Effectiveness of Transcutaneous Bilirubin Measurement in High-Risk Neonates and to Evaluate Validity of Transcutaneous Bilirubin With Total Serum Bilirubin Levels in Both Low and High-Risk Neonates at a Tertiary Care Center in a Developing Country.

Objectives To evaluate the usefulness of transcutaneous bilirubin (TcBR) nomogram in high-risk neonates and to identify the validity of TcBR and total serum bilirubin (TsBR) in both low and high-risk neonates to guide management in under-resourced settings. Methodology A cross-sectional study was conducted at the well-baby nursery of a tertiary care center in Karachi, Pakistan. All neonates admitted in the well-baby nursery with jaundice were stratified into high and low-risk groups. Eighty-seven neonates were included in the low-risk group and 121 neonates in the high-risk group. The usefulness of the TcBR nomogram in high-risk neonates and the validity of TcBR and TsBR in both low and high-risk neonates were determined through sensitivity and specificity analysis. Results The correlation coefficients (r) were found to be comparable in the high-risk group (r = 0.82, p < 0.001) and the low-risk group (r = 0.87, p < 0.001). The specificity of cutaneous bilirubin measurement based on bilirubin levels in the high-risk group was higher (93.0%) than that of the low-risk group (90.1%). However, the sensitivity was found to be lower (60.0%) in the high-risk group compared to the low-risk group (68.8%). The mean value of TsBR was equal in both groups. The mean TcBR in the high-risk group was 10 ± 2.3 compared to 11 ± 2.1 in the low-risk group. Phototherapy was given in 67.0% of the high-risk cases and 41.4% of the low-risk cases. Bland Altman analysis was also performed to depict the relationship between TcBR and TsBR measurements. Conclusion The TcBR nomogram was effective in high-risk neonates and also had validity in both high and low-risk neonates. A phototherapy-driven protocol based on TcBR would be a cost-effective and useful tool in the identification and management of neonatal jaundice in both high and low-risk groups in developing countries like Pakistan.

Community based nutritional rehabilitation of severely malnourished children.

OBJECTIVE: To improve nutrition of malnourished children in the community, using home based treatment. METHODS: A prospective cohort study was conducted in a squatter settlement of Karachi (Khuda Ki Basti). The study was conducted from August 2006 to March 2007. All children <5 years who were <-3sd weight for height were included as per WHO guidelines. After initial screening for complications, the children were provided with high density diet (HDD). Daily weight, amount of HDD consumed and complications were recorded. RESULTS: A total of 24 children were included in the study. Eleven children (45.8%) reached - 1SD at the end of 3 months while 10 patients (41.6%) took 4 months. Twenty two patients (91.6%) were at the median weight for height by the end of 5 months. CONCLUSION: Home based treatment with locally available foods can be used successfully to rehabilitate severely malnourished children.