Aetiologic profile, outcomes and associated factors for infantile obstructive jaundice cases managed at a tertiary hospital in Uganda: A retrospective study

Background The care for children with infantile obstructive jaundice remains a significant challenge in low-resource settings such as in Uganda. These patients often present late with significant complications of prolonged cholestasis. However, a complete etiologic spectrum, outcomes and the associated factors for outcomes of infantile obstructive jaundice cases in Uganda remain largely unknown. Objective To determine the aetiologies, short-term outcomes and influencing factors, among neonates and infants with obstructive jaundice managed at Mulago National Referral Hospital. Methodology This was a retrospective study on consecutive children with the diagnosis of infantile obstructive jaundice managed at MNRH for a period of 10 years, from January 2014 to December 2023. Demographic and clinical data from medical records were extracted and analysed. Aetiology and outcome were expressed as percentage proportions of total cases evaluated. A logistic regression model was used to identify independent factors associated with outcomes of infantile obstructive jaundice. Results A total of 109 cases of IOJ were evaluated. Male cases were 62 (56.9%) and females; 47 (43.1%). The median duration of symptoms before admission was 90 days (IQR: 29– 179 days). Biliary atresia was the commonest cause of IOJ; 82 (75.2%) cases followed by Biliary cyst, 14 cases (12.8%) and inspissated bile plug syndrome, 9 cases (8.3%). Thirteen cases (11.9%) died, 84 cases (77.1%) were on palliative care and 12 cases (11.0%) showed clinical improvement at the time of assessment. Significant factors for poor outcomes were: IOJ caused by biliary atresia (adjusted OR = 6.24, (95% CI: 1.5–23.6)) and prolonged duration of symptoms prior to admission (adjusted OR = 1.01, 95% CI: 1.00–1.02)). Conclusion Infantile obstructive jaundice at MNRH is predominantly caused by biliary atresia, and is associated with an unacceptably high rate of poor outcomes. Outcomes are particularly poor for those with longer duration of symptoms prio