Comparative analysis of Bilirubin, Aspartate Transaminase, Alanine Aminotransaminase, Alkaline Phosphatase and Lactate Dehydrogenase in Neonates with Jaundice and Healthy Controls in Keffi, Nigeria

Abstract

Background: Approximately 60% of full-term neonates experience jaundice due to increased bilirubin concentration. Jaundice is caused by increased serum bilirubin levels that accumulate in tissues, resulting from the destruction of red blood cells. Furthermore, increased levels of lactate dehydrogenase (LDH) are observed in cases of haemolytic jaundice, and elevated levels of Aspartate Transaminase (AST), Alanine aminotransaminase (ALT) and Alkaline Phosphatase (ALP) are characteristic of hepatocellular jaundice. Jaundice remains a significant cause of neonatal morbidity and mortality in Nigeria and other low-resource settings, largely due to inadequate and a lack of access to neonatal care. Objective: This study evaluated the biochemical alterations associated with neonates diagnosed with jaundice compared to healthy neonates in Keffi, Nasarawa State, focusing on bilirubin metabolism, liver enzyme activity, and lactate dehydrogenase levels. Study Design: An unmatched case-control study was conducted. Place and Duration of Study: This study was carried out in Federal Medical Centre Keffi, Nasarawa State, Nigeria, from July 2024 to September 2024. Methodology: Five ml of venous blood were collected from a total of 137 term neonates, comprising 46 diagnosed with jaundice in the study site and 91 healthy neonates without jaundice (controls), into plain vacutainer tubes and allowed to clot, then spun at 3000 rpm for 10 minutes before collecting the serum into labelled tubes and stored at -20 °C until ready for analysis. Bilirubin (Direct and Total), AST, ALT, ALP and LDH levels were estimated using DiaLab reagents (DiaLab Austria) with the fully automated ChemWell 2902 Biochemistry Analyser (Awareness Technologies, USA). The data obtained were analysed using descriptive and inferential statistics, including independent t-tests, chi-square tests, ANOVA, and Pearson’s correlation (P<0.05). Results: The results revealed significantly elevated levels of total bilirubin (241.3 ± 108.5 µmol/L vs. 124.5 ± 35.1 µmol/L), direct bilirubin (80.2 ± 83.2 µmol/L vs. 33.2 ± 9.2 µmol/L), ALP (528.8 ± 385.5 IU/L vs. 231.4 ± 96.5 IU/L), AST (119.1 ± 222.7 IU/L vs. 21.7 ± 3.7 IU/L), ALT (107.4 ± 214.3 IU/L vs. 19.0 ± 4.3 IU/L), and LDH (722.2 ± 181.2 IU/L vs. 473.3 ± 174.0 IU/L) in neonates with jaundice compared with controls (P < 0.05). Strong correlations were observed between bilirubin and LDH (r = 0.68) and between AST and LDH (r = 0.61), highlighting the interplay of haemolysis and hepatic stress. Biochemical derangements were most pronounced within the first five days of life, after which values gradually declined, reflecting the natural course of disease and response to treatment. Conclusion: The elevated levels of bilirubin, liver enzymes and lactate dehydrogenase in this study are significant. It provides region-specific evidence that they are reliable diagnostic and prognostic biomarkers for jaundice in resource-limited settings. It underscores the critical need for early neonatal biochemical monitoring and the provision of neonatal care services that are accessible and affordable to reduce the preventable morbidity and mortality associated with the disease.