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Patterns of acute bilirubin encephalopathy in Nigeria: a multicenter pre-intervention study



Acute bilirubin encephalopathy (ABE) is an important cause of neonatal morbidity in Nigeria, accounting for 5–14% of neonatal deaths. Most newborns with severe ABE have irreversible damage before receiving treatment emphasizing the need for timely pre-admission monitoring and referral. There is limited evidence that educational interventions targeting mothers and health care providers will reduce delayed care.


To provide baseline data on the incidence of ABE and associated pre-admission risk factors in five centers of Nigeria in order to evaluate the effect of subsequent educational interventions on outcome.

Study design

The incidence of ABE among newborns treated for hyperbilirubinemia was documented prospectively. Bivariate analysis and multivariate logistic regression were used to evaluate risk factors for acute bilirubin encephalopathy and reasons for regional differences in its occurrence.


Of 1040 infants, 159 treated for hyperbilirubinemia (15.3%) had mild to severe bilirubin encephalopathy (including 35 deaths), but the incidence ranged from 7 to 22% between centers. Logistic regression identified four common predictors: total serum bilirubin (odds ratio 1.007 per mg/dl rise), out-of-hospital births (OR 2.6), non-alloimmune hemolytic anemia (OR 2.8), and delayed care seeking (OR 4.3).


The high occurrence of bilirubin encephalopathy in Nigeria is due in large part to a delay in seeking care. A planned intervention strategy will target conditions leading to severe hyperbilirubinemia and delay.

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This study was made possible in part through the generous support of the Saving Lives at Birth partners: the United States Agency for International Development (USAID), the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and the UK Government. It was prepared by the “Stop Kernicterus in Nigeria” consortium and Bilimetrix, srl and does not necessarily reflect the views of the Saving Lives at Birth partners.”

Author contributions

The study results from the concerted contributions of the entire “Stop Kernicterus in Nigeria” (SKIN) team who also reviewed and approved the manuscript. Trieste (ITA): C Greco, C Tiribelli; Asaba (NGA): A Okolo, OU Chima; Lagos (NGA): Z Imam,; A Odunsi, S Olaifa; Jos(NGA): F Bode-Thomas, C Isichei, CS Yilgwan, Z Hassan, D Shwe, AO Ofakunrin, H Abdu, E Olagbaju, VC Pam, JO Abba, SN Attah; Zaria(NGA): WN Ogala, LHassan, F Abdullahi, S Purdue; Kano(NGA): BW Jibir, IY Mohammed, HA Usman, M Abdusalam, SU Abdullahi, F Usman, A Kuliya-Gwarzo, FI Tsiga-Ahmad, L Umar.

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Correspondence to Udochukwu M Diala.

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The authors declare that they have no conflict of interest.

Electronic supplementary material

Table 1. (supplemental) PARTICIPATING CENTERS(DOCX 17 kb)

Table 2 (supplemental) Database(DOCX 17 kb)


Supplement Figure 1. Receiver-Operator-Characteristic (ROC) curve measuring the power of the Multiple Logistic Regression model for predicting ABE(DOCX 35 kb)

Supplement Table 3. Regional variations in incidence of ABE and associated risk factors(DOCX 35 kb)

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Diala, U.M., Wennberg, R.P., Abdulkadir, I. et al. Patterns of acute bilirubin encephalopathy in Nigeria: a multicenter pre-intervention study. J Perinatol 38, 873–880 (2018).

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