2 • PERINATOLOGY Vol 24 • No. 1 • May–Aug 2023 Research Article Datta M, et al. Determinants of Severe Neonatal Jaundice > 48 hours between the diagnosis of severe jaundice in the neonates and their hospital admission to be the factors responsible for an increased risk of severe jaundice. Conclusion: The delayed hospitalization of neonates with severe jaundice was found to be because of low maternal education and poor utilization of maternal and child health care services. The mothers’ ability to detect the signs of jaundice in their neonates early will aid in timely seeking of medical help. Key Words: Kernicterus, maternal education, antenatal care, total serum bilirubin, exchange transfusion, phototherapy Introduction Neonatal jaundice is defined as yellow discoloration of the skin and the sclera in the first 28 days of life due to hyperbilirubinemia. This condition occurs among 50% of term and 80% of preterm neonates, and it is a common cause of hospital readmission among neonates. Unconjugated bilirubin is potentially neurotoxic in neonates and can cause kernicterus or bilirubin encephalopathy.1 In developed countries, this condition has nearly disappeared; however, in developing countries, this preventable condition still causes considerable neonatal morbidity and mortality.2-4 Hence, it is necessary to explore the sociodemographic and mother–neonate health care service– related factors that act as barriers to the early detection of and intervention for neonatal jaundice in developing countries. The 2010 British National Institute for Health and Care Excellence guidelines stressed on the role of parents’ and caregivers’ education in the early detection of neonatal jaundice.5 The Integrated Management of Neonatal and Childhood Illness guidelines, implemented at the primary care level in India, also emphasize on the early detection of neonatal jaundice.6 However, the necessary awareness about this condition remains poor. A study conducted in India reports poor sensitivity and a low positive predictive value for the detection of neonatal jaundice by the mothers.7 As there is an incomplete understanding of the socio-demographic determinants of severe neonatal jaundice at presentation, in India, we conducted this case–control study. Aims • To describe the cases and controls according to their demographic and disease profiles • To estimate the added risk of adverse sociodemographic, maternal, perinatal, and poor service utilization factors on the incidence of severe neonatal jaundice at admission Materials and Methods Study design This case–control study was conducted at the Department of Pediatric Medicine, BC Roy Post Graduate Institute of Pediatric Sciences (Kolkata, West Bengal, India), a tertiary care center. The study was conducted between March 2019 and February 2020 and was compliant with the Helsinki declaration on bioethics policy and was approved by the institutional ethics committee. All the parents provided informed consent for their neonates to participate in the study. Data confidentiality and anonymity were maintained through all stages. The study population consisted of neonates born at gestational age ≥ 35 weeks, referred from peripheral health institutes, and admitted to the study center with a diagnosis of jaundice, during the data collection period. The neonates were categorized as cases and controls based on
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