Scripties UMCG - Rijksuniversiteit Groningen
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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

(2017) Wouda, E. (Eva)

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.

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