Physiological and Pharmacological Determinants of Neonatal Hyperbilirubinemia: A Hospital Based Cross Sectional Study in Nasiriyah, Iraq
Author(s):
Amena L Muttlaq
Date: 09/10/2026
doi: https://doi.org/10.5281/zenodo.8425890
Abstract
Background; In low- and middle-income countries, newborn hyperbilirubinemia is a major cause of
preventable neurological illness. Risk assessment and early intervention require clinical and physiologic
predictors of severe hyperbilirubinemia.
To investigate the physiological characteristics and pharmacological interventions related with severe
neonatal hyperbilirubinemia and its independent predictors in hospitalised neonates in Nasiriyah, Iraq.
Methods: From October 2024 to May 2025, 200 babies with hyperbilirubinemia were studied in two
prominent Nasiriyah hospitals, Bint Al-Huda Hospital and Mohammed Al-Moussawi Children Hospital.
Age, sex, birth weight, gestational age, and ABO/Rh blood group incompatibility were gathered.
Hyperbilirubinemia was characterised by TSB level as mild, moderate, or severe. To find severe
hyperbilirubinemia predictions, multivariate logistic regression was used .
Results: The average age of infants was 6.9 ± 4.2 days, with a 71.4% male predominance. The severity
of hyperbilirubinemia was 25.7%. Twenty-two percent of babies were Rh-incompatible and 42.9% ABO
incompatible. Low birth weight was the only independent risk factor for severe hyperbilirubinemia in
multivariate. Serious cases were more likely to have ABO incompatibility, however this was not
significant after confounders adjustment. Further, the therapy significantly reduced TSB levels (13.4 ± 4.5
mg/dL versus 7.2 ± 2.5 mg/dL, p < 0.05.)
Conclusions:In conclusion, babies with severe hyperbilirubinemia are still frequent. Low birth weight is
the highest independent predictor of hepatic immaturity and poor bilirubin metabolism, requiring rigorous
supervision of this high-risk group. Despite its prevalence, ABO incompatibility has little effect once
bilirubin is normalised. Prevention of serious neurological sequelae requires early clinical detection and
management of high-risk neonates.
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