Indirect neonatal hyperbilirubinemia in hospitalized neonates on the Thai-Myanmar border: a review of neonatal medical records from 2009 to 2014.

BACKGROUND: Indirect neonatal hyperbilirubinemia (INH) is a common neonatal disorder worldwide which can remain benign if prompt management is available. However there is a higher morbidity and mortality risk in settings with limited access to diagnosis and care. The manuscript describes the characteristics of neonates with INH, the burden of severe INH and identifies factors associated with severity in a resource-constrained setting. METHODS: We conducted a retrospective evaluation of anonymized records of neonates hospitalized on the Thai-Myanmar border. INH was defined according to the National Institute for Health and Care Excellence guidelines as 'moderate' if at least one serum bilirubin (SBR) value exceeded the phototherapy threshold and as 'severe' if above the exchange transfusion threshold. RESULTS: Out of 2980 records reviewed, 1580 (53%) had INH within the first 14 days of life. INH was moderate in 87% (1368/1580) and severe in 13% (212/1580). From 2009 to 2011, the proportion of severe INH decreased from 37 to 15% and the mortality dropped from 10% (8/82) to 2% (7/449) coinciding with the implementation of standardized guidelines and light-emitting diode (LED) phototherapy. Severe INH was associated with: prematurity (< 32 weeks, Adjusted Odds Ratio (AOR) 3.3; 95% CI 1.6-6.6 and 32 to 37 weeks, AOR 2.2; 95% CI 1.6-3.1), Glucose-6-phosphate dehydrogenase deficiency (G6PD) (AOR 2.3; 95% CI 1.6-3.3), potential ABO incompatibility (AOR 1.5; 95% CI 1.0-2.2) and late presentation (AOR 1.8; 95% CI 1.3-2.6). The risk of developing severe INH and INH-related mortality significantly increased with each additional risk factor. CONCLUSION: INH is an important cause of neonatal hospitalization on the Thai-Myanmar border. Risk factors for severity were similar to previous reports from Asia. Implementing standardized guidelines and appropriate treatment was successful in reducing mortality and severity. Accessing to basic neonatal care including SBR testing, LED phototherapy and G6PD screening can contribute to improve neonatal outcomes.

A common rule governs the synaptic locus of both short-term and long-term potentiation.

BACKGROUND: At synapses between neurons in the brain, transmitter molecules are released from presynaptic terminals in multi-molecular packets called quanta. Excitatory synapses in the CA1 region of the hippocampus show a long-lasting increase in strength known as long-term potentiation (LTP), which may be important for some kinds of learning and memory. LTP can involve an increase in the number of quanta released, or in the size of the response each quantum produces in the postsynaptic cell, or both, depending on the initial condition of the synapse. These synapses also show two forms of brief potentiation: post-tetanic potentiation (PTP), which lasts for a minute or less and involves only modifications at the presynaptic terminal, and short-term potentiation (STP), which lasts rather longer. The significance of STP, the mechanisms whereby it is produced and its relationship to other forms of potentiation are poorly understood. We have studied STP electrophysiologically using slices of the rat hippocampus maintained in vitro. RESULTS: We found that STP, like LTP, can involve increases in either the number of quanta released, or their postsynaptic effect, or both. The rule governing the relative contribution from these two mechanisms appears to be the same as operates during LTP. Both the presynaptic and postsynaptic changes can develop equally rapidly and so must involve fast-acting messenger systems. CONCLUSIONS: STP seems to be a separate phenomenon from PTP, but appears closely related to LTP. The rapidity of its onset may require a reappraisal of current understanding of the messenger systems involved in bringing about changes in synaptic strength.

Presynaptic release probability influences the locus of long-term potentiation.

The quantal hypothesis proposes that chemical synaptic transmission involves the probabilistic release of multimolecular packets of transmitter. Analysis of the resulting trial-to-trial fluctuations in postsynaptic response can provide estimates both of the number of quanta released and of the size of their postsynaptic effect. This in turn permits the quantification of the relative contributions of pre- and postsynaptic factors to the strength of a given synapse. Quantal analysis of excitatory synapses in the hippocampus has proved difficult and has led to contradictory conclusions when applied to long-term potentiation. Here we report the use of a combination of quantal analysis procedures to provide evidence that both pre- and postsynaptic changes can contribute substantially to the maintenance of long-term potentiation in the CA1 region of the hippocampus. The initial setting of the presynaptic release mechanism seems to determine their relative importance.