{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T19:06:48Z","timestamp":1785179208119,"version":"3.55.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T00:00:00Z","timestamp":1633564800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Population risks for neonatal hyperbilirubinaemia (NH) vary. Knowledge of local risks permits interventions that may reduce the proportion becoming severe. Between January 2015 and May 2016, in a resource-limited setting on the Thailand-Myanmar border, neonates from 28 weeks\u2019 gestation were enrolled into a prospective birth cohort. Each neonate had total serum bilirubin measurements: scheduled (24, 48, 72 and 144 hours of life) and clinically indicated; and weekly follow up until 1 month of age. Risk factors for developing NH were evaluated using Cox proportional hazard mixed model. Of 1710 neonates, 22% (376) developed NH (83% preterm, 19% term). All neonates born &lt;35 weeks, four in five born 35\u201337 weeks, and three in twenty born \u226538 weeks had NH, giving an overall incidence of 249 per 1000 livebirths [95%CI 225, 403]. Mortality from acute bilirubin encephalopathy was 10% (2\/20) amongst the 5.3% (20\/376) who reached the severe NH threshold. One-quarter (26.3%) of NH occurred within 24 hours. NH onset varied with gestational age: at a median [IQR] 24 hours [24, 30] for neonates born 37 weeks or prematurely<jats:italic>vs<\/jats:italic>59 hours [48, 84] for neonates born \u226538 weeks. Risk factors for NH in the first week of life independent of gestational age were: neonatal G6PD deficiency, birth bruising, Sgaw Karen ethnicity, primigravidae, pre-eclampsia, and prolonged rupture of membranes. The genetic impact of G6PD deficiency on NH was partially interpreted by using the florescent spot test and further genotyping work is in progress. The risk of NH in Sgaw Karen refugees may be overlooked internationally as they are most likely regarded as Burmese in countries of resettlement. Given high levels of pathological jaundice in the first 24 hours and overall high NH burden, guidelines changes were implemented including preventive PT for all neonates &lt;35 weeks and for those 35\u201337 weeks with risk factors.<\/jats:p>","DOI":"10.1371\/journal.pone.0258127","type":"journal-article","created":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T23:11:27Z","timestamp":1633648287000},"page":"e0258127","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border"],"prefix":"10.1371","volume":"16","author":[{"given":"Laurence","family":"Thielemans","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pimnara","family":"Peerawaranun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mavuto","family":"Mukaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moo Kho","family":"Paw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacher","family":"Wiladphaingern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8619-9775","authenticated-orcid":true,"given":"Jordi","family":"Landier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Germana","family":"Bancone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephane","family":"Proux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrike","family":"Elsinga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margreet","family":"Trip-Hoving","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borimas","family":"Hanboonkunupakarn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tha Ler","family":"Htoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thaw Shee","family":"Wah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candy","family":"Beau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7951-0745","authenticated-orcid":true,"given":"Francois","family":"Nosten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1621-3257","authenticated-orcid":true,"given":"Rose","family":"McGready","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2758-0872","authenticated-orcid":true,"given":"Verena I.","family":"Carrara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,10,7]]},"reference":[{"issue":"9814","key":"pone.0258127.ref001","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/S0140-6736(11)61577-8","article-title":"Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review","volume":"379","author":"MK Mwaniki","year":"2012","journal-title":"Lancet"},{"issue":"3","key":"pone.0258127.ref002","first-page":"199","article-title":"The Neurological Sequelae of Neonatal Hyperbilirubinemia: Definitions, Diagnosis and Treatment of the Kernicterus Spectrum Disorders (KSDs)","volume":"13","author":"JB Le Pichon","year":"2017","journal-title":"Curr Pediatr Rev"},{"issue":"2","key":"pone.0258127.ref003","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2017-1471","article-title":"The Contribution of Neonatal Jaundice to Global Child Mortality: Findings From the GBD 2016 Study","volume":"141","author":"BO Olusanya","year":"2018","journal-title":"Pediatrics"},{"issue":"1","key":"pone.0258127.ref004","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1080\/20469047.2019.1707397","article-title":"Management of neonatal jaundice in low- and middle-income countries","volume":"40","author":"TM Slusher","year":"2020","journal-title":"Paediatr Int Child Health"},{"key":"pone.0258127.ref005","unstructured":"Neonatal jaundice: clinical guideline. National Collaborating Centre for Women\u2019s and Children\u2019s Health. Royal College of Obstetricians and Gynaecologists; London. 2010."},{"issue":"1","key":"pone.0258127.ref006","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1186\/s12887-018-1165-0","article-title":"Indirect neonatal hyperbilirubinemia in hospitalized neonates on the Thai-Myanmar border: a review of neonatal medical records from 2009 to 2014","volume":"18","author":"L Thielemans","year":"2018","journal-title":"BMC Pediatr"},{"issue":"12","key":"pone.0258127.ref007","doi-asserted-by":"crossref","first-page":"e116063","DOI":"10.1371\/journal.pone.0116063","article-title":"Characterization of G6PD genotypes and phenotypes on the northwestern Thailand-Myanmar border","volume":"9","author":"G Bancone","year":"2014","journal-title":"PLoS One"},{"key":"pone.0258127.ref008","doi-asserted-by":"crossref","first-page":"72","DOI":"10.12688\/wellcomeopenres.12338.1","article-title":"Prevalences of inherited red blood cell disorders in pregnant women of different ethnicities living along the Thailand-Myanmar border","volume":"2","author":"G Bancone","year":"2017","journal-title":"Wellcome Open Res"},{"issue":"1","key":"pone.0258127.ref009","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12884-015-0444-0","article-title":"Quality of intrapartum care by skilled birth attendants in a refugee clinic on the Thai-Myanmar border: a survey using WHO Safe Motherhood Needs Assessment","volume":"15","author":"G Hoogenboom","year":"2015","journal-title":"BMC pregnancy and childbirth"},{"issue":"11","key":"pone.0258127.ref010","doi-asserted-by":"crossref","first-page":"e887","DOI":"10.1371\/journal.pntd.0000887","article-title":"Complex Interactions between soil-transmitted helminths and malaria in pregnant women on the Thai-Burmese border","volume":"4","author":"M Boel","year":"2010","journal-title":"PLoS neglected tropical diseases"},{"key":"pone.0258127.ref011","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/1471-2393-11-45","article-title":"Improved pregnancy outcome in refugees and migrants despite low literacy on the Thai-Burmese border: results of three cross-sectional surveys","volume":"11","author":"VI Carrara","year":"2011","journal-title":"BMC pregnancy and childbirth"},{"issue":"12","key":"pone.0258127.ref012","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1017\/S0007114519000758","article-title":"Nutrition in transition: historical cohort analysis summarising trends in under- and over-nutrition among pregnant women in a marginalised population along the Thailand-Myanmar border from 1986 to 2016","volume":"121","author":"AH Hashmi","year":"2019","journal-title":"Br J Nutr"},{"issue":"1","key":"pone.0258127.ref013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0022-3476(70)80038-5","article-title":"Clinical assessment of gestational age in the newborn infant","volume":"77","author":"LM Dubowitz","year":"1970","journal-title":"J Pediatr"},{"issue":"4","key":"pone.0258127.ref014","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1002\/uog.7350","article-title":"Obstetric ultrasound scanning by local health workers in a refugee camp on the Thai-Burmese border","volume":"34","author":"MJ Rijken","year":"2009","journal-title":"Ultrasound Obstet Gynecol"},{"key":"pone.0258127.ref015","unstructured":"Guideline: Delayed Umbilical Cord Clamping for Improved Maternal and Infant Health and Nutrition Outcomes. WHO Guidelines Approved by the Guidelines Review Committee. Geneva. 2014."},{"issue":"8","key":"pone.0258127.ref016","doi-asserted-by":"crossref","first-page":"e72721","DOI":"10.1371\/journal.pone.0072721","article-title":"Neonatal intensive care in a Karen refugee camp: a 4 year descriptive study","volume":"8","author":"C Turner","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"pone.0258127.ref017","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12887-017-0798-8","article-title":"Neonatal Hyperbilirubinemia in a Marginalized Population on the Thai-Myanmar Border: a study protocol","volume":"17","author":"L Thielemans","year":"2017","journal-title":"BMC Pediatr"},{"issue":"1","key":"pone.0258127.ref018","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1542\/peds.114.1.297","article-title":"Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation","volume":"114","author":"American Academy of Pediatrics Subcommittee on H","year":"2004","journal-title":"Pediatrics"},{"issue":"15","key":"pone.0258127.ref019","doi-asserted-by":"crossref","first-page":"2434","DOI":"10.3109\/14767058.2015.1086743","article-title":"The effect of the pre-pregnancy weight of the mother and the gestational weight gain on the bilirubin level of term newborn","volume":"29","author":"S Ozdek","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"9403","key":"pone.0258127.ref020","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S0140-6736(03)15268-3","article-title":"Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies","volume":"363","author":"Consultation WHOE","year":"2004","journal-title":"Lancet"},{"issue":"1","key":"pone.0258127.ref021","doi-asserted-by":"crossref","first-page":"e0190419","DOI":"10.1371\/journal.pone.0190419","article-title":"Early neonatal mortality and neurological outcomes of neonatal resuscitation in a resource-limited setting on the Thailand-Myanmar border: A descriptive study","volume":"13","author":"S Janet","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"pone.0258127.ref022","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/1471-2431-13-93","article-title":"Changes in the body weight of term infants, born in the tropics, during the first seven days of life","volume":"13","author":"C Turner","year":"2013","journal-title":"BMC Pediatr"},{"issue":"9946","key":"pone.0258127.ref023","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/S0140-6736(14)60932-6","article-title":"International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project","volume":"384","author":"J Villar","year":"2014","journal-title":"Lancet"},{"issue":"3","key":"pone.0258127.ref024","doi-asserted-by":"crossref","first-page":"e827","DOI":"10.1542\/peds.2011-3552","article-title":"Breastfeeding and the use of human milk","volume":"129","author":"M Johnston","year":"2012","journal-title":"Pediatrics"},{"issue":"4","key":"pone.0258127.ref025","first-page":"e99","article-title":"Physiological weight loss in the breastfed neonate: a systematic review","volume":"2","author":"J Noel-Weiss","year":"2008","journal-title":"Open Med"},{"issue":"1","key":"pone.0258127.ref026","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/0973-6247.75963","article-title":"Hemolytic disease of the fetus and newborn: Current trends and perspectives","volume":"5","author":"S Basu","year":"2011","journal-title":"Asian J Transfus Sci"},{"key":"pone.0258127.ref027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12688\/wellcomeopenres.13373.1","article-title":"Diagnostic performances of the fluorescent spot test for G6PD deficiency in newborns along the Thailand-Myanmar border: A cohort study","volume":"3","author":"L Thielemans","year":"2018","journal-title":"Wellcome Open Res"},{"key":"pone.0258127.ref028","doi-asserted-by":"crossref","first-page":"32","DOI":"10.12688\/wellcomeopenres.10352.1","article-title":"The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the Thailand-Myanmar border: a population cohort study","volume":"1","author":"R McGready","year":"2016","journal-title":"Wellcome Open Res"},{"issue":"1","key":"pone.0258127.ref029","doi-asserted-by":"crossref","first-page":"e000105","DOI":"10.1136\/bmjpo-2017-000105","article-title":"Burden of severe neonatal jaundice: a systematic review and meta-analysis","volume":"1","author":"TM Slusher","year":"2017","journal-title":"BMJ Paediatr Open"},{"issue":"9941","key":"pone.0258127.ref030","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/S0140-6736(14)60750-9","article-title":"From evidence to action to deliver a healthy start for the next generation","volume":"384","author":"E Mason","year":"2014","journal-title":"Lancet"},{"issue":"4","key":"pone.0258127.ref031","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1542\/peds.2009-0329","article-title":"Hyperbilirubinemia in the newborn infant > or = 35 weeks\u2019 gestation: an update with clarifications","volume":"124","author":"MJ Maisels","year":"2009","journal-title":"Pediatrics"},{"issue":"8","key":"pone.0258127.ref032","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/S2352-4642(18)30139-1","article-title":"Neonatal hyperbilirubinaemia: a global perspective","volume":"2","author":"BO Olusanya","year":"2018","journal-title":"Lancet Child Adolesc Health"},{"issue":"1","key":"pone.0258127.ref033","doi-asserted-by":"crossref","first-page":"e000641","DOI":"10.1136\/bmjpo-2020-000641","article-title":"Extreme neonatal hyperbilirubinaemia in refugee and migrant populations: retrospective cohort","volume":"4","author":"EMN Wouda","year":"2020","journal-title":"BMJ Paediatr Open"},{"issue":"2","key":"pone.0258127.ref034","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.clp.2016.01.001","article-title":"Hyperbilirubinemia in Preterm Neonates","volume":"43","author":"VK Bhutani","year":"2016","journal-title":"Clin Perinatol"},{"issue":"1","key":"pone.0258127.ref035","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1002\/ebch.1898","article-title":"Cochrane Review: Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants","volume":"8","author":"CI Okwundu","year":"2013","journal-title":"Evid Based Child Health"},{"issue":"9","key":"pone.0258127.ref036","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1038\/jp.2012.64","article-title":"Does aggressive phototherapy increase mortality while decreasing profound impairment among the smallest and sickest newborns?","volume":"32","author":"JE Tyson","year":"2012","journal-title":"J Perinatol"},{"issue":"6","key":"pone.0258127.ref037","doi-asserted-by":"crossref","first-page":"e0197888","DOI":"10.1371\/journal.pone.0197888","article-title":"Umbilical cord blood bilirubins, gestational age, and maternal race predict neonatal hyperbilirubinemia","volume":"13","author":"A Castillo","year":"2018","journal-title":"PLoS One"},{"issue":"2","key":"pone.0258127.ref038","first-page":"128","article-title":"Evaluation of Maternal Risk Factors in Neonatal Hyperbilirubinemia","volume":"23","author":"H Boskabadi","year":"2020","journal-title":"Arch Iran Med"},{"issue":"5","key":"pone.0258127.ref039","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1542\/hpeds.2017-0234","article-title":"Beyond \"Asian\": Specific East and Southeast Asian Races or Ethnicities Associated With Jaundice Readmission","volume":"8","author":"MG Bentz","year":"2018","journal-title":"Hosp Pediatr"},{"key":"pone.0258127.ref040","unstructured":"Refugee Resettlement and Movement Management [Website]. IOM Thailand [cited 2021 March 3]. https:\/\/thailand.iom.int\/refugee-resettlement-and-movement-management."},{"issue":"7","key":"pone.0258127.ref041","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1080\/14767058.2017.1300650","article-title":"A neurologic dysfunction scoring protocol for jaundiced neonates requiring exchange transfusion","volume":"31","author":"BO Olusanya","year":"2018","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"9","key":"pone.0258127.ref042","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1080\/14767058.2018.1521796","article-title":"Birthplace is a risk factor for exchange transfusion in outborn infants admitted for jaundice in Myanmar: a case-control study","volume":"33","author":"F Cavallin","year":"2020","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"6","key":"pone.0258127.ref043","doi-asserted-by":"crossref","first-page":"e017180","DOI":"10.1136\/bmjopen-2017-017180","article-title":"Determinants of knowledge of critical danger signs, safe childbirth and immediate newborn care practices among auxiliary midwives: a cross sectional survey in Myanmar","volume":"7","author":"KK Than","year":"2017","journal-title":"BMJ Open"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0258127","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,9]],"date-time":"2024-09-09T14:35:08Z","timestamp":1725892508000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0258127"}},"subtitle":[],"editor":[{"given":"Benedikt","family":"Ley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,10,7]]},"references-count":43,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0258127","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,7]]}}}