Acute bilirubin encephalopathy (ABE) remains a significant cause of morbidity and mortality throughout the world, especially in low-middle-income countries where it can account for up to 15% of neonatal death. The pathophysiology of this acute life-threatening event of infancy and its potential evolution to kernicterus remain poorly understood. In this review, we start by reviewing the terminology of hyperbilirubinemia and its clinical consequences, ABE and later kernicterus spectrum disorder (KSD). We then review the pathogenesis of ABE and discuss clinical factors that can contribute to its pathogenicity. We examine in detail the clinical correlates of ABE and KSD. We present a comprehensive approach to its diagnosis and conclude with a set of simple clinical interventions ranging between primary preventive and rehabilitative measures that may help reduce the incidence of this largely preventable disease.

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.

BackgroundThe Outpatient Therapeutic Program (OTP) for treatment brings the management of Severe Acute Malnutrition (SAM) closer to the community. Many lives have been saved through this approach, but little data exists on the outcome of the children after discharge from such programmes. This study was aimed to determine the survival and nutritional status of children at six months after discharge from OTP for SAM.MethodologyThis was a prospective study of children with SAM admitted into 10 OTPs in two local government areas of Jigawa state from June 2016 to July 2016.Home visits at six months after discharge enabled the collection of data on survival and nutritional status.The primary outcome measures were survival and nutritional status (Mid upper arm circumference and weight-for-height z-score).ResultOf 494 children with SAM, 410 were discharged and 379 were followed up. Of these, 354, (93.4%) were found alive while 25 (6.6%) died. Among the survivors 333 (94.1%) had MUAC ≥12.5cm and 64 (18.1%) had WHZ<-3.Mortality rates were higher 10 (8.4%) among the 6-11months old. Most deaths 16 (64%) occurred within the first 3months post-discharge. Those who died were significantly more stunted, p = 0.016 and had a smaller head circumference, p = 0.005 on entry to OTP programme.There was improvement from admission to six months follow up in the number of children with complete immunization (27.4% to 35.6%), and a decrease in the number of unimmunized children (34.8% vs 20.6%) at follow-up.ConclusionThe study demonstrates good post discharge survival rate and improved nutritional status for SAM patients managed in OTPs. There were, however considerable post discharge mortality, especially in the first three months and lower immunization uptake post discharge. A follow-up programme will improve these indices further.

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Objectives:To determine the utility of mid-upper arm circumference (MUAC) in identifying acutely malnourished children compared with weight-for-height (WHZ), body mass index (BMI) for age (BAZ) and MUAC z-score (MUACZ) in clinical and field practice. Design: Cross-sectional study. Setting: Children from immunisation and paediatric outpatient clinics of Jos University Teaching Hospital and two schools in Jos, Plateau state, Nigeria. Subjects: Children 6-59 months with parental consent, and no chronic medical condition or pedal oedema. Outcome measures: MUAC, height and weight were measured. The WHZ, BAZ and MUACZ were determined using the World Health Organisation (WHO) Anthro software 3.0. Prevalence of acute malnutrition was compared between these data and those given by MUAC. The World Health Organisation (WHO) z-score cut-off of < -3 and < -2 and MUAC of ≤ 11.5 cm and 11.6 -12.5 cm was used to define severe acute malnutrition (SAM) and moderate acute malnutrition (MAM), respectively. Stata 12SE was used to determine frequency distribution, means and significance. Results: The mean age of subjects was 22.4 ± 15.5 months. The mean MUAC was 14.7 ± 1.5 cm. The MUAC differed between males and females in the age-groups of 6-11 (p = 0.02) and 36-47 (p = 0.006) months. The prevalence of SAM by WHZ was 3.4%, MUAC was 1.5%, BAZ was 4.3% and MUACZ was 1.0%. When compared, WHZ and BAZ were concordant in 77.8% (p = 0.001) of SAM subjects. MUAC and MUACZ indicated that none of the subjects were classified as SAM by WHZ and BAZ. Conclusion: Neither WHZ or MUAC as a single parameter identifies all children with acute malnutrition. A re-definition of MUAC criteria for malnutrition or consistent application of both parameters is required.