Neonatal jaundice is a prevalent condition affecting 60% of term and 80% of preterm newborns to a variable degree worldwide (1). If severe jaundice develops, it can lead to acute bilirubin encephalopathy or kernicterus with a significant risk of neonatal mortality and long-term neurodevelopment squeals such as cerebral palsy, sensor neural hearing loss, intellectual difficulties, or gross developmental delays (2).

Neonatal jaundice is characterized by a yellowish discoloration of the mucous membranes, skin, and sclera due to the accumulation of unconjugated, non-polar, lipid-soluble bilirubin pigment in the skin (3). Neonatal jaundice is most common during the first few weeks of neonatal age. It is a significant concern that requires medical attention. Approximately 10% of breastfed babies continue to exhibit jaundice at 1 month of age. This illness is prevalent worldwide, with approximately 75% of hospital readmissions being attributed to it (4).

Neonatal jaundice is particularly important due to the strong association between elevated unconjugated bilirubin levels and neurotoxic effects, which can lead to long-term complications such as cerebral palsy, and hearing impairment (5). Neonatal jaundice occurs when there is an excess release of hemoglobin from the breakdown of red cells due to high levels of hemoglobin at birth, as well as due to the reduced life span of newborn red blood cells (70–80 days compared with 90–120 days in adults) and the reduced hepatic metabolism of bilirubin due to the immature liver. The majority of neonatal jaundice is a natural transition that typically resolves within the first week of life as the liver function matures (6).

Early diagnosis of high-risk infants with severe neonatal jaundice plays an important role in the timely and accurate prevention of the condition in the first 14 days after birth (7). Neonatal jaundice may have serious side effects on the health of infants; it is important to take into consideration its associated factors in newborns. Kernicterus is one of the most critical and, at times, most dangerous complications of the disease (8). Neonatal jaundice is considered one of the most dangerous signs of neonatal illness, as recognized by the World Health Organization (9). Annually, approximately 1.1 million infants worldwide experience neonatal jaundice, either with or without bilirubin encephalopathy. Of those newborns, 481,000 were born at full term. Among these, 114,000 died annually, while over 63,000 managed to survive with a moderate or severe disability. The vast majority of affected neonates reside in sub-Saharan Africa, including Ethiopia, accounting for 75% of the overall affected population (10). According to a recent review, sub-Saharan Africa and South Asia are the primary regions responsible for an estimated 1.1 million babies who would develop severe hyperbilirubinemia worldwide annually. Early identification of infants who are at risk of developing severe hyperbilirubinemia is therefore crucial for this potentially devastating condition (10). A study conducted in Calabar, South-South Nigeria, revealed that neonatal jaundice is a prevalent issue among infants admitted to the neonatal intensive care unit (NICU). The study identified the major factors associated with neonatal jaundice, including infection, i.e., septicemia (71.4%), ABO incompatibility (19.1%), glucose-6-phosphate dehydrogenase deficiency (9.5%), and gestational age <37weeks (11).

In a 2015 study conducted by Bahbah et al. (12) in Nigeria, it was found that neonatal jaundice had a strong correlation with premature neonates and developed earlier after birth in premature babies compared with full-term babies. The average gestational age of preterm neonates in the study was 32.78–34.82 weeks, and jaundice started at 1.88–5.52 days after birth. However, among full-term babies, the average gestational age was 37.28–39.12 weeks, and jaundice developed 3.36–6.44 days after birth. A retrospective study conducted in Ethiopia on the magnitude and associated factors of neonatal jaundice found that 44.9% of the neonates developed jaundice, with 89 (25%) of males and 71 (19.9%) of females affected. In this study, ABO incompatibility 57 (35.6%), sepsis 30 (18.8%), idiopathic cause 22 (13.8%), breastfeeding jaundice 16 (10%), and Rh-incompatibility14 (8.8%) were significantly associated with neonatal jaundice (13). A study conducted in Pakistan indicated that neonatal jaundice is the leading cause of neonatal mortality and morbidity, an inclusion from the global child health agenda under the Million Development Goals initiative. The study conducted in Nigeria identified several factors associated with neonatal jaundice, including hemolytic disease of the newborn, preterm birth, ABO incompatibility, infection, and other associated factors. These factors were the most increasingly acknowledged as significant contributors to the increasing neonatal mortality and morbidity worldwide (14). Therefore, it is evident that neonatal jaundice is a major health problem worldwide, especially in sub-Saharan Africa. Thus, the objective of this study is to determine the magnitude and associated factors of neonatal jaundice in newborns who were admitted to the neonatal intensive care units of public hospitals in the city of Dessie.

This study revealed that the proportion of neonatal jaundice was found to be 62 cases (28.4%). This finding was consistent with studies conducted in India and Pakistan (11, 19). However, it was lower than the prevalence found in cross-sectional studies conducted in Addis Ababa, Southeast Nigeria, Nigeria, Gondar, sub-Saharan Africa, and northern Ethiopia (13, 17, 20–23). This may be due to differences in the study area, study design, time variability, and methodology. The multivariable logistic regression analysis revealed that a low APGAR score of < 7, ABO incompatibility, sepsis, prolonged labor, Rh incompatibility, and gestational age < 37 weeks were found to be independent predictors of neonatal jaundice.

Neonates who had ABO incompatibility were 24 times more likely to be affected by jaundice compared with those without ABO incompatibility. This finding was supported by the studies conducted in Nigeria (24). Neonates who had sepsis were approximately 10 times more affected by neonatal jaundice compared with those who had no sepsis diagnosis. This is in line with the studies conducted in Nigeria (11) and South India (25) and the study conducted by Israel-Aina and Omoigberale (26). This might be because hemolysis, hepatocellular damage, ileus, and/or acidosis may occur as a result of sepsis. These factors may increase bilirubin production (hemolysis), decrease bilirubin removal (liver cell damage), and increase the reabsorption of bilirubin or hepatic dysfunction, resulting in the accumulation of serum bilirubin in the body (23, 27). Neonates with preterm birth were six times more likely to be affected by neonatal jaundice compared with neonates with a gestation period of 37 weeks or more. This result is in line with the studies conducted by Narayan in India and Nigeria (17, 21). Infants who were delivered prematurely (less than 37 weeks) were at a higher risk to have jaundice due to the immaturity of their bilirubin conjugating system, a higher rate of hemolysis, increased enterohepatic circulation, and decreased caloric intake (28). Another neonatal variable that was found to be significantly associated with neonatal jaundice was a low APGAR score of < 7. Specifically, neonates with a low APGAR score of < 7 were approximately eight times more likely to be affected by neonatal jaundice compared with those who had an APGAR score of > 7. This finding was supported by the studies conducted in Nigeria [(25) South India (16), which revealed that a low APGAR score below 7 is an independent risk factor for neonatal jaundice. The APGAR score is the overall indicator for of the newborn’s condition in the extra uterine environment, and neonates with low APGAR scores could be in a state of bradycardia asphyxia and sepsis, which can potentially lead to neonatal jaundice (29). The odds of jaundice were about nine times higher among neonates who were born with a long duration of labor compared with those born in normal labor. This finding was in line with the findings in other studies (23, 30). This might be attributed to the occurrence of bruising and swelling on the scalp of newborns due to the excessive pressure exerted by birth attendants as a solution for prolonged labor, which in turn, increases the risk of jaundice by increasing bilirubin levels in the blood. Neonates with Rh incompatibility were 30 times more affected by neonatal jaundice compared with the newborn without Rh incompatibility. This finding was supported by a study conducted in West India (18). This might be due to the fact that the mother is Rh-negative and the fetus is Rh-positive, and some fetal RBCs cross the placenta and enter the maternal circulation through a minor tear or at the time of delivery; fetal red cells sensitize the mother to antigens on the surface of the fetal red cells, causing the synthesis of anti-D, IgM, and IgG antibodies, leading to neonatal jaundice (22).

Various data collection tools were employed to gather information from diverse sources and enhance the credibility of the study. The data collection instrument underwent a preliminary evaluation, while the principal investigator supervised the entire data collection procedure.

This study utilized a cross-sectional study design, which examines the exposure and outcome simultaneously. However, it does not establish causality and relies on previously collected secondary data that may be subject to change.

The findings of this study suggest that neonatal jaundice was prevalent at Dessie Town public hospitals, with a prevalence rate of 62 (28.4%) cases. Factors such as low Apgar score, prematurity, blood type incompatibility, prolonged labor duration, and neonatal sepsis were found to be significantly associated with neonatal jaundice. In order to prevent and detect neonatal jaundice early, it is essential to conduct blood group testing for all women as part of their antenatal follow-up, particularly those with blood type O. In addition, healthcare professionals should strictly adhere to aseptic techniques while performing invasive procedures on newborns, and policymakers should strive to meet the overall satisfaction of women's needs. By implementing these measures, we may effectively address the issue of neonatal jaundice and improve the health outcomes for both mothers and infants.