Hour‐specific nomogram for transcutaneous Bilirubin in newborns in Myanmar

Abstract

Background: Neonatal hyperbilirubinemia is a significant health problem in Myanmar, and the rate of kernicterus is also higher than in developed countries. Non-invasive methods for early detection and treatment of hyperbilirubinemia are urgently needed. In this study, we used transcutaneous bilirubin (TcB) measurements to develop an hour-specific TcB nomogram for the effective management of hyperbilirubinemia in Myanmar newborns. Methods: The bilirubin levels of neonates born in Central Women Hospital in Yangon, Myanmar were measured three times a day within 72 h after birth using a transcutaneous bilirubinometer. An hour-specific TcB nomogram was created based on the data. Results: Participants were 512 infants (287 boys, 225 girls) born in Central Women's Hospital in Yangon. The mean (AESD) gestational age was 38.4 AE 1.2 weeks; birthweight was 3078 AE 412 g. A total of 3,039 plots were obtained, and the TcB nomogram was created with smoothed percentile curves (97.5th, 50th, and 2.5th percentiles) for 0-72 h after birth. Conclusions: An hour-specific TcB nomogram was successfully created to manage hyperbilirubinemia in Myanmar newborns.

Applicability of the hour of life approach in hyperbilirubinemia among Filipino term infants

“…However, recent studies have shown TcB readings are not affected by skin color ( 28 ). High correlation between TcB and TsB has also been shown among infants of Asian descent such as Japanese ( 29 ), Chinese ( 24 ), Mongolian ( 30 ) and specifically those of Malay descent (darker skin)—Indonesian ( 31 ), Myanmar ( 12 ) and Thai ( 26 ). This study further supports that TcB measurements can reliably estimate total serum bilirubin levels among Filipino infants and as such can be used for bilirubin screening prior to discharge.…”

“…Unfortunately, only 4.1% of Bhutani's infant population were of Asian descent—a race with a higher incidence of hyperbilirubinemia. Several studies have shown that Asian neonates reach earlier bilirubin peaking as well as higher total bilirubin values ( 10 – 12 ). As such, it is important that each population develop its own nomogram ( 11 ).…”

Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand-Myanmar border

“…Transcutaneous bilirubin assessments are routinely used in many Western Countries and in hospital settings of some tropical countries. Their reliability in populations with more pigmented skin has not been tested widely (19-21) and was evaluated against capillary TSB levels in neonates of Karen and Burman ethnicity here for the first time. Results from this study indicate that TcB values, with an appropriate simple correction, can be used reliably against TSB nomograms to identify neonates who need confirmatory laboratory blood tests to detect clinically significant bilirubin levels.…”

“…Transcutaneous bilirubin assessments are routinely used in many Western Countries and in hospital settings of some tropical countries. Their reliability in populations with more pigmented skin has not been tested widely (19)(20)(21) represents an initial insurmountable investment for most constrained-resource settings, but other transcutaneous devices might be as accurate and more affordable (24). Other cheaper screening tools have been tested, such as icterometers (25,26) and phone-based apps (27)(28)(29), and when properly evaluated could be used by health workers at birthing centers and in remote settings, and even by parents (30) after discharge from the hospital.…”

Transcutaneous bilirubin-based screening reduces the need for blood exchange transfusion in Myanmar newborns: A single-center, retrospective study

“…Therefore, it is necessary to develop a nomogram specific for each target population. Indeed, with the approval of the Ethics and Review Committee of Myanmar, we successfully developed an hour-specific TcB nomogram to achieve early detection for Myanmar newborns in 2017 ( 15 ).…”