Clinical and neurodevelopmental outcome of newborns with excessively high levels of serum bilirubin in amarginalized population along the Thai-Myanmar border: a matched case-control study

Wouda, E. (Eva) (2017) Clinical and neurodevelopmental outcome of newborns with excessively high levels of serum bilirubin in amarginalized population along the Thai-Myanmar border: a matched case-control study. thesis, Medicine.

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Abstract

English Introduction: Neonatal hyperbilirubinemia (NH) is the most common condition that requires medical attention in newborns. In some infants serum bilirubin (SBR) levels rise excessively and cause acute bilirubin encephalopathy (ABE) leading to death or lifelong neurological impairment. This study aimed to describe the clinical and neurodevelopmental outcome in infants with NH born in a limited-resource setting along the Thai-Myanmar border, without immediate access to exchange transfusion, but with phototherapy facilities. Methods: The study consisted of a description of 132 cases; neonates > 28 weeks of gestational age hospitalized between 2009 and 2014 who had two consecutive high SBR measurements that would justify exchange transfusion, or a rapid rise in SBR with neurological signs. Additionally, follow-up information of 39 two to eight year-old survivors was compared to 39 matched controls with no to moderately raised SBR levels. Neurodevelopmental outcome was evaluated with the Griffiths Mental Development Scale (GMDS) and expressed as centile. Results: Neonatal mortality among cases was 11%, all neonatal deaths occurred in ABE cases. At follow-up three cases (7.7%) showed severe clinical and neurological impairment, with untestable GMDS-scores. Overall, cases had significantly poorer neurodevelopmental scores on ‘Hearing and Language’ and ‘Practical Reasoning’ subscales and poorer summarizing scores (Median Percentile 10 (IQR <1 – 42) compared to Median Percentile 30.5 (IQR 4 - 67); p=0.013) Conclusion: In this setting with constrained exchange transfusion possibilities, 89% of infants with excessively high SBR levels survive the neonatal period. Survivors have an increased risk of neurodevelopmental delay compared to matched controls who had no to moderately raised SBR levels. Overall, GMDS-scores were low in this marginalized population where stunting prevalence is high and pre-school activities rarely available. Systematic follow-up of cases and attention for prevention of confounding factors might decrease the overall risk of neurodevelopmental delay.

Item Type:	Thesis (Thesis)
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:03
Last Modified:	25 Jun 2020 11:03
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2271

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