Abstract
BackgroundIn Myanmar, approximately half of all neonatal hospital admissions are for hyperbilirubinaemia, and tertiary facilities report high rates of Exchange Transfusion (ET). The aim of this study was to evaluate the effectiveness of the pilot program in reducing ET, separately of inborn and outborn neonates.MethodsThe study was conducted in the Neonatal Care Units of four national tertiary hospitals: two exclusively treating inborn neonates, and two solely for outborn neonates. Prior to intervention, no high intensity phototherapy was available in these units. Intervention in late November 2011 comprised, for each hospital, provision of two high intensity LED phototherapy machines, a photo radiometer, and training of personnel. Hospital-specific data were assessed as Relative Risk (RR) ratios comparing ET rates pre- and post-intervention, and individual hospital results were pooled when appropriate.ResultsIn 2011, there were 118 ETs among inborn neonates and 140 ETs among outborn neonates. The ET rate was unchanged at Inborn Hospital A (RR = 1.07; 95 % CI: 0.80–1.43; p = 0.67), and reduced by 69 % at Inborn Hospital B (RR = 0.31; 95 % CI: 0.17–0.57; p < 0.0001). For outborn neonates, the pooled estimate indicated that ET rates reduced by 33 % post-intervention (RRMH = 0.67; 95 % CI: 0.52–0.87; p = 0.002); heterogeneity was not a problem.ConclusionTogether with a photoradiometer and education, intensive phototherapy can significantly reduce the ET rate. Inborn Hospital A had four times as many admissions for jaundice as Inborn Hospital B, and did not reduce ET until it received additional high intensity machines. The results highlight the importance of providing enough intensive phototherapy units to treat all neonates requiring high intensity treatment for a full course.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12615001171505, 2 November 2015.
Highlights
In Myanmar, approximately half of all neonatal hospital admissions are for hyperbilirubinaemia, and tertiary facilities report high rates of Exchange Transfusion (ET)
At Inborn Hospital A, the ET rate among neonates admitted for jaundice was 10.0 % pre-intervention and 10.7 % post-intervention (RR = 1.07; 95 % confidence interval (CI): 0.80–1.43; p = 0.68)
We report on a simple intervention at four hospitals comprising the provision, to each hospital, of two LED phototherapy machines to improve the irradiance provided for treatment of jaundice, one photo radiometer to allow hospitals to triage neonates to the most effective conventional phototherapy machines and to allow them to ensure high output from conventional machines, and training in the use of standard guidelines for management of hyperbilirubinaemia
Summary
In Myanmar, approximately half of all neonatal hospital admissions are for hyperbilirubinaemia, and tertiary facilities report high rates of Exchange Transfusion (ET). Neonatal jaundice is found in about 60 % of term and 80 % of preterm neonates in the first week of life [1], because neonates produce bilirubin at unusually high rates, and are inefficient at metabolising and excreting it [2]. The ET rate among inborn neonates at a single hospital in the USA during the period 1986– 2006 averaged an estimated 74 neonates per 100,000 live births, with a statistically significant reduction in exchange transfusion incidence over time [7]. A pilot program was implemented at these four hospitals, to improve treatment of neonates admitted to the Neonatal Care Units (NCUs)
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