Can transcutaneous bilirubinometry reduce the need for serum bilirubin estimations in term and near term infants?

Introduction: Phototherapy remains mainstay of treating neonatal hyperbilirubinemia across gestational age spectrum. Neonates under phototherapy (PTx) require frequent estimation of serum bilirubin (TSB) to monitor disease progression. Transcutaneous bilirubinometer (TcB) is widely used for estimation of TSB with limited data for neonates receiving PTx. The aim of study was to assess the diagnostic accuracy of TcB as compared to TSB in preterm and term infants receiving phototherapy.Methods: This prospective study analyzed 385 paired TcB-TSB samples from 234 hemodynamically stable preterm (89) and term (145) neonates receiving in-hospital PTx. Indigenous photo-opaque patch was applied to sternum before starting PTx. TcB was measured from patched area of skin using Dräger JM-103 device at 12 and 24 hours during phototherapy within 5 minutes of blood collection for TSB. Linear regression and Bland-Altman plots were used to compare TcB with TSB.Results: The mean (SD) gestational age and birth weight were 35.8 (2.43) weeks and 2250 (560) grams. Difference of mean of TcB and TSB was ranging between 0.7-1 mg/dl with TcB underestimating TSB. At 12 hours and 24 hours of PTx, the correlation coefficient were (r = 0.84 and 0.81, p<0.01) among preterm and (r = 0.76 and 0.79, p<0.01) among term infants. Bland–Altman plot showed significant agreement between TcB from patched site and TSB in both preterm and term neonates.Conclusion: TcB demonstrated significant accuracy in predicting TSB in both term and preterm neonates receiving PTx with slight underestimation of TSB. The study showed marginally higher correlation for preterm infants.

Download Full-text

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

Journal of Perinatology ◽

10.1038/s41372-021-01132-4 ◽

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.

Download Full-text

Transcutaneous billirubinometry to estimate total serum bilirubin in neonatal jaundice

Paediatrica Indonesiana ◽

10.14238/pi57.1.2017.8-11 ◽

2017 ◽

Vol 57 (1) ◽

pp. 8 ◽

Cited By ~ 2

Author(s):

Andra Kurnianto ◽

Herman Bermawi ◽

Afifa Darmawanti ◽

Erial Bahar

Keyword(s):

Neonatal Jaundice ◽

Serum Bilirubin ◽

Subcutaneous Tissue ◽

Correlation Coefficients ◽

Total Serum Bilirubin ◽

Blood Sampling ◽

Total Serum ◽

Transcutaneous Bilirubin ◽

Non Invasive ◽

Transcutaneous Bilirubinometry

Background The gold standard for diagnosis of neonatal jaundice is total serum bilirubin (TSB) measurement. This method, however, is invasive, painful, and costly in terms of workload, time, and money. Moreover, repeated blood sampling may lead to significant blood loss, which is of particular concern in preterm infants. To overcome these drawbacks, non-invasive methods of bilirubin measurement have been proposed. Transcutaneous bilirubinometry (TcB) determines the yellowness of the subcutaneous tissue of a newborn infant by measuring the difference between optical densities for light in the blue and green wavelength regions.Objective To evaluate the accuracy of transcutaneous bilirubinometry for estimating TSB levels in neonatal jaundice.Methods Subjects were infants aged < 28 days with jaundice who had never been treated with phototherapy or exchange transfusion. The study was done from February to July 2016 in Mohammad Hoesin Hospital. Subjects underwent transcutaneous bilirubin (TcB) and TSB assays, with a maximum interval of 15 minutes between tests.Results One hundred fifty patients were included in this study. The TcB values > 5 mg/dL were correlated to TSB > 5 mg/dL, with 100% sensitivity and 83.3% specificity. This cut-off point was obtained from a receiver-operator characteristic (ROC) curve with AUC 99.3% (95%CI 97.9 to 100%; P< 0.001).The correlation coefficients (r) for TSB and TcB measurements on the forehead were 0.897 (P<0.001).Conclusion Transcutaneous bilirubinometry can be used to accurately estimate TSB levels in neonatal jaundice, and may be useful in clinical practice as a non-invasive method to reduce blood sampling.

Download Full-text

Intermodal Enhancement of Stimulus Localisation in Infants Born Prematurely

Perceptual and Motor Skills ◽

10.2466/pms.1989.69.1.43 ◽

1989 ◽

Vol 69 (1) ◽

pp. 43-50 ◽

Cited By ~ 2

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.

Download Full-text

Delivery room resuscitation of near-term infants: Role of the laryngeal mask airway

Resuscitation ◽

10.1016/j.resuscitation.2009.11.005 ◽

2010 ◽

Vol 81 (3) ◽

pp. 327-330 ◽

Cited By ~ 22

Author(s):

Vincenzo Zanardo ◽

Gary Weiner ◽

Massimo Micaglio ◽

Nicoletta Doglioni ◽

Ramona Buzzacchero ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Laryngeal Mask ◽

Delivery Room ◽

Term Infants ◽

Near Term

Download Full-text

Transcutaneous Bilirubinometry: A New Light on an Old Subject

PEDIATRICS ◽

10.1542/peds.69.1.124 ◽

1982 ◽

Vol 69 (1) ◽

pp. 124-125 ◽

Cited By ~ 2

Author(s):

Thomas Hegyi

Keyword(s):

Central Nervous System ◽

Skin Color ◽

Serum Bilirubin ◽

Cellular Injury ◽

Bilirubin Concentration ◽

Specific Serum ◽

Relationship Of ◽

The Relationship ◽

Transcutaneous Bilirubinometry

The role of bilirubin as a cause of central nervous system morbidity in the newborn infant has been well recognized for several decades. The specific serum concentration that leads to cellular injury, as well as the precise mechanism of damage, are as yet unclear but general principles of therapy have been established. Early detection of hyperbilirubinemia is based on the clinical assessment of dermal icterus followed by appropriate serum tests to determine the degree of serum bilirubin elevation. The relationship of dermal icterus and serum bilirubin concentration has intrigued clinicians for more than a century.1 In an attempt to utilize skin color as an index of hyperbilirubinemia many techniques have been investigated.

Download Full-text

Bovine Milk Oligosaccharides with Sialyllactose for Preterm Piglets

Nutrients ◽

10.3390/nu10101489 ◽

2018 ◽

Vol 10 (10) ◽

pp. 1489 ◽

Cited By ~ 4

Author(s):

Karina Obelitz-Ryom ◽

Amalie Rendboe ◽

Duc Nguyen ◽

Silvia Rudloff ◽

Anne Brandt ◽

...

Keyword(s):

Bacterial Colonization ◽

Bovine Milk ◽

Protective Effects ◽

Gut Development ◽

Artificial Rearing ◽

Milk Oligosaccharides ◽

Term Infants ◽

Brain Functions ◽

Near Term ◽

Dietary Treatments

Oligosaccharides support gut development and bacterial colonization in term infants, but it is unknown if they benefit preterm infants. Using preterm pigs, we investigated effects of bovine milk supplements enriched with oligosaccharides to improve gut development and colonization. Caesarean-delivered preterm pigs (n = 57) were reared for 19 days. The pigs were fed bovine milk supplemented with an oligosaccharide-enriched whey containing sialyllactose, or a heterogeneous oligosaccharide ingredient. To evaluate the influence of artificial rearing, near-term, vaginally born pigs raised by their sow (n = 12) were compared with artificially reared, caesarean-delivered near-term pigs (n = 14). In preterm pigs, the clinical outcome, gut function, gut microbiota, and systemic immunity were similar among dietary treatments. Natural rearing increased growth rates, gut functions, colon short chain fatty acid concentrations and bacterial diversity, relative to artificial rearing. In conclusion, supplements with bovine milk oligosaccharides were well tolerated, but did not improve gut maturation or clinical outcomes in artificially reared preterm piglets. Immaturity at birth, coupled with artificial rearing, may render the neonate unresponsive to the gut-protective effects of milk oligosaccharides. Whether bovine milk oligosaccharides may affect other endpoints (e.g., brain functions) in conditions of immaturity remains to be investigated.

Download Full-text

Predictability of transcutaneous bilirubinometry in late preterm and term infants at risk for pathological hyperbilirubinemia

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200486 ◽

2020 ◽

pp. 1-7

Author(s):

E. Dianova ◽

J. Fogel ◽

R.P. Verma

Keyword(s):

At Risk ◽

Serum Bilirubin Level ◽

Late Preterm ◽

Term Infants ◽

Term Neonates ◽

Transcutaneous Bilirubin ◽

Immune Mediated ◽

Positive Direct ◽

Neonatal Population ◽

Transcutaneous Bilirubinometry

BACKGROUND: The aim was to assess the predictability of transcutaneous bilirubinometry in late preterm and term neonates at risk for pathological hyperbilirubinemia, and to identify the neonatal population in which transcutaneous bilirubin most accurately predicts serum bilirubin level (SB, mg/dl). METHODS: The correlations between transcutaneous bilirubin (TCB, mg/dl) and SB in different neonatal population subsets; and between ΔTSB (TCB-SB) and relevant neonatal variables and clinical groups were analyzed. RESULTS: TCB correlated with SB (r = 0.82, p < 0.05) in the cohort (n = 350) and in population subsets (r = 0.81–0.9, p < 0.001). Black infants with gestational age (GA) >35 weeks and chronological age (CA) >3 days recorded strongest correlation (r = 0.9, p < 0.001) followed by Blacks, and non-Black infants with CA >3 days and GA >35 weeks. ΔTSB was positive in Blacks, and in infants with CA <3 days, or with no phototherapy. ΔTSB was negative in non-Blacks, in infants with positive direct Coombs test (DC+) or those receiving phototherapy. Black race [beta (SE) = 1.3(0.33), p < 0.001] had positive, while CA [beta (SE) =−1.74 (0.36), p < 0.001], DC + status [beta (SE) =−0.72 (0.25), p = 0.004] and receipt of phototherapy [beta (SE) =−0.84 (0.21), p < 0.001] each had negative correlation with ΔTSB. ΔTSB for Blacks was >Whites, Hispanics and Asians. CONCLUSION: SB is best predicted by TCB in Black infants with CA over 3 days and GA over 35 weeks. Variability in SB estimation by TCB is race, CA and immune mediated hemolysis specific.

Download Full-text