Extreme neonatal hyperbilirubinaemia in refugee and migrant populations: retrospective cohort

Eva Maria Nadine Wouda,Sanda Khing,Aye Aye Nge,Jordi Landier,Claudia Turner,Mue Chae Darakamon,Borimas Hanboonkunupakarn,Laurence Thielemans,Francois Nosten,Thatsanun Ngerseng,Rose Mcgready,Verena Ilona Carrara,Patrick Ferry Van Rheenen,Wah Say

doi:10.1136/bmjpo-2020-000641

Abstract

ObjectiveTo describe neonatal survival and long-term neurological outcome in neonatal hyperbilirubinaemia (NH) with extreme serum bilirubin (SBR) values.DesignRetrospective chart review, a one-off neurodevelopmental evaluation.SettingSpecial care baby unit in a refugee...

Highlights

In the most severe form of neonatal hyperbilirubinaemia (NH), serum bilirubin (SBR) levels rise to extreme values, causing a life- threatening condition that can lead to lifelong disability.[1]
Definitions For this analysis, NH with SBR values rising above levels that could justify exchange transfusion (ET), reported in the text as ‘extreme NH’, was defined as either (1) two consecutive SBR measurements above the ET threshold of the National Institute for Health and Clinical Excellence (NICE) guideline, (2) SBR levels rising faster than 8.5 μmol/L/hour in combination with one SBR measurement above the ET threshold or with clinical symptoms of Acute bilirubin encephalopathy (ABE), or (3) a clinical diagnosis of ABE.[15]
Extreme NH incidence among neonates delivered in Shoklo Malaria Research Unit (SMRU) birthing units (110/10398) was estimated at 105.8 per 10000 live births

Summary

Introduction

In the most severe form of neonatal hyperbilirubinaemia (NH), serum bilirubin (SBR) levels rise to extreme values, causing a life- threatening condition that can lead to lifelong disability.[1] Acute bilirubin encephalopathy (ABE) happens during the early phase of. ►► Extreme values of serum bilirubin (SBR) in the neonatal period can lead to death and long-term disability. ►► Low-income and middle-income countries bear the highest burden of disease but have limited access to diagnosis, treatment and supportive care for disability. ►► Early recognition and adequate treatment are key to minimising the risk of extreme SBR values or neurological symptoms. A review of the worldwide burden of severe NH published in 2017 reported an incidence of 251.3 per 10 000 live births in Southeast Asia, Wouda EMN, et al BMJ Paediatrics Open 2020;4:e000641.

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Conclusion