Table 1

Characteristics of neonatal period of 129 neonates with extreme NH

CharacteristicsExtreme NH (N=129)
Year of admission200922 (17.0)
201026 (20.2)
201112 (9.3)
201224 (18.6)
201327 (20.9)
201418 (14.0)
StatusRefugee91 (70.5)
Migrant38 (29.5)
Gender (male)75 (58.1)
Gestational age ≥35 weeks*92 (71.3)
Place of deliverySMRU clinic110 (85.3)
Tertiary hospital4 (3.1)
Home15 (11.6)
Birth weight (kg) (n=125), median (IQR)†2.53 (1.96–2.90)
Small for gestational age (n=125)‡23 (18.4)
Poor start to life§15 (11.6)
Mother primigravid60 (46.5)
Normal vaginal delivery114 (88.4)
Age at admission (days), median (IQR)1 (0–4)
Duration of admission (days), median (IQR)6 (4–11)
Extreme NH category¶Two SBRs above ET101 (78.3)
Rapid SBR rise+ABE signs27 (20.9)
Clinical diagnosis of ABE1 (0.8)
Duration of phototherapy (hours), median (IQR)76 (48–124)
Peak SBR (µmol/L), median (IQR)430 (371–487)
Age at peak SBR (hours), median (IQR)97 (68–136)
Peak SBR at <72 hours of life41 (31.8)
Underwent ET4 (3.1)
Potential blood group ABO incompatibility** (n=126)24 (19.0)
G6PD-deficient male†† (n=75)33 (44.0)
Polycythaemia‡‡10 (7.8)
Birth trauma (visible bruising after birth recorded in the chart)6 (4.7)
Clinical diagnosis of sepsis prior to onset of NH§§34 (26.4)
  • Data shown in number and percentage (%) unless stated otherwise.

  • *Gestational age: based on first trimester ultrasound.25

  • †Birthweight: weight measurement considered valid if done in the first 72 hours of life.

  • ‡Small for gestational age: defined as birth weight below the 10th percentile for gestational age and sex, calculated with the INTERGROWTH-21st newborn size application tool (https://intergrowth21.tghn.org).

  • §Poor start to life: Apgar score<7 at 5 min and/or clinical suspicion of meconium aspiration and/or resuscitation at birth with at least five inflation breaths.

  • ¶Extreme NH categories: (1) two consecutive SBR measurements above the ET threshold of the NICE guideline, (2) SBR levels rising faster than 8.5 µmol/L/hour in combination with one SBR measurement above the ET threshold or with clinical symptoms of acute bilirubin encepalopathy, and (3) a clinical diagnosis of ABE.

  • **Potential blood group ABO incompatibility: mother–foetus pairs with mother blood group ‘O’ and neonate blood group ‘A’ or ‘B’. Rhesus factor and Coombs test were not available.

  • ††Diagnosed by G6PD fluorescent test.22

  • ‡‡Polycythaemia: two consecutive haematocrit values>70% from a capillary sample or a diagnosis of polycythaemia recorded in the clinical chart.

  • §§Clinical diagnosis of sepsis: sepsis reported as clinical diagnosis treated at least 5 days by intravenous antibiotics (blood culture confirmations were not available).

  • ABE, acute bilirubin encepalopathy; ET, exchange transfusion; G6PD, glucose-6-phosphate dehydrogenase; NH, neonatal hyperbilirubinaemia; NICE, National Institute for Health and Clinical Excellence; SBR, serum bilirubin; SMRU, Shoklo Malaria Research Unit.