Beyond “Asian”: Specific East and Southeast Asian Races or Ethnicities Associated With Jaundice Readmission

Bentz, Michael; Carmona, Nancy; Bhagwat, Manavi M.; Thimmig, Lindsay M.; Saleh, Jamal K; Eke, Uchechukwu; Kokroko, Jolene; Dadasovich, Rand; Rice, Brooke; Cabana, Michael D.

doi:10.1542/hpeds.2017-0234

Cited by 14 publications

(8 citation statements)

References 21 publications

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“…One additional context-specific factor was recognized: neonates of Sgaw Karen ethnicity showed an increased risk to develop NH in the first week of life compared to the other ethnic groups. A study in 105 neonates of different Asian ethnicities proposed differences in genes involved in bilirubin metabolism or environmental factors as a possibility for NH readmission [ 39 ]. In this setting, Sgaw Karen have a higher frequency of G6PD deficiency [ 7 ] and analysis of genetic factors involved in bilirubin metabolism is ongoing.…”

Section: Discussionmentioning

confidence: 99%

High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border

et al. 2021

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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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Section: Discussionmentioning

confidence: 99%

High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border

et al. 2021

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“…A systematic review has shown that only 45% of hypernatremia cases have jaundice [ 25 ]. The literature has shown increased risk of hyperbilirubinemia among neonates of Asian, both Far East and Southeast Asian descent, and lower propensity among non-Hispanic White infants and African-American infants [ 52 , 53 , 54 ]. The case infant was non-Hispanic White and had minimal elevation of bilirubin.…”

Section: Discussionmentioning

confidence: 99%

Fatal Hypernatremic Dehydration in a Term Exclusively Breastfed Newborn

Castillo-Hegyi

Achilles²,

Segrave-Daly³

et al. 2022

Children

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Hypernatremic dehydration in term newborns has steadily increased in incidence with increasing efforts to promote exclusive breastfeeding before hospital discharge, a key metric of the Baby-Friendly Hospital Initiative. The following report details a case of a term newborn infant who had evidence of poor intake while exclusively breastfeeding during his hospital stay that may not have been recognized by health care providers. The infant was discharged home and was subsequently found by the parents in cardiac arrest 12 h after discharge and was found to have hypernatremic dehydration. Although return of spontaneous circulation was achieved after fluid resuscitation, the infant sustained extensive hypoxic-ischemic brain injury due to cardiovascular collapse. Due to the infant’s extremely poor prognosis, life support was withdrawn at 19 days of age and the infant expired. This sentinel case demonstrates multiple pitfalls of current perceptions of normal vs. abnormal newborn feeding behavior, weight loss percentages, elimination patterns, and acceptable clinical thresholds believed to be safe for neonates. Newer data have shown that hypernatremia occurs commonly in healthy, term breastfed newborns at weight loss percentages previously deemed normal by most health professionals and hospital protocols. In-hospital strategies to prevent excessive weight loss and screening for hypernatremia in response to signs of inadequate feeding have the potential to prevent tens of thousands of readmissions for feeding complications a year, as well as hundreds of millions in health care costs.

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“…For example, mutations of the UGT1A1 gene are linked to an increased risk of neonatal hyperbilirubinemia in Asian populations, as compared with white populations. In the absence of genetic testing, race or ethnicity is likely a rough approximation of the likelihood of these genetic variations related to hyperbilirubinemia [ 9 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Massage Therapy for the Treatment of Neonatal Jaundice: A Systematic Review and Dose-Response Meta-analysis

Shahbazi

Khazaei

Moslehi

et al. 2022

International Journal of Pediatrics

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Background. The effectiveness of massage therapy in the treatment of neonatal jaundice has been established in previous literature, but how much the level of massage can reduce the mean of bilirubin in neonates with jaundice is a question that has been addressed in this review. Methods. Four electronic databases, including Cochrane, PubMed, Scopus, and Web of Science, were searched for relevant literature. For the dose-response association between massage therapy and treatment of neonatal icterus, we conducted a meta-analysis using the random-effects model. For any level of intervention, we calculated the overall mean difference (MD) with 95% confidence intervals (CI). Results. Twenty studies were included in our meta-analysis. There was a positive and significant increasing dose-response trend between massage therapy and the mean reduction of bilirubin in neonates with hyperbilirubinemia as follows: <50 minutes massage during the experiment -0.36 (95% CI: -0.67, -0.06; I 2 = 66 %), 50-60 minutes massage during the experiment -0.41 (95% CI: -0.95, 0.13; I 2 = 84 %), and ≥101 minutes massage during the experiment -1.20 (95% CI: -1.63, -0.78; I 2 = 83 %). The heterogeneity across studies was mild to moderate. Conclusions. The presence of a dose-response relationship favors the causal relationship between massage therapy and reduction of neonatal jaundice.

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Beyond “Asian”: Specific East and Southeast Asian Races or Ethnicities Associated With Jaundice Readmission

Abstract: In this study, we help clarify and move beyond the term "Asian" as a risk factor for readmission due to hyperbilirubinemia.

Cited by 14 publications

References 21 publications

High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border

High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border

Fatal Hypernatremic Dehydration in a Term Exclusively Breastfed Newborn

Effect of Massage Therapy for the Treatment of Neonatal Jaundice: A Systematic Review and Dose-Response Meta-analysis

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