Transcutaneous bilirubin screening for hyperbilirubinemia in African newborns

Okwundu, Charles I. (2019-04)

Thesis (PhD)--Stellenbosch University, 2019.

Thesis

ENGLISH SUMMARY : Background: In many parts of the world, including African countries, apparently healthy newborns are usually discharged home early. Serum bilirubin levels usually peaks on postnatal days 3 to 5, by when many newborns have already been discharged home. Severe neonatal hyperbilirubinemia constitutes an important cause of neonatal mortality and morbidity in Africa. There is a need for ways of identifying newborns at risk of severe jaundice before hospital discharge especially in developing countries with poor health systems and inadequate follow-up procedures after discharge from hospital. Objectives: The objective of this combination of studies is to provide evidence for the use of transcutaneous bilirubin (TcB) screening in a population of indigenous African newborns. Methods: We summarized the available evidence on the accuracy and effectiveness of TcB screening in two Cochrane systematic reviews. In the first systematic review, we summarized the evidence on the effectiveness of TcB screening in newborns. The second review summarized the evidence on the accuracy of TcB measurement compared to total serum bilirubin (TsB) measurement. We also conducted research on the effects of TcB screening and on the accuracy of the TcB measurement in a population of South African newborns. Results: For our first systematic review, we did not identify any randomized controlled trial that assessed the effect of TcB screening on readmission for jaundice or on the incidence of severe hyperbilirubinemia in newborns. Findings from included observational studies from North America suggest that universal pre-discharge TcB screening in newborns reduces readmission for hyperbilirubinemia and also reduces the incidence of severe hyperbilirubinemia. We conducted a randomized controlled trial of TcB screening in an indigenous population of African newborns from South Africa. Findings from our trial confirmed that TcB screening reliably identified newborns at risk of severe hyperbilirubinemia and led to a 75% reduction in the readmission rate for hyperbilirubinemia and up to 73% decrease in the incidence of severe hyperbilirubinemia. However, the effect of TcB screening on kernicterus and bilirubin induced neurology dysfunction is not known. Findings from our second systematic review of accuracy of TcB measurement compared to TsB measurement in the laboratory, suggest a significant correlation coefficient of up to 0.98 between these two measurements. However, there are mixed findings from the included studies on the effect of various factors including: gestational age, race, postnatal age, TsB concentration, on the correlation. Also, there are limited studies in indigenous African newborns. Our cross-sectional study on the accuracy of the TcB measurement in a population of South African newborns showed a good correlation between TcB measurement and TsB measured in the laboratory. Conclusion: The TcB tool can be used to reliably estimate TsB in African newborns and can help identify newborns who need phototherapy before hospital discharge. We recommend that every newborn should be assessed for hyperbilirubinemia using objective means of measuring or estimating serum bilirubin measurement such as the TcB or TsB before discharge from hospital. This could go a long way in reducing hyperbilirubinemia related readmissions and incidence of severe hyperbilirubinemia. Pre-discharge TcB screening in newborns can therefore be used to identify newborns in need of phototherapy or those who are at risk of readmission for hyperbilirubinemia after discharge.

AFRIKAANSE OPSOMMING : Agtergrond: In baie dele van die wêreld, insluitende Afrikalande, word oënskynlike gesonde pasgebore babas vroeg uit die hospitaal ontslaan. Serum bilirubienvlakke bereik gewoonlik ‘n hoogtepunt drie tot vyf dae na geboorte, teen die tyd wanneer baie babas alreeds ontslaan en by die huis is. Ernstige hiperbilirubinemie onder pasgeborenes is ‘n belangrike oorsaak van neonatale sterftes en morbiditeit in Afrika. Daar is behoefte aan maniere om pasgebore babas wat ‘n risiko vir ernstige geelsug het te identifiseer nog voordat hul uit die hospitaal ontslaan word, veral in ontwikkelende lande met swak gesondheidstelsels en onvoldoende opvolgprosedures na hospitaalontslag. Doelwitte: Die doelwit van hierdie kombinasie van studies is om navorsingsbewyse te verskaf vir die gebruik van bilirubien (“TcB”) sifting deur skandering van die vel, in ‘n bevolking van inheemse pasgebore babas in Afrika. Metodes: Ons het die beskikbare navorsingsbewyse met betrekking tot die akkuraatheid en effektiwiteit van TcB sifting opgesom in twee Cochrane stelselmatige oorsigte. In die eerste stelselmatige oorsig het ons die navorsingsbewyse rakende die effektiwiteit van TcB sifting in pasgeborenes opgesom. In die tweede oorsig het ons die navorsingsbewys rakende die akkuraatheid van TcB metings vergelyk met die totale serum bilirubien (“TsB”) meting. Ons het ook navorsing gedoen rakende die effek van TcB sifting asook die akkuraatheid van die TcB meting in ‘n bevolking van Suid-Afrikaanse pasgeborenes. Resultate: Vir ons eerste stelselmatige oorsig het ons nie enige ewekansige steekproewe geïdentifiseer wat die effek van heropname in die hospitaal vir hiperbilirubinemie ondersoek het nie, of wat die insidensie van pasgeborenes met ernstige hiperbilirubinemie wat TcB sifting ondergaan het, ondersoek het nie. Bevindinge van ingesluite waarnemingstudies van Noord-Amerika suggereer dat universele TcB sifting in pasgeborenes voor hospitaalontslag die heropname vir hiperbilirubinemie, asook die insidensie van ernstige hiperbilirubinemie, verlaag. Ons het ‘n ewekansige gekontroleerde proef uitgevoer van TcB sifting in ‘n inheemse Suid-Afrikaanse bevolking van pasgebore babas. Bevindings van ons proef het bevestig dat TcB sifting van pasgebore babas wat ‘n risiko het vir ernstige hiperbilirubinemie betroubaar is, en tot ‘n 75% afname in die heropnamekoers vir hiperbiliruminemie gelei het, asook tot en met ‘n 73% afname in die insidensie van hiperbilirubinemie. Die effek van TcB sifting op kernikterus en bilirubien-geïnduseerde neurologie is egter nie bekend nie. Bevindings van ons tweede stelselmatige oorsig oor die akkuraatheid van die TcB meting teenoor die TsB meting in die laboratorium suggereer ‘n beduidende korrelasie van tot 0.98 tussen hierdie twee metings. Die ingesluite studies het egter gemengde bevindinge getoon in terme van faktore soos swangerskapsouderdom, ras, postnatale ouderdom en TsB konsentrasie wat die effek op korrelasie kan beïnvloed. Daar is ook ‘n beperkte aantal studies oor inheemse pasgeborenes in Afrika. Ons deursnitstudie oor die TcB meting se akkuraatheid in ‘n Suid-Afrikaanse bevolking van pasgebore babas het ‘n goeie korrelasie getoon tussen TcB meting en TsB meting in die laboratorium. Gevolgtrekkings: Die TcB hulpmiddel is betroubaar en kan gebruik word om TsB in pasgebore babas in Afrika te skat. Dit kan ook pasgeborenes identifiseer wat fototerapie voor hospitaalontslag benodig. Ons beveel aan dat elke pasgebore baba getoets moet word vir hiperbilirubinemie deur middel van ‘n objektiewe meting of skatting van serum bilirubien, byvorbeeld TcB of TsB. Dit kan hiperbilirubinemie-verwante hertoelatings in hospitale en die insidensie van ernstige hiperbilirubinemie verlaag. TcB sifting in pasgeborenes voor ontslag uit die hospital kan dus gebruik word om babas te identifiseer wat fototerapie benodig, of wat ‘n risiko het vir heropname vir hiperbilirubinemie na hospitaalontslag.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105924
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