Early Detection of Communicable Viral Causes of Neonatal Jaundice: A Hospital-Based Study From Kyrgyzstan

Abstract

Introduction:
Neonatal jaundice affects more than half of all term newborns, yet pathological hyperbilirubinemia continues to contribute to preventable morbidity in resource-limited settings. While metabolic and hematologic causes are well recognized, congenital and perinatally acquired viral infections such as cytomegalovirus (CMV) and herpes simplex virus (HSV) remain underdiagnosed contributors. Early identification of these communicable etiologies is critical to guide timely antiviral therapy and prevent severe outcomes. This study aimed to determine the prevalence of CMV and HSV infection among infants presenting with persistent pathological jaundice and to evaluate associated clinical and treatment characteristics.

Materials and Methods:

A prospective observational study was conducted from January to December 2024 across two major neonatal referral centers in Bishkek, Kyrgyzstan. Full-term infants with pathological hyperbilirubinemia were evaluated through clinical examination, transcutaneous and serum bilirubin measurements, and graded using the Kramer scale. Phototherapy was administered according to standardized protocols. Infants with persistent jaundice or inadequate phototherapy response underwent CMV and HSV PCR testing. Data were analyzed using SPSS version 25.

Results:
Among 150 enrolled infants, the mean age at presentation was 23.4 ± 13.2 days, with 78% presenting after 15 days of life. Moderate or severe jaundice was observed in 95% of infants. Continuous ICU-based phototherapy achieved greater bilirubin reduction (31% at 24 hours; 66% at 120 hours) compared with outpatient therapy. Of 20 infants tested, HSV-1/2 DNA was detected in 2 (10%), while no CMV infections were identified. All infants improved with treatment, and no fatalities occurred.

Conclusion:
HSV infection accounted for a notable proportion of persistent neonatal jaundice cases. Incorporating viral PCR testing into jaundice evaluation protocols may enhance early detection of communicable causes in resource-limited settings.