Outcome Analysis of Severe Hyperbilirubinemia in Neonates Undergoing Exchange Transfusion

Developmental outcome of neonates underwent exchange transfusion due to hyperbilirubinemia: A single-center experience

BACKGROUND

Exchange transfusion due to hyperbilirubinemia is performed in neonates with signs of encephalopathy or if the level of bilirubin is more than the exchange threshold and not responding to intensive phototherapy. Bilirubin passage through the blood-brain barrier can cause injury to different sites of the brain and may have long-life effects. In this study, we aimed to evaluate the neonates who underwent exchange transfusion and investigated their developmental problems. By recognizing their developmental delay, we can recommend screening time and early occupational therapy if needed.

METHODS AND MATERIAL

This is a retrospective study on neonates who underwent exchange transfusion due to hyperbilirubinemia in Namazi and Hafez hospitals, in Shiraz, Iran, between 2016 and 2021. The exclusion criteria were the unwillingness of the parents to participate in the study or incomplete data. Children who died were also excluded from the study. Demographic and clinical data were obtained from hospital records. Children were invited to the clinic for examination, and development was assessed by Ages and Stages Questionnaires (ASQ). All neonates had done auditory brainstem response. The result was obtained. Quantitative data are reported as mean standard deviation (SD) and qualitative data with frequency and percentage. Spearman's correlation coefficient and Chi-square test were used, and the P value was significant below 0.05.

RESULTS

Eighty-seven neonates were enrolled. Forty-nine (56.3%) were female, and 38 (43.7%) were male. Glucose-6-phosphate dehydrogenase(G6PD) deficiency was the most prevalent hematologic cause of hyperbilirubinemia (23%). Auditory disorder, speech disorder, motor disorder, and encephalopathy were seen in four (4.6%), two (2.3%), three (3.4%), and four infants (4.6%), respectively.

CONCLUSION

Bilirubin neurotoxicity can cause developmental impairment including auditory, speech, and motor disorders besides encephalopathy. Early recognition and proper early intervention can lead to better outcomes for the child, family, and society.

Cerebral Palsy Heterogeneity: Clinical Characteristics and Diagnostic Significance from a Large-Sample Analysis

INTRODUCTION

Cerebral palsy (CP) is a nonprogressive movement disorder resulting from a prenatal or perinatal brain injury that benefits from early diagnosis and intervention. The timing of early CP diagnosis remains controversial, necessitating analysis of clinical features in a substantial cohort.

METHODS

We retrospectively reviewed medical records from a university hospital, focusing on children aged ≥24 months or followed up for ≥24 months and adhering to the International Classification of Diseases-10 for diagnosis and subtyping.

RESULTS

Among the 2012 confirmed CP cases, 68.84% were male and 51.44% had spastic diplegia. Based on the Gross Motor Function Classification System (GMFCS), 62.38% were in levels I and II and 19.88% were in levels IV and V. Hemiplegic and diplegic subtypes predominantly fell into levels I and II, while quadriplegic and mixed types were mainly levels IV and V. White matter injuries appeared in 46.58% of cranial MRI findings, while maldevelopment was rare (7.05%). Intellectual disability co-occurred in 43.44% of the CP cases, with hemiplegia having the lowest co-occurrence (20.28%, 58/286) and mixed types having the highest co-occurrence (73.85%, 48/65). Additionally, 51.67% (697/1,349) of the children with CP aged ≥48 months had comorbidities.

CONCLUSIONS

This study underscores white matter injury as the primary CP pathology and identifies intellectual disability as a common comorbidity. Although CP can be identified in infants under 1 year old, precision in diagnosis improves with development. These insights inform early detection and tailored interventions, emphasizing their crucial role in CP management.

Treatment Outcome of Jaundice and Its Associated Factors Among Neonates Treated in Neonatal Intensive Care Unit of Comprehensive and Specialized Hospitals of Southern Nations Nationalities and Peoples Region, Ethiopia 2022

Introduction

Jaundice is a common problem that affects up to 50-60% of full-term babies and 80% of preterm babies. It is a benign condition, but sometimes it can cause profound complications and eventually death. Identifying the treatment outcome of jaundice and the factors affecting it is crucial to preventing the death associated with it.

Objective

To determine the treatment outcome of jaundice and its associated factors among neonates treated in neonatal intensive care unit of comprehensive and specialized hospitals of SNNPR, Ethiopia, 2022.

Methods

An institution-based retrospective follow up study was conducted from April 2018 to April 2022. The data was checked for completeness and then entered into Epi-data version 4.6 and exported to STATA version 17. The results were presented in frequencies and percentages for categorical variables as well as mean and median for continuous variables. A binary logistic regression model was used to estimate the effect of an independent variable and the outcome variable.

Results

A total of 423 charts were reviewed, and 416 (98%) were included in the final analysis. Almost 91.3% (95% CI: 88.2, 93.7) of neonates had improved. Factors significantly associated with the treatment outcome were: residence (AOR = 0.36, 95% CI: 0.2, 0.8); origin of admission (AOR = 0.35, 95% CI: 0.2, 0.8); gestational age (AOR = 0.26, 95% CI: 0.1, 0.8); and total serum bilirubin level (AOR = 0.40, 95% CI: 0.2, 0.9).

Conclusion and Recommendation

Improvement was lower compared to other low and middle-income countries; more emphasis should be given to improving treatment outcomes in hospitals.