scholarly journals 19 Treatment of Neonatal Hyperbilirubinemia – Ontario Cohort 2014-2018

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e7-e7
Author(s):  
Saisujani Rasiah ◽  
Thivia Jegathesan ◽  
Douglas Campbell ◽  
Michael Sgro
Keyword(s):  
Exchange Transfusion ◽  
Cochrane Review ◽  
Ivig Therapy ◽  
Population Based ◽  
Significant Rise ◽  
Neonatal Hyperbilirubinemia ◽  
Term Infants ◽  
Near Term ◽  
Almost All ◽  
Severe Hyperbilirubinemia

Abstract Background Serious complications that could result from severe neonatal hyperbilirubinemia include acute and chronic bilirubin encephalopathy. In Ontario, the incidence of severe neonatal hyperbilirubinemia and its associated treatments in term and near-term infants is currently unknown. Although IVIG therapy has been increasingly discussed in the literature, a recent Cochrane review (2018) indicated that there was a lack of evidence for recommending IVIG therapy for routine use. Objectives The purpose of this study was to determine the current incidence of severe neonatal hyperbilirubinemia and its treatments (Intravenous Immunoglobulin (IVIG) therapy, exchange transfusion and phototherapy) most often used in Ontario. Design/Methods A population-based retrospective cohort study of all term and near-term infants (≥ 35 weeks’ gestation) born in Ontario from April 2014 to March 2018 was conducted. National and provincial databases including Better Outcomes Registry Network Ontario (BORN) and Canadian Neonatal Network (CNN) were utilized. Results Data was collected from 533,084 infants born in Ontario over the 4 years. Of the total infants screened, 29,756 (6%) infants were diagnosed with neonatal hyperbilirubinemia. In terms of treatments, 24,646 (83%) infants received phototherapy, 54 (0.18%) infants received an exchange transfusion and 458 (1.5%) infants received IVIG therapy. In Ontario, neonatal hyperbilirubinemia had a statistically significant increase from 2014 to 2018 (P<0.0001). Although phototherapy was used on almost all neonates with hyperbilirubinemia (83%) there was a significant decrease from 2014 to 2018 (from 88% to 80%) (P<0.0001). Of the babies with hyperbilirubinemia in 2014, 71 (1.06%) infants received IVIG therapy and 15 (0.22%) infants received exchange transfusion. Within 4 years, IVIG therapy incidence had a significant increase from 71 (1.06%) infants to 156 (2.04%) infants (P<0.0001), while exchange transfusion remained relatively constant (P=.315). Exchange transfusion rates allows for the prediction that the rate of severe neonatal hyperbilirubinemia is stable in Ontario. Conclusion In conclusion, (severe) hyperbilirubinemia still exists amongst neonates in Ontario, despite the advancements in managing hyperbilirubinemia, indicating the need for better treatments and/or monitoring. There was also a significant rise in the use of IVIG despite the continued debate about its utility. Further research should be conducted nationally to determine the incidence of severe neonatal hyperbilirubinemia and to indicate the usage of IVIG therapy.

A Comparison of Alternative Risk-Assessment Strategies for Predicting Significant Neonatal Hyperbilirubinemia in Term and Near-Term Infants

PEDIATRICS ◽  
2008 ◽  
Vol 121 (1) ◽  
pp. e170-e179 ◽  
Author(s):  
R. Keren ◽  
X. Luan ◽  
S. Friedman ◽  
S. Saddlemire ◽  
A. Cnaan ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Neonatal Hyperbilirubinemia ◽  
Term Infants ◽  
Near Term ◽  
Assessment Strategies

scholarly journals Developmental outcome of severe neonatal indirect hyperbilirubinemia

2021 ◽  
Vol 9 (1) ◽  
pp. 1-1
Author(s):  
Manizheh Mostafa Gharehbaghi ◽  
Seifolah Heidatabady ◽  
Masoomeh Ghasempour ◽  
Mahsa Alizade
Keyword(s):  
Exchange Transfusion ◽  
Neonatal Period ◽  
Neurodevelopmental Outcome ◽  
Total Serum ◽  
Term Infants ◽  
Abo Incompatibility ◽  
Ages And Stages Questionnaire ◽  
Classic Form ◽  
Sensory Neural ◽  
Severe Hyperbilirubinemia

Background: Indirect hyperbilirubinemia is one of the most common causes of hospitalization in the neonatal period and its potential association with brain damage is well established. This study was conducted to determine neurodevelopmental outcome of children who had severe indirect hyperbilirubinemia in neonatal period and received intensive phototherapy with or without double volume exchange transfusion for its management. Material & methods: This descriptive analytical study was performed in healthy infants with the history of severe indirect hyperbilirubinemia and need intensive phototherapy with or without exchange transfusion. We invited the enrolled infants at their 2-3 years age. Neurodevelopmental assessment was performed by a trained nurse using Ages and Stages Questionnaire. Results: The mean total serum bilirubin (TSB) of studied children was 26.4±4.1 mg/dl at their neonatal period. The estimated rate of severe hyperbilirubinemia with the TSB of 25-30 mg/dl was 48.7/100,000 live born infants and 11.4 /100,000 for hyperbilirubinemia higher than 30 mg/dl. The most common cause of jaundice in patients with exchange transfusion was ABO incompatibility. At their follow up examination, the classic form of bilirubin induced encephalopathy (Kernicterus) was diagnosed in 3 neonates. Two of them had sensory neural hearing loss too. Eleven children had low score based on ASQ in at least one area. The score was less than 2SD in 3 patients. Conclusion: Severe hyperbilirubinemia and kernicterus is still occurring in term and late pre-term infants. Early detection and management of severe hyperbilirubinemia may improve the neurodevelopmental outcome in high risk infants.

scholarly journals Management of hyperbilirubinemia in near ... term newborns according to American Academy of Pediatrics Guidelines: Report of three cases

2009 ◽  
Vol 49 (2) ◽  
pp. 125
Author(s):  
Naomi Esthemita Dewanto ◽  
Rinawati Rohsiswatmo
Keyword(s):  
Case Report ◽  
American Academy ◽  
Newborn Infants ◽  
Maternal Anxiety ◽  
Term Infants ◽  
American Academy Of Pediatrics ◽  
Transient Rise ◽  
Term Newborns ◽  
Near Term ◽  
Severe Hyperbilirubinemia

All neonates have a transient rise inbilirubin levels, and about 30-50% ofinfants become visibly jaundiced.1,2Most jaundice is benign; however,because of the potential brain toxicity of bilirubin,newborn infants must be monitored to identifythose who might develop severe hyperbilirubinemiaand, in rare cases, acute bilirubin encephalopathyor kernicterus. Ten percent of term infantsand 25% of near-term infants have significanthyperbilirubinemia and require phototherapy. 3The American Academy of Pediatrics (AAP)recommends procedures to reduce the incidenceof severe hyperbilirubinemia and bilirubinencephalopathy, and to minimize the risks ofunintended harm such as maternal anxiety,decreased breastfeeding, and unnecessary costsor treatment.4The guidelines provide a framework for theprevention and management of hyperbilirubinemiain newborn infants of 35 weeks or more ofgestational age (term and near-term newborns).This case report details the management of threenewborns of 35 or more gestational age at theSiloam Lippo Cikarang Hospital, Tanggerang, WestJava, Indonesia according to the AAP guidelines.

scholarly journals Report about term infants with severe hyperbilirubinemia undergoing exchange transfusion in Southwestern China during an 11-year period, from 2001 to 2011

PLoS ONE ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. e0179550 ◽  
Author(s):  
Canfeng Yu ◽  
Huifan Li ◽  
Qiannan Zhang ◽  
Huayun He ◽  
Xinhong Chen ◽  
...  
Keyword(s):  
Exchange Transfusion ◽  
Southwestern China ◽  
Term Infants ◽  
Severe Hyperbilirubinemia

scholarly journals A prospective study on etiological factors and clinical indicators in term and near term neonates admitted with hyperbilirubinemia in nicu in a tertiary care hospital in Hyderabad, India

2021 ◽  
Vol 7 (2) ◽  
pp. 51-56
Author(s):  
C.V.S. Lakshmi ◽  
Syed Adnan Ali ◽  
Uppin Narayan Reddy ◽  
Farhana Nazneen ◽  
Muzammil
Keyword(s):  
Risk Factors ◽  
Blood Group ◽  
Exchange Transfusion ◽  
Serum Bilirubin ◽  
Tertiary Care ◽  
Neonatal Hyperbilirubinemia ◽  
Neurological Dysfunction ◽  
Safe Procedure ◽  
Care Hospital ◽  
Near Term

1.To study the etiology and risk factors of neonatal hyperbilirubinemia in term and near-term infants. 2. To study the clinical course of these infants during NICU stayThe present study was conducted at NICU, Department of Pediatrics, Princess Esra hospital, Deccan Medical College, Hyderabad, India, from October 2019 to October 2020. Term and late preterm infants admitted in NICU with Serum Bilirubin levels more than 12mg/dl were included in the study. The risk factors, etiology and clinical profile of these infants during NICU stay were studied. 210 neonates were admitted in NICU with hyperbilirubinemia (Serum Bilirubin >12mg/dl) during the study period, out of which 118 were male (56.20%) and 92 were female (43.80%). Neonates were further distributed based on gestational age, in which 46 (21.90%) were late pre-terms i.e. between 34-37 weeks and 164 neonates (78.10%) were full term i.e. greater than 37 weeks. The neonates were also classified based on their birth weight, with neonates between 2500-3000 grams having the highest incidence (46.19%). Lastly, the etiological and risk factors were assessed and quantified, with physiological jaundice occurring as the major cause and late prematurity as the most common risk factor associated with neonatal hyperbilirubinemia. The average duration of phototherapy was 2.50 days and 3 babies required Double Volume Exchange Transfusion (DVET) for significant hyperbilirubinemia.None of the babies requiring DVET had clinical features of Bilirubin Induced Neurological Dysfunction (BIND) during NICU stay. 1. Most common cause of neonatal hyperbilirubinemia was found to be Physiological followed by Septicemia and Idiopathic etiologies. Blood group incompatibilities were less common causes. 2. Phototherapy is a cheap and effective way to reduce bilirubin levels in neonatal jaundice. 3. Exchange transfusion is a safe procedure and should be considered when indicated, to decrease the incidence of BIND. All cases requiring DVET were due to blood group incompatibility.

Direct Comparison of Sn-Mesoporphyrin, An Inhibitor of Bilirubin Production, and Phototherapy in Controlling Hyperbilirubinemia in Term and Near-Term Newborns

PEDIATRICS ◽  
1995 ◽  
Vol 95 (4) ◽  
pp. 468-474
Author(s):  
Attallah Kappas ◽  
George S. Drummond ◽  
Claudia Henschke ◽  
Timos Valaes
Keyword(s):  
Single Dose ◽  
Birth Weight ◽  
Resource Use ◽  
Exchange Transfusion ◽  
Potent Inhibitor ◽  
Term Infants ◽  
Medical Observation ◽  
Plasma Bilirubin ◽  
Term Newborns ◽  
Near Term

Background. Sn-mesoporphyrin (SnMP) is a potent inhibitor of bilirubin production. In our previous studies a single dose (6 µmol/kg birth weight) significantly moderated hyperbilirubinemia and reduced phototherapy (PT) time by >75% when administered within 24 hours of birth to preterm infants. Objective. To directly compare the efficacy of SnMP and PT for controlling hyperbilirubinemia in term and near-term infants. Methods. Two randomized, sequentially analyzed trials (Study I: male term infants; Study II: infants of both sexes and gestational age [GA] 245-265 days) were conducted. SnMP (6 µmol/kg birth weight) or PT (Phillips F20T12/BB lamps) was administered to paired infants according to strict criteria of plasma bilirubin levels and age. Time of enrollment and closure of cases and crossover, if necessary, of SnMP infants to PT or all infants to exchange transfusion were precisely defined in each pair. SnMP or PT was considered superior if the time between enrollment and closure of the case was reduced by >24 hours over the alternative treatment or if crossover had occurred. Results. None of the 44 SnMP-treated infants required supplemental PT. Of the 22 pairs of term infants enrolled in Study I, SnMP proved superior to PT in 20 and equal in two. Of the 20 pairs of near-term infants enrolled in Study II, SnMP was superior in 12 and PT in two; six were tied. Two SnMP-treated infants were unpaired. The PT-treated infants in Study I required an average of 33 hours of treatment; those in Study II, 48 hours. None of the enrolled infants required exchange transfusion or interruption of breast-feeding. In both studies, times between case enrollment and closure were reduced by >30 hours in SnMP compared with PT infants; requirements for additional days of medical observation and bilirubin measurements were also significantly less in SnMP infants. Conclusion. A single dose of SnMP entirely supplanted the need for PT in jaundiced term and near-term newborns and significantly reduced medical resource use to monitor hyperbilirubinemia.

scholarly journals Erythropoietin monotherapy for neuroprotection after neonatal encephalopathy in low-to-middle income countries: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Phoebe Ivain ◽  
Paolo Montaldo ◽  
Aamir Khan ◽  
Ramyia Elagovan ◽  
Constance Burgod ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Neonatal Encephalopathy ◽  
Neurodevelopmental Outcomes ◽  
Term Infants ◽  
Middle Income ◽  
Middle Income Countries ◽  
Pooled Data ◽  
Risk Of Death ◽  
Low Middle Income Countries ◽  
Near Term

Abstract Objective We examined whether erythropoietin monotherapy improves neurodevelopmental outcomes in near-term and term infants with neonatal encephalopathy (NE) in low-middle income countries (LMICs). Methods We searched Pubmed, Embase, and Web of Science databases to identify studies that used erythropoietin (1500–12,500 units/kg/dose) or a derivative to treat NE. Results Five studies, with a total of 348 infants in LMICs, were retrieved. However, only three of the five studies met the primary outcome of death or neuro-disability at 18 months of age or later. Erythropoietin reduced the risk of death (during the neonatal period and at follow-up) or neuro-disability at 18 months or later (p < 0.05). Death or neuro-disability occurred in 27.6% of the erythropoietin group and 49.7% of the comparison group (risk ratio 0.56 (95% CI: 0.42–0.75)). Conclusion The pooled data suggest that erythropoietin monotherapy may improve outcomes after NE in LMICs where therapeutic hypothermia is not available.

Intermodal Enhancement of Stimulus Localisation in Infants Born Prematurely

1989 ◽  
Vol 69 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Nigel Foreman ◽  
Alistair Fielder
Keyword(s):  
Visual Fields ◽  
Visual Stimuli ◽  
Peripheral Stimulus ◽  
Term Infants ◽  
Visual Enhancement ◽  
Sensory Space ◽  
Near Term ◽  
Gestational Age At Birth ◽  
Age At Birth ◽  
Prematurely Born Infants

The interaction of auditory and visual modalities in the enhancement of orientation was examined in premature and near-term infants by presenting them auditory or visual stimuli or auditory-visual stimulus combinations at various positions in sensory space. In 4.5–15-mo.-olds, brisk orienting responses could be elicited to very peripheral stimulus positions but only when the stimulus consisted of a spatially coherent auditory-visual combination (i.e., where a sound and a light occurred at the same point in space). This occurred for all infants, irrespective of age or gestational age at birth. First, the result shows that infants can respond to visual stimuli at eccentric positions, beyond the supposed limits of their effective visual fields as measured by standard perimetry. Second, the result extends earlier studies showing that intersensory integration and stimulus localisation develop relatively normally in prematurely born infants. The auditory-visual enhancement test as used here may have a number of further uses and applications in the clinic and laboratory.

P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O L Rueda Ochoa ◽  
L R Bons ◽  
S Rohde ◽  
K E L Ghoud ◽  
R Budde ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Risk ◽  
Cardiovascular Mortality ◽  
Total Mortality ◽  
Population Based ◽  
Cardiovascular Outcomes ◽  
Increased Risk ◽  
Almost All

Abstract Background Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist. Purpose To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk. Methods and results 2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up. Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women. Conclusions Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.

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