Table 1.
Characteristics of neonatal period of 129 neonates with extreme NH
| Characteristics | Extreme NH (N=129) | |
| Year of admission | 2009 | 22 (17.0) |
| 2010 | 26 (20.2) | |
| 2011 | 12 (9.3) | |
| 2012 | 24 (18.6) | |
| 2013 | 27 (20.9) | |
| 2014 | 18 (14.0) | |
| Status | Refugee | 91 (70.5) |
| Migrant | 38 (29.5) | |
| Gender (male) | 75 (58.1) | |
| Gestational age ≥35 weeks* | 92 (71.3) | |
| Place of delivery | SMRU clinic | 110 (85.3) |
| Tertiary hospital | 4 (3.1) | |
| Home | 15 (11.6) | |
| Birth weight (kg) (n=125), median (IQR)† | 2.53 (1.96–2.90) | |
| Small for gestational age (n=125)‡ | 23 (18.4) | |
| Poor start to life§ | 15 (11.6) | |
| Mother primigravid | 60 (46.5) | |
| Normal vaginal delivery | 114 (88.4) | |
| Age at admission (days), median (IQR) | 1 (0–4) | |
| Duration of admission (days), median (IQR) | 6 (4–11) | |
| Extreme NH category¶ | Two SBRs above ET | 101 (78.3) |
| Rapid SBR rise+ABE signs | 27 (20.9) | |
| Clinical diagnosis of ABE | 1 (0.8) | |
| Duration of phototherapy (hours), median (IQR) | 76 (48–124) | |
| Peak SBR (µmol/L), median (IQR) | 430 (371–487) | |
| Age at peak SBR (hours), median (IQR) | 97 (68–136) | |
| Peak SBR at <72 hours of life | 41 (31.8) | |
| Underwent ET | 4 (3.1) | |
| Potential blood group ABO incompatibility** (n=126) | 24 (19.0) | |
| G6PD-deficient male†† (n=75) | 33 (44.0) | |
| Polycythaemia‡‡ | 10 (7.8) | |
| Birth trauma (visible bruising after birth recorded in the chart) | 6 (4.7) | |
| Clinical diagnosis of sepsis prior to onset of NH§§ | 34 (26.4) |
Data shown in number and percentage (%) unless stated otherwise.
*Gestational age: based on first trimester ultrasound.25
†Birthweight: weight measurement considered valid if done in the first 72 hours of life.
‡Small for gestational age: defined as birth weight below the 10th percentile for gestational age and sex, calculated with the INTERGROWTH-21st newborn size application tool (https://intergrowth21.tghn.org).
§Poor start to life: Apgar score<7 at 5 min and/or clinical suspicion of meconium aspiration and/or resuscitation at birth with at least five inflation breaths.
¶Extreme NH categories: (1) two consecutive SBR measurements above the ET threshold of the NICE guideline, (2) SBR levels rising faster than 8.5 µmol/L/hour in combination with one SBR measurement above the ET threshold or with clinical symptoms of acute bilirubin encepalopathy, and (3) a clinical diagnosis of ABE.
**Potential blood group ABO incompatibility: mother–foetus pairs with mother blood group ‘O’ and neonate blood group ‘A’ or ‘B’. Rhesus factor and Coombs test were not available.
††Diagnosed by G6PD fluorescent test.22
‡‡Polycythaemia: two consecutive haematocrit values>70% from a capillary sample or a diagnosis of polycythaemia recorded in the clinical chart.
§§Clinical diagnosis of sepsis: sepsis reported as clinical diagnosis treated at least 5 days by intravenous antibiotics (blood culture confirmations were not available).
ABE, acute bilirubin encepalopathy; ET, exchange transfusion; G6PD, glucose-6-phosphate dehydrogenase; NH, neonatal hyperbilirubinaemia; NICE, National Institute for Health and Clinical Excellence; SBR, serum bilirubin; SMRU, Shoklo Malaria Research Unit.