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.
BackgroundNeonatal hyperbilirubinemia is a significant health problem in Myanmar. We introduced transcutaneous bilirubin (TcB) measurements in 2017 and developed an hour-specific TcB nomogram for early detection and treatment of hyperbilirubinemia in Myanmar neonates. This study aimed to evaluate whether our screening method for hyperbilirubinemia decreased the requirement of blood exchange therapy (ET).MethodsThis retrospective cohort study was conducted at the Central Women’s Hospital, Yangon. Two groups were included as follows: group 1 (control group; comprising infants born in 2016 and screened on the basis of Kramer’s rule), and group 2 (intervention group; comprising infants born in 2019 and screened by TcB measurement using a nomogram). The number of ETs was analyzed based on causes of hyperbilirubinemia and number of days after birth.ResultsGroups 1 and 2 comprised 12,968 and 10,090 infants, respectively. Forty-six and two infants in Groups 1 and 2, respectively, required an ET. The odds ratio for ET was 18.0 (Group 1 to Group 2; 95% confidence interval [CI]: 4.8–67.1; p = 0.000). Serum bilirubin values at the time ET was administered were significantly higher in Group 1 than those in Group 2 (median: 23.0 and 16.8, respectively).ConclusionThe management of hyperbilirubinemia using our screening method (TcB Nomogram) can effectively reduce the need for ET in neonates in Myanmar.
Had a stormy post-operative course with two incidents of peri-arrest due to blocked tracheostomy. These two incidents caused significant anxiety and distress for the child, for which he received psychology input. Decannulation done day 5 postop, discharged home on post-op day 10, with a course oral antibiotics. Conclusions The present case describes a typical but severe case of Ludwig's angina in a relatively atypical age group. This is a life -threatening condition, which requires early intervention along with a multidisciplinary team input. While relatively uncommon in the paediatric population, clinicians should be aware and understand the urgency of immediate treatment when it does present.
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