Correlation Between Heavy Metals and Neonatal Hyperbilirubinemia Among the Patients Attended at Bangabandhu Sheikh Mujib Medical University

Abstract

Neonatal hyperbilirubinemia is a frequently encountered problem in 60%–80% of newborns worldwide. The burden is high in low-income and middle-income countries like Bangladesh. A recent report noted that at least 4,81,000 term/near-term neonates are affected by hyperbilirubinemia each year, with 1,14,000 dying and an additional 63,000 surviving with kernicterus. Under this circumstance, it is essential to tackle severe neonatal jaundice as one key component of optimizing neurodevelopmental outcome to achieve the sustainable development goals. Therefore, this study has designed to find the incidence and relation of neonatal jaundice with heavy metals such as copper, zinc and magnesium to inform child health policy regarding its prevention and management. About 594 neonates were collected from the outpatient and inpatient Department of Clinical Pathology (Laboratory medicine) and Neonatology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Infants with severe congenital malformation, sepsis, or birth asphyxia were excluded from this study. They were divided into case and control groups. This study was approved by the institutional ethical committees of Institute of Biological Sciences (IBSc), University of Rajshahi, Bangladesh (Approval Memo no-82/320/IAMEBBC/IBSc, 20 August, 2017). The mean age of the respondents was 3.08 and 3.21 days; the sex variable of the respondents were male 187 and 160 in case and control group respectively and female were 132 and 115 in case and control group respectively which was not significant. The mean weight of the respondents was 2.62±0.4 and 2.84±0.3 kilogram which was significant. The concentration of serum bilirubin was significantly (p<0.001) higher (171.14 mg/L) in case group when compare to control group (35.42 mg/L). Because the liver function becomes progressively worse in case group. The serum magnesium was 23.98 mg/L and 19.19 mg/L in case and control group, respectively. The concentration of serum magnesium is higher in case group when compared with control which is very significant (p<0.001). The level of serum zinc was 0.50 mg/L in case group and 0.68 mg/L in control group. The serum zinc level is significantly (p<0.001) lower in case group when compared with control group. In case group the level of copper was 0.75 mg/L and in control group was 0.43 mg/L. It was significantly (p<0.001) higher in case group when compared with control group. There was a positive significant Pearson correlation (r=0.817, pvalue<0.001) between serum total bilirubin level and serum magnesium level in both groups. It means if serum bilirubin is increased, serum magnesium also increased in case group and control group. Relation between serum total bilirubin level and serum zinc level was negative significant Pearson correlation (r= -0.773, p value <0.001) in both groups. It is justified that if serum bilirubin level is increased the serum zinc level also decreased in case group and control group. The positive significant Pearson correlation (r=0.832, p value <0.001) was in between serum total bilirubin and serum copper level in both groups and it can be said that if serum bilirubin level is increased, the serum copper level also increased in case group and control group. So, in this study, the heavy metal like zinc, copper and magnesium has relation with neonatal hyperbilirubinemia. If serum bilirubin is increased, serum magnesium and copper also increased but when serum bilirubin level is increased, the serum zinc level decreased in the patient of neonatal hyperbilirubinemia.