117 - Three decades of trends in mortality and burden of Extreme Hyperbilirubinemia (EHB) in Philippines.

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 117
Publication Number: 117.238

Maria Esterlita T. Villanueva-Uy, Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines Manila, Quezon City, National Capital Region, Philippines; Ramesh Vidavalur, Weill Cornell Medicine, Ithaca, NY, United States; Vinod K.. Bhutani, Sanford Children's Hospital - Fargo, STANFORD, CA, United States

Presenting Author(s)

Maria Esterlita T. Villanueva-Uy, MD MSPH (she/her/hers)

Institute Director
Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines Manila
Quezon City, National Capital Region, Philippines

Background: The Filipino infant is at higher risk of developing significant hyperbilirubinemia due to the following risk factors: high breastfeeding rate, Asian race, high incidence G6PD deficiency and polymorphisms of the glucuronyl-transferase enzymes.

Objective:

To assess the trend in EHB related infant mortality (EHB-IMR) in Philippines, to estimate overall burden of disease in terms of disability adjusted life year (DALY) losses and to evaluate the impacts of improvements attributed to better penetration of neonatal services.

Design/Methods:

We relied on the Global Health Data Exchange tool, to access data for annual deaths and DALYs lost due to hemolysis and other neonatal causes from 1990 to 2019 by age (early: 0-6days, late: 7-27d, post neonatal: >28d-365d) and location in our analysis (https://ghdx.healthdata.org/). Mean estimates are reported with 95% uncertainty intervals (UIs) and these intervals are based on 1000 runs of the models for each quantity of interest, with the 2·5th and 97·5th percentiles considered as the 95% UI. For annual birth cohorts from 1990-2019, we extracted United Nations Population Prospects data for Philippines (https://population.un.org). We present lost DALYs per 100,000 mid-year population. We assessed changes in rates of early, late, post neonatal EHB-IMR per 1000 live births and calculated mean annual percent changes (APC). To calculate mean APC, we used Joinpoint regression software version 4.9.1.0 (National Cancer Institute, USA) which accounts for non-linear trends by inflection points and by weighting for the trend segments.

Results:

Estimated incident infant deaths due to EHB (1990-2019) decreased by 55% being 256 (95% UI:214-306) in 1990 versus 114 (95% UI:82-151) in 2019. Concurrently, the live birth rate increased by 20%. We observed distinct joinpoint trends in EHB-IMR during this period. APC rates for early neonatal mortality showed five joinpoint trends with average APC at -3.3 (95% CI: -3.7, -2.9). We observed four and two joinpoint trends for late [Average APC: -3.6 (95%CI:-3.9, -3.3)] and post neonatal [(Average APC: -2.9 (95% CI:-3.1, 2.6)] EHB related mortality, respectively. Overall EHB-IMR was -3.4 (95% CI -3.7, -3.0; P< 0.001). Hemolysis and other causes of hyperbilirubinemia related DALY losses decreased from 37 (95% UI:31-44) in 1990 to 9 (95% UI:7-12) per 100,000 population in 2019. From 1990-2019, overall EHB-IMR decreased by 63% among infants in Philippines.

Conclusion(s):

EHB-IMR decreased significantly over the past 3 decades in the Philippines. This may be due to effective dissemination of proper management of hyperbilirubinemia.