Supra-treatment threshold neonatal jaundice: Incidence in HIV-exposed compared to non-exposed neonates at Queen Elizabeth Central Hospital in Blantyre, Malawi

INTRODUCTION: Jaundice is the yellowish pigmentation of the skin, sclera, and mucous membranes resulting from bilirubin deposition. Children born to mothers with HIV are more likely to be born premature, with low birth weight, and to become septic-all risk factors for neonatal jaundice. Further, there has been a change in the prevention of mother-to-child transmission (PMTCT) of HIV guidelines from single-dose nevirapine to a six-week course, all of which theoretically put HIV-exposed newborns at greater risk of developing neonatal jaundice.

AIM: We carried out a study to determine the incidence of severe and clinical neonatal jaundice in HIV-exposed neonates admitted to the Chatinkha Nursery (CN) neonatal unit at Queen Elizabeth Central Hospital (QECH) in Blantyre.

METHODS: Over a period of four weeks, the incidence among non-exposed neonates was also determined for comparison between the two groups of infants. Clinical jaundice was defined as transcutaneous bilirubin levels greater than 5 mg/dL and severe jaundice as bilirubin levels above the age-specific treatment threshold according the QECH guidelines. Case notes of babies admitted were retrieved and information on birth date, gestational age, birth weight, HIV status of mother, type of feeding, mode of delivery, VDRL status of mother, serum bilirubin, duration of stay in CN, and outcome were extracted.

RESULTS: Of the 149 neonates who were recruited, 17 (11.4%) were HIV-exposed. One (5.88%) of the 17 HIV-exposed and 19 (14.4%) of 132 HIV-non-exposed infants developed severe jaundice requiring therapeutic intervention (p = 0.378). Eight (47%) of the HIV-exposed and 107 (81%) of the non-exposed neonates had clinical jaundice of bilirubin levels greater than 5 mg/dL (p < 0.001).

CONCLUSIONS: The study showed a significant difference in the incidence of clinical jaundice between the HIV-exposed and HIV-non-exposed neonates. Contrary to our hypothesis, however, the incidence was greater in HIV-non-exposed than in HIV-exposed infants.

« La liste des seigneurs, barons, chevaliers et gentilshommes, envoyez en France par Elizabeth, royne d'Angleterre, pour confirmer la ligue d'entre le très victorieux et très magnanime roy, Charles neufiesme, et ladicte dame, à present regnantz ».

Tel est le titre qu'on lit au r° du feuillet 1 de ce volume. Au bas de ce feuillet on a ajouté, faisant allusion aux membres de cette ambassade : « Arrivez à Paris le 8 juin 1572 ». Les feuillets 2-4 sont occupés par un prologue adressé « au roy » Charles IX, par l'auteur de cette liste, lequel se dit « son très humble serviteur, secretaire et historiographe ès langues angloise, galoise, irlandoise et escossoise », et signe : « JEHAN BENARD ». Les feuillets 5 à 25 donnent des noms des principaux personnages de cette ambassade, à commencer par l'ambassadeur, « le comte de Lyncolne,... Edouard Fines,... admiral d'Angleterre », de courtes notices, précédées pour la plupart de leurs noms et de leurs armoiries peintes. « Les gentilz hommes de moindre degré et condition que les susnommez », sont simplement énumérés ; après quoi l'auteur termine ainsi : «... Oultre les susnommez seigneurs, barons, chevaliers et gentilz-hommes, monsieur l'admiral a à sa suite XXXV gentilzhommes de sa maison » et « ses autres serviteurs, appellez Yemen, par terme du païs, reduitz au nombre de XXXVI », lesquels « ont pareilz manteaux de livrée » que les gentilshommes de sa maison, « mais au lieu de veloux, ilz ont une bande de drap noir sur chasque manteau avec passement rouge ». Lettres ornées, armoiries peintes.

Welland Canal Survey of Lands Widow Elizabeth Ball, 1834

Survey map and description of Widow Elizabeth Ball's land created by The Welland Canal Company. Included is a written description of the land along with a drawing of the land. Noteable features include; locks no. 28, 29, 30, 31, line between Widow Ball and Thomas Ker's land, township line between Grantham and Thorold, waste weir. Surveyor notes are seen in pencil on the map. The land was originally surveyed in 1826(?) and then re-surveyed on November 28th, 1834. The land was used by the Welland Canal Company for canal and hydraulic purposes and was located in lot 9 in the 10th concession of Grantham township.

Genealogical notes of Elizabeth Pettit and Benjamin Bell

Genealogical notes of Elizabeth Pettit and Benjamin Bell. Lists dates of birth for Benjamin Bell and Elizabeth and includes birth dates for ten children. Also included is the date of the death of Benjamin and Elizabeth and four of their children.

Invitation: Gala Concert in honour of Her Majesty Queen Elizabeth and His Royal Highness the Duke of Edinburgh

An invitation from The Right Honourable Pierre Elliott Trudeau for a gala concert in the Opera of the National Arts Centre in honour of Her Majesty Queen Elizabeth and His Royal Highness the Duke of Edinburgh.

Ticket for The Coronation of Her Majesty Queen Elizabeth II

A ticket to attend the Coronation of Queen Elizabeth II on 2 June 1953. The ticket is for Mrs. Arthur Schmon for seat no. C29.

Certificate of Baptism - Margaret Elizabeth Woodruff

Certificate of Baptism for Margaret Elizabeth Woodruff, the child of Percy Carruthers and Margaret Julia Band who was baptized at St. George's Church, St. Catharines, June 14, 1935. The sponsors listed are: Maude Band Mabee, Alice Eaton, and Clifford Scott Howard.

Indenture between William Arnott and Elizabeth Arnott and Nathan Thomas Fitch

Indenture of mortgage between William Arnott and Elizabeth Arnott of Welland County to Nathan Thomas Fitch of Welland County for Lots numbered 37 and the south half of 40 and 41 in the village of Merritville - instrument no. 5400, September 12, 1836.

Indenture between Margaret Stewart and Elizabeth Clench Stewart and Archibald Gilkison

Indenture of bargain and sale between Margaret Stewart and Elizabeth Clench Stewart of the Town of Niagara to Archibald Gilkison of Niagara regarding the westerly half of Lot no. 24 in the 5th Concession of the Township of Brooke. May 12, 1841.

Province of Upper Canada Grant to Elizabeth MacKay

Province of Upper Canada Grant (vellum) to Elizabeth MacKay of the Township of Charlottenburgh in the County of Glengarry. She was the daughter of William MacKay, a United Empire Loyalist. She was granted 200 acres in the east halves of lots no. 8 and 10 in the 2nd Concession in the Township of Orillia. This was registered June 4, 1836 – Folio 168, May 27, 1836.

Invitation to the Funeral of Ann Elizabeth Woodruff

Invitation to the funeral of Ann Elizabeth Woodruff, daughter of the late Richard N. Woodruff. The funeral was to be held on Oct. 17, 1871 at her residence in St. Davids, Oct. 16, 1871.

Announcement of Birth of Margaret Elizabeth

Announcement of the birth of Margaret Elizabeth by Mr. and Mrs. P.C. Band, Toronto, June 6, 1924.