Magnitude of Neonatal Jaundice and Its Associated Factor

Research ArticleMagnitude of Neonatal Jaundice and ItsAssociated Factor in Neonatal Intensive CareUnits of Mekelle City Public Hospitals Northern Ethiopia

Eyasu A Lake 1 Gerezgiher B Abera2 Gedion A Azeze 1

Natnaeal A Gebeyew1 and BirhanuW Demissie1

1College of Health Sciences and Medicine Wolaita Sodo University Sodo Ethiopia2College of Health Sciences Mekelle University Mekelle Ethiopia

Correspondence should be addressed to Eyasu A Lake eyasmsc208gmailcom

Received 10 December 2018 Revised 10 February 2019 Accepted 17 March 2019 Published 10 April 2019

Academic Editor Samuel Menahem

Copyright copy 2019 Eyasu A Lake et al This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Background Jaundice in the neonate is one of the most common clinical problems Globally every year about 11 million babiesdevelop it and the vast majority reside in sub-Saharan Africa and South Asia Study on magnitude and local factors associated withneonatal jaundice is limited in Ethiopia So this study was aimed at assessingmagnitude and predictors of neonatal jaundice amongneonates admitted to neonatal intensive care unit of public hospitals in Mekelle city Northern EthiopiaMethods Institution basedcross-sectional study was conducted from February to April 2016 in neonatal intensive care unit of Mekelle city public hospitalsSystematic random sampling technique was used to select study participants Data was collected by interviewing mothers throughstructured questionnaire and reviewing neonatesrsquo medical records using checklistMultivariable binary logistic regression analyseswere employed to identify factors associated with neonatal jaundice Results A total of 209 neonates with their mothers wereincluded The proportion of neonatal jaundice was found to be 373 Prolonged labor [AOR = 439 95 CI (18-1069)] beingmale [AOR = 37 95 CI (154-887)] maternal ldquoOrdquo blood group [AOR = 505 95 CI (153-1672)] sepsis [AOR = 264 95 CI(115-605)] and blood type incompatibility [AOR = 1821 95 CI (636-5213)] were positively associated with neonatal jaundicewhile night time delivery [AOR 042 95 CI (018-096)] showed negative association Conclusion The magnitude of neonataljaundice among neonates was found to be high Duration of labor time of delivery sexes of neonate sepsis maternal blood groupand blood type incompatibility were significantly associatedwith neonatal jaundiceTherefore improving newborn care and timelyintervention for neonates with ABORh incompatibility are recommended

1 Background

Neonatal jaundice is yellowish discoloration of the skinsclera and mucous membranes due to accumulation ofunconjugated nonpolar lipid-soluble bilirubin pigment inthe skin [1 2] Jaundice in the new born is the most commonclinical problem that requires close attention [3] evaluationand treatment as it is the most common cause of neonatalreadmission during neonatal period [4 5] It is among thoseeasily preventable and treatable clinical conditions despite thefact that letting it in advance can lead to irreversible clinicalproblem that ends up with neonatal mortality

Neonatal jaundice has a significant importance in neona-tal morbidity and mortality world-wide [6ndash8] It occurs inup to 60 [9] of term and 80 [3] of preterm newborns inthe first week of life About 10 of breast-fed babies are stillsuffering from neonatal jaundice during the first months oftheir life [4] It is also accountable for 70neonatalmorbidityand 10 mortality [6 10] About 75 of neonatal mortalitybecause of jaundice complication occurred in South Asia andsub-Saharan Africa [8]

In Ethiopia neonatal mortality and morbidity are amongthe highest in the world on which more than one-third ofchildhood death occurs within the first 28 days of age [11]

HindawiInternational Journal of PediatricsVolume 2019 Article ID 1054943 9 pageshttpsdoiorg10115520191054943

2 International Journal of Pediatrics

As studies revealed the incidence etiology and risk factorsof neonatal jaundice vary according to ethnicity economicstatus and geographical differences of countries [12] Butthere is limited data on themagnitude of neonatal jaundice inEthiopia So this study was aimed at assessing the magnitudeof neonatal jaundice and its determinants in Mekelle cityNorthern Ethiopia

2 Methods and Materials

21 Study Design and Setting An institution based cross-sectional study was conducted to assess the magnitude ofneonatal jaundice and its associated factors at neonatalintensive care unit of Mekelle city public hospitals fromFebruary to April 2016 Mekelle is located 783kms northof Addis Ababa with a latitude and longitude of 13∘291015840N39∘281015840E coordinates Based on the 2007 Census conductedby the Central Statistical Agency of Ethiopia (CSA) the totalpopulation projection value of 2016 at Mekelle city is 340858of whom 168261 are females [13]

Mekelle city has three public hospitals ie Ayder referralhospital Mekelle hospital and Quiha hospital Ayder referralhospital is one of the biggest tertiary level referral andteaching hospitals in Ethiopia which provides a broad rangeofmedical services to both in and out patients of all age groupin its catchment area [14] Similarly Mekelle hospital is thebiggest regional hospital in Tigray region Service of neonatalintensive care was rendered in Ayder and Mekelle hospitalsbut not inQuiha hospitalTherefore this study was conductedin neonatal intensive care unit (NICU) of Ayder and Mekellehospitals

22 Sample Size and Sampling Procedure The source pop-ulations were all neonates with their mothersrsquo who wereadmitted to neonatal intensive care unit of those hospitalsThe sample size was determined by using single populationproportion formula with the assumption of 350 [15] preva-lence of neonatal jaundice 95 confidence level and 5margin of error The sample size was calculated to be 350but since the estimated total populations in the study areaduring the study period were less than 10000 the followingcorrection formula was used

119899119891 =119899119894

1 + 119899119894119873=350

1 + 350416= 190 (1)

Assumptions

nf= final sample size

ni= initial sample size=350

N=total estimated neonates with their mother in thestudy area during data collection time=416

BY adding 10 nonresponses rate the final studyparticipants were calculated to be 209 Study participantswere selected by a systematic random sampling methodThe number of neonates selected from each hospital wasproportional to their case flow during the study period

23 Exclusion Criteria Neonate whosemother critically ill orunable to give informed consent

Neonate whowas admitted to NICUmore than once dur-ing data collection time but either interviewed or excludedonce by this study

Late preterm neonates

24 Data Collection Procedures and Quality Control Thedata were collected through interviewing of mother usingstructured questionnaire and review of medical records Thequestionnaire was adapted from previous similar literatures[8 15ndash17] It had three parts the first part was mater-nal sociodemographic characteristics the second part wasobstetric characteristics and the third part embracesmedicalenvironmental and neonatal related factors

Data was collected by four BSc nurses who had anexperience of data collection and one day training was givenThe overall supervision was carried out by the principalinvestigators A pretest was conducted on 10 of similarstudy populations at Wukro hospital located 47 km easternof Mekelle city and appropriate modifications were made

25 Data Processing and Analysis The filled questionnaireswere checked for completeness and entered into EPI INFOversion 353 statistical software and then exported to SPSSversion 20 for further analysis Descriptive statistics wasmade Using bivariate analysis candidate variables were iden-tified for multiple regressions at a p-value up to 025 Thoseeligible variables were entered into multiple logistic regres-sion analysis to control the possible confounding variablesand to identify independent predictors of neonatal jaundiceFinally adjusted odds ratio (AOR) and their 95 CI werecomputed and variables with p-value less than 005 wereconsidered as significantly associated with neonatal jaundice

26 Diagnostic Criteria for Neonatal Jaundice Gestationalage is greater than or equal to 32wks

Neonatal Jaundice For this particular study physicianrsquos diag-nosis was used to identify neonatal jaundice Then sincephysicians did not register the type of neonatal jaundice asphysiological pathological or kernicterus those trained datacollectors classified the type of jaundice using bilirubin leveland IMNCI clinical features

27 Operational Definitions

Neonate An infant from birth to 28 days of age

Late Preterm Newborn whose gestational age less than 32weeks

Neonatal Jaundice Neonates diagnosed as jaundiced byphysician

Physiological Jaundice Total bilirubin value along withIMNCI clinical features of physiological jaundice was used todiagnose physiological jaundice Neonates in the presence ofone more of the established IMNCI criteria (only skin on the

International Journal of Pediatrics 3

face or eyes yellow and infant aged 2-13 days old) along withtotal bilirubin value 12mg100ml in term babies and under15mg100ml in preterm babies [18 19]

Pathological Jaundice Total bilirubin value alongwith IMNCIclinical features of pathological jaundice was used to diagnosepathological jaundice Neonates in the presence of one morethe established IMNCI criteria (palms andor soles yellow orskin and eyes yellow and baby is lt 24 hrs old or skin and eyesyellow and baby is ge14 days old) along with total bilirubinmore than 12mg100ml in term and more than 15mg100mlin preterm [18 19]

Kernicterus It was defined on the basis of unconjugatedhyperbilirubinaemia of more than 340120583molL in the termnewborn or 200120583molL in preterm with features such aspoor sucking vomiting drowsiness hypertonia paralysis ofupward gaze high pitched cry involuntary movements highfever and convulsions in the established category [15]

Skilled Birth Attendant A midwife physician nurse or otherhealth professionals who provide basic and emergency healthcare service to women and newborn during pregnancychildbirth and postpartum period

Neonatal Sepsis The hematological criteria along with theestablished Integrated Management of Neonatal and Child-hood Illness (IMNCI) clinical features of neonatal sepsiswere used to diagnose neonatal sepsis in this study Neonatesin the presence of one or more of the established IMNCIclinical features [either of fever (ge375∘C) or hypothermia(le 355∘C) fast breathing (ge60 breath per minute) severechest indrawing not feeding well movement only whenstimulated convulsion and lethargic or unconscious] alongwith ge 2 of the hematological criteria total leukocyte count(lt4000 or gt12000 cellsm3 absolute neutrophil count (lt1500cellsmm3 or gt7500 cellsmm3) erythrocyte sedimentationrate (ESR) (gt151 h) and platelet count (lt150 or gt440cellsm3) were considered to have neonatal sepsis [20]

ABO Incompatibility For this particular study it was definedas neonates with laboratory confirmed to have ABO incom-patibility [21]

3 Result

31 Sociodemographic Characteristic of Mothers In this studya total of 209 neonates with their mother were includedmaking 100 response rate The median (plusmnIQ range) age ofmothers was 27plusmn7 years ranging from 18 to 50 years and agerange of more than three-fourths of the mothers was between20 and 35 years About 142 (679) mothers were living inurban areas About 189 (904) and 191 (914)mothers wereTegaru in ethnicity and orthodox in religion respectively Ofthe total interviewed mothers 90 (431) were housewives byoccupation

Regarding educational status unable to read and write(n=45) able to read and write (n=14) primary education

(n=42) secondary education (n=49) and college and above(n=59) were documented among study participants

Their marital status revealed that 197 (943) motherswere married while 8 (38) mothers were single Regardingmonthly income 30(144) mothers had a monthly incomeof 500 and below ETB 76(364) mothers had a monthlyincome of 500-1500 ETB and the remaining 103 (493)mothers had monthly income more than 1500 ETB [Table 1]

32 Neonate Characteristics One hundred twenty-five(598) neonates were male in sex and the median (plusmnIQrange) of age at the time of admission was 1plusmn3 days rangingfrom 1 to 26 days of whom 90 (188) of neonates age lieswithin a week As well about 103 (493) neonates weredelivered at term with birth weight of 25 kg and above Inthis study APGAR score of 7-10 was recorded by 149 (713)neonates Regarding the feeding status 191 (913) neonatesfed breast milk of whom 184 (88) were EBF In this studythe blood group of neonates was assessed blood groups ArdquoldquoBrdquo ldquoABrdquo ldquoOrdquo and unknown were recorded by 4336 2258 and 50 respondents respectively [Table 2]

33 Obstetric Characteristics The median (+IQ range) ofparity was 2plusmn 3 ranging from 1 to 13 live births Onehundred and seventy-four (833) neonates were singletonOne hundred ninety-six (938 ) respondents had antenatalcare (ANC) follow up at least once during pregnancy but13(62) had not In this study gestational diabetes mellitusby 2(67) gestational hypertension by 11(367) prematurerapture ofmembrane (PROM)by 16(533) and hyperemesisgravidarum by 1 (33) mothers are identified as obstetriccomplication

With regard to mode of delivery spontaneous vaginaldelivery accounted for 150 (718) whereas instrumentaland cesarean section 14 (67) and 45 (215) mothersrespectively The duration of labor ranges from 4 to 72 hoursof which normal duration of labor was recorded by 146(699)participants Oxytocin was used as induction of laborby 97 (466) mothers

34 Environmental and Medical Factors One hundred andthirty-one (627) and 67 (321) neonates were delivered athospital and health center respectively Home delivery wasaccounted by 11(53) mothers Regarding birth attendant198 (947) deliveries were attended by a skilled birthattendant 10 (48) by a traditional birth attendant and 1(05) no attendant at all About 113 (541) neonates weredelivered at day time

About three-fourths 158 (756) mothers took drugsduring pregnancy and insulin 2 (13) iron with folic acid145 (918) magnesium sulphate 3 (19) and others 8(51) were the drugs taken by respondents Regarding thesubstance use 22 (105) mothers took substances duringpregnancy of the participant neonate The substances werealcohol 19 (864) chat 1 (45) and herbal medication2 (91) In this study the blood group of mothers wasassessed blood groups ldquoArdquo ldquoBrdquo ldquoABrdquo ldquoOrdquo and unknownwere witnessed by 55 46 14 43 and 51 respondentsrespectively Sepsis (n=98) ABO incompatibility (n= 29) and


Table 1 Maternal Sociodemographic distribution of mothers at neonatal intensive care unit of Mekelle city public hospitals NorthernEthiopia 2016

Variable Category Frequency Percentage ()

Mothers agelt20 13 6220-35 181 866gt35 15 72

Marital statusSingle 8 38Married 197 943Divorced 4 19

Residence Urban 142 679Rural 67 321

Occupation

House wives 90 431Farmer 39 187

Governmental employee 48 230Nongovernmental employee 12 57

Merchant 20 96

Table 2 Neonatal characteristic distribution among neonates admitted to neonatal intensive care unit of Mekelle city public hospitalsNorthern Ethiopia 2016

Characteristics Category Frequency Percentage ()

Sex of neonate Male 125 598Female 84 402

Blood group

A 43 205B 36 173AB 22 105O 58 278

Unknown 50 239

Gestational age at birth(in weeks)lt37 60 28737-42 143 684gt42 6 29

Birth weight (kg) lt25 80 383ge25 129 617

Five minute APGAR score le6 60 2877-10 149 713

Familysibling history of jaundice Yes 38 182No 171 818

Rh incompatibility (n=22) were documented as a medicalcomplication

35 Proportion of Neonatal Jaundice The proportion ofneonatal jaundice among neonates admitted to the neonatalintensive care unit of Mekelle city public hospitals wasfound to be 373 (78) Among these 46 (22) cases werepathological jaundice and the rest 32 (15) were foundto be physiological jaundice All jaundiced neonates tookphototherapy as a mode of treatment but no exchange bloodtransfusion

36 Bivariate Analysis of Different Factors with NeonatalJaundice On bivariate binary logistic regression the oddsneonatal jaundice among mothers with a monthly of le 500Ethiopian birr was 66 less likely compared to mothers with

a monthly income of greater than 1500 Ethiopian birr [COR= 034 95 CI (013-089)] Neonates who were born athealth center were 60 less likely to have neonatal jaundicecompared to neonate who were born at hospital [COR = 0495 CI (02-076)]

Regarding time of delivery night time delivery was 66less risk for neonatal jaundice compared to day time delivery[COR = 033 95 CI (018-060)] Prolonged durationof labor had 272 times higher risk for neonatal jaundicecompared to normal duration of labor [COR = 272 95 CI(146-499)]

Neonatal jaundice among male neonate was 468 timesmore likely compared to female neonates [COR = 468 95CI (242-904)] Similarly neonates with ldquoOrdquo blood groupwere 238 timely more likely to have neonatal jaundicecompared with those neonate with ldquoArdquo blood group [COR= 238 95 CI (105-54)]


The odds of neonatal jaundice among mothers with ldquoOrdquoblood group were 26 times more likely compared to thosewith ldquoArdquo blood group [COR = 26 95CI (114-592)] Septicneonates were 259 times higher risk for neonatal jaundicecompared with nonseptic neonates [COR = 259 95 CI(146-461)]

Moreover neonate who had a familysibling history ofjaundice was 282 times more likely to develop neonataljaundice compared to a neonate with no familysiblinghistory of jaundice [COR = 282 95 CI (138-579)] Bloodincompatibility was 1771 times higher risk for neonataljaundice compared to a compatible blood group [COR= 177195 CI (734-4277)] [Table 3]

37 Factors Associated with Neonatal Jaundice Multivariablebinary logistic regression analysis was done by taking vari-ables showing significant association on bivariate analysis atp-value of le025 to control (adjust) the possible confoundingProlonged duration of labor time of delivery mothers bloodgroup sex of neonate sepsis and blood incompatibility hada significant association with neonatal jaundice at p-valuelt005 in multivariate analysis

The finding of this study showed that the odds of havingneonatal jaundice among neonates who were delivered withlong duration of laborwere almost 44 times higher comparedwith those who were delivered with a normal duration oflabor [AOR= 439 95CI (18-1069)] Aswell neonates whowere born during night time were 58 less likely to have oddsof neonatal jaundice compared with those neonates whowereborn during day time [AOR = 042 95 CI (018-096)]

The odd of neonatal jaundice among male neonates was37 times higher compared with those female neonates [AOR= 37 95 CI (154-887)] Similarly the odds of developingneonatal jaundice among neonates whose mother had ldquoOrdquoblood group were five times higher compared with thoseneonates whose mother had ldquoArdquo blood group [AOR = 50595 CI (153-1672)]

In this study sepsis and blood type incompatibility hadsignificant association with the dependent variable The oddsof neonatal jaundice among neonates who had sepsis was26 times higher compared with those neonates who had nosepsis diagnosis [AOR=264 95CI (115-605)] In the sameway neonates with blood type incompatibility had higherodds of neonatal jaundice compared with those neonateswithout blood type incompatibility [AOR = 1821 95 CI(636-5213)] (Table 4)

4 Discussion

Neonatal jaundice has a significant importance on neonatalmorbidity and a little bit on neonatal mortality world-wide The vast majority of the affected neonates reside insub-Saharan Africa and South Asia [15 22] Limited datawere available on magnitude and local factors associatedwith neonatal jaundice in Ethiopia This study was aimedat assessing proportion and predictors of neonatal jaundiceamong neonates admitted to neonatal intensive care unit ofpublic hospitals in Mekelle city Northern Ethiopia

The proportion of neonatal jaundice was found to be373 This finding was consistent with previous study con-ducted in Southeast Nigeria (35 ) [15] However it waslower than finding from Shimla India (64) [22] On theother hand this result was higher than the findings fromOsijek Croatia (248 ) [23] Tehran (126 ) [5] SouthernNepal (293) [16] Egypt (166) [24] Lagos Nigeria (67)[25] BeninCity (265) [17] NigerDeltaUniversity TeachingHospitalNigeria (179) [26] andEthiopia (2645) [27]Thedifference could be due to variation in study setting timeand design among different studies Besides the variationsmight be due to difference in sociocultural and economiccondition level of obstetrics care and gestational age amongstudy populations

This study had shown that prolonged duration of laborhad significant effect on development of neonatal jaundiceThe odd of jaundice was about four times higher amongneonates who were born with long duration of labor com-pared with those neonates born in normal labor This findingwas in line with findings in Nepal [16] This might beattributed to bruising and swelling of scalp of newborns dueto the excessive pressure applied by birth attendants as asolution for prolonged labor in turn increases risk of jaundiceby increasing bilirubin level in the blood [28]

Timing of delivery was significantly associated withneonatal jaundice with an increased risk observed amongneonates born during day time Neonates who were bornduring night time were 58 less likely to develop neonataljaundice compared to those who were born during day timeThis could be explained by the fact that room temperature ishigh during day time compared with night time Consideringthe relative high room temperature during day time theremight be improper immediate new born care especially onkeeping the newborn warm that leads to hypothermia whichis a known risk factor of neonatal jaundice by increasingunconjugated serum bilirubin level [29]

This study revealed that male neonates had higher oddsof developing neonatal jaundice compared to their femalecounterparts The finding was supported by studies donein Nepal [16] and Nigeria [25] Conversely this result wasinconsistent with findings in Croatia [23] Iran [5] and Egypt[24] This finding could explain that male newborns haverelatively immature liver which may not be able to processall the bilirubin formed from red blood cells [30 31]

It was also found that the odds of developing neonataljaundice among neonates whose mother had ldquoOrdquo bloodgroup were almost five times higher compared with thoseneonates whose mother had ldquoArdquo blood group Study donein Iran showed that mothers of ldquoOrdquo blood group hadno significant effect on development of neonatal jaundice[5]

Moreover the study revealed that neonatal jaundice hadsignificant association with sepsis The odds of developingneonatal jaundice amongneonates whohad sepsiswere abouttwo times higher compared with those neonates who hadno sepsis diagnosis Sepsis was also identified as the possiblecauses of neonatal jaundice in studies conducted in India[22 32 33] Iran [34 35] and Nigeria [15 26] This might bedue to the fact that sepsis might cause hemolysis of red blood


Table 3 Bivariate logistic regression analysis of different factors with neonatal jaundice among neonates admitted to NICU of Mekelle citypublic hospitals Northern Ethiopia 2016

(a)

Variable CategoryJaundice COR(95CI) P-value

Yes NoN () N ()

Residence Urban 57(401) 85(599) 1Rural 21(313) 46(687) 068(037-126) 0221

Maternal occupation

Housewife 34(378) 56(622) 1Farmer 9(231) 30(769) 049(021-117) 0107

Governmental employee 24(50) 24(50) 165(081-334) 0167Nongovernmental employee 4(333) 8(667) 082(023-294) 0765

Merchant 7(35) 13(65) 089(032-244) 0816

Average monthly incomele500 6(20) 24(80) 034(013-089) 0028

500-1500 28(368) 48(632) 078(043-144) 0428gt1500 44(427) 59(573) 1

Types of pregnancy Single 68(391) 106(609) 1Multiple 10(286) 25(714) 062(028-138) 0244

Place of deliveryHome 4(364) 7(636) 072(02-258) 0613

Health center 16(239) 51(761) 04(02-076) 0006Hospital 58(443) 73(557) 1

Mode of deliverySVD 50(333) 100(667) 1

Instrumental 7(50) 7(50) 2(0 67-602) 0217CS 21(443) 24(557) 175(089-344) 0105

COR=crude odds ratio SVD=spontaneous vaginal delivery CS=cesarean section

(b)

Variable Category

Presence of JaundiceCOR(95CI) P-value

Yes NON () N ()

Oxytocin during labor Yes 46(474) 51(526) 226(127-399) 0005No 32(286) 80(714) 1

Duration of labor Normal 44(301) 102(699) 1Prolonged 34(54) 29(46) 272(146-499) 0001

Timing of delivery Day 55(513) 58(487) 033(018-060) lt0001Night 23(24) 73(76) 1

Sex of neonate Male 63(504) 62(496) 468(242-904) lt0001Female 15(179) 69(821) 1

Gestational agelt37 25(417) 35(583) 137(074-254) 010237-42 49(343) 94(657) 1gt42 4(667) 2(333) 384(068-2169) 056

Five minute APGAR score le6 27(45) 33(55) 157(085-2896) 01477-10 51(342) 98(658) 1

Neonates blood group

A 14(326) 29(674) 1B 17(472) 19(528) 185(074-462) 0186AB 7(318) 15(682) 097(032-291) 0952O 31(534) 27(466) 238(105-54) 0038

Unknown 9(18) 41(82) 046(017-119) 0109

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 188(084-423) 0124AB 4(286) 10(714) 082(023-298) 0766O 24(558) 19(442) 26(114-592) 0023

Unknown 10(196) 41(804) 050(021-122) 0129


(b) Continued

Variable Category


Yes NON () N ()

Sepsis Yes 48(49) 50(51) 259(146-461) 0001No 30(27) 81(73) 1

Blood type incompatibility Yes 39(848) 7(152) 1771(734-4277) lt0001No 39(239) 124(761) 1

Familysibling history Yes 22(579) 16(421) 282(138-579) 0005No 56(327) 115(673) 1

COR=crude odds ratio

Table 4 Multivariate regression analysis of different variables with neonatal jaundice among neonates admitted to neonatal intensive careunit of Mekelle city public hospitals Northern Ethiopia 2016

Variable Category Jaundice Adjusted odds ratio (AOR) (95CI) p-valueYes No




Timing of delivery Day 55(513) 58(487) 042(018-096) 0039Night 23(24) 73(76) 1

Sex of neonate Male 63(504) 62(496) 37(154-887) 0003Female 15(179) 69(821) 1



A 14(326) 29(674) 1B 17(472) 19(528) 085(02-366) 0697AB 7(318) 15(682) 053(01-278) 0967O 31(534) 27(466) 17(056-516) 0531

Unknown 9(18) 41(82) 091(024-353) 0170

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 266(082-861) 070AB 4(286) 10(714) 063(059-223) 0751O 24(558) 19(442) 505(153-1672) 0012

Unknown 10(196) 41(804) 093(029-300) 0387

Sepsis Yes 48(49) 50(51) 264(115-605) 0022No 30(27) 81(73) 1


Note In bivariate analysis variables with P-value of le025 were entered in multivariate model

cells and hepatic dysfunction that leads to accumulation ofserum bilirubin in the body [36 37]

Another contributing factor of neonatal jaundice wasblood incompatibility In this study 27 (931) neonates withABO incompatibility developed neonatal jaundice and itrepresents that 3462 of the total jaundiced neonates hadABO incompatibility Similarly this disorder was reported asa leading cause of neonatal jaundice in the studies conductedinCanada [38] India [22 33] Iran [35] Egypt [24] andBenin[17]

The limitation of the study was using small sample sizestudy participants with unknown ABO blood group werenumbered as lacking ABORh incompatibility and G6PDwas not assessed

5 Conclusion

Neonatal jaundice is one of the common causes of neona-tal morbidity in neonatal intensive care unit (NICU) Themagnitude of neonatal jaundice among neonates admitted to


neonatal intensive care unit of Mekelle city public hospitalswas high Being male day time delivery prolonged durationof labor maternal ldquoOrdquo blood group sepsis and blood typeincompatibility were the independent predictors of neonataljaundice It is recommended to have blood test duringpregnancy with early intervention for those who had risks offetomaternal blood group incompatibility

Abbreviations

AOR Adjusted odds ratioANC Antenatal careAPGAR score Appearance pulse grimace activity

respirationscoreCOR Crude odds ratioEDHS Ethiopian Demographic and Health

SurveyPNC Postnatal careNICU Neonatal intensive care unit

Data Availability

Data supporting this finding can be found upon request

Ethical Approval

Ethical clearance was obtained from institutional reviewboard of Mekelle University Official letter of permissionwas written to the respective hospitals The interview wasconducted in a private environment convenient for theparticipants

Consent

After giving clear and deep explanation about the aim ofthe study all mothers that were involved in the study wereasked for their willingness and informed written consent wasobtained from each respondent Persons who were unwillingto response were exempted from the study

Conflicts of Interest

The authors declare that there are no conflicts of interestregarding the publication of this paper

Acknowledgments

We are very grateful to Mekelle University for the financialsupport to this study and all study participants for theircommitment in responding to our questionnaire MekelleUniversity has covered the per diem for data collectors

References

[1] ldquoAmerican Academy of Pediatrics Jaundice what isjaundicerdquo 2015 httpswwwhealthychildrenorgEnglishages-stagesbabyPagesJaundiceaspx

[2] A Richard and C Pamela Lippincottrsquos Illustrated Review ofBiochemistry Williams andWilkins 5th edition 2010

[3] S Mishra R Agarwal A K Deorari and V K Paul ldquoJaundicein the newbornsrdquoThe Indian Journal of Pediatrics vol 75 no 2pp 157ndash163 2008

[4] National Institute for Health and Clinical Excellence ldquoNeonataljaundice Clinical guideline 98rdquo August 2014 httpwwwniceorgukCG98

[5] Z Kavehmanesh N E Mohammadieh A A K Zarchi SAmirsalari Z K Matinzadeh and M Torkaman ldquoPrevalenceof readmission for hyperbilirubinemia in healthy newbornsrdquoIranian Journal of Pediatrics vol 18 no 2 pp 130ndash136 2008

[6] S Ip M Chung J Kuling et al ldquoTo Study the Knowledge andAttitude of PostnatalMothers onNeonatal Jaundice inMotahariHospital Iranrdquo Official Journal of the American Academy ofPediatrics vol 114 no 1 pp 130ndash153 2004

[7] S K Kulkarni A L Dolas and M K Doibale ldquoRisk factorsof neonates with indirect hyperbilirubinemia in a tertiary carehospitalrdquo International Journal of Basic and Applied MedicalSciences vol 4 no 1 pp 395ndash399 2014

[8] V K Bhutani A Zipursky H Blencowe et al ldquoNeonatal hyper-bilirubinemia and Rhesus disease of the newborn incidenceand impairment estimates for 2010 at regional and global levelsrdquoPediatric Research vol 74 no S1 pp 86ndash100 2013

[9] G Karylein ldquoSickle cell anemia in neonatal periodrdquo SouthernMedical Journal vol 72 no 4 pp 492-493 1979

[10] S K Moerschel L B Cianciaruso and L R Tracy ldquoA practicalapproach to neonatal jaundicerdquoAmerican Family Physician vol77 no 9 pp 1255ndash1262 2008

[11] Federal Democratic Republic of Ethiopia and Ministry ofHealth National Newborn and Child Survival Strategy Doc-ument Brief Summary 2015-2020 FMOH Addis AbabaEthiopia 2015 Federal Democratic Republic of Ethiopia Min-istry of Health National Newborn and Child Survival StrategyDocument Brief Summary

[12] T W Hansen ldquoNeonatal jaundicerdquo 2015 httpsemedicinemedscapecomneonataljaundice974786-ov

[13] Central Statistical Agency of Ethiopia Population Projection ofEthiopia for All Regions at Wereda Level from 2014 ndash 2017 AddisAbaba Central Statistical Agency 2013

[14] MekelleUniversity ldquoTheAyder Referral Hospital Backgroundrdquohttpwwwmueduetchsindexphpayder-referral-hospital

[15] C N Onyearugha B N Onyire and H A A UgbomldquoNeonatal jaundice prevalence and associated factors as seen inFederal Medical Centre Abakaliki Southeast Nigeriardquo Journalof Clinical Medicine and Research vol 3 no 3 pp 40ndash45 2011

[16] C G Scrafford L C Mullany J Katz et al ldquoIncidence of andrisk factors for neonatal jaundice among newborns in southernNepalrdquo Tropical Medicine amp International Health vol 18 no 11pp 1317ndash1328 2013

[17] Y Israel-Aina and A Omoigberale ldquoRisk factors for neonataljaundice in babies presenting at the University of Benin Teach-ingHospital BeninCityrdquoNigerian Journal of Paediatrics vol 39no 4 pp 159ndash163 2012

[18] ldquoDrug administration and control authority of Ethiopiastandard treatment guide line for district hospital first editionrdquo2004 httpappswhointmedicinedocsdocumentss17820ens17820enpdf

[19] Federal Ministry of HealthIntegrated Management ofChildhood Illness (IMNCI) ldquoClassify all sick young infants forjaundice Addis Ababardquo Ethiopia November 2011 httpwwwopeneduopenlearncreatepluginfilephp71991mod resourcecontent2IMNCI Part 2 Final Print-ready March 2011 pdf


[20] D Gebremedhin H Berhe and K Gebrekirstos ldquoRisk factorsfor neonatal sepsis in public hospitals of Mekelle City NorthEthiopia 2015 unmatched case control studyrdquo PLoS ONE vol11 no 5 Article ID e0154798 2016

[21] Wikipedia ldquoWhat Is Rh Incompatibility - NHLBI NIHrdquoMarch 2016 httpswwwnhlbinihgovhealthhealth-topicstopicsrh

[22] L Bahl R Sharma and J Sharma ldquoEtiology of neonataljaundice at Shimlardquo Indian Pediatrics vol 31 no 10 pp 1275ndash1278 1994

[23] I Mesic VMilas MMedimurec and Z Rimar ldquoUnconjugatedpathological jaundice in newbornsrdquoCollegiumAntropologicumvol 38 no 1 pp 173ndash178 2014

[24] T Abdel-Aziz N Azab M Odah and I M El-deen ldquoFactorsand assays identifying babies at riskto develop significant hyper-bilirubinemiardquo International Journal of Innovative Research inScience Engineering and Technology vol 3 no 2 pp 9804ndash9809 2014

[25] B O Olusanya A A Akande A Emokpae and S A OloweldquoInfants with severe neonatal jaundice in Lagos Nigeria inci-dence correlates and hearing screening outcomesrdquo TropicalMedicineamp International Health vol 14 no 3 pp 301ndash310 2009

[26] D E OmekweM Duke George B T Kennis et al ldquoSurvey andmanagement outcome of neonatal jaundice from a developingtertiary health centre SouthernNigeriardquo IOSR Journal ofDentaland Medical Sciences vol 13 no 4 pp 35ndash39 2014

[27] B Worku A Kassie A Mekasha B Tilahun and A workuldquoPredictors of early neonatal mortality at a neonatal intensivecare unit of a specialized referral teaching hospital in EthiopiardquoEthiopian Journal of Health Development vol 26 no 3 pp 200ndash207 2012

[28] Healthline ldquoCaput succedaneum causes symptoms andtreatmentrdquo httpswwwhealthlinecomhealthcaput-succedaneum

[29] B Kleigman Jonson and Stanton Nelson Text Book of PediatricsElsevier Philadelphia Pa USA 18th edition 2008

[30] UNICEF ldquoBaby boys at higher risk of death and disability due topremature birthrdquo httpswwwuniceforgeapromedia-21774html

[31] Better health jaundice in babies httpswwwcpscaenglishpublicationsStatementsIndexhtm

[32] D Nilesh A Sumi G Paridhi et al ldquoStudy of etiologyof neonatal jaundice at tertiary care centre in maharashtrardquoScholars Journal of Applied Medical Sciences vol 3 no 4C pp1787ndash1790 2015

[33] A Ali and A Tomar ldquoEtiological profile of neonatal hyper-bilirubinaemia in the rural area of Rajasthanrdquo Indian Journalof Basic and AppliedMedical Research vol 4 no 2 pp 223ndash2322015

[34] K S Najib F Saki F Hemmati and S Inaloo ldquoIncidencerisk factors and causes of severe neonatal hyperbilirubinemiain South of Iran (Fars Province)rdquo Iranian Red Crescent MedicalJournal vol 15 no 3 pp 260ndash263 2013

[35] H Boskabadi F Ashrafzadeh F Azarkish and A KhakshourldquoComplications of neonatal jaundice and the predisposingfactors in newbornsrdquo Journal of BABOL University of MedicalSciences vol 17 no 9 pp 7ndash13 2015

[36] ldquoAASLD Hepatologyrdquo httpswwwbetterhealthvicgovauhealthHealthyLivingjaundice-in-babies

[37] Medic Guide ldquoHow sepsis does cause jaundicerdquo httpmedicguideblogspotcom200903how-does-sepsis-cause-jaundicehtml

[38] M Sgro D Campbell and V Shah ldquoIncidence and causesof severe neonatal hyperbilirubinemia in Canadardquo CanadianMedical Association Journal vol 175 no 6 pp 587ndash590 2006

Stem Cells International

Hindawiwwwhindawicom Volume 2018


MEDIATORSINFLAMMATION

of

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

Hindawi Publishing Corporation httpwwwhindawicom Volume 2013Hindawiwwwhindawicom

The Scientific World Journal

Volume 2018

Immunology ResearchHindawiwwwhindawicom Volume 2018

Journal of

ObesityJournal of



Computational and Mathematical Methods in Medicine


Behavioural Neurology

OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinsonrsquos Disease

Evidence-Based Complementary andAlternative Medicine

Volume 2018Hindawiwwwhindawicom

Submit your manuscripts atwwwhindawicom


As studies revealed the incidence etiology and risk factorsof neonatal jaundice vary according to ethnicity economicstatus and geographical differences of countries [12] Butthere is limited data on themagnitude of neonatal jaundice inEthiopia So this study was aimed at assessing the magnitudeof neonatal jaundice and its determinants in Mekelle cityNorthern Ethiopia

2 Methods and Materials

21 Study Design and Setting An institution based cross-sectional study was conducted to assess the magnitude ofneonatal jaundice and its associated factors at neonatalintensive care unit of Mekelle city public hospitals fromFebruary to April 2016 Mekelle is located 783kms northof Addis Ababa with a latitude and longitude of 13∘291015840N39∘281015840E coordinates Based on the 2007 Census conductedby the Central Statistical Agency of Ethiopia (CSA) the totalpopulation projection value of 2016 at Mekelle city is 340858of whom 168261 are females [13]

Mekelle city has three public hospitals ie Ayder referralhospital Mekelle hospital and Quiha hospital Ayder referralhospital is one of the biggest tertiary level referral andteaching hospitals in Ethiopia which provides a broad rangeofmedical services to both in and out patients of all age groupin its catchment area [14] Similarly Mekelle hospital is thebiggest regional hospital in Tigray region Service of neonatalintensive care was rendered in Ayder and Mekelle hospitalsbut not inQuiha hospitalTherefore this study was conductedin neonatal intensive care unit (NICU) of Ayder and Mekellehospitals

22 Sample Size and Sampling Procedure The source pop-ulations were all neonates with their mothersrsquo who wereadmitted to neonatal intensive care unit of those hospitalsThe sample size was determined by using single populationproportion formula with the assumption of 350 [15] preva-lence of neonatal jaundice 95 confidence level and 5margin of error The sample size was calculated to be 350but since the estimated total populations in the study areaduring the study period were less than 10000 the followingcorrection formula was used

119899119891 =119899119894

1 + 119899119894119873=350

1 + 350416= 190 (1)

Assumptions

nf= final sample size

ni= initial sample size=350

N=total estimated neonates with their mother in thestudy area during data collection time=416

BY adding 10 nonresponses rate the final studyparticipants were calculated to be 209 Study participantswere selected by a systematic random sampling methodThe number of neonates selected from each hospital wasproportional to their case flow during the study period

23 Exclusion Criteria Neonate whosemother critically ill orunable to give informed consent

Neonate whowas admitted to NICUmore than once dur-ing data collection time but either interviewed or excludedonce by this study

Late preterm neonates

24 Data Collection Procedures and Quality Control Thedata were collected through interviewing of mother usingstructured questionnaire and review of medical records Thequestionnaire was adapted from previous similar literatures[8 15ndash17] It had three parts the first part was mater-nal sociodemographic characteristics the second part wasobstetric characteristics and the third part embracesmedicalenvironmental and neonatal related factors

Data was collected by four BSc nurses who had anexperience of data collection and one day training was givenThe overall supervision was carried out by the principalinvestigators A pretest was conducted on 10 of similarstudy populations at Wukro hospital located 47 km easternof Mekelle city and appropriate modifications were made

25 Data Processing and Analysis The filled questionnaireswere checked for completeness and entered into EPI INFOversion 353 statistical software and then exported to SPSSversion 20 for further analysis Descriptive statistics wasmade Using bivariate analysis candidate variables were iden-tified for multiple regressions at a p-value up to 025 Thoseeligible variables were entered into multiple logistic regres-sion analysis to control the possible confounding variablesand to identify independent predictors of neonatal jaundiceFinally adjusted odds ratio (AOR) and their 95 CI werecomputed and variables with p-value less than 005 wereconsidered as significantly associated with neonatal jaundice

26 Diagnostic Criteria for Neonatal Jaundice Gestationalage is greater than or equal to 32wks

Neonatal Jaundice For this particular study physicianrsquos diag-nosis was used to identify neonatal jaundice Then sincephysicians did not register the type of neonatal jaundice asphysiological pathological or kernicterus those trained datacollectors classified the type of jaundice using bilirubin leveland IMNCI clinical features

27 Operational Definitions

Neonate An infant from birth to 28 days of age

Late Preterm Newborn whose gestational age less than 32weeks

Neonatal Jaundice Neonates diagnosed as jaundiced byphysician

Physiological Jaundice Total bilirubin value along withIMNCI clinical features of physiological jaundice was used todiagnose physiological jaundice Neonates in the presence ofone more of the established IMNCI criteria (only skin on the








3 Result













Mothers agelt20 13 6220-35 181 866gt35 15 72



Occupation



Merchant 20 96




Blood group

A 43 205B 36 173AB 22 105O 58 278

Unknown 50 239


















4 Discussion










(a)


Yes NoN () N ()


Maternal occupation



Merchant 7(35) 13(65) 089(032-244) 0816


500-1500 28(368) 48(632) 078(043-144) 0428gt1500 44(427) 59(573) 1





Instrumental 7(50) 7(50) 2(0 67-602) 0217CS 21(443) 24(557) 175(089-344) 0105


(b)

Variable Category


Yes NON () N ()








A 14(326) 29(674) 1B 17(472) 19(528) 185(074-462) 0186AB 7(318) 15(682) 097(032-291) 0952O 31(534) 27(466) 238(105-54) 0038

Unknown 9(18) 41(82) 046(017-119) 0109

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 188(084-423) 0124AB 4(286) 10(714) 082(023-298) 0766O 24(558) 19(442) 26(114-592) 0023

Unknown 10(196) 41(804) 050(021-122) 0129


(b) Continued

Variable Category


Yes NON () N ()

Sepsis Yes 48(49) 50(51) 259(146-461) 0001No 30(27) 81(73) 1













A 14(326) 29(674) 1B 17(472) 19(528) 085(02-366) 0697AB 7(318) 15(682) 053(01-278) 0967O 31(534) 27(466) 17(056-516) 0531

Unknown 9(18) 41(82) 091(024-353) 0170

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 266(082-861) 070AB 4(286) 10(714) 063(059-223) 0751O 24(558) 19(442) 505(153-1672) 0012

Unknown 10(196) 41(804) 093(029-300) 0387

Sepsis Yes 48(49) 50(51) 264(115-605) 0022No 30(27) 81(73) 1






5 Conclusion




Abbreviations




Data Availability


Ethical Approval


Consent




Acknowledgments


References












































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of


























3 Result













Mothers agelt20 13 6220-35 181 866gt35 15 72



Occupation



Merchant 20 96




Blood group

A 43 205B 36 173AB 22 105O 58 278

Unknown 50 239


















4 Discussion










(a)


Yes NoN () N ()


Maternal occupation



Merchant 7(35) 13(65) 089(032-244) 0816


500-1500 28(368) 48(632) 078(043-144) 0428gt1500 44(427) 59(573) 1





Instrumental 7(50) 7(50) 2(0 67-602) 0217CS 21(443) 24(557) 175(089-344) 0105


(b)

Variable Category


Yes NON () N ()








A 14(326) 29(674) 1B 17(472) 19(528) 185(074-462) 0186AB 7(318) 15(682) 097(032-291) 0952O 31(534) 27(466) 238(105-54) 0038

Unknown 9(18) 41(82) 046(017-119) 0109

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 188(084-423) 0124AB 4(286) 10(714) 082(023-298) 0766O 24(558) 19(442) 26(114-592) 0023

Unknown 10(196) 41(804) 050(021-122) 0129


(b) Continued

Variable Category


Yes NON () N ()

Sepsis Yes 48(49) 50(51) 259(146-461) 0001No 30(27) 81(73) 1













A 14(326) 29(674) 1B 17(472) 19(528) 085(02-366) 0697AB 7(318) 15(682) 053(01-278) 0967O 31(534) 27(466) 17(056-516) 0531

Unknown 9(18) 41(82) 091(024-353) 0170

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 266(082-861) 070AB 4(286) 10(714) 063(059-223) 0751O 24(558) 19(442) 505(153-1672) 0012

Unknown 10(196) 41(804) 093(029-300) 0387

Sepsis Yes 48(49) 50(51) 264(115-605) 0022No 30(27) 81(73) 1






5 Conclusion




Abbreviations




Data Availability


Ethical Approval


Consent




Acknowledgments


References












































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of






















Mothers agelt20 13 6220-35 181 866gt35 15 72



Occupation



Merchant 20 96




Blood group

A 43 205B 36 173AB 22 105O 58 278

Unknown 50 239


















4 Discussion










(a)


Yes NoN () N ()


Maternal occupation



Merchant 7(35) 13(65) 089(032-244) 0816


500-1500 28(368) 48(632) 078(043-144) 0428gt1500 44(427) 59(573) 1





Instrumental 7(50) 7(50) 2(0 67-602) 0217CS 21(443) 24(557) 175(089-344) 0105


(b)

Variable Category


Yes NON () N ()








A 14(326) 29(674) 1B 17(472) 19(528) 185(074-462) 0186AB 7(318) 15(682) 097(032-291) 0952O 31(534) 27(466) 238(105-54) 0038

Unknown 9(18) 41(82) 046(017-119) 0109

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 188(084-423) 0124AB 4(286) 10(714) 082(023-298) 0766O 24(558) 19(442) 26(114-592) 0023

Unknown 10(196) 41(804) 050(021-122) 0129


(b) Continued

Variable Category


Yes NON () N ()

Sepsis Yes 48(49) 50(51) 259(146-461) 0001No 30(27) 81(73) 1













A 14(326) 29(674) 1B 17(472) 19(528) 085(02-366) 0697AB 7(318) 15(682) 053(01-278) 0967O 31(534) 27(466) 17(056-516) 0531

Unknown 9(18) 41(82) 091(024-353) 0170

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 266(082-861) 070AB 4(286) 10(714) 063(059-223) 0751O 24(558) 19(442) 505(153-1672) 0012

Unknown 10(196) 41(804) 093(029-300) 0387

Sepsis Yes 48(49) 50(51) 264(115-605) 0022No 30(27) 81(73) 1






5 Conclusion




Abbreviations




Data Availability


Ethical Approval


Consent




Acknowledgments


References












































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of


























4 Discussion










(a)


Yes NoN () N ()


Maternal occupation



Merchant 7(35) 13(65) 089(032-244) 0816


500-1500 28(368) 48(632) 078(043-144) 0428gt1500 44(427) 59(573) 1





Instrumental 7(50) 7(50) 2(0 67-602) 0217CS 21(443) 24(557) 175(089-344) 0105


(b)

Variable Category


Yes NON () N ()








A 14(326) 29(674) 1B 17(472) 19(528) 185(074-462) 0186AB 7(318) 15(682) 097(032-291) 0952O 31(534) 27(466) 238(105-54) 0038

Unknown 9(18) 41(82) 046(017-119) 0109

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 188(084-423) 0124AB 4(286) 10(714) 082(023-298) 0766O 24(558) 19(442) 26(114-592) 0023

Unknown 10(196) 41(804) 050(021-122) 0129


(b) Continued

Variable Category


Yes NON () N ()

Sepsis Yes 48(49) 50(51) 259(146-461) 0001No 30(27) 81(73) 1













A 14(326) 29(674) 1B 17(472) 19(528) 085(02-366) 0697AB 7(318) 15(682) 053(01-278) 0967O 31(534) 27(466) 17(056-516) 0531

Unknown 9(18) 41(82) 091(024-353) 0170

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 266(082-861) 070AB 4(286) 10(714) 063(059-223) 0751O 24(558) 19(442) 505(153-1672) 0012

Unknown 10(196) 41(804) 093(029-300) 0387

Sepsis Yes 48(49) 50(51) 264(115-605) 0022No 30(27) 81(73) 1






5 Conclusion




Abbreviations




Data Availability


Ethical Approval


Consent




Acknowledgments


References












































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of





















(a)


Yes NoN () N ()


Maternal occupation



Merchant 7(35) 13(65) 089(032-244) 0816


500-1500 28(368) 48(632) 078(043-144) 0428gt1500 44(427) 59(573) 1





Instrumental 7(50) 7(50) 2(0 67-602) 0217CS 21(443) 24(557) 175(089-344) 0105


(b)

Variable Category


Yes NON () N ()








A 14(326) 29(674) 1B 17(472) 19(528) 185(074-462) 0186AB 7(318) 15(682) 097(032-291) 0952O 31(534) 27(466) 238(105-54) 0038

Unknown 9(18) 41(82) 046(017-119) 0109

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 188(084-423) 0124AB 4(286) 10(714) 082(023-298) 0766O 24(558) 19(442) 26(114-592) 0023

Unknown 10(196) 41(804) 050(021-122) 0129


(b) Continued

Variable Category


Yes NON () N ()

Sepsis Yes 48(49) 50(51) 259(146-461) 0001No 30(27) 81(73) 1













A 14(326) 29(674) 1B 17(472) 19(528) 085(02-366) 0697AB 7(318) 15(682) 053(01-278) 0967O 31(534) 27(466) 17(056-516) 0531

Unknown 9(18) 41(82) 091(024-353) 0170

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 266(082-861) 070AB 4(286) 10(714) 063(059-223) 0751O 24(558) 19(442) 505(153-1672) 0012

Unknown 10(196) 41(804) 093(029-300) 0387

Sepsis Yes 48(49) 50(51) 264(115-605) 0022No 30(27) 81(73) 1






5 Conclusion




Abbreviations




Data Availability


Ethical Approval


Consent




Acknowledgments


References












































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of




















(b) Continued

Variable Category


Yes NON () N ()

Sepsis Yes 48(49) 50(51) 259(146-461) 0001No 30(27) 81(73) 1













A 14(326) 29(674) 1B 17(472) 19(528) 085(02-366) 0697AB 7(318) 15(682) 053(01-278) 0967O 31(534) 27(466) 17(056-516) 0531

Unknown 9(18) 41(82) 091(024-353) 0170

Mothers blood group

A 18(327) 37(673) 1B 22(478) 24(522) 266(082-861) 070AB 4(286) 10(714) 063(059-223) 0751O 24(558) 19(442) 505(153-1672) 0012

Unknown 10(196) 41(804) 093(029-300) 0387

Sepsis Yes 48(49) 50(51) 264(115-605) 0022No 30(27) 81(73) 1






5 Conclusion




Abbreviations




Data Availability


Ethical Approval


Consent




Acknowledgments


References












































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of





















Abbreviations




Data Availability


Ethical Approval


Consent




Acknowledgments


References












































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of











































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of























of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of



















Documents

Magnitude of Neonatal Jaundice and Its Associated Factor