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Chae H, Kwoun W, Lee JJ, Youn YA. Comparative analysis of the quantitative point-of-care CareSTART™ total bilirubin with central laboratory total bilirubin assays in neonatal blood samples. Medicine (Baltimore) 2024; 103:e38267. [PMID: 38787980 PMCID: PMC11124654 DOI: 10.1097/md.0000000000038267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
This study aimed to assess and compare the accuracy of point-of-care CareSTART™ S1 Total Bilirubin test with a central laboratory total bilirubin assay using neonatal samples. This study was conducted using 152 paired measurements obtained from 122 neonates admitted to the neonatal intensive care unit. Total serum bilirubin (TSB) levels assayed with the central laboratory assay, laboratory bilirubinomter, trancutaneous bliribubin (TcB) instrument and CareSTART were compared using Bland-Altman analysis. The mean difference between the CareSTART and TSB values was -1.43 mg/dL and the 95% limit of agreement (LoA) was -4.25 to 1.39 mg/dL. CareSTART tended to underestimate total bilirubin concentrations compared with TcB, however, the LoA was narrower due to the smaller SD of mean difference for CareSTART. The CareSTART Total Bilirubin test provides an accurate alternative to TcB for total serum bilirubin measurement. Given its low-cost, ease-of-use, and portability, the use of CareSTART is expected to provide point-of-care measurements, especially in low-resource settings.
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Affiliation(s)
- Hyojin Chae
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Woojae Kwoun
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Jeong Joong Lee
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Young-Ah Youn
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
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2
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Clemence P, Moshiro R, Manji K. Validity of BiliDx as a point-of-care bilirubin measurement device to diagnose and monitor neonatal jaundice at Muhimbili National Hospital, an observational study. BMC Pediatr 2024; 24:114. [PMID: 38350890 PMCID: PMC10863160 DOI: 10.1186/s12887-024-04565-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/14/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Neonatal jaundice is a condition caused by elevated levels of bilirubin in the bloodstream. Laboratory determination of serum bilirubin concentration by total serum bilirubin (TSB) test is still considered as gold standard for clinical guidance and practice. In developed countries, diagnosis of neonatal jaundice is shifting towards point-of-care medical devices. BiliDx is a device developed to allow a fast, blood-based determination of bilirubin levels at the point of care. This study aimed to determine the accuracy of the BiliDx device relative to a standard laboratory total serum bilirubin to diagnose and monitor jaundice among neonates admitted at Muhimbili National Hospital (MNH). MATERIAL AND METHODOLOGY This was a prospective hospital-based observational study conducted at the Neonatal Ward - MNH, Dar-es-Salaam, Tanzania from November 2022 to January 2023. A total of 180 neonates admitted at the neonatal ward with jaundice and whose parents consented were enrolled in the study. Blood samples were collected; 2 ml of venous blood into the vacutainer bottle for standard laboratory measurement of total serum bilirubin (TSB) and 25µL blood collected into a transfer pipette tube and applied to BiliDx. STATA version 15.1 was used for data analysis. RESULTS Out of 180 neonates, 39.4% (71/180) had birth weight between 1500 - 2499.9 g, approximately 2/3rd (120/180) were preterm, 92/180 (51.1%) were males and 100/180 (55.6%) were undergoing phototherapy treatment the moment sample taken. The mean bilirubin concentration was 92 mmol/l for BiliDx and 118 mmol/l for standard laboratory TSB. The minimum and maximum values obtained with BiliDx were, 3.4 and 427.5 mmol/l respectively, compared with 10.7 and 382.1 mmol/l using standard laboratory TSB. A linear relationship and correlation coefficient of 0.8408 (p = 0.000) between BiliDx and standard laboratory TSB was found. The regression analysis showed the presence of constant error [coefficient of BiliDx/slope = 0.91, 95% CI (0.82-0.99), p = 0.000] and random error exclusively [coefficient of constant/y-intercept = 48.52, 95%CI (37.70-59.34), p = 0.000]. The Bland-Altman plot showed an acceptable mean difference of 39.1mmol/l, limits of agreement of -48.3mmol/l to 126.4mmol/l, and 179 points (179/180 = 99.4%) lying inside the limits of agreement. CONCLUSION The results support the use of BiliDx for rapid and accurate testing of elevated levels of bilirubin in the bloodstream among neonates since 99.4% of the differences between BiliDx and standard laboratory TSB lie between the lines of agreement.
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Affiliation(s)
- Pascal Clemence
- Department of Paediatrics and child health, Muhimbili University of Health and Allied Sciences, P.O BOX 65001, Dar es Salaam, Tanzania.
| | - Robert Moshiro
- Department of Paediatrics and Child Health, Muhimbili National Hospital, P.O BOX 65000, Dar es Salaam, Tanzania
| | - Karim Manji
- Department of Paediatrics and child health, Muhimbili University of Health and Allied Sciences, P.O BOX 65001, Dar es Salaam, Tanzania
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Sampurna MTA, Pratama DC, Visuddho V, Oktaviana N, Putra AJE, Zakiyah R, Ahmad JM, Etika R, Handayani KD, Utomo MT, Angelica D, Ayuningtyas W, Hendrarto TW, Rohsiswatmo R, Wandita S, Kaban RK, Liem KD. A review of existing neonatal hyperbilirubinemia guidelines in Indonesia. F1000Res 2023; 11:1534. [PMID: 38025296 PMCID: PMC10682606 DOI: 10.12688/f1000research.110550.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the management of this condition were present. This study aimed to compare the existing guidelines regarding prevention, diagnosis, treatment and monitoring in order to create the best recommendation for a new hyperbilirubinemia guideline in Indonesia. METHODS Through an earlier survey regarding adherence to the neonatal hyperbilirubinemia guideline, we identified that three main guidelines are being used in Indonesia. These were developed by the Indonesian Pediatric Society (IPS), the Ministry of Health (MoH), and World Health Organization (WHO). In this study, we compared factors such as prevention, monitoring, methods for identifying, risk factors in the development of neonatal jaundice, risk factors that increase brain damage, and intervention treatment threshold in the existing guidelines to determine the best recommendations for a new guideline. RESULTS The MoH and WHO guidelines allow screening and treatment of hyperbilirubinemia based on visual examination (VE) only. Compared with the MoH and WHO guidelines, risk assessment is comprehensively discussed in the IPS guideline. The MoH guideline recommends further examination of an icteric baby to ensure that the mother has enough milk without measuring the bilirubin level. The MoH guideline recommends referring the baby when it looks yellow on the soles and palms. The WHO and IPS guidelines recommend combining VE with an objective measurement of transcutaneous or serum bilirubin. The threshold to begin phototherapy in the WHO guideline is lower than the IPS guideline while the exchange transfusion threshold in both guidelines are comparably equal. CONCLUSIONS The MoH guideline is outdated. MoH and IPS guidelines are causing differences in approaches to the management hyperbilirubinemia. A new, uniform guideline is required.
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Affiliation(s)
- Mahendra Tri Arif Sampurna
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Danny Chandra Pratama
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Visuddho Visuddho
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Novita Oktaviana
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Achmad Januar Er Putra
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Rahmi Zakiyah
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Jordy Maulana Ahmad
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Risa Etika
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Kartika Darma Handayani
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Martono Tri Utomo
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Dina Angelica
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Wurry Ayuningtyas
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Toto Wisnu Hendrarto
- Neonatal Intensive Care Unit, Harapan Kita Mother and Child Hospital, Jakarta, 11420, Indonesia
| | - Rinawati Rohsiswatmo
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Setya Wandita
- Neonatology Division, Department of Child Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Risma Karina Kaban
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Kian Djien Liem
- Department of Neonatology, Radboud University Medical Centre, Nijmegen, 6525, Netherlands Antilles
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4
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Sampurna MTA, Pratama DC, Visuddho V, Oktaviana N, Putra AJE, Zakiyah R, Ahmad JM, Etika R, Handayani KD, Utomo MT, Angelica D, Ayuningtyas W, Hendrarto TW, Rohsiswatmo R, Wandita S, Kaban RK, Liem KD. A review of existing neonatal hyperbilirubinemia guidelines in Indonesia. F1000Res 2023; 11:1534. [PMID: 38025296 PMCID: PMC10682606 DOI: 10.12688/f1000research.110550.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the management of this condition were present. This study aimed to compare the existing guidelines regarding prevention, diagnosis, treatment and monitoring in order to create the best recommendation for a new hyperbilirubinemia guideline in Indonesia. Methods Through an earlier survey regarding adherence to the neonatal hyperbilirubinemia guideline, we identified that three main guidelines are being used in Indonesia. These were developed by the Indonesian Pediatric Society (IPS), the Ministry of Health (MoH), and World Health Organization (WHO). In this study, we compared factors such as prevention, monitoring, methods for identifying, risk factors in the development of neonatal jaundice, risk factors that increase brain damage, and intervention treatment threshold in the existing guidelines to determine the best recommendations for a new guideline. Results The MoH and WHO guidelines allow screening and treatment of hyperbilirubinemia based on visual examination (VE) only. Compared with the MoH and WHO guidelines, risk assessment is comprehensively discussed in the IPS guideline. The MoH guideline recommends further examination of an icteric baby to ensure that the mother has enough milk without measuring the bilirubin level. The MoH guideline recommends referring the baby when it looks yellow on the soles and palms. The WHO and IPS guidelines recommend combining VE with an objective measurement of transcutaneous or serum bilirubin. The threshold to begin phototherapy in the WHO guideline is lower than the IPS guideline while the exchange transfusion threshold in both guidelines are comparably equal. Conclusions The MoH guideline is outdated. MoH and IPS guidelines are causing differences in approaches to the management hyperbilirubinemia. A new, uniform guideline is required.
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Affiliation(s)
- Mahendra Tri Arif Sampurna
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Danny Chandra Pratama
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Visuddho Visuddho
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Novita Oktaviana
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Achmad Januar Er Putra
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Rahmi Zakiyah
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Jordy Maulana Ahmad
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Risa Etika
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Kartika Darma Handayani
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Martono Tri Utomo
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Dina Angelica
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Wurry Ayuningtyas
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Toto Wisnu Hendrarto
- Neonatal Intensive Care Unit, Harapan Kita Mother and Child Hospital, Jakarta, 11420, Indonesia
| | - Rinawati Rohsiswatmo
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Setya Wandita
- Neonatology Division, Department of Child Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Risma Karina Kaban
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Kian Djien Liem
- Department of Neonatology, Radboud University Medical Centre, Nijmegen, 6525, Netherlands Antilles
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5
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Shapiro A, Mtenthaonga P, Mjumira R, Reuben M, Samuel A, Bond M, Carns J, Schwarz R, Johnston R, Mangwiro L, Odedere O, Miros R, McHugh S, Kawaza K, Dube Q, Ezeaka C, Richards-Kortum R. Design and field evaluation of a lateral flow cassette device for point-of-care bilirubin measurement. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002262. [PMID: 37552665 PMCID: PMC10409260 DOI: 10.1371/journal.pgph.0002262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/15/2023] [Indexed: 08/10/2023]
Abstract
Neonatal jaundice is an important cause of morbidity and mortality worldwide, and neonates born in low and middle-income countries bear a disproportionate burden. We previously developed a low-cost, point-of-care system to measure total serum bilirubin (TSB) in neonates. This device was effective at detecting and monitoring jaundice; however, the disposable strips were difficult to produce at scale. Here, we report a new lateral flow cassette design, called BiliDx, that was produced at scale using traditional manufacturing techniques. We evaluated the performance of BiliDx at sites in Nigeria and Malawi. The lateral flow strip consists of plasma separation membranes, nitrocellulose, and a plastic cassette. We evaluated the performance of the strips and reader at two hospitals located in Nigeria and Malawi compared to reference standard TSB. We also assessed performance for samples with high direct bilirubin (DB) and high hematocrit (HCT). We collected 1,144 samples from 758 neonates (TSB ranged from 0.2 to 45.9 mg/dL). The mean bias of BiliDx measurements in the validation set was +0.75 mg/dL, and 95% limits of agreement were -2.57 to 4.07 mg/dL. The mean bias and limits of agreement were comparable for samples with HCT < 60% and HCT ≥ 60%, and for samples with low and intermediate DB levels; the samples with high DB levels had wider 95% limits of agreement (-4.50 to +3.03 mg/dL). Error grid analysis shows that 96.9% of samples measured with BiliDx would have resulted in the same clinical decision as the reference standard. This performance is comparable to previous results that used a handmade two-dimensional strip. Additionally, error grid analysis shows that all 20 samples with high DB levels would have resulted in the same clinical decision as the reference standard. This evaluation supports the use of BiliDx lateral flow cassettes to provide accurate point-of-care measurements in low-resource settings.
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Affiliation(s)
- Alyssa Shapiro
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
| | - Prince Mtenthaonga
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Rowland Mjumira
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Margaret Reuben
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ayodele Samuel
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Meaghan Bond
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
| | - Jennifer Carns
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
| | - Richard Schwarz
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
| | - Ryan Johnston
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
| | | | - Opeyemi Odedere
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
| | - Robert Miros
- 3rd Stone Design, San Rafael, California, United States of America
| | - Sean McHugh
- DCN Dx, Carlsbad, California, United States of America
| | - Kondwani Kawaza
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Queen Dube
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Chinyere Ezeaka
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rebecca Richards-Kortum
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
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6
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Ndabakuranye JP, Prawer S, Ahnood A. Bi-modal system-on-chip platform for bilirubin monitoring by using photometric and temporal degradation approaches. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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7
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Ndabakuranye JP, Choy KW, Prawer S, Ahnood A. Spectral and temporal detection of blood bilirubin level using a point-of-care device. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083572 DOI: 10.1109/embc40787.2023.10340716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Bilirubin is a biomarker for liver inflammation used to assess liver functions. Its concentration in the blood has been measured using a range of techniques both in clinical and point-of-care settings. Existing point-of-care devices utilize a spectral approach, namely dual-wavelength absorption measurement, to assess the blood bilirubin concentration. This work examines a novel temporal approach based on the photodegradation of bilirubin in the blood sample. It demonstrates that combining photodegradation characteristics with dual-wavelength measurement produces a more accurate technique for measuring blood bilirubin concentration. Tracking the evolution of absorbed light as a function of time represents a low-cost and simple way of improving the accuracy of point-of-care devices for bilirubin measurements.Clinical Relevance - This work demonstrates a facile and cheap bilirubin monitoring approach that may allow bilirubin monitoring applications in homes after a patient is discharged from a hospital, which may decrease the burden on patients, families, and clinicians.
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Westenberg LEH, Been JV, Willemsen SP, Vis JY, Tintu AN, Bramer WM, Dijk PH, Steegers EAP, Reiss IKM, Hulzebos CV. Diagnostic Accuracy of Portable, Handheld Point-of-Care Tests vs Laboratory-Based Bilirubin Quantification in Neonates: A Systematic Review and Meta-analysis. JAMA Pediatr 2023; 177:479-488. [PMID: 36912856 PMCID: PMC10012043 DOI: 10.1001/jamapediatrics.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Importance Quantification of bilirubin in blood is essential for early diagnosis and timely treatment of neonatal hyperbilirubinemia. Handheld point-of-care (POC) devices may overcome the current issues with conventional laboratory-based bilirubin (LBB) quantification. Objective To systematically evaluate the reported diagnostic accuracy of POC devices compared with LBB quantification. Data Sources A systematic literature search was conducted in 6 electronic databases (Ovid MEDLINE, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar) up to December 5, 2022. Study Selection Studies were included in this systematic review and meta-analysis if they had a prospective cohort, retrospective cohort, or cross-sectional design and reported on the comparison between POC device(s) and LBB quantification in neonates aged 0 to 28 days. Point-of-care devices needed the following characteristics: portable, handheld, and able to provide a result within 30 minutes. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data Extraction and Synthesis Data extraction was performed by 2 independent reviewers into a prespecified, customized form. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was performed of multiple Bland-Altman studies using the Tipton and Shuster method for the main outcome. Main Outcomes and Measures The main outcome was mean difference and limits of agreement in bilirubin levels between POC device and LBB quantification. Secondary outcomes were (1) turnaround time (TAT), (2) blood volumes, and (3) percentage of failed quantifications. Results Ten studies met the inclusion criteria (9 cross-sectional studies and 1 prospective cohort study), representing 3122 neonates. Three studies were considered to have a high risk of bias. The Bilistick was evaluated as the index test in 8 studies and the BiliSpec in 2. A total of 3122 paired measurements showed a pooled mean difference in total bilirubin levels of -14 μmol/L, with pooled 95% CBs of -106 to 78 μmol/L. For the Bilistick, the pooled mean difference was -17 μmol/L (95% CBs, -114 to 80 μmol/L). Point-of-care devices were faster in returning results compared with LBB quantification, whereas blood volume needed was less. The Bilistick was more likely to have a failed quantification compared with LBB. Conclusions and Relevance Despite the advantages that handheld POC devices offer, these findings suggest that the imprecision for measurement of neonatal bilirubin needs improvement to tailor neonatal jaundice management.
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Affiliation(s)
- Lauren E H Westenberg
- Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jasper V Been
- Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jolande Y Vis
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrei N Tintu
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Peter H Dijk
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Christian V Hulzebos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
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9
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Satrom KM, Farouk ZL, Slusher TM. Management challenges in the treatment of severe hyperbilirubinemia in low- and middle-income countries: Encouraging advancements, remaining gaps, and future opportunities. Front Pediatr 2023; 11:1001141. [PMID: 36861070 PMCID: PMC9969105 DOI: 10.3389/fped.2023.1001141] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/17/2023] [Indexed: 02/15/2023] Open
Abstract
Neonatal jaundice (NJ) is common in newborn infants. Severe NJ (SNJ) has potentially negative neurological sequelae that are largely preventable in high resource settings if timely diagnosis and treatment are provided. Advancements in NJ care in low- and middle-income countries (LMIC) have been made over recent years, especially with respect to an emphasis on parental education about the disease and technological advancements for improved diagnosis and treatment. Challenges remain, however, due to lack of routine screening for SNJ risk factors, fragmented medical infrastructure, and lack of culturally appropriate and regionally specific treatment guidelines. This article highlights both encouraging advancements in NJ care as well as remaining gaps. Opportunities are identified for future work in eliminating the gaps in NJ care and preventing death and disability related to SNJ around the globe.
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Affiliation(s)
- Katherine M Satrom
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, United States
| | - Zubaida L Farouk
- Department of Pediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria.,Centre for Infectious Diseases Research, Bayero University, Kano, Nigeria
| | - Tina M Slusher
- Department of Pediatrics, Global Health Program, Critical Care Division, University of Minnesota, Minneapolis, MN, United States.,Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
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10
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Westenberg LEH, van der Geest BAM, Lingsma HF, Nieboer D, Groen H, Vis JY, Ista E, Poley MJ, Dijk PH, Steegers EAP, Reiss IKM, Hulzebos CV, Been JV. Better assessment of neonatal jaundice at home (BEAT Jaundice @home): protocol for a prospective, multicentre diagnostic study. BMJ Open 2022; 12:e061897. [PMID: 36396315 PMCID: PMC9677012 DOI: 10.1136/bmjopen-2022-061897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Severe neonatal hyperbilirubinaemia can place a neonate at risk for acute bilirubin encephalopathy and kernicterus spectrum disorder. Early diagnosis is essential to prevent these deleterious sequelae. Currently, screening by visual inspection followed by laboratory-based bilirubin (LBB) quantification is used to identify hyperbilirubinaemia in neonates cared for at home in the Netherlands. However, the reliability of visual inspection is limited. We aim to evaluate the effectiveness of universal transcutaneous bilirubin (TcB) screening as compared with visual inspection to: (1) increase the detection of hyperbilirubinaemia necessitating treatment, and (2) reduce the need for heel pricks to quantify bilirubin levels. In parallel, we will evaluate a smartphone app (Picterus), and a point-of-care device for quantifying total bilirubin (Bilistick) as compared with LBB. METHODS AND ANALYSIS We will undertake a multicentre prospective cohort study in nine midwifery practices across the Netherlands. Neonates born at a gestational age of 35 weeks or more are eligible if they: (1) are at home at any time between days 2 and 8 of life; (2) have their first midwife visit prior to postnatal day 6 and (3) did not previously receive phototherapy. TcB and the Picterus app will be used after visual inspection. When LBB is deemed necessary based on visual inspection and/or TcB reading, Bilistick will be used in parallel. The coprimary endpoints of the study are: (1) hyperbilirubinaemia necessitating treatment; (2) the number of heel pricks performed to quantify LBB. We aim to include 2310 neonates in a 2-year period. Using a decision tree model, a cost-effectiveness analysis will be performed. ETHICS AND DISSEMINATION This study has been approved by the Medical Research Ethical Committee of the Erasmus MC Rotterdam, Netherlands (MEC-2020-0618). Parents will provide written informed consent. The results of this study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Dutch Trial Register (NL9545).
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Affiliation(s)
- Lauren E H Westenberg
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Berthe A M van der Geest
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jolande Y Vis
- Department of Clinical Chemistry, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Erwin Ista
- Department of Pediatric Intensive Care, Division of Paediatric Surgery, Erasmus MC Sophia Children Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Nursing Science, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Marten J Poley
- Department of Pediatric Intensive Care, Division of Paediatric Surgery, Erasmus MC Sophia Children Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Peter H Dijk
- Division of Neonatology, Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, Groningen, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Christian V Hulzebos
- Division of Neonatology, Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, Groningen, The Netherlands
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
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11
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Shapiro A, Anderson J, Mtenthaonga P, Kumwenda W, Bond M, Schwarz R, Carns J, Johnston R, Dube Q, Chiume M, Richards-Kortum R. Evaluation of a Point-of-Care Test for Bilirubin in Malawi. Pediatrics 2022; 150:188493. [PMID: 35799070 DOI: 10.1542/peds.2021-053928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES BiliSpec is a low-cost spectrophotometric reader and disposable paper-based strip to quantify total serum bilirubin from several blood drops. This study was a prospective evaluation of BiliSpec in 2 neonatal wards in Malawi compared with a reference standard bilirubinometer over a large range of bilirubin and hematocrit levels. METHODS The accuracy of BiliSpec and a transcutaneous bilirubinometer were compared with the reference standard of spectrophotometry for 475 blood samples collected from 375 subjects across a range of total serum bilirubin concentrations from 0.0 to 33.7 mg/dL. The development of error grids to assess the clinical effects of measurement differences is reported. RESULTS BiliSpec was found to have a mean bias of -0.48 mg/dL and 95% limits of agreement of -5.09 mg/dL to +4.12 mg/dL. Results show 90.7% of BiliSpec measurements would have resulted in the same clinical decision as the reference standard, whereas 55.0% of transcutaneous bilirubin measurements would have resulted in the same clinical decision as the reference standard. CONCLUSIONS This evaluation supports use of BiliSpec to provide accurate, low-cost, point-of-care bilirubin measurements in low-resource hospitals. Future work is needed to evaluate BiliSpec among a larger number of users.
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Affiliation(s)
- Alyssa Shapiro
- Department of Bioengineering, Rice University, Houston, Texas
| | - Jessica Anderson
- Rice 360° Institute for Global Health, Rice University, Houston, Texas
| | - Prince Mtenthaonga
- Rice 360° Institute for Global Health, Rice University, Houston, Texas.,Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Watson Kumwenda
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Meaghan Bond
- Department of Bioengineering, Rice University, Houston, Texas.,Rice 360° Institute for Global Health, Rice University, Houston, Texas
| | - Richard Schwarz
- Department of Bioengineering, Rice University, Houston, Texas
| | - Jennifer Carns
- Department of Bioengineering, Rice University, Houston, Texas
| | - Ryan Johnston
- Rice 360° Institute for Global Health, Rice University, Houston, Texas
| | - Queen Dube
- Rice 360° Institute for Global Health, Rice University, Houston, Texas.,Department of Pediatrics, University of Malawi College of Medicine, Blantyre, Malawi
| | - Msandeni Chiume
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Rebecca Richards-Kortum
- Department of Bioengineering, Rice University, Houston, Texas.,Rice 360° Institute for Global Health, Rice University, Houston, Texas
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12
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Ndabakuranye JP, Prawer S, Ahnood A. A purely solid-state based method for bilirubin levels determination in plasma. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4700-4703. [PMID: 36086277 DOI: 10.1109/embc48229.2022.9871703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In the past half-century, the advent of solid-state electronics, i.e., microcontrollers, transistors, photodiodes, light-emitting diodes and more, has led to the improvement of the tools we, as a human race, need and use in our daily lives. Solid-state electronics has specifically contributed significantly to the field of biomedical engineering and has allowed various round-the-clock point-of-care testing applications. These include handheld, wearable, and implantable sensors and devices for accelerated interventions. Furthermore, miniaturization has accelerated the implementation of low-cost and energy-efficient systems with increased performance. In this paper, we have used optical techniques along with the benefits of solid-state electronics to measure bilirubin concentration in plasma with concentrations projected from healthy individuals to hyperbilirubinemia (0 - 30 mg/dL). Traditionally, full-range spectrophotometry is the gold standard optical method and provides the most accurate results but suffers from instrument complexity. Thus, this paper proposes and investigates the measurement of bilirubin by using a dual-wavelength approach combined with photodegradation kinetics. By tracking the changes in the spectral characteristics of bilirubin for 10 minutes (~3 J/cm2), a new model was built to measure bilirubin concentrations and distinguish between low vs high and risky vs non-risky levels. Results show a high positive correlation between the optical responses and concentration (R-square > 0.93) with an average accuracy of ~1.4 mg/dL. On top of that, the technique's viability for point-of-care testing of bilirubin levels was studied using a system-on-chip optical module. Thus, this could help suggest neonatal therapeutic interventions, including enteral feeding, phototherapy, and blood transfusion.
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13
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Harrison-Smith B, Dumont AP, Arefin MS, Sun Y, Lawal N, Dobson D, Nwaba A, Grossarth S, Paed AM, Farouk ZL, Weitkamp JH, Patil CA. Development of a mobile phone camera-based transcutaneous bilirubinometer for low-resource settings. BIOMEDICAL OPTICS EXPRESS 2022; 13:2797-2809. [PMID: 35774304 PMCID: PMC9203089 DOI: 10.1364/boe.449625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 05/19/2023]
Abstract
Newborns in high-income countries are routinely screened for neonatal jaundice using transcutaneous bilirubinometery (TcB). In low-and middle-income countries, TcB is not widely used due to a lack of availability; however, mobile-phone approaches for TcB could help expand screening opportunities. We developed a mobile phone-based approach for TcB and validated the method with a 37 patient multi-ethnic pilot study. We include a custom-designed snap-on adapter that is used to create a spatially resolved diffuse reflectance detection configuration with the illumination provided by the mobile-phone LED flash. Monte-Carlo models of reflectance from neonatal skin were used to guide the design of an adapter for filtered red-green-blue (RGB) mobile-phone camera reflectance measurements. We extracted measures of reflectance from multiple optimized spatial-offset regions-of-interest (ROIs) and a linear model was developed and cross-validated. This resulted in a correlation between total serum bilirubin and mobile-phone TcB estimated bilirubin with a R 2= 0.42 and Bland-Altman limits of agreement of +6.4 mg/dL to -7.0 mg/dL. These results indicate that a mobile phone with a modified adapter can be utilized to measure neonatal bilirubin values, thus creating a novel tool for neonatal jaundice screening in low-resource settings.
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Affiliation(s)
- Brandon Harrison-Smith
- Department of Bioengineering, Temple University, 1801 N. Broad St., Philadelphia, PA 19121, USA
| | - Alexander P. Dumont
- Department of Bioengineering, Temple University, 1801 N. Broad St., Philadelphia, PA 19121, USA
| | | | - Yu Sun
- Department of Bioengineering, Temple University, 1801 N. Broad St., Philadelphia, PA 19121, USA
| | - Nuradeen Lawal
- Department of Pediatrics, Aminu Kano Teaching Hospital(AKTH), Kano 7002 31, Nigeria
| | - Dorianna Dobson
- Department of Pediatrics, Vanderbilt University Medical Center(VUMC), Nashville, TN 37203, USA
| | - Amy Nwaba
- Department of Pediatrics, Vanderbilt University Medical Center(VUMC), Nashville, TN 37203, USA
| | - Sarah Grossarth
- Department of Pediatrics, Vanderbilt University Medical Center(VUMC), Nashville, TN 37203, USA
| | | | - Zubaida L. Farouk
- Department of Pediatrics, Aminu Kano Teaching Hospital(AKTH), Kano 7002 31, Nigeria
| | - Jorn-Hendrik Weitkamp
- Department of Pediatrics, Vanderbilt University Medical Center(VUMC), Nashville, TN 37203, USA
| | - Chetan A. Patil
- Department of Bioengineering, Temple University, 1801 N. Broad St., Philadelphia, PA 19121, USA
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14
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Thomas M, Greaves RF, Tingay DG, Loh TP, Ignjatovic V, Newall F, Oeum M, Tran MTC, Rajapaksa AE. Current and emerging technologies for the timely screening and diagnosis of neonatal jaundice. Crit Rev Clin Lab Sci 2022; 59:332-352. [PMID: 35188857 DOI: 10.1080/10408363.2022.2038074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Neonatal jaundice is one of the most common clinical conditions affecting newborns. For most newborns, jaundice is harmless, however, a proportion of newborns develops severe neonatal jaundice requiring therapeutic interventions, accentuating the need to have reliable and accurate screening tools for timely recognition across different health settings. The gold standard method in diagnosing jaundice involves a blood test and requires specialized hospital-based laboratory instruments. Despite technological advancements in point-of-care laboratory medicine, there is limited accessibility of the specialized devices and sample stability in geographically remote areas. Lack of suitable testing options leads to delays in timely diagnosis and treatment of clinically significant jaundice in developed and developing countries alike. There has been an ever-increasing need for a low-cost, simple to use screening technology to improve timely diagnosis and management of neonatal jaundice. Consequently, several point-of-care (POC) devices have been developed to address this concern. This paper aims to review the literature, focusing on emerging technologies in the screening and diagnosing of neonatal jaundice. We report on the challenges associated with the existing screening tools, followed by an overview of emerging sensors currently in pre-clinical development and the emerging POC devices in clinical trials to advance the screening of neonatal jaundice. The benefits offered by emerging POC devices include their ease of use, low cost, and the accessibility of rapid response test results. However, further clinical trials are required to overcome the current limitations of the emerging POC's before their implementation in clinical settings. Hence, the need for a simple to use, low-cost POC jaundice detection technology for newborns remains an unsolved challenge globally.
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Affiliation(s)
- Mercy Thomas
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Australia
| | - Ronda F Greaves
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Victorian Clinical Genetics Services, Melbourne, Australia.,International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy
| | - David G Tingay
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
| | - Tze Ping Loh
- International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy.,Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Hematology, Murdoch Children's Research Institute, Melbourne, Australia
| | - Fiona Newall
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Australia
| | - Michelle Oeum
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | - Mai Thi Chi Tran
- International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy.,National Children's Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - Anushi E Rajapaksa
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Think Project Global, Melbourne, Australia
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15
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Ndabakuranye JP, Rajapaksa AE, Burchall G, Li S, Prawer S, Ahnood A. A novel optical assay system for bilirubin concentration measurement in whole blood. IEEE Trans Biomed Eng 2021; 69:983-990. [PMID: 34516369 DOI: 10.1109/tbme.2021.3111150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As a biomarker for liver disease, bilirubin has been utilized in prognostic scoring systems for cirrhosis. While laboratory-based methods are used to determine bilirubin levels in clinical settings, they do not readily lend themselves to applications outside of hospitals. Consequently, bilirubin monitoring for cirrhotic patients is often performed only intermittently; thus, episodes requiring clinical interventions could be missed. This work investigates the feasibility of measuring bilirubin concentration in whole porcine blood samples using dual-wavelength transmission measurement. A compact and low-cost dual-wavelength transmission measurement setup is developed and optimized to measure whole blood bilirubin concentrations. Using small volumes of whole porcine blood (72 L), we measured the bilirubin concentration within a range corresponding to healthy individuals and cirrhotic patients (1.2-30 mg/dL). We demonstrate that bilirubin levels can be estimated with a positive correlation (R-square > 0.95) and an accuracy of 1.7 mg/dL, with higher reliability in cirrhotic bilirubin concentrations (> 4 mg/dL) critical for high-risk patients. The optical and electronic components utilized are economical and can be readily integrated into a miniature, low-cost, and user-friendly system. This could provide a pathway for point-of-care monitoring of blood bilirubin outside of medical facilities (e.g. patients home).
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16
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Diagnostic methods for neonatal hyperbilirubinemia: benefits, limitations, requirements, and novel developments. Pediatr Res 2021; 90:277-283. [PMID: 33948000 DOI: 10.1038/s41390-021-01546-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/20/2021] [Accepted: 04/10/2021] [Indexed: 11/09/2022]
Abstract
Invasive bilirubin measurements remain the gold standard for the diagnosis and treatment of infants with severe neonatal hyperbilirubinemia. The present paper describes different methods currently available to assess hyperbilirubinemia in newborn infants. Novel point-of-care bilirubin measurement methods, such as the BiliSpec and the Bilistick, would benefit many newborn infants, especially in low-income and middle-income countries where the access to costly multi-analyzer in vitro diagnostic instruments is limited. Total serum bilirubin test results should be accurate within permissible limits of measurement uncertainty to be fit for clinical purposes. This implies correct implementation of internationally endorsed reference measurement systems as well as participation in external quality assessment programs. Novel analytic methods may, apart from bilirubin, include the determination of bilirubin photoisomers and bilirubin oxidation products in blood and even in other biological matrices. IMPACT: Key message: Bilirubin measurements in blood remain the gold standard for diagnosis and treatment of severe neonatal hyperbilirubinemia (SNH). External quality assessment (EQA) plays an important role in revealing inaccuracies in diagnostic bilirubin measurements. What does this article add to the existing literature? We provide analytic performance data on total serum bilirubin (TSB) as measured during recent EQA surveys. We review novel diagnostic point-of-care (POC) bilirubin measurement methods and analytic methods for determining bilirubin levels in biological matrices other than blood. Impact: Manufacturers should make TSB test results traceable to the internationally endorsed total bilirubin reference measurement system and should ensure permissible limits of measurement uncertainty.
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17
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Abstract
Acute bilirubin encephalopathy (ABE) is still an insufficiently addressed cause of mortality and long-term morbidity in low- and middle-income countries (LMICs). This article highlights that delayed or incorrect medical advice, inaccurate bilirubin measurements as well as ineffective phototherapy are some of the relevant causes predisposing jaundiced newborns to develop extreme hyperbilirubinemia [EHB, total serum/plasma bilirubin (TB) ≥ 25 mg/dL (428 µmol/L)] and subsequent ABE. Obstacles preventing state of the art management of such infants are also discussed. Prevention of ABE cannot occur without a system-based approach tailored to suit the needs and available resources of each community. Clear set protocols, rigorous training, monitoring, and accurate documentation together with simple innovative affordable technologies that can be locally produced, are essential to observe the change desired.
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Affiliation(s)
- Iman Iskander
- Departments of Pediatrics and Neonatology, Cairo University Medical School, 1 Aly Ibrahim Street, El Sayedah Zeinab, Cairo 11799, Eqypt.
| | - Rasha Gamaleldin
- Departments of Pediatrics and Neonatology, Cairo University Medical School, 1 Aly Ibrahim Street, El Sayedah Zeinab, Cairo 11799, Eqypt
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18
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Kamineni B, Tanniru A, Vardhelli V, Sharma D, Pawale D, Kulkarni D, Muppidi PR, Deshabhotla S, Murki S. Accuracy of Bilistick (a Point-of-Care Device) to Detect Neonatal Hyperbilirubinemia. J Trop Pediatr 2020; 66:630-636. [PMID: 32433770 DOI: 10.1093/tropej/fmaa026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Early diagnosis and appropriate management of neonatal jaundice is crucial in avoiding severe hyperbilirubinemia and brain injury. A low-cost, minimally invasive, point-of-care (PoC) tool for total bilirubin (TB) estimation which can be useful across all ranges of bilirubin values and all settings is the need of the hour. OBJECTIVE To assess the accuracy of Bilistick system, a PoC device, for measurement of TB in comparison with estimation by spectrophotometry. DESIGN/METHODS In this cross-sectional clinical study, in infants who required TB estimation, blood samples in 25-µl sample transfer pipettes were collected at the same time from venous blood obtained for laboratory bilirubin estimation. The accuracy of Bilistick in estimating TB within ±2 mg/dl of bilirubin estimation by spectrophotometry was the primary outcome. RESULTS Among the enrolled infants, 198 infants were eligible for study analysis with the mean gestation of 36 ± 2.3 weeks and the mean birth weight of 2368 ± 623 g. The median age at enrollment was 68.5 h (interquartile range: 48-92). Bilistick was accurate only in 54.5% infants in measuring TB within ±2 mg/dl difference of TB measured by spectrophotometry. There was a moderate degree of correlation between the two methods (r = 0.457; 95% CI: 0.339-0.561, p value < 0.001). Bland-Altman analysis showed a mean difference of 0.5 mg/dl (SD ± 4.4) with limits of agreement between -8.2 and +9.1 mg/dl. CONCLUSION Bilistick as a PoC device is not accurate to estimate TB within the clinically acceptable difference (±2 mg/dl) of TB estimation by spectrophotometry and needs further improvement to make it more accurate.
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Affiliation(s)
- Bhargavi Kamineni
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
| | - Anusha Tanniru
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
| | | | - Deepak Sharma
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
| | - Dinesh Pawale
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
| | - Dattatray Kulkarni
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
| | | | - Saikiran Deshabhotla
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
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19
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Tan W, Zhang L, Doery JCG, Shen W. Three-dimensional microfluidic tape-paper-based sensing device for blood total bilirubin measurement in jaundiced neonates. LAB ON A CHIP 2020; 20:394-404. [PMID: 31853529 DOI: 10.1039/c9lc00939f] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
More than 60% newborns experience hyperbilirubinemia and jaundice within the initial week after birth due to the accumulation of total bilirubin in blood. Left untreated high levels of bilirubin may result in brain impairment. Simple, fast, accurate, low-cost and timely point-of-care (POC) analysis of total bilirubin is an unmet need especially in resource-limited areas. This work introduces a novel sensing device, named a "tape-paper sensor", capable of separating plasma from whole blood and measuring total bilirubin by a colorimetric diazotization method. The tape-paper sensing method overcomes non-homogeneous color distribution caused by the "coffee stain" effect, which improves the accuracy of colorimetric evaluation on paper-based analytical devices. The level of hemolysis in the plasma extracted by the device is evaluated, confirming no interference in the detection of total bilirubin. The accuracy of the tape-paper sensing approach for neonatal blood sample measurement is verified by comparison with the hospital pathology laboratory method. The small volume of samples and reagents, minimal equipment (an office scanner), fast detection (<10 min) and low fabrication cost (∼A$ 0.6) reveal the suitability of the device for POC use and in resource-limited settings. The tape-paper sensor is a low-cost, fast, and user-friendly device for measurement of blood total bilirubin levels in neonatal jaundice diagnostics.
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Affiliation(s)
- Weirui Tan
- Department of Chemical Engineering, Monash University, Wellington Road, Clayton, VIC 3800, Australia.
| | - Liyuan Zhang
- Department of Chemical Engineering, Monash University, Wellington Road, Clayton, VIC 3800, Australia. and National Local Joint Engineering Laboratory for Advanced Textile Processing and Clean Production, Science and Technology Institute, Wuhan Textile University, Wuhan 430200, China
| | - James C G Doery
- Monash Pathology, Monash Health, Clayton Road, VIC 3168, Australia and Department of Medicine, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Wei Shen
- Department of Chemical Engineering, Monash University, Wellington Road, Clayton, VIC 3800, Australia.
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20
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Shapiro SM, Riordan SM. Review of bilirubin neurotoxicity II: preventing and treating acute bilirubin encephalopathy and kernicterus spectrum disorders. Pediatr Res 2020; 87:332-337. [PMID: 31581172 DOI: 10.1038/s41390-019-0603-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 11/09/2022]
Abstract
Previously in Part I of this two-part review, we discussed the current and recent advances in the understanding of the molecular biology and neuropathology of bilirubin neurotoxicity (BNTx). Here in Part II, we summarize current treatment options available to treat the severely jaundiced infants to prevent significant brain damage and improve clinical outcomes. In addition, we review potential novel therapies that are in various stages of research and development. We will emphasize treatments for both prevention and treatment of both acute bilirubin encephalopathy (ABE) and kernicterus spectrum disorders (KSDs), highlighting the treatment of the most disabling neurological sequelae of children with mild-to-severe KSDs whose "rare disease" status often means they are overlooked by the clinical research community at large. As with other secondary dystonias, treatment of the dystonic motor symptoms in kernicterus is the greatest clinical challenge.
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Affiliation(s)
- Steven M Shapiro
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA. .,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA. .,Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA. .,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.
| | - Sean M Riordan
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
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Dani C. Commentary on "The point-of-care Bilistick method has very short turn-around-time and high accuracy at lower cut-off levels to predict laboratory-measured TSB.". Pediatr Res 2019; 86:147-148. [PMID: 30903018 DOI: 10.1038/s41390-019-0378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/05/2019] [Accepted: 03/15/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy. .,Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy.
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22
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The point-of-care Bilistick method has very short turn-around-time and high accuracy at lower cutoff levels to predict laboratory-measured TSB. Pediatr Res 2019; 86:216-220. [PMID: 30696987 DOI: 10.1038/s41390-019-0304-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/13/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to determine the accuracy of a point-of-care Bilistick method for measuring total serum bilirubin (TSB) and its turn-around-time (TAT) against hospital laboratory methods. METHODS This prospective study was carried out on 561 term-gestation jaundiced neonates in two Malaysian hospitals. Venous blood sample was collected from each neonate for contemporary measurement of TSB by hospital laboratories and Bilistick. TAT was the time interval between specimen collection and TSB result reported by each method. RESULTS The mean laboratory-measured TSB was 194.85 (±2.844) µmol/L and Bilistick TSB was 169.37 (±2.706) µmol/L. Pearson's correlation coefficient was: r = 0.901 (p < 0.001). The mean difference of [laboratory TSB- Bilistick TBS] was 26.48 (±29.41) µmol/L. The Bland-Altman plots show that the 95% limits of agreement (-31.1577, 84.11772) contain 94.7% (=531/561) of the difference in TSB readings. Bilistick has a 99% accuracy and 100% sensitivity to predict laboratory TSB levels of ≥80 µmol/L and ≥360 µmol/L at lower Bilistick TSB levels of ≥55 and ≥315 µmol/L, respectively. TAT of Bilistick TSB (2.0 min) was significantly shorter than TAT (105 min) of laboratory TSB (p < 0.001). CONCLUSIONS Bilistick has shorter TAT. The accuracy and sensitivity of Bilistick TSB for predicting laboratory TSB is high at lower cutoff levels.
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Thielemans L, Hashmi A, Priscilla DD, Kho Paw M, Pimolsorntong T, Ngerseng T, Van Overmeire B, Proux S, Nosten F, McGready R, Carrara VI, Bancone G. Laboratory validation and field usability assessment of a point-of-care test for serum bilirubin levels in neonates in a tropical setting. Wellcome Open Res 2018; 3:110. [PMID: 30271889 PMCID: PMC6137410 DOI: 10.12688/wellcomeopenres.14767.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Screening and monitoring serum bilirubin (SBR) in neonates is crucial to prevent neonatal hyperbilirubinemia (NH)-associated morbidity and mortality worldwide. A lack of resources is often a barrier for measuring SBR in developing countries. Reliable, cost-effective, easy to use point-of-care (POC) SBR tests are needed. This study aimed to evaluate the technical accuracy and usability of the Bilistick System (BS), a new bilirubin POC test, in a tropical setting. Methods: This was a mixed-methods study, including laboratory validation of the BS, direct observation of technical procedures as performed by the midwives and midwives' assessment of the device's easiness of use through focus group discussions (FGD) and a self-administered questionnaire. The study was conducted in a field clinic of the Shoklo Malaria Research Unit along the Thailand-Myanmar border between January and December 2017. Results: A total of 173 samples were tested at a median age of 4 days. BS generated an error message-providing no SBR readout-in 48.6% of the tests performed. For the tests that yielded a result, the correlation coefficient (95% CI) between BS and routine laboratory bilirubinometer SBR was 0.87 (0.77-0.93). The accuracy decreased with increasing haematocrit and at higher humidity (≥75%). Direct observation of the operators using the device and analysis of the focus group discussions and questionnaires indicated that the BS was considered easy to use and required limited training. Conclusions: This evaluation showed that the BS, in its current formulation, does not provide reliable results for measuring SBR in a tropical, low-resource setting but has acceptable usability features.
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Affiliation(s)
- Laurence Thielemans
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
- Neonatology, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, 1070, Belgium
| | - Ahmar Hashmi
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Dah Dah Priscilla
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Tekel Pimolsorntong
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Thatsanun Ngerseng
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Bart Van Overmeire
- Neonatology, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, 1070, Belgium
| | - Stephane Proux
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Verena I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
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Morgan MC, Spindler H, Nambuya H, Nalwa GM, Namazzi G, Waiswa P, Otieno P, Cranmer J, Walker DM. Clinical cascades as a novel way to assess physical readiness of facilities for the care of small and sick neonates in Kenya and Uganda. PLoS One 2018; 13:e0207156. [PMID: 30462671 PMCID: PMC6248954 DOI: 10.1371/journal.pone.0207156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/25/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Globally, there were 2.7 million neonatal deaths in 2015. Significant mortality reduction could be achieved by improving care in low- and middle-income countries (LMIC), where the majority of deaths occur. Determining the physical readiness of facilities to identify and manage complications is an essential component of strategies to reduce neonatal mortality. METHODS We developed clinical cascades for 6 common neonatal conditions then utilized these to assess 23 health facilities in Kenya and Uganda at 2 time-points in 2016 and 2017. We calculated changes in resource availability over time by facility using McNemar's test. We estimated mean readiness and loss of readiness for the 6 conditions and 3 stages of care (identification, treatment, monitoring-modifying treatment). We estimated overall mean readiness and readiness loss across all conditions and stages. Finally, we compared readiness of facilities with a newborn special care unit (NSCU) to those without using the two-sample test of proportions. RESULTS The cascade model estimated mean readiness of 26.3-26.6% across the 3 stages for all conditions. Mean readiness ranged from 11.6% (respiratory distress-apnea) to 47.8% (essential newborn care) across both time-points. The model estimated overall mean readiness loss of 30.4-31.9%. There was mild to moderate variability in the timing of readiness loss, with the majority occurring in the identification stage. Overall mean readiness was higher among facilities with a NSCU (36.8%) compared to those without (20.0%). CONCLUSION The cascade model provides a novel approach to quantitatively assess physical readiness for neonatal care. Among 23 facilities in Kenya and Uganda, we identified a consistent pattern of 30-32% readiness loss across cascades and stages. This aggregate measure could be used to monitor and compare readiness at the facility-, health system-, or national-level. Estimates of readiness and loss of readiness may help guide strategies to improve care, prioritize resources, and promote neonatal survival in LMICs.
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Affiliation(s)
- Melissa C. Morgan
- Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
- Institute of Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
- Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hilary Spindler
- Institute of Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Harriet Nambuya
- Department of Pediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Grace M. Nalwa
- Department of Pediatrics and Child Health, Maseno University, Maseno, Kenya
| | - Gertrude Namazzi
- Maternal, Newborn and Child Health Centre of Excellence, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Peter Waiswa
- Maternal, Newborn and Child Health Centre of Excellence, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Phelgona Otieno
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - John Cranmer
- School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Dilys M. Walker
- Institute of Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
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Cavallin F, Trevisanuto D, Thein A, Booth A, Arnolda G, Kumara D, U P, Myint S, Moccia L. Birthplace is a risk factor for exchange transfusion in outborn infants admitted for jaundice in Myanmar: a case-control study. J Matern Fetal Neonatal Med 2018; 33:1526-1531. [PMID: 30407090 DOI: 10.1080/14767058.2018.1521796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Aim: To evaluate the role of pathway to admission for jaundice among the risk factors for exchange transfusion in outborn infants in a low resource setting.Methods: This retrospective case-control study (1:1 ratio) was carried out at the Yankin Children's Hospital in Yangon (Myanmar). All cases were neonates admitted for treatment of jaundice between March 2013 and February 2014 and who required an exchange transfusion. Each control was the next noncase neonate admitted for treatment of jaundice and treated with phototherapy. Infant characteristics, pathways of admission and clinically relevant factors for exchange transfusion were collected.Results: One hundred thirty-four cases and 134 controls were included in the study. Among cases, home was the most common place of birth while public hospital was the most frequent source of referral. Among controls, private/public hospitals were the commonest places of birth and referral. At multivariable analysis, homebirth was associated with increased likelihood of receiving exchange transfusion at admission (OR 3.30, 95% C.I. 1.31-8.56).Conclusion: Homebirth was an independent risk factor for exchange transfusion at admission for jaundice in a low-resource setting. Appropriate health education of pregnant women and traditional/home birth attendants may contribute to reduce the need for exchange transfusion in low-resource settings.
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Affiliation(s)
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, Azienda Ospedaliera di Padova, University of Padua, Padua, Italy.,Amici della Neonatologia Trentina, Trento, Italy
| | - Aye Thein
- Department of Neonatology, University of Medicine 1, Yangon, Myanmar
| | | | - Gaston Arnolda
- School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Phyu U
- Department of Neonatology, University of Medicine 2, Yangon, Myanmar
| | - Sandar Myint
- Department of Neonatology, University of Medicine 2, Yangon, Myanmar
| | - Luciano Moccia
- Amici della Neonatologia Trentina, Trento, Italy.,Day One Health, Redding, CA, USA
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Arnolda G, Chien TD, Hayen A, Hoi NTX, Maningas K, Joe P, Cavallin F, Trevisanuto D, Moccia L. A comparison of the effectiveness of three LED phototherapy machines, single- and double-sided, for treating neonatal jaundice in a low resource setting. PLoS One 2018; 13:e0205432. [PMID: 30308024 PMCID: PMC6181361 DOI: 10.1371/journal.pone.0205432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/25/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Neonatal jaundice is one of the most common reasons for hospital admission in low resource settings. Treatment is frequently inadequate as conventional phototherapy requires frequent bulb changes. LED phototherapy has comparable efficacy to conventional phototherapy, and the bulbs last over 40,000 hours. This observational study compares the effectiveness of three LED machines, two single-sided and one double-sided in routine use in Vietnam. METHODS We included all infants weighting ≥1500g and with jaundice diagnosed visually or by Total Serum Bilirubin (TSB) measurement at The Da Nang Hospital for Women and Children (Da Nang, Vietnam). The primary endpoint was the average hourly change in TSB over the first six hours of treatment. The secondary endpoints were duration of treatment; average hourly change in TSB over treatment, and length of stay in the neonatal unit. Multivariable analysis and bootstrap methods was performed to compare outcomes, adjusting for potential confounders. RESULTS All outcomes were comparable in the two single-sided machines. The double-sided machine showed 54% increase in the hourly speed of TSB reduction (1.3 μmol/L/hr, 95% CI 0.3-2.3), with a 45% increase in the speed of TSB reduction over the duration of treatment (0.9 μmol/L/hr, 95% CI 0.6-1.3). In addition, the double-sided machine was associated with 21% reduction in the duration of treatment (14 hours, 95% CI 5-22) and 16% reduction of length of stay (14 hours, 95% CI 3-25). CONCLUSION The results confirm and quantify the benefits of increasing surface-area exposure during phototherapy. Adjusted for multiple potential confounders, use of double-sided phototherapy can substantially increase the speed of TSB reduction, and substantially decrease the duration of treatment and length of stay in the NCU.
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Affiliation(s)
- Gaston Arnolda
- School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales, NSW, Australia
| | | | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, NSW, Australia
| | | | | | - Priscilla Joe
- Division of Neonatology, Children’s Hospital and Research Center, Oakland, CA, United States of America
| | | | - Daniele Trevisanuto
- Amici della Neonatologia Trentina, Trento, Italy
- Department of Woman and Child Health, Medical School, University of Padova, Padova, Italy
- * E-mail:
| | - Luciano Moccia
- Amici della Neonatologia Trentina, Trento, Italy
- Day One Health, Redding, California, United States of America
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Rohsiswatmo R, Oswari H, Amandito R, Sjakti HA, Windiastuti E, Roeslani RD, Barchia I. Agreement test of transcutaneous bilirubin and bilistick with serum bilirubin in preterm infants receiving phototherapy. BMC Pediatr 2018; 18:315. [PMID: 30268107 PMCID: PMC6162930 DOI: 10.1186/s12887-018-1290-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 09/24/2018] [Indexed: 11/21/2022] Open
Abstract
Background This study compares the minimally invasive Bilistick and a noninvasive method with standard Total Serum Bilirubin (TSB) measurement in preterm newborns receiving phototherapy. We assess the agreement of Transcutaneous Bilirubinometer (TcB) and Bilistick bilirubin measurements with standard TSB measurement in preterm infants receiving phototherapy. Methods Bilirubin was measured by using TcB and Bilistick in 94 preterm infants in RSCM Jakarta Neonatal Ward from October 2016 to March 2017, with gestational ages of < 35 weeks, before phototherapy and after 24 and 48 h of phototherapy. Results There was significant correlation before, at 24 and 48 h of phototherapy between TSB and either TcB (r = 0.874; r = 0.889; r = 0.878 respectively; p < 0.0001), or Bilistick (r = 0.868; r = 0.877; r = 0.918 respectively; p < 0.0001). The mean difference and limits of agreement before, at 24 and 48 h of phototherapy between TcB and TSB were 0.81 ± 1.51 mg/dL (− 2.14 to 3.77 mg/dL); 0.43 ± 1.57 mg/dL (− 2.66 to 3.51 mg/dL); 0.41 ± 1.58 mg/dL (− 2.69 to 3.50 mg/dL), respectively. For Bilistick they were − 1.50 ± 1.47 mg/dL (− 4.38 to 1.38 mg/dL); − 1.43 ± 1.47 mg/dL (− 4.32 to 1.46 mg/dL); − 1,15 ± 1.31 mg/dL (− 3,72 to 1,42 mg/dL), respectively. Conclusions Both methods are reliable for measuring TSB before, during, and after phototherapy in preterm infants. TcB tends to overestimate while Bilistick underestimates TSB.
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Affiliation(s)
- Rinawati Rohsiswatmo
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl Pangeran Diponegoro No. 71, Salemba, Kenari, Senen, Jakarta Pusat, DKI Jakarta, 10430, Indonesia.,Neonatal Intensive Care Unit, Pondok Indah General Hospital, Jl Metro Duta Kav UE, Pondok Indah, Pondok Pinang, Kebayoran Lama, Jakarta Selatan, DKI Jakarta, 12310, Indonesia
| | - Hanifah Oswari
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl Pangeran Diponegoro No. 71, Salemba, Kenari, Senen, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Radhian Amandito
- Neonatal Intensive Care Unit, Pondok Indah General Hospital, Jl Metro Duta Kav UE, Pondok Indah, Pondok Pinang, Kebayoran Lama, Jakarta Selatan, DKI Jakarta, 12310, Indonesia
| | - Hikari Ambara Sjakti
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl Pangeran Diponegoro No. 71, Salemba, Kenari, Senen, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Endang Windiastuti
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl Pangeran Diponegoro No. 71, Salemba, Kenari, Senen, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Rosalina Dewi Roeslani
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl Pangeran Diponegoro No. 71, Salemba, Kenari, Senen, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Indrayady Barchia
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl Pangeran Diponegoro No. 71, Salemba, Kenari, Senen, Jakarta Pusat, DKI Jakarta, 10430, Indonesia.
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Ngashangva L, Bachu V, Goswami P. Development of new methods for determination of bilirubin. J Pharm Biomed Anal 2018; 162:272-285. [PMID: 30273817 DOI: 10.1016/j.jpba.2018.09.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/11/2018] [Accepted: 09/16/2018] [Indexed: 02/06/2023]
Abstract
The ever-increasing demand for a sensitive, rapid and reliable method for determination of serum bilirubin level has been inciting the interest of the researchers to develop new methods for both laboratory set up and point of care applications. These efforts embrace measurement of different forms of bilirubin, such as, unconjugated (free and albumin bound) bilirubin, conjugated (direct) bilirubin, and total (both conjugated and unconjugated) bilirubin in the serum that may provide critical information useful for diagnosis of many diseases and metabolic disorders. Herein, an effort has been made to provide a broad overview on the subject starting from the conventional spectroscopy based analytical methods widely practiced in the laboratory setup along with the sophisticated instrument based sensitive methods suitable for determination of different forms of bilirubin to various portable low cost systems applicable in point of care (POC) settings. In all these discussions emphasis is given on the novel methods and techniques bearing potential to measure the bilirubin level in biological samples reliably with less technical complexity and cost. We expect that this review will serve as a ready reference for the researchers and clinical professionals working on the subject and allied fields.
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Affiliation(s)
- Lightson Ngashangva
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Vinay Bachu
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Pranab Goswami
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India.
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Thielemans L, Hashmi A, Priscilla DD, Kho Paw M, Pimolsorntong T, Ngerseng T, Van Overmeire B, Proux S, Nosten F, McGready R, Carrara VI, Bancone G. Laboratory validation and field usability assessment of a point-of-care test for serum bilirubin levels in neonates in a tropical setting. Wellcome Open Res 2018; 3:110. [PMID: 30271889 PMCID: PMC6137410 DOI: 10.12688/wellcomeopenres.14767.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Screening and monitoring serum bilirubin (SBR) in neonates is crucial to prevent neonatal hyperbilirubinemia (NH)-associated morbidity and mortality worldwide. A lack of resources is often a barrier for measuring SBR in developing countries. Reliable, cost-effective, easy to use point-of-care (POC) SBR tests are needed. This study aimed to evaluate the technical accuracy and usability of the Bilistick System (BS), a new bilirubin POC test, in a tropical setting. Methods: This was a mixed-methods study, including laboratory validation of the BS, direct observation of technical procedures as performed by the midwives and midwives' assessment of the device's easiness of use through focus group discussions (FGD) and a self-administered questionnaire. The study was conducted in a field clinic of the Shoklo Malaria Research Unit along the Thailand-Myanmar border between January and December 2017. Results: A total of 173 samples were tested at a median age of 4 days. BS generated an error message-providing no SBR readout-in 48.6% of the tests performed. For the tests that yielded a result, the correlation coefficient (95% CI) between BS and routine laboratory bilirubinometer SBR was 0.87 (0.77-0.93). The accuracy decreased with increasing haematocrit and at higher humidity (≥75%). Direct observation of the operators using the device and analysis of the focus group discussions and questionnaires indicated that the BS was considered easy to use and required limited training. Conclusions: This evaluation showed that the BS, in its current formulation, does not provide reliable results for measuring SBR in a tropical, low-resource setting but has acceptable usability features.
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Affiliation(s)
- Laurence Thielemans
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
- Neonatology, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, 1070, Belgium
| | - Ahmar Hashmi
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Dah Dah Priscilla
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Tekel Pimolsorntong
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Thatsanun Ngerseng
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Bart Van Overmeire
- Neonatology, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, 1070, Belgium
| | - Stephane Proux
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Verena I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
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Diala UM, Wennberg RP, Abdulkadir I, Farouk ZL, Zabetta CDC, Omoyibo E, Emokpae A, Aravkin A, Toma B, Oguche S, Slusher T. Patterns of acute bilirubin encephalopathy in Nigeria: a multicenter pre-intervention study. J Perinatol 2018; 38:873-880. [PMID: 29593357 DOI: 10.1038/s41372-018-0094-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/16/2018] [Accepted: 02/26/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute bilirubin encephalopathy (ABE) is an important cause of neonatal morbidity in Nigeria, accounting for 5-14% of neonatal deaths. Most newborns with severe ABE have irreversible damage before receiving treatment emphasizing the need for timely pre-admission monitoring and referral. There is limited evidence that educational interventions targeting mothers and health care providers will reduce delayed care. OBJECTIVE To provide baseline data on the incidence of ABE and associated pre-admission risk factors in five centers of Nigeria in order to evaluate the effect of subsequent educational interventions on outcome. STUDY DESIGN The incidence of ABE among newborns treated for hyperbilirubinemia was documented prospectively. Bivariate analysis and multivariate logistic regression were used to evaluate risk factors for acute bilirubin encephalopathy and reasons for regional differences in its occurrence. RESULTS Of 1040 infants, 159 treated for hyperbilirubinemia (15.3%) had mild to severe bilirubin encephalopathy (including 35 deaths), but the incidence ranged from 7 to 22% between centers. Logistic regression identified four common predictors: total serum bilirubin (odds ratio 1.007 per mg/dl rise), out-of-hospital births (OR 2.6), non-alloimmune hemolytic anemia (OR 2.8), and delayed care seeking (OR 4.3). CONCLUSION The high occurrence of bilirubin encephalopathy in Nigeria is due in large part to a delay in seeking care. A planned intervention strategy will target conditions leading to severe hyperbilirubinemia and delay.
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Affiliation(s)
| | | | | | | | | | | | | | - Aleksandr Aravkin
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | | | | | - Tina Slusher
- University of Minnesota and Hennepin County Medical Center, Minneapolis, MN, USA
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Greco C, Iskander IF, El Houchi SZ, Rohsiswatmo R, Rundjan L, Ogala WN, Ofakunrin AO, Moccia L, Hoi NTX, Bedogni G, Tiribelli C, Coda Zabetta CD. Diagnostic Performance Analysis of the Point-of-Care Bilistick System in Identifying Severe Neonatal Hyperbilirubinemia by a Multi-Country Approach. EClinicalMedicine 2018; 1:14-20. [PMID: 31193593 PMCID: PMC6537563 DOI: 10.1016/j.eclinm.2018.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/11/2018] [Accepted: 05/22/2018] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE The real prevalence and clinical burden of severe neonatal jaundice are undefined due to difficulties in measuring total serum bilirubin (TSB) outside secondary and tertiary clinical centers. OBJECTIVE To assess the diagnostic performance of the point-of care Bilistick System (BS) in identifying neonatal jaundice patients requiring treatment. DESIGN Between April 2015 and November 2016, 1911 neonates, were recruited to participate in the study. Blood samples were simultaneously collected for the TSB determination by BS and by hospital laboratory (Lab). Data were collected and sent to the Bilimetrix headquarter in Trieste where statistical analysis was performed. Newborns with neonatal jaundice were treated with phototherapy according to each center's guidelines. SETTING 17 hospitals from Nigeria, Egypt, Indonesia, and Viet Nam. PARTICIPANTS 1911 newborns were included, of which 1458 (76·3%) fulfilled the inclusion criteria. RESULTS TSB level measured by BS agreed (p < .0001) with the lab result in all four countries. The diagnostic performance of BS showed a positive predictive value (PPV) of 92·5% and a negative predictive value (NPV) of 92·8%. CONCLUSIONS AND RELEVANCE BS is a reliable system to detect neonatal jaundice over a wide range of bilirubin levels. Since Bilistick is a point-of-care test, its use may provide appropriate and timely identification of jaundiced newborns requiring treatment.
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Affiliation(s)
- Chiara Greco
- Bilimetrix s.r.l., Area Science Park, 34149 Trieste, Italy
| | - Iman F. Iskander
- Department of Pediatrics, Cairo University Children Hospital, Cairo, Egypt
| | - Salma Z. El Houchi
- Department of Pediatrics, Cairo University Children Hospital, Cairo, Egypt
| | - Rinawati Rohsiswatmo
- Neonatology Division, Child Health Department, Cipto Mangunkusumo Hospital - University of Indonesia, Jakarta, Indonesia
| | - Lily Rundjan
- Neonatology Division, Child Health Department, Cipto Mangunkusumo Hospital - University of Indonesia, Jakarta, Indonesia
| | - Williams N. Ogala
- Neonatal Unit, Department of Paediatrics, Ahmadu Bello University/Teaching Hospital, Zaria, Nigeria
| | | | | | | | - Giorgio Bedogni
- Fondazione Italiana Fegato-Onlus, Area Science Park, 34149 Trieste, Italy
| | - Claudio Tiribelli
- Bilimetrix s.r.l., Area Science Park, 34149 Trieste, Italy
- Fondazione Italiana Fegato-Onlus, Area Science Park, 34149 Trieste, Italy
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Amandito R, Putradista R, Jikesya C, Utaminingsih D, Rusin J, Rohsiswatmo R, Malik A. UGT1A1 gene and neonatal hyperbilirubinemia: a preliminary study from Bengkulu, Indonesia. BMC Res Notes 2018. [PMID: 29534743 PMCID: PMC5851072 DOI: 10.1186/s13104-018-3284-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective The genetic involvement in unconjugated neonatal hyperbilirubinemia has been extensively studied. Despite the high incidence of hyperbilirubinemia in Indonesia, studies are lacking. The objective of this study is to elucidate the role of polymorphism in the UGT1A1 in Neonatal Hyperbilirubinemia in Bengkulu, Indonesia. Results There were 41 neonates enrolled in the study; 30 had a total serum bilirubin level ≥ 15 mg/dL (hyperbilirubinemia neonates) while 11 has < 15 mg/dL (control neonates). Genetic mutations in Exon 1, UGT1A1*6 (c211g > a) and one in promoter region, UGT1A1*60 (c3279t > g) were determined by polymerase chain reaction–restriction fragment length polymorphism. We found 18 (60%) mutation in exon 1 in hyperbilirubinemia group and 7 (64%) in the control group with an identical allele frequency of 0.3 in both groups. We found heterozygous UGT1A1*60 4 times (13.3%) and homozygous 26 times (86.7%) in the hyperbilirubinemia group, with an identical allele frequency of 0.935 in hyperbilirubinemia and 1 in control group. This study supports the involvement of genetic factors in the development of unconjugated hyperbilirubinemia in Bengkulu population.
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Affiliation(s)
- Radhian Amandito
- M Yunus General Hospital, Jl Bhayangkara, Bengkulu City, Bengkulu, Indonesia.,Neonatal Intensive Care Unit, Pondok Indah General Hospital, Jl Metro Duta Kav. UE, Pondok Indah, Jakarta, Indonesia
| | - Raihandhana Putradista
- Division of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmacy, Universitas Indonesia, UI Depok Campus, Depok, West Java, 16424, Indonesia
| | - Clara Jikesya
- Division of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmacy, Universitas Indonesia, UI Depok Campus, Depok, West Java, 16424, Indonesia
| | - Dwi Utaminingsih
- Division of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmacy, Universitas Indonesia, UI Depok Campus, Depok, West Java, 16424, Indonesia
| | - Jumnalis Rusin
- Department of Pediatrics, M Yunus General Hospital, Jl Bhayangkara, Bengkulu City, Bengkulu, Indonesia
| | - Rinawati Rohsiswatmo
- Neonatal Intensive Care Unit, Pondok Indah General Hospital, Jl Metro Duta Kav. UE, Pondok Indah, Jakarta, Indonesia.,Division of Perinatology, Department of Pediatrics, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jl Pangeran Diponegoro No. 71, Central Jakarta, Jakarta, Indonesia
| | - Amarila Malik
- Division of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmacy, Universitas Indonesia, UI Depok Campus, Depok, West Java, 16424, Indonesia.
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Keahey PA, Simeral ML, Schroder KJ, Bond MM, Mtenthaonnga PJ, Miros RH, Dube Q, Richards-Kortum RR. Point-of-care device to diagnose and monitor neonatal jaundice in low-resource settings. Proc Natl Acad Sci U S A 2017; 114:E10965-E10971. [PMID: 29203650 PMCID: PMC5754796 DOI: 10.1073/pnas.1714020114] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Newborns are at increased risk of jaundice, a condition in which excess bilirubin accumulates in blood. Left untreated, jaundice can lead to neurological impairment and death. Jaundice resulting from unconjugated hyperbilirubinemia is easily treated with exposure to blue light, and phototherapy systems have been developed for low-resource settings; however, there are no appropriate solutions to diagnose and monitor jaundice in these settings. To address this need we present BiliSpec, a low-cost reader and disposable lateral flow card designed to measure the concentration of total bilirubin from several drops of blood at the point of care. We evaluated the performance of BiliSpec, using blood from normal volunteers spiked with varying amounts of bilirubin; results measured using BiliSpec correlated well with a reference laboratory bilirubinometer (r = 0.996). We then performed a pilot clinical study using BiliSpec to measure total bilirubin in neonates at risk for jaundice at Queen Elizabeth Central Hospital in Blantyre, Malawi. Concentrations measured using BiliSpec correlated well with those measured using a laboratory reference standard in 94 patient samples ranging from 1.1 mg/dL to 23.0 mg/dL in concentration (r = 0.973). The mean difference between bilirubin levels measured with BiliSpec and the reference standard was 0.3 mg/dL (95[Formula: see text] CI: -1.7-2.2 mg/dL).
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Affiliation(s)
- Pelham A Keahey
- Department of Bioengineering, Rice University, Houston, TX 77030
| | | | | | - Meaghan M Bond
- Department of Bioengineering, Rice University, Houston, TX 77030
| | | | | | - Queen Dube
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
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Slusher TM, Day LT, Ogundele T, Woolfield N, Owa JA. Filtered sunlight, solar powered phototherapy and other strategies for managing neonatal jaundice in low-resource settings. Early Hum Dev 2017; 114:11-15. [PMID: 28919246 DOI: 10.1016/j.earlhumdev.2017.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Challenges in treating severe neonatal jaundice in low and middle-income country settings still exist at many levels. These include: a lack of awareness of causes and prevention by families, communities and even sometimes health care professionals; insufficient, ineffective, high quality affordable diagnostic and therapeutic options; limited availability of rehabilitation provision for kernicterus. Collectively these challenges lead to an unacceptably high global morbidity and mortality from severe neonatal jaundice. In the past decade, there has been an explosion of innovations addressing some of these issues and these are increasingly available for scale up. Scientists, healthcare providers, and communities are joining hands to explore educational tools, low cost screening and diagnostic options including at point-of-care and treatment modalities including filtered sunlight and solar powered phototherapy. For the first time, the possibility of eliminating the tragedy of preventable morbidity and mortality from severe NNJ is on the horizon, for all.
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Affiliation(s)
- Tina M Slusher
- Division of Global Pediatrics, University of Minnesota, Minneapolis, MN 55415, USA; Pediatric Intensive Care Unit, Hennepin County Medical Center, 701 Park Ave., MC G7, Minneapolis, MN 55415, USA.
| | - Louise Tina Day
- Paediatrics, LAMB Integrated Rural Health & Development, Parbatipur, Dinajpur, Bangladesh
| | - Tolulope Ogundele
- Department of Paediatrics, University of Medical Sciences, Nigeria.; State Specialist Hospital, Ondo City, Ondo, Nigeria
| | - Nick Woolfield
- UNICEF, Kyrgyzstan; 63 Elliott St., Caboolture, Queensland, Australia
| | - Joshua Aderinsola Owa
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Majors CE, Smith CA, Natoli ME, Kundrod KA, Richards-Kortum R. Point-of-care diagnostics to improve maternal and neonatal health in low-resource settings. LAB ON A CHIP 2017; 17:3351-3387. [PMID: 28832061 PMCID: PMC5636680 DOI: 10.1039/c7lc00374a] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Each day, approximately 830 women and 7400 newborns die from complications during pregnancy and childbirth. Improving maternal and neonatal health will require bringing rapid diagnosis and treatment to the point of care in low-resource settings. However, to date there are few diagnostic tools available that can be used at the point of care to detect the leading causes of maternal and neonatal mortality in low-resource settings. Here we review both commercially available diagnostics and technologies that are currently in development to detect the leading causes of maternal and neonatal mortality, highlighting key gaps in development where innovative design could increase access to technology and enable rapid diagnosis at the bedside.
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Affiliation(s)
- Catherine E Majors
- Department of Bioengineering, Rice University, 6100 Main Street, MS-142, Houston, TX 77005, USA.
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Comparison between Bilistick System and transcutaneous bilirubin in assessing total bilirubin serum concentration in jaundiced newborns. J Perinatol 2017; 37:1028-1031. [PMID: 28617429 DOI: 10.1038/jp.2017.94] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the performance and accuracy of the JM-103 transcutaneous bilirubinometer and Bilistick System in measuring total serum bilirubin for the early identification of neonatal hyperbilirubinemia. STUDY DESIGN The study was performed on 126 consecutive term and near-term (⩾36 weeks' gestational age) jaundiced newborns in Cairo University Children Hospital NICU, Egypt. Total serum bilirubin was assayed concurrently by the clinical laboratory and Bilistick System and estimated using the JM-103 transcutaneous bilirubin instrument. Bland-Altman analysis was used to evaluate the agreement between determinations. RESULT The limits of agreement of the Bilistick System (-5.8 to 3.3 mg dl-1) and JM-103 system (-5.4 to 6.0 mg dl-1) versus the clinical laboratory results were similar. CONCLUSION The Bilistick System is an accurate alternative to transcutaneous (TcB) determination for early diagnosis and proper management of the neonatal jaundice.
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Wennberg R. 50 Years Ago in TheJournal ofPediatrics: Early versus Delayed Feeding of Low Birth Weight Infants: Effects on Physiologic Jaundice. J Pediatr 2016; 173:153. [PMID: 27234285 DOI: 10.1016/j.jpeds.2015.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Greco C, Arnolda G, Boo NY, Iskander IF, Okolo AA, Rohsiswatmo R, Shapiro SM, Watchko J, Wennberg RP, Tiribelli C, Coda Zabetta CD. Neonatal Jaundice in Low- and Middle-Income Countries: Lessons and Future Directions from the 2015 Don Ostrow Trieste Yellow Retreat. Neonatology 2016; 110:172-80. [PMID: 27172942 DOI: 10.1159/000445708] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/22/2016] [Indexed: 11/19/2022]
Abstract
Severe neonatal hyperbilirubinemia, defined as total serum bilirubin (TSB) ≥20 mg/dl, is associated with a higher risk of permanent neurological sequelae and death. Jaundice can and should be promptly diagnosed and treated. Reliable methods for TSB assay are not always readily available, particularly in low- and middle-income countries, making the true incidence of severe neonatal jaundice (NNJ) difficult to estimate. To gather a more comprehensive picture, a symposium addressing NNJ worldwide was organized during the 2015 Don Ostrow Trieste Yellow Retreat. Data collected by several researchers in different regions of the world were presented and differences/similarities discussed. This report points out the need for: (1) a coordinated worldwide effort to define the burden and the causes of severe NNJ and its consequences; (2) aggressive educational programs for families and health personnel to facilitate timely care-seeking, and (3) accurate diagnostics and effective phototherapy.
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Olusanya BO, Imam ZO, Emokpae AA, Iskander IF. Revisiting the Criteria for Exchange Transfusion for Severe Neonatal Hyperbilirubinemia in Resource-Limited Settings. Neonatology 2016; 109:97-104. [PMID: 26594786 DOI: 10.1159/000441324] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 09/25/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Exchange transfusion (ET) for severe neonatal hyperbilirubinemia (SNH) is frequently undertaken in low- and middle-income countries (LMIC), in sharp contrast to the prevailing practice in high-income countries. However, the criteria for initiating this procedure in settings with limited resources for treating infants with SNH have not been systematically explored. OBJECTIVE To identify key considerations for initiating ET in resource-poor countries to curtail its unnecessary use for the prevention of kernicterus. METHODS A review of the existing guidelines and literature on the management of neonatal hyperbilirubinemia worldwide was conducted to identify criteria and underlying factors for initiating ET. RESULTS There is a dearth of evidence from randomized clinical trials to support clear criteria for indicated ET worldwide. Because risk assessment for kernicterus based solely on the levels of total serum bilirubin (TSB) has often proved inadequate, a combination of plasma/serum bilirubin estimation and clinical evaluation for acute bilirubin encephalopathy (ABE) has been recommended for predicting the risk of kernicterus. However, there is a lack of consistency regarding the TSB levels for which ET should be initiated in relation to the clinical signs/symptoms of ABE and hemolytic disorders. CONCLUSIONS A decision-making framework that combines TSB thresholds and evidence of neurotoxicity is needed for evaluating the risk of kernicterus and prioritising infants for ET in LMICs to curtail unnecessary interventions.
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Arnolda G, Nwe HM, Trevisanuto D, Thin AA, Thein AA, Defechereux T, Kumara D, Moccia L. Risk factors for acute bilirubin encephalopathy on admission to two Myanmar national paediatric hospitals. Matern Health Neonatol Perinatol 2015; 1:22. [PMID: 27057339 PMCID: PMC4823679 DOI: 10.1186/s40748-015-0024-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background Jaundice is the commonest neonatal ailment requiring treatment. Untreated, it can lead to acute bilirubin encephalopathy (ABE), chronic bilirubin encephalopathy (CBE) or death. ABE and CBE have been largely eliminated in industrialised countries, but remain a problem of largely undocumented scale in low resource settings. As part of a quality-improvement intervention in the Neonatal Care Units of two paediatric referral hospitals in Myanmar, hospitals collected de-identified data on each neonate treated on new phototherapy machines over 13–20 months. The information collected included: diagnosis of ABE at hospital presentation; general characteristics such as place of birth, source of referral, and sex; and a selection of suspected causes of jaundice including prematurity, infection, G6PD status, ABO and Rh incompatibility. This information was analysed to identify risk factors for hospital presentation with ABE, using multiple logistic regression. Results Data on 251 neonates was recorded over 20 months in Hospital A, and 339 neonates over 13 months in Hospital B; the number of outborn neonates presenting with ABE was 32 (12.7 %) and 72 (21.2 %) respectively. In the merged dataset the final multivariate model identified the following independent risk and protective factors: home birth, ORadj = 2.3 (95 % CI: 1.04-5.4); self-referral, ORadj = 2.6 (95 % CI: 1.2-6.0); prematurity, ORadj = 0.40 (95 % CI: 0.18-0.85); and a significant interaction between hospital and screening status because screening positive for G6PD deficiency was a strong and significant risk factor at Hospital B (ORadj = 5.9; 95 % CI: 3.0-11.6), but not Hospital A (ORadj = 1.1; 95 % CI: 0.5-2.5). Conclusion The study identifies home birth, self-referral and G6PD screening status as important risk factors for presentation with ABE; prematurity was protective, but this is interpreted as an artefact of the study design. As operational research, there is likely to be substantial measurement error in the risk factor data, suggesting that the identified risk factor estimates are robust. Additional interventions are required to ensure prompt referral of jaundiced neonates to treatment facilities, with particular focus on home births and communities with high rates of G6PD deficiency.
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Affiliation(s)
- G Arnolda
- Thrive Networks, Oakland, CA USA ; School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales, Wales, NSW Australia
| | - H M Nwe
- Department of Paediatrics, University of Medicine (1), Yangon, Myanmar
| | - D Trevisanuto
- Amici della Neonatologia Trentina, Trento, Italy ; Children and Women's Health Department, Medical School University of Padua, Padua, Italy
| | - A A Thin
- Mandalay Children's Hospital (300), Mandalay, Myanmar
| | - A A Thein
- Department of Neonatology, University of Medicine (1), Yangon, Myanmar
| | - T Defechereux
- Department of Surgery, Liege University Hospital, Liege, Belgium
| | - D Kumara
- Thrive Networks, Oakland, CA USA
| | - L Moccia
- Thrive Networks, Oakland, CA USA ; Amici della Neonatologia Trentina, Trento, Italy
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Olusanya BO, Ogunlesi TA, Kumar P, Boo NY, Iskander IF, de Almeida MFB, Vaucher YE, Slusher TM. Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings. BMC Pediatr 2015; 15:39. [PMID: 25884679 PMCID: PMC4409776 DOI: 10.1186/s12887-015-0358-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/30/2015] [Indexed: 11/16/2022] Open
Abstract
Hyperbilirubinaemia is a ubiquitous transitional morbidity in the vast majority of newborns and a leading cause of hospitalisation in the first week of life worldwide. While timely and effective phototherapy and exchange transfusion are well proven treatments for severe neonatal hyperbilirubinaemia, inappropriate or ineffective treatment of hyperbilirubinaemia, at secondary and tertiary hospitals, still prevails in many poorly-resourced countries accounting for a disproportionately high burden of bilirubin-induced mortality and long-term morbidity. As part of the efforts to curtail the widely reported risks of frequent but avoidable bilirubin-induced neurologic dysfunction (acute bilirubin encephalopathy (ABE) and kernicterus) in low and middle-income countries (LMICs) with significant resource constraints, this article presents a practical framework for the management of late-preterm and term infants (≥35 weeks of gestation) with clinically significant hyperbilirubinaemia in these countries particularly where local practice guidelines are lacking. Standard and validated protocols were followed in adapting available evidence-based national guidelines on the management of hyperbilirubinaemia through a collaboration among clinicians and experts on newborn jaundice from different world regions. Tasks and resources required for the comprehensive management of infants with or at risk of severe hyperbilirubinaemia at all levels of healthcare delivery are proposed, covering primary prevention, early detection, diagnosis, monitoring, treatment, and follow-up. Additionally, actionable treatment or referral levels for phototherapy and exchange transfusion are proposed within the context of several confounding factors such as widespread exclusive breastfeeding, infections, blood group incompatibilities and G6PD deficiency, which place infants at high risk of severe hyperbilirubinaemia and bilirubin-induced neurologic dysfunction in LMICs, as well as the limited facilities for clinical investigations and inconsistent functionality of available phototherapy devices. The need to adjust these levels as appropriate depending on the available facilities in each clinical setting and the risk profile of the infant is emphasised with a view to avoiding over-treatment or under-treatment. These recommendations should serve as a valuable reference material for health workers, guide the development of contextually-relevant national guidelines in each LMIC, as well as facilitate effective advocacy and mobilisation of requisite resources for the optimal care of infants with hyperbilirubinaemia at all levels.
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Affiliation(s)
- Bolajoko O Olusanya
- Centre for Healthy Start Initiative, 286A, Corporation Drive, Dolphin Estate, Ikoyi, Lagos, Nigeria.
| | - Tinuade A Ogunlesi
- Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.
| | - Praveen Kumar
- Department of Paediatrics, Neonatal Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Nem-Yun Boo
- Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Bandar Sungai Long, Selangor, Malaysia.
| | | | | | - Yvonne E Vaucher
- Division of Neonatal/Perinatal Medicine, School of Medicine, University of California at San Diego, San Diego, USA.
| | - Tina M Slusher
- Division of Global Paediatrics, University of Minnesota, Minneapolis, Minnesota, USA. .,Hennepin County Medical Centre, Minneapolis, Minnesota, USA.
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Olusanya BO, Ogunlesi TA, Slusher TM. Why is kernicterus still a major cause of death and disability in low-income and middle-income countries? Arch Dis Child 2014; 99:1117-21. [PMID: 25123403 DOI: 10.1136/archdischild-2013-305506] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Neonatal jaundice is predominantly a benign condition that affects 60%-80% of newborns worldwide but progresses to potentially harmful severe hyperbilirubinaemia in some. Despite the proven therapeutic benefits of phototherapy for preventing extreme hyperbilirubinaemia, acute bilirubin encephalopathy or kernicterus, several low-income and middle-income countries (LMIC) continue to report high rates of avoidable exchange transfusions, as well as bilirubin-induced mortality and neurodevelopmental disorders. Considering the critical role of appropriate timing in treatment effectiveness, this review set out to examine the contributory factors to the burden of severe hyperbilirubinaemia and kernicterus based on the 'three delays model' described by Thaddeus and Maine in the 91 most economically disadvantaged LMICs with Gross National Income per capita ≤US$6000 and median human development index of 0.525 (IQR: 0.436-0.632). Strategies for addressing these delays are proposed including the need for clinical and public health leadership to curtail the risk and burden of kernicterus in LMICs.
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Affiliation(s)
| | - Tinuade A Ogunlesi
- Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Tina M Slusher
- Department of Pediatrics, University of Minnesota & Hennepin County Medical Center, Minneapolis, Minnesota, USA
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Gotink MJ, Benders MJ, Lavrijsen SW, Rodrigues Pereira R, Hulzebos CV, Dijk PH. Severe neonatal hyperbilirubinemia in the Netherlands. Neonatology 2013; 104:137-42. [PMID: 23887661 DOI: 10.1159/000351274] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 04/05/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The occurrence of severe neonatal hyperbilirubinemia (SH) is partly attributed to nonhospitalized perinatal care. The Netherlands have a high frequency of home births and nonhospitalized perinatal care, and the incidence of SH is unknown. OBJECTIVE To assess the effects of home births and early hospital discharge on the incidence of SH in term-born infants in the Netherlands. METHODS In this nationwide prospective surveillance study between 2005 and 2009, infants (≥37 weeks GA) were included if total serum bilirubin (TSB) was ≥500 µmol/l or if they received an exchange transfusion when TSB was ≥340 µmol/l. RESULTS Seventy-one infants had SH (incidence 10.4/100,000); 43 had a TSB ≥500 μmol/l (incidence 6.3/100,000) and 45 (63%) underwent an exchange transfusion. 26% of the infants with SH were born at home, which is similar to 22% of all term infants who are born at home in the Netherlands (p = 0.41). Maximum TSB levels were similar in infants born at home (523 ± 114 μmol/l) and infants born in hospital (510 ± 123 μmol/l; p = 0.70). Of the 51 infants born in hospital, 33 were discharged and readmitted with SH, with maximal TSB levels (567 ± 114 μmol/l), which were higher than in infants who remained hospitalized (406 ± 47 μmol/l; p = 0.0001). CONCLUSION The incidence of severe hyperbilirubinemia in term-born infants in the Netherlands is 10.4 per 100,000, which is similar to other developed countries. Home birth and early hospital discharge do not necessarily lead to a higher incidence of SH, provided that perinatal home care is well organized.
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Affiliation(s)
- Mark J Gotink
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
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