High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border
Open accessAbstract
Population risks for neonatal hyperbilirubinaemia (NH) vary. Knowledge of local risks permits interventions that may reduce the proportion becoming severe. Between January 2015 and May 2016, in a resource-limited setting on the Thailand-Myanmar border, neonates from 28 weeks' gestation were enrolled into a prospective birth cohort. Each neonate had total serum bilirubin measurements: scheduled (24, 48, 72 and 144 hours of life) and clinically indicated; and weekly follow up until 1 month of age. Risk factors for developing NH were evaluated using Cox proportional hazard mixed model. Of 1710 neonates, 22% (376) developed NH (83% preterm, 19% term). All neonates born <35 weeks, four in five born 35-37 weeks, and three in twenty born ≥38 weeks had NH, giving an overall incidence of 249 per 1000 livebirths [95%CI 225, 403]. Mortality from acute bilirubin encephalopathy was 10% (2/20) amongst the 5.3% (20/376) who reached the severe NH threshold. One-quarter (26.3%) of NH occurred within 24 hours. NH onset varied with gestational age: at a median [IQR] 24 hours [24, 30] for neonates born 37 weeks or prematurely vs 59 hours [48, 84] for neonates born ≥38 weeks. Risk factors for NH in the first week of life independent of gestational age were: neonatal G6PD deficiency, birth bruising, Sgaw Karen ethnicity, primigravidae, pre-eclampsia, and prolonged rupture of membranes. The genetic impact of G6PD deficiency on NH was partially interpreted by using the florescent spot test and further genotyping work is in progress. The risk of NH in Sgaw Karen refugees may be overlooked internationally as they are most likely regarded as Burmese in countries of resettlement. Given high levels of pathological jaundice in the first 24 hours and overall high NH burden, guidelines changes were implemented including preventive PT for all neonates <35 weeks and for those 35-37 weeks with risk factors.
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Newborns from the Karen ethnic group are at increased risk of neonatal hyperbilirubinemia.
“Newborns from the Karen ethnic group are at increased risk of neonatal hyperbilirubinemia (Bancone et al., 2022; Thielemans et al., 2021).”
From Mother, child and adolescent health outcomes in two long-term refugee camp settings at the Thai-Myanmar border 2000–2018: a retrospective analysis (2024) · cites this paper as Thielemans et al., 2021
The Discussion reports that neonates of Sgaw Karen ethnicity had an increased risk of neonatal hyperbilirubinaemia in the first week of life compared with other ethnic groups. The claim broadens this finding to the Karen ethnic group as a whole, which this paper does not establish. (LLM, conf=0.85)
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- Authors
- Thielemans, L., Peerawaranun, P., Mukaka, M., Paw, M. K., Wiladphaingern, J., Landier, J., Bancone, G., Proux, S., Elsinga, H., Trip-Hoving, M., Hanboonkunupakarn, B., Htoo, T. L., Wah, T. S., Beau, C., Nosten, F., McGready, R., & Carrara, V. I.
- Affiliations
- Université Libre de Bruxelles (BE)
- Mahidol University (TH)
- Inserm (FR)
- Swiss Tropical and Public Health Institute (CH)
- Corresponding author
- Carrara, Verena I.
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-10-07
- Volume
- 16
- Issue
- 10
- Pages
- e0258127
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC8496801
- OpenAlex
- W3204573125
- Cited by
- 20
- References
- 45
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 3 · 2023: 5 · 2022: 5
- FWCI
- 3.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Greater South Information System
- Funders
- Wellcome Trust (220211)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal Health and Biochemistry
- Health Sciences › Medicine › Surgery › Pediatric Hepatobiliary Diseases and Treatments
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- neonatal hyperbilirubinaemia, pathological jaundice, risk factors, glucose-6-phosphate dehydrogenase deficiency, preterm birth, acute bilirubin encephalopathy, neonatal phototherapy, Thai-Myanmar border, resource-limited settings, birth cohort, ethnic minority health, prolonged rupture of membranes
- MeSH terms
- Bilirubin, Myanmar, Ethnicity, Female, Genotype, Glucosephosphate Dehydrogenase Deficiency, Humans, Infant, Newborn, Kernicterus, Male, Pre-Eclampsia, Pregnancy, Prospective Studies, Risk Factors, Thailand, Cohort Studies, Proportional Hazards Models, Epidemiologic Studies, Hyperbilirubinemia, Neonatal
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