Clinical Profile and Factors Associated with Severe Neonatal Hyperbilirubinemia in a Tertiary Care Special Newborn Care Unit: A Prospective Observational Analytical Study

Background: Neonatal hyperbilirubinemia is a leading contributor to neonatal admissions and carries a risk of bilirubin-induced neurological dysfunction. Objective: To evaluate demographic parameters, clinical presentation, and factors associated with severe hyperbilirubinemia among jaundiced neonates admitted to a tertiary Special Newborn Care Unit (SNCU). Methods: A prospective observational analytical study was conducted over one year (August 2025-July 2026) at the SNCU of a tertiary care hospital in Raipur, Chhattisgarh, India. One hundred neonates aged 1-28 days with clinical jaundice were enrolled. Severe hyperbilirubinemia was defined a priori as peak total serum bilirubin (TSB) ≥20 mg/dL. Univariable logistic regression was used for factors without zero cells; Fisher's exact test was used when complete separation prevented finite odds-ratio estimation. Results: Among 100 neonates, mean gestational age was 37.2 ± 2.1 weeks and mean birth weight was 2.85 ± 0.52 kg; 58% were male. Median age at presentation was 72 hours (IQR: 48-96), and median peak TSB was 18.4 mg/dL (IQR: 15.2-21.7). Severe hyperbilirubinemia occurred in 40% (n = 40). Sepsis was associated with severe hyperbilirubinemia (OR 9.00; 95% CI 2.97-27.24; P < 0.001), as was hypoalbuminemia (OR 3.24; 95% CI 1.15-9.17; P = 0.026). Hypocalcemia showed a borderline association (OR 3.00; 95% CI 0.99-9.07; P = 0.052). Hemolytic/immunologic factors and acidosis occurred only in the severe group and were associated with severity by Fisher's exact test (both P < 0.001). Conclusion: Several clinical factors, including sepsis, hypoalbuminemia, hemolytic/immunologic factors, and acidosis, were associated with severe hyperbilirubinemia in this single-centre cohort. Because the analyses were unadjusted and exploratory, larger multi-centre studies with adjustment for confounding are required.