High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border.

Population risks for neonatal hyperbilirubinaemia (NH) vary. Knowledge of local risks permits interventions that may reduce the proportion becoming severe. Between January 2015 and May 2016, in a resource-limited setting on the Thailand-Myanmar border, neonates from 28 weeks' gestation were enr...

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Autores principales:	Laurence Thielemans, Pimnara Peerawaranun, Mavuto Mukaka, Moo Kho Paw, Jacher Wiladphaingern, Jordi Landier, Germana Bancone, Stephane Proux, Henrike Elsinga, Margreet Trip-Hoving, Borimas Hanboonkunupakarn, Tha Ler Htoo, Thaw Shee Wah, Candy Beau, Francois Nosten, Rose McGready, Verena I Carrara
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/d867bafb0a7f4efba2a58c4c2e4e27c6
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spelling	oai:doaj.org-article:d867bafb0a7f4efba2a58c4c2e4e27c62021-12-02T20:17:12ZHigh levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border.1932-620310.1371/journal.pone.0258127https://doaj.org/article/d867bafb0a7f4efba2a58c4c2e4e27c62021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0258127https://doaj.org/toc/1932-6203Population risks for neonatal hyperbilirubinaemia (NH) vary. Knowledge of local risks permits interventions that may reduce the proportion becoming severe. Between January 2015 and May 2016, in a resource-limited setting on the Thailand-Myanmar border, neonates from 28 weeks' gestation were enrolled into a prospective birth cohort. Each neonate had total serum bilirubin measurements: scheduled (24, 48, 72 and 144 hours of life) and clinically indicated; and weekly follow up until 1 month of age. Risk factors for developing NH were evaluated using Cox proportional hazard mixed model. Of 1710 neonates, 22% (376) developed NH (83% preterm, 19% term). All neonates born <35 weeks, four in five born 35-37 weeks, and three in twenty born ≥38 weeks had NH, giving an overall incidence of 249 per 1000 livebirths [95%CI 225, 403]. Mortality from acute bilirubin encephalopathy was 10% (2/20) amongst the 5.3% (20/376) who reached the severe NH threshold. One-quarter (26.3%) of NH occurred within 24 hours. NH onset varied with gestational age: at a median [IQR] 24 hours [24, 30] for neonates born 37 weeks or prematurely vs 59 hours [48, 84] for neonates born ≥38 weeks. Risk factors for NH in the first week of life independent of gestational age were: neonatal G6PD deficiency, birth bruising, Sgaw Karen ethnicity, primigravidae, pre-eclampsia, and prolonged rupture of membranes. The genetic impact of G6PD deficiency on NH was partially interpreted by using the florescent spot test and further genotyping work is in progress. The risk of NH in Sgaw Karen refugees may be overlooked internationally as they are most likely regarded as Burmese in countries of resettlement. Given high levels of pathological jaundice in the first 24 hours and overall high NH burden, guidelines changes were implemented including preventive PT for all neonates <35 weeks and for those 35-37 weeks with risk factors.Laurence ThielemansPimnara PeerawaranunMavuto MukakaMoo Kho PawJacher WiladphaingernJordi LandierGermana BanconeStephane ProuxHenrike ElsingaMargreet Trip-HovingBorimas HanboonkunupakarnTha Ler HtooThaw Shee WahCandy BeauFrancois NostenRose McGreadyVerena I CarraraPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10, p e0258127 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Laurence Thielemans Pimnara Peerawaranun Mavuto Mukaka Moo Kho Paw Jacher Wiladphaingern Jordi Landier Germana Bancone Stephane Proux Henrike Elsinga Margreet Trip-Hoving Borimas Hanboonkunupakarn Tha Ler Htoo Thaw Shee Wah Candy Beau Francois Nosten Rose McGready Verena I Carrara High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border.
description	Population risks for neonatal hyperbilirubinaemia (NH) vary. Knowledge of local risks permits interventions that may reduce the proportion becoming severe. Between January 2015 and May 2016, in a resource-limited setting on the Thailand-Myanmar border, neonates from 28 weeks' gestation were enrolled into a prospective birth cohort. Each neonate had total serum bilirubin measurements: scheduled (24, 48, 72 and 144 hours of life) and clinically indicated; and weekly follow up until 1 month of age. Risk factors for developing NH were evaluated using Cox proportional hazard mixed model. Of 1710 neonates, 22% (376) developed NH (83% preterm, 19% term). All neonates born <35 weeks, four in five born 35-37 weeks, and three in twenty born ≥38 weeks had NH, giving an overall incidence of 249 per 1000 livebirths [95%CI 225, 403]. Mortality from acute bilirubin encephalopathy was 10% (2/20) amongst the 5.3% (20/376) who reached the severe NH threshold. One-quarter (26.3%) of NH occurred within 24 hours. NH onset varied with gestational age: at a median [IQR] 24 hours [24, 30] for neonates born 37 weeks or prematurely vs 59 hours [48, 84] for neonates born ≥38 weeks. Risk factors for NH in the first week of life independent of gestational age were: neonatal G6PD deficiency, birth bruising, Sgaw Karen ethnicity, primigravidae, pre-eclampsia, and prolonged rupture of membranes. The genetic impact of G6PD deficiency on NH was partially interpreted by using the florescent spot test and further genotyping work is in progress. The risk of NH in Sgaw Karen refugees may be overlooked internationally as they are most likely regarded as Burmese in countries of resettlement. Given high levels of pathological jaundice in the first 24 hours and overall high NH burden, guidelines changes were implemented including preventive PT for all neonates <35 weeks and for those 35-37 weeks with risk factors.
format	article
author	Laurence Thielemans Pimnara Peerawaranun Mavuto Mukaka Moo Kho Paw Jacher Wiladphaingern Jordi Landier Germana Bancone Stephane Proux Henrike Elsinga Margreet Trip-Hoving Borimas Hanboonkunupakarn Tha Ler Htoo Thaw Shee Wah Candy Beau Francois Nosten Rose McGready Verena I Carrara
author_facet	Laurence Thielemans Pimnara Peerawaranun Mavuto Mukaka Moo Kho Paw Jacher Wiladphaingern Jordi Landier Germana Bancone Stephane Proux Henrike Elsinga Margreet Trip-Hoving Borimas Hanboonkunupakarn Tha Ler Htoo Thaw Shee Wah Candy Beau Francois Nosten Rose McGready Verena I Carrara
author_sort	Laurence Thielemans
title	High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border.
title_short	High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border.
title_full	High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border.
title_fullStr	High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border.
title_full_unstemmed	High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border.
title_sort	high levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the thailand-myanmar border.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/d867bafb0a7f4efba2a58c4c2e4e27c6
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High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border.

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