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BackgroundThis study aimed to determine the accuracy of a point-of-care Bilistick method for measuring total serum bilirubin (TSB) and its turn-around-time (TAT) against hospital laboratory methods.MethodsThis prospective study was carried out on 561 term-gestation jaundiced neonates in two Malaysian hospitals. Venous blood sample was collected from each neonate for contemporary measurement of TSB by hospital laboratories and Bilistick. TAT was the time interval between specimen collection and TSB result reported by each method.ResultsThe mean laboratory-measured TSB was 194.85 (±2.844) µmol/L and Bilistick TSB was 169.37 (±2.706) µmol/L. Pearson’s correlation coefficient was: r = 0.901 (p < 0.001). The mean difference of [laboratory TSB− Bilistick TBS] was 26.48 (±29.41) µmol/L. The Bland–Altman plots show that the 95% limits of agreement (−31.1577, 84.11772) contain 94.7% (=531/561) of the difference in TSB readings. Bilistick has a 99% accuracy and 100% sensitivity to predict laboratory TSB levels of ≥80 µmol/L and ≥360 µmol/L at lower Bilistick TSB levels of ≥55 and ≥315 µmol/L, respectively. TAT of Bilistick TSB (2.0 min) was significantly shorter than TAT (105 min) of laboratory TSB (p < 0.001).ConclusionsBilistick has shorter TAT. The accuracy and sensitivity of Bilistick TSB for predicting laboratory TSB is high at lower cutoff levels.

Since 2000, targeted reduction in mortality of children younger than 5 years has been the cornerstone of global child health policy. This policy was expanded with the sustainable development goals (SDGs) to include targeted reduction in neonatal mortality, which accounted for 41% (4 million/9.8 million) of child deaths in 2000.1,2 The United Nations (UN) Inter-agency Group for Child Mortality Estimation, led by the United Nations Children’s Fund (UNICEF), is entrusted with tracking progress on the neonatal and under-five mortality targets until 2030.2 According to the latest report of the inter-agency group published in 2021, neonatal mortality rate declined by 11% (from 19 to 17 deaths per 1000 livebirths) and under-five mortality rate declined by 14% (from 43 to 37 deaths per 1000 livebirths) in 2020 – 5 years after the launch of the SDGs. Many countries are on track to achieving the targets of 12 neonatal deaths and 25 child deaths per 1000 livebirths by 2030.

Hyperbilirubinaemia is a ubiquitous transitional morbidity in the vast majority of newborns and a leading cause of hospitalisation in the first week of life worldwide. While timely and effective phototherapy and exchange transfusion are well proven treatments for severe neonatal hyperbilirubinaemia, inappropriate or ineffective treatment of hyperbilirubinaemia, at secondary and tertiary hospitals, still prevails in many poorly-resourced countries accounting for a disproportionately high burden of bilirubin-induced mortality and long-term morbidity. As part of the efforts to curtail the widely reported risks of frequent but avoidable bilirubin-induced neurologic dysfunction (acute bilirubin encephalopathy (ABE) and kernicterus) in low and middle-income countries (LMICs) with significant resource constraints, this article presents a practical framework for the management of late-preterm and term infants (≥35 weeks of gestation) with clinically significant hyperbilirubinaemia in these countries particularly where local practice guidelines are lacking. Standard and validated protocols were followed in adapting available evidence-based national guidelines on the management of hyperbilirubinaemia through a collaboration among clinicians and experts on newborn jaundice from different world regions. Tasks and resources required for the comprehensive management of infants with or at risk of severe hyperbilirubinaemia at all levels of healthcare delivery are proposed, covering primary prevention, early detection, diagnosis, monitoring, treatment, and follow-up. Additionally, actionable treatment or referral levels for phototherapy and exchange transfusion are proposed within the context of several confounding factors such as widespread exclusive breastfeeding, infections, blood group incompatibilities and G6PD deficiency, which place infants at high risk of severe hyperbilirubinaemia and bilirubin-induced neurologic dysfunction in LMICs, as well as the limited facilities for clinical investigations and inconsistent functionality of available phototherapy devices. The need to adjust these levels as appropriate depending on the available facilities in each clinical setting and the risk profile of the infant is emphasised with a view to avoiding over-treatment or under-treatment. These recommendations should serve as a valuable reference material for health workers, guide the development of contextually-relevant national guidelines in each LMIC, as well as facilitate effective advocacy and mobilisation of requisite resources for the optimal care of infants with hyperbilirubinaemia at all levels.

Correspondence to Dr Bolajoko O Olusanya; bolajoko.olusanya@uclmail.net In September 2015, 193 member states of the United Nations (UN) unanimously signed a social contract with their citizens to commit resources to realising a global agenda consisting of 17 development goals under the Sustainable Development Goals (SDGs).1 Unlike the Millennium Development Goals, the SDG agenda makes explicit provisions for disability inclusiveness in policy interventions over the life course: childhood, adolescence, adulthood and old age. The specific focus on early childhood development (ECD) for children under 5 years as one of the targets under the fourth SDG (SDG 4.2) is unprecedented and a clear recognition of the importance of the early years from birth as the foundation of optimal human capital development. Surprisingly, none of the targets and indicators for SDG 4, including ECD for children under 5 years, are listed among the health-related SDGs by the WHO or the global health community in general.2 As a result, a lacuna emerged that has been exploited by various ECD champions to promote discordant narratives that do not align with the extensive scientific evidence on the crucial role of the health sector in facilitating early detection and intervention services (EDIS) for all children at risk of poor development in early childhood.3 This situation potentially impairs the opportunity for effective primary school enrolment among children under 5 years with disabilities as envisioned by SDGs. [...]the absence of an effective and universally accepted priority ECD framework for children under 5 years continues to undermine political support for appropriate policy and investment. [...]the flagship ECD programme by the WHO, UNICEF and the World Bank Group, titled Nurturing Care Framework (NCF), was premised on an estimated 250 million children under 5 years in low-income and middle-income countries (LMICs) who are suspected to be at risk of poor development or developmental delays due to stunting and poverty in 2015.4 The recommended core interventions are home-based psychosocial stimulation and responsive caregiving among children younger than 3 years, which can be helpful but largely insufficient in addressing the special needs of children with disabilities.

ObjectivesTo determine a 10-year trend of survival, morbidities and care practices, and predictors of in-hospital mortality in very preterm neonates (VPTN, gestation 22 to <32 weeks) in the Malaysian National Neonatal Registry.DesignRetrospective cohort study.Setting43 Malaysian neonatal intensive care units.Patients29 010 VPTN (without major malformations) admitted between 1 January 2009 and 31 December 2018.Main outcome measuresCare practices, survival, admission hypothermia (AH, <36.5°C), late-onset sepsis (LOS), pneumothorax, necrotising enterocolitis grade 2 or 3 (NEC), severe intraventricular haemorrhage (sIVH, grade 3 or 4) and bronchopulmonary dysplasia (BPD).ResultsDuring this 10-year period, there was increased use of antenatal steroid (ANS), lower segment caesarean section (LSCS) and early continuous positive airway pressure (eCPAP); but decreased use of surfactant therapy. Survival had increased from 72% to -83.9%. The following morbidities had decreased: LOS (from 27.9% to 7.1%), pneumothorax (from 6.0% to 2.7%), NEC (from 8.1% to 4.7%) and sIVH (from 12.2% to 7.5%). However, moderately severe AH (32.0°C–35.9°C) and BPD had increased. Multiple logistic regression analyses showed that lower birth weight, no ANS, no LSCS, admission to neonatal intensive care unit with <100 VPTN admissions/year, no surfactant therapy, no eCPAP, moderate and severe AH, LOS, pneumothorax, NEC and sIVH were significant predictors of mortality.ConclusionSurvival and major morbidities had improved modestly. Failure to use ANS, LSCS, eCPAP and surfactant therapy, and failure to prevent AH and LOS increased risk of mortality.

Haemoglobin Constant Spring (Hb CoSp) and Haemoglobin Adana (Hb Adana), are two non-deletion type of α-thalassemia reported in Malaysia. Owing to their structural instability, they cause hemolysis and hyperbilirubinemia. This observational study was part of a large study investigating multiple factors associated with severe neonatal jaundice. In this part we aimed to determine the prevalence of Hb CoSp and Hb Adana and their association with clinically significant neonatal hyperbilirubinemia (SigNH, total serum bilirubin (TSB>290µmol/L)) among jaundiced Malaysian term neonates.INTRODUCTIONHaemoglobin Constant Spring (Hb CoSp) and Haemoglobin Adana (Hb Adana), are two non-deletion type of α-thalassemia reported in Malaysia. Owing to their structural instability, they cause hemolysis and hyperbilirubinemia. This observational study was part of a large study investigating multiple factors associated with severe neonatal jaundice. In this part we aimed to determine the prevalence of Hb CoSp and Hb Adana and their association with clinically significant neonatal hyperbilirubinemia (SigNH, total serum bilirubin (TSB>290µmol/L)) among jaundiced Malaysian term neonates.The inclusion criteria were normal term-gestation neonates admitted consecutively for phototherapy. PCR-restriction fragment length polymorphism method was applied on DNA extracted from dry blood spot specimens of each neonate to detect for Hb CoSp and Hb Adana gene. Positive samples were verified by gene sequencing.MATERIALS AND METHODSThe inclusion criteria were normal term-gestation neonates admitted consecutively for phototherapy. PCR-restriction fragment length polymorphism method was applied on DNA extracted from dry blood spot specimens of each neonate to detect for Hb CoSp and Hb Adana gene. Positive samples were verified by gene sequencing.Of the 1121 neonates recruited (719 SigNH and 402 no-SigNH), heterozygous Hb CoSp gene was detected in only two (0.27%) neonates. Both were SigNH neonates (0.3% or 2/719). No neonate had Hb Adana variant.RESULTSOf the 1121 neonates recruited (719 SigNH and 402 no-SigNH), heterozygous Hb CoSp gene was detected in only two (0.27%) neonates. Both were SigNH neonates (0.3% or 2/719). No neonate had Hb Adana variant.Hb CoSp was not common but could be a risk factor associated with SigNH. No Hb Adana was detected.CONCLUSIONHb CoSp was not common but could be a risk factor associated with SigNH. No Hb Adana was detected.

Tracheal aspirate culture and polymerase chain reaction for Mycobacterium were also positive.

Invasive neonatal Group B streptococcal (GBS) disease is a globally recognised serious condition. Its most devastating impact is during perinatal and postnatal periods. Epidemiological studies from high-income countries (HICs) showed that maternal rectovaginal GBS colonisation is the leading cause. It was estimated that world-wide, there were 20 million pregnant women with rectovaginal GBS colonisation which has caused 46,200 stillbirths, 40,500 cases of invasive maternal diseases, and 231,800 cases of early-onset and 162,200 cases of late-onset sepsis in neonates/infants. Among neonates/infants who have recovered from the disease, 37,100 suffered neurodevelopmental impairment. The current preventive measures in HICs consist of universal screening for maternal rectovaginal GBS colonisation at 35- to 37-week gestation, followed by intrapartum antibiotic prophylaxis for positive cases. This has prevented more than 80% of early-onset GBS disease. In Malaysian public hospitals, only targeted screening for maternal GBS colonisation was practiced in high-risk women with previous perinatal GBS infection/disease. We do not have national data on a) maternal GBS rectovaginal colonisation rates, b) stillbirths caused by GBS infections, c) preterm birth associated with maternal GBS colonisation, and d) neurodevelopmental impairment following invasive neonatal GBS disease. We only have national data of neonatal GBS sepsis which showed high morbidity and mortality. To reduce invasive neonatal GBS disease in Malaysia, we need national data on the prevalence of maternal GBS rectovaginal colonisation, its associated risk with stillbirths, and GBS-associated preterm births to help improve current preventive strategies to reduce invasive GBS disease during the perinatal and postnatal periods.

Objectives To determine the screening rates and incidence of retinopathy of prematurity (ROP), and risk factors associated with ROP in very low birthweight (VLBW, <1500 g) neonates of gestation <32 wk admitted to neonatal intensive care units (NICUs) in a middle-income country. Methods It was a retrospective cohort study of prospectively submitted data by 44 Malaysian NICUs participating in the Malaysian National Neonatal Registry. All VLBW neonates of gestation <32 wk born in 2015–2020 and survived to discharge were included. Results Of 11768 survivors, 90.5% (n = 10436) had ROP screening; 16.1% (1685/10436) had ROP. ROP was significantly more common in neonates <28 wk gestation (extremely preterm, EPT) than ≥28 wk gestation (37.7% vs. 9.7%; p  <0.001), and more common in those with birthweight <1000 g (extremely low birthweight, ELBW) than ≥1000 g (32.9% vs. 9.1%; p  <0.001). Multiple logistic regression analysis showed that the significant independent factors associated with increased risk of ROP were ELBW, EPT, Indian ethnic group, vaginal delivery, mechanical ventilation >5 d, high frequency ventilation, total parenteral nutrition, late-onset sepsis, bronchopulmonary dysplasia, and intraventricular hemorrhage. Receiving oxygen therapy at birth was associated with significantly lower risk of ROP. Conclusions The incidence and severity of ROP increased with decreasing gestation and birthweight. Prolonged duration of oxygen therapy, infection, invasive respiratory support, and conditions commonly causing fluctuations of oxygenation were significant factors associated with increased risk of ROP. Receiving oxygen at birth did not increase risk.

UNICEF and other international bodies must produce a clear plan that prioritizes development and education for children with disabilities, especially in low- and middle-income settings, as required for achieving the United Nations Sustainable Development Goals.