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Neonatal hyperbilirubinemia in a low resource setting

par Thielemans, Laurence
Président du jury Corazza, Francis
Promoteur Casimir, Georges
Co-Promoteur Carrara, Verena Ilona
Publication Non publié, 2019-07-01

Thèse de doctorat

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Résumé :

This thesis is divided in 3 parts. Neonatal jaundice and NH are defined and physiology and physiopathology described in Part 1. Chapter 1 presents the main causes of neonatal jaundice and NH, in particular G6PD deficiency; the consequences of severe NH and its resulting burden. In Chapter 2 the Shoklo Malaria Research Unit (SMRU) is portrayed including details on the Special Care Baby Unit (SCBU), the unit dedicated to unwell neonates. An overview of the population seeking care at SMRU is presented.The rationale of the studies presented in this thesis introduces Part 2. Then the burden of the disease on the Thai-Myanmar border is explored in two retrospective analysis: Chapter 3 describes the prevalence of NH and factors associated with severity among neonates admitted in the SCBU between 2009 and 2014 1 and Chapter 4 describes the immediate and long term consequences of extreme NH in the same setting where exchange transfusion is not available. Findings from those two studies led to the development of a protocol to further detail the epidemiology of NH using a prospective birth cohort design presented in Chapter 52. In Chapter 6, timing of NH occurrence and risk factors associated with NH in the first week of life and by gestational age categories are explored. Factors influencing the SBR response to phototherapy (PT) and the risk of recurrence after initially successful PT are explained in Chapter 7. Chapters 8 & 9 focus on a new POC tool for SBR measurements and on the challenges to diagnose G6PD-deficiency with a fluorescent spot test in newborns 3,4. In Part 3, the challenges encountered by the health staff while managing neonates with NH are presented and solutions suggested in Chapter 10. In Chapter 11, the barriers to care for NH in a low resource setting are discussed and recommendations proposed. The main results that have emerged from this thesis, as well as their strengths and limitations are summarized in Chapter 12 and recommendations for future work proposed.