Background Causes and severity of neonatal indirect hyperbilirubinemia (IH) vary geographically. Understanding local differences may assist in prevention of complications.

Objective To study the causes and severity of IH in readmitted neonates in Al Ahsa district.

Methods Records of all neonates readmitted for IH to Almana General Hospital at Al Ahsa between 2009 and 2013 were reviewed. Data included: maternal and neonatal characteristics, laboratory results, associated causes of IH and interventions.

Results 323 neonates were readmitted for IH (gestational age: 38 ± 1.8 weeks, birth weight: 3023 ± 513 g and males: 66%). The age and weight at readmission were 125 ± 770 h and 2923 ± 508 g respectively. History of previous jaundiced sibling was documented in 15%. The most common cause for IH was G6 PD deficiency (39.9%), followed by ABO incompatibility (12%) and breast milk jaundice (11%). The cause could not be determined in 31%.

Based on 2004-AAP phototherapy guideline, 30% infants were categorised as at lower risk, 58% at medium and 14% at higher risk. The highest serum bilirubin during readmission was 322 ± 59 µmol/L (range:198–686 µmol/L). All infants received phototherapy, and 2 required blood exchange transfusions. One case of kernicterus was documented (highest serum bilirubin: 686 µmol/L) with no mortality. The median length of hospital stay was 2 days. 25(7.7%) required more than one admission.

Conclusions In Al Ahsa, the commonest cause of neonatal indirect hyperbilirubinemia is G6 PD deficiency. Screening for G6 PD deficiency and close postnatal follow up are recommended.