing imely ea men o ea ly in ec ions.
Compliance wi h e hical s anda ds
Acknowledgmen s
The esea che s independen ly unded his s udy.
Disclosu e o con lic o in e es
The au ho s decla e ha hey ha e no con lic s o in e es .
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
Re e ences
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