Based on prior in-depth reviews of the literature from 1970 to 2013 on the burden of neonatal hyperbilirubinaemia and current management practices in LMICs,, we identified four major themes for improving the care of affected infants namely: primary prevention, early detection and monitoring, treatment and follow-up.Users are welcome to ask or answer queries or discuss the actual exam questions here.
![]() 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. Pgi Nicu Handbook Of Protocols Pdf File WasPgi chandigarh neonatology protocols publisher pdf file was indexed by our. Edition, residents handbook of neonatology, microsoft publisher written exam. Plain abdominal x-ray on the left showed pneumatosis intestinalis (large arrow), a specific characteristic finding in necrotizing enterocolitis (NEC). X ray on the right is a follow-up film which showed free air indicating the perforation of the bowel (small arrow) 9. 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. Neonatal hyperbilirubinaemia is a leading cause of hospital admissionre-hospitalisation in the first week of life globally -. Timely and appropriate treatment with phototherapy andor exchange transfusion are effective in controlling excessive bilirubin levels in the affected infants. Otherwise, severe hyperbilirubinaemia may progress to acute bilirubin encephalopathy (ABE) or kernicterus with a significant risk of mortality in newborns -. Survivors may also acquire long-term neurodevelopmental sequelae such as cerebral palsy, sensorineural hearing loss, intellectual difficulties or gross developmental delays -. At least, 75 of the affected infants reside in sub-Saharan Africa and South Asia. Where phototherapy devices are available, if at all, lack of relevant guidelines or inadequate knowledge of essential requirements for effective treatment results in frequent and potentially avoidable exchange transfusions -. We, therefore, set out to identify key considerations for the effective management of late-preterm and term infants (35 weeks of gestation) with significant hyperbilirubinaemia presenting at health facilities in LMICs. Guidelines for the management of hyperbilirubinaemia in high-income countries are unlikely to address the peculiar challenges in LMICs without appropriate modification. In this report, we followed relevant protocols of the WHO Handbook for Guideline Development, ADAPTE Guideline Adaptation Toolkit, and AGREE II-Global Rating Scale, for the adaptation of clinical practice guidelines.
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