Background
Methods
Setting
Clinical approach of INH
Jaundice cases classification
Variables definitions
Statistical analysis
Ethics statement
Results
INH trends
Time line | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 |
---|---|---|---|---|---|---|
Data available | ||||||
Refugee site | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
Migrants sites | ✓ | ✓ | ✓ | |||
SBR available | ||||||
Refugee site | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
Migrants sites | ✓ | ✓ | ✓ | |||
NICE guidelines and LED phototherapy available a | ✓ | ✓ | ✓ | ✓ | ||
Proportion of NH by total livebirth, n, (%) | 82/1520 (5.4) | 112/1381 (8.1) | 114/1298 (8.8) | 364/2573 (14.1) | 459/2547 (18.0) | 449/2532 (17.7) |
NH as sole clinical diagnosis in proportion of total NH b, n (%) | 29/82 (35.4) | 48/112 (42.9) | 61/114 (53.5) | 195/364 (53.6) | 280/459 (61.0) | 298/449 (66.4) |
Postnatal age at diagnosis in hours, median, [IQR] | 74.5 [48–106] | 73.5 [22–122] | 67.5 [47–102] | 53.5 [37–91] | 52 [33–77] | 49 [33–81] |
Severe INH in proportion of total INH, n (%) | 30/82 (36.6) | 39/112 (34.8) | 17/114 (14.9) | 46/364 (12.6) | 43/459 (9.4) | 37/449 (8.2) |
Mortality rate in neonates with severe INH, n (%) | 7/30 (23.3) | 4/39 (10.3) | 2/17 (11.8) | 3/46 (6.5) | 1/43 (2.3) | 0/37 (0.0) |
General characteristics of neonates with INH
Characteristics | Neonates with INH n=1580a |
---|---|
Maternal characteristics | |
Site, n (%) | |
Refugee | 1056 (66.8) |
Migrant | 524 (33.2) |
Ethnicity, n (%) | |
Karen | 1165/1546 (75.4) |
Burman | 258/1546 (16.7) |
Other | 123/1546 (8.0) |
Age in years, median, (IQR) | 24 (20–30) n = 1579 |
Literacy, n (%) | 947/1442 (56.7) |
Smoking, n (%) | 222/1574 (14.1) |
Primigravida, n (%) | 763 (48.3) |
Multiple pregnancy, n (%) | 61 (3.9) |
Place of birth, n (%) | |
SMRU | 1423 (90.1) |
Tertiary hospital | 68 (4.3) |
Home | 77 (4.9) |
Other | 12 (0.8) |
Type of delivery | |
Normal vaginal delivery, n (%) | 1427 (90.3) |
Breech and face delivery, n (%) | 49 (3.1) |
Instrumental vaginal delivery, n (%) | 62 (3.9) |
Caesarian section, n (%) | 42 (2.7) |
Newborn characteristics | |
Gestational age, n (%) | |
< 32 weeks | 53/1578 (3.4) |
32 < 37 weeks | 437/1578 (27.7) |
≥ 37 weeks | 1088/1578 (68.9) |
Gender (male), n (%) | 922 (58.4) |
Small for gestational age, n (%) | 297/1554 (19.1) |
Congenital abnormality, n (%) | 44 (2.8) |
Hospitalization characteristics | |
INH as sole clinical diagnosisb, n (%) | 911 (57.7) |
Infection | |
Severe infection, n (%) | 296 (18.7) |
Mild infection, n (%) | 206 (13.0) |
Age in days at admission, median, (IQR) | 2 (1–3) |
Age in hours at presentation of INH, median, (IQR) | 55 [36–92] |
Length of stay in days, median, (IQR) | |
1–3 days | 588 (37.2) |
> 3–5 days | 307 (19.4) |
> 5–8 days | 323 (35.1) |
> 8 days | 362 (39.3) |
Mortality during hospitalization, n (%) | 31 (2.0) |
Characteristics of neonates with severe INH
Characteristics | Moderate INH, n=1368a | Severe INH, n=212a | OR [95%CI] | p-value | AORb [95%CI] | p-value |
---|---|---|---|---|---|---|
Maternal characteristics | ||||||
Site, n (%) | ||||||
Migrant | 464 (33.9) | 60 (28.3) | 1 | 0.107 | – | – |
Refugee | 904 (66.1) | 152 (71.7) | 1.3 [0.9–1.8] | – | ||
Ethnicity, n (%) | ||||||
Karen | 1014/1348 (75.2) | 151/198 (76.3) | 1 | 0.434 | – | – |
Burman | 230/1348 (17.1) | 28/198 (13.2) | 0.8 [0.5–1.2] | – | – | |
Other | 104/1348 (7.7) | 19/198 (9.0) | 1.2 [0.7–2.1] | – | – | |
Age in years, median, (IQR) | 24 (20–30) | 23 (20–31) | 1.0 [0.9–1.0] | 0.777 | – | – |
Literacy, n (%) | 846/1280 (66.1) | 101/162 (62.3) | 0.9 [0.6–1.2] | 0.347 | – | – |
Smoking, n (%) | 189/1364 (13.9) | 33/210 (15.7) | 1.2 [0.8–1.7] | 0.477 | – | – |
Primigravida, n (%) | 668 (48.8) | 95 (44.8) | 0.9 [0.6–1.1] | 0.276 | – | – |
Multiple pregnancy, n (%) | 52 (3.8) | 9 (4.2) | 1.1 [0.5–2.3] | 0.758 | – | – |
Place of birth, n (%) | ||||||
SMRU | 1241 (90.7) | 182 (85.8) | 1 | 0.011 | – | – |
Tertiary hospital | 61 (4.5) | 7 (3.3) | 0.8 [0.4–1.7] | – | – | |
Home | 58 (4.2) | 19 (9.0) | 2.2 [1.3–3.8] | – | – | |
Other | 8 (0.6) | 4 (1.9) | 3.4 [1.0–11.4] | – | – | |
Breech and face delivery, n (%) | 36 (2.6) | 13 (6.1) | 2.4 [1.3–4.6] | 0.008 | 2.0 [1.0–4.3] | 0.056 |
Instrumental vaginal delivery, n (%) | 58 (4.4) | 4 (1.9) | 0.4 [0.2–1.2] | 0.073 | – | – |
Newborn characteristics | ||||||
Gender (male), n (%) | 796 (58.2) | 126 (59.7) | 1.1 [0.8–1.4] | 0.731 | – | – |
Small for gestational age, n (%) | 251/1350 (18.6) | 46/204 (15.5) | 1.3 [0.9–1.8] | 0.188 | 1.3 [0.9–2.0] | 0.139 |
Gestational age, n (%) | ||||||
< 32 weeks | 38/1367 (2.8) | 15/211 (7.1) | 3.5 [1.9–6.5] | < 0.001 | 3.3 [1.6–6.6] | < 0.001 |
32 < 37 weeks | 352/1367 (25.7) | 85/211 (40.3) | 2.1 [1.6–2.9] | 2.2 [1.6–3.1] | ||
≥ 37 weeks | 977/1367 (71.5) | 111/211 (52.6) | 1 | 1 | ||
Congenital abnormality, n (%) | 34 (2.5) | 10 (4.7) | 1.9 [1.0–4.0] | 0.089 | 2.4 [1.1–5.3] | 0.027 |
G6PD deficiency, n (%) | 213/1364 (15.6) | 54 (25.5) | 1.9 [1.3–2.6] | < 0.001 | 2.3 [1.6–3.3] | < 0.001 |
Potential ABO incompatibility, n (%) | 238/1341 (17.7) | 45/205 (22.0) | 1.3 [0.9–1.9] | 0.155 | 1.5 [1.0–2.2] | 0.032 |
INH as sole clinical diagnosis, n (%) | 814 (59.5) | 97 (45.8) | 1.7 [1.3–2.3] | < 0.001 | – | – |
Infection, n (%) | ||||||
No infection associated | 955 (69.8) | 123 (58.0) | 1 | 0.003 | 1 | 0.006 |
Associated severe infection | 240 (17.5) | 56 (26.4) | 1.8 [1.3–2.6] | 1.8 [1.2–2.7] | ||
Associated mild infection | 173 (12.6) | 33 (15.6) | 1.5 [0.9–2.3] | 1.4 [0.9–2.2] | ||
Age at presentation, n (%) | ||||||
0–24 h | 154 (11.3) | 37 (17.5) | 2.1 [1.4–3.3] | < 0.001 | 1.5 [0.9–2.4] | 0.003 |
> 24–72 h | 160 (55.6) | 85 (40.1) | 1 | 1 | ||
> 72 h | 454 (33.2) | 90 (42.5) | 1.8 [1.3–2.4] | 1.8 [1.3–2.6] | ||
Length of phototherapy in hours, median, (IQR) | 36 (22–66) | 72 (43–133) | – | < 0.001 | – | |
Mortality during hospitalization, n, (%) | 14 (1.0) | 17 (8.0) | 8.4 [4.1–17.4] | < 0.001 | – | – |
Number of risk factorsa | Moderate INH N = 1368 | Severe INH N = 212 | Severity OR [95%CI] |
---|---|---|---|
No associated factor, n (%) | 523 (38.2) | 43 (20.3) | 1 |
One associated factor, n (%) | 604 (44.2) | 95 (44.8) | 1.9 [1.3–2.8] |
Combination of 2 factors, n (%) | 212 (15.5) | 54 (25.5) | 3.1 [2.0–4.8] |
Combination of 3 or 4 factors, n (%) | 29 (2.1) | 20 (9.4) | 8.4 [4.4–16.1] |