Glucose-6-phosphate dehydrogenase deficiency and neonatal indirect hyperbilirubinemia: a retrospective cohort study among 40,305 consecutively born babies.

BACKGROUND AND OBJECTIVE: Glucose-6-phosphate dehydrogenase deficiency (G6PDD) being highly prevalent in the Middle East, the primary objective was to estimate the incidence of neonatal jaundice among G6PD-deficient neonates and to explore its association with various risk factors. METHODS: This retrospective cohort study includes 7 years data of neonates diagnosed with G6PDD between 1st January 2015, and 30 September 2022, from Al Wakra Hospital, HMC Qatar. RESULTS: Among the 40,305 total births, 1013 had G6PDD with an incidence of 2.51%. Of all the G6PDD babies, 24.6% (249/1013) received phototherapy and three babies required exchange transfusion. Statistically significant associations were noted between the need for phototherapy and gestational age, gestational age groups, birth weight, and birth weight groups, but logistic regression analysis showed significant association for phototherapy only with the gestational age group. CONCLUSION: Universal screening and proper follow-up is essential for G6PDD as it plays crucial role in neonatal jaundice.

Successful breastfeeding following a level II NICU stay in Qatar - a longitudinal study.

BACKGROUND: Exclusive breastfeeding is an essential need for mothers and newborn babies, but cultural practices and employment demands significantly influence feeding practices. The association between neonatal intensive care unit (NICU) admission and breastfeeding outcomes are variable. Data for Qatar and Middle East, in particular, are limited. Hence, this study aims to estimate the rate of breastfeeding at the time of NICU discharge and the rate of successful breastfeeding after NICU discharge in Qatar during well-baby follow-ups. METHODS: This quantitative longitudinal study was conducted over 18 months from January 2019 and included neonates born in Al Wakra Hospital admitted to the NICU. Demographic data, feeding during NICU stay and at discharge were obtained from lactation charts. Data regarding feeding practices after discharge were obtained through a questionnaire administered at 4 weeks and 8 weeks in well-baby clinics. Descriptive statistics and logistic regression analyses were performed to determine the rates of breastfeeding and the association between the various factors. RESULTS: Of the 678 participants screened, 364 were eligible for analysis. The rates of exclusive breastfeeding were 20% (73/364), 54% (197/364) and 42% (153/364) at discharge, 4 weeks and 8 weeks, respectively. Any breastfeeding was 64% (233/364), 40% (146/364) and 43% (157/364) at discharge, 4 weeks and 8 weeks, respectively. Logistic regression analysis showed that neonates who had NICU stays longer than 4 days had a higher rate of exclusive breastfeeding at discharge (adjusted odds ratio 3.000; 95% CI 1.25, 7.198) but had a reduced rate of breastfeeding and higher rate of formula feeding during follow-ups. Although breastfeeding rates were better in preterm infants at NICU discharge, regression analysis showed that none of the other factors, including gestation and maternal education had a significant association with the rate of exclusive breastfeeding at the time of discharge or during follow-ups. CONCLUSIONS: The overall breastfeeding rates from this level II NICU in Qatar are better than previously available data. Studies with extended follow-up and assessment of intervention methods should be planned to improve and sustain the practice of exclusive breastfeeding.

Cost-effectiveness of Oral Versus Intravenous Ibuprofen Therapy in Preterm Infants With Patent Ductus Arteriosus in the Neonatal Intensive Care Setting: A Cohort-based Study.

PURPOSE: Use of ibuprofen for the patent ductus arteriosus (PDA) has become increasingly common. This study aimed to evaluate the clinical and economic impact of oral ibuprofen versus intravenous ibuprofen for PDA among preterm infants. METHODS: This retrospective, cohort-based pilot study examined the clinical and economic associations of oral versus intravenous ibuprofen for PDA. A decision-analytic model was constructed, from the hospital perspective, to follow the oral versus intravenous administrations of ibuprofen for PDA and their clinical and economic consequences. The course regimen of either formulation was an initial 10 mg/kg followed by 5 mg/kg at 24- and 48-h intervals. Clinical and resource utilization data were extracted from Cerner medical database, from 2014 through 2018, at the tertiary neonatal intensive care unit setting in Qatar. The primary outcome measures were the rate of successful closure based on the ductal diameter measure after the first course of treatment and the overall direct medical cost of PDA management. A population of 118 neonates was required for results with 80% power and 0.05 significance. Sensitivity analyses involving unit costs and a subgroup analysis based on gestational age and birth weight, added to a second-order probabilistic analysis of all model inputs, were performed. FINDINGS: Forty infants were available for inclusion in the oral ibuprofen study group, not achieving the desired sample size, with successful PDA closure reported in 64% of cases compared with a reduced success of 36% with intravenous ibuprofen (n = 59) (risk ratio = 0.56; 95% CI, 0.32-0.97; P = 0.04), which was associated with economic advantage to oral ibuprofen. The probabilistic analysis illustrated that oral ibuprofen costs less than intravenous ibuprofen in 72% of patient cases, with QAR 48,751 (US $13,356) (95% CI, QAR 47,500-50,000, US $13,014-$13,699) in mean savings. Sensitivity analyses confirmed the robustness of study conclusions and found that the rate of closure success versus failure was the most influential on results, followed by the occurrence of adverse drug events with both intravenous and oral ibuprofen. Although both ibuprofen formulations had similar safety profiles (P = 0.16), the intravenous formulation was associated with a larger number of adverse drug effects. IMPLICATIONS: This is the first cost-effectiveness evaluation of oral versus intravenous formulations of ibuprofen among infants with PDA. The oral ibuprofen might be associated with an enhanced ductal closure at a considerably lower cost. The study results support recent trends in neonatal intensive care unit practices in favor of the oral administration of ibuprofen.