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 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.

Neonatal Hyperbilirubinemia in a Marginalized Population on the Thai-Myanmar Border: a study protocol.

BACKGROUND: This study aims to identify risk factors and the neurodevelopmental impact of neonatal hyperbilirubinemia in a limited-resource setting among a refugee and migrant population residing along the Thai-Myanmar border, an area with a high prevalence of glucose-6-phosphate dehydrogenase-deficiency. METHODS: This is an analytic, observational, prospective birth cohort study including all infants of estimated gestational age equal to or greater than 28 weeks from mothers who followed antenatal care in the Shoklo Malaria Research Unit clinics. At birth, a series of clinical exams and laboratory investigations on cord blood will be carried out. Serum bilirubin will be measured in all infants during their first week of life. All the infants of the cohort will be clinically followed until the age of one year, including monitoring of their neurodevelopment. DISCUSSION: The strength of this study is the prospective cohort design. It will allow us to collect information about the pregnancy and detect all infants with neonatal hyperbilirubinemia, to observe their clinical response under treatment and to compare their neurodevelopment with infants who did not develop neonatal hyperbilirubinemia. Our study design has some limitations in particular the generalizability of our findings will be limited to infants born after the gestational age of 28 weeks onwards and neurodevelopment to the end of the first year of life. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT02361788 , registration date September 1st, 2014.

A Survey of Practice and Knowledge of Refugee and Migrant Pregnant Mothers Surrounding Neonatal Jaundice on the Thailand-Myanmar Border.

BACKGROUND: In populations with a high prevalence of glucose-6-phosphate dehydrogenase deficiency, practices that can induce haemolysis need to be identified to raise awareness of preventable risks. The aim of this survey was to determine the proportion of prospective mothers using haemolytic agents and their knowledge and practice surrounding neonatal jaundice. METHODS: Pregnant mothers were invited to participate in a cross-sectional survey conducted at Shoklo Malaria Research Unit on the Thailand-Myanmar border. RESULTS: From 12 April 2015 to 12 June 2015, 522 pregnant women completed the survey. Mothball use in the household was reported by 41.4% (216 of 522) of prospective mothers and menthol containing products on baby skin by 46.7% (244 of 522). CONCLUSION: Just over 40% of the households reported use of naphthalene-containing mothballs. Future health promotion activities that focus on reducing naphthalene mothball and menthol-containing products use have the potential to reduce rates of severe neonatal jaundice in this population.

[Psychosocial deprivation as a cause of growth retardation in children]. / Psychosociale deprivatie als oorzaak van groeivertraging bij kinderen.

Patient A, a 3-year-old boy with short stature, in whom a partial growth hormone deficiency had been diagnosed, was treated with growth hormone. Further evaluation, however, showed that there was evidence of psychosocial deprivation as a result of an unstable family situation. After psychosocial circumstances improved, growth hormone therapy was discontinued, following which no further growth retardation was observed. In the case of patient B, a 10-year-old girl with short stature, reconstruction of the growth curve showed that growth stagnation had occurred around the age of 6 years. The cause was psychosocial deprivation during a severe illness in one of her triplet sisters. Following stagnation, there was insufficient compensatory growth, resulting in short stature. These cases emphasize the importance of reconstruction of the growth curve and of taking a thorough psychosocial case history in all children with growth retardation or small stature. The clinical picture of psychosocial growth retardation can be similar to the picture of idiopathic, isolated growth hormone deficiency. Prompt and accurate diagnosis prevents unnecessary, extensive investigations and enables adequate treatment and support.

Endovenous laser therapy of the small saphenous vein: patient satisfaction and short-term results.

OBJECTIVE: Conventional surgical treatment for small saphenous vein (SSV) reflux is associated with high recurrence rates and complications. Endovenous laser ablation (EVLA) is a treatment modality with promising results. This study reports patient satisfaction and short-term results after EVLA of SSV reflux. METHODS: Fifty-two legs of 49 consecutive patients were treated with EVLA for reflux of the SSV. Patients were investigated clinically and by duplex scanning before and 6 weeks after treatment. Patient records were studied and a questionnaire was completed. RESULTS: Technical success was accomplished in all patients. After 6 weeks the occlusion rate was 100% and after 6.5 months no recurrent varicosities were reported. Complications consisted of bruising (51%), induration (39%), delayed tightness (16%), phlebitis (2%), and temporary paresthesia (6%) and were all self-limiting. One deep venous thrombosis occurred in a patient with a protein C deficiency. Ninety-two percent (45/49) of patients were satisfied with the results and in 98% symptoms had significantly improved or completely disappeared. Working activities were resumed after a mean of 4 days. Forty-three patients (88%) would consider having endovenous laser treatment again if indicated. CONCLUSIONS: EVLA of the SSV seems to be a safe modality with excellent short-term results and high patient satisfaction. Controlled studies assessing the effectiveness of EVLA in comparison to conventional treatment of SSV reflux are crucial before considering EVLA as the standard treatment.