scholarly journals Home phototherapy for neonatal jaundice in the UK: a single-centre retrospective service evaluation and parental survey

2021 ◽  
Vol 5 (1) ◽  
pp. e001027
Author(s):  
Mona Noureldein ◽  
Grace Mupanemunda ◽  
Helen McDermott ◽  
Katy Pettit ◽  
Richard Mupanemunda
Keyword(s):  
Neonatal Intensive Care ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Community Outreach ◽  
Service Evaluation ◽  
Serum Bilirubin Level ◽  
Special Care Unit ◽  
Hospital Readmission Rates ◽  
Select Group ◽  
The Uk

BackgroundIn the UK setting, where neonatal jaundice treatment is required, it is largely carried out in hospitals. However, it is possible to safely administer home phototherapy (HPT).ObjectiveTo report on our centre’s experience of HPT and its potential benefits.DesignRetrospective observational study performed as a service evaluation.PatientsInfants ≥35 weeks corrected gestational age with a weight of 2 kg and serum bilirubin ≤50 µmol/L above treatment thresholds. Controls were a matched group of infants who received inpatient phototherapy (IPT).SettingThe catchment area of two neonatal intensive care units, one special care unit and a birth centre at four different hospitals that is covered by a single neonatal community outreach nursing team in Birmingham, UK.InterventionHPT was started either in the community or as a continuation of IPT. Controls received IPT.Main outcome measuresThe rate of bilirubin reduction, hospital readmission rates and parental satisfaction.Results100 infants received HPT while 50 received IPT. No infant showed a progressive rise of serum bilirubin level while receiving HPT. The rate of bilirubin reduction was similar in both HPT and IPT groups (2.4±1.9 and 2.5±1.6 µmol/L/hour, respectively, MD=−0.1, 95% CI −0.74 to 0.53, p=0.74). Readmission rate was 3% in the HPT group. 97% of parents stated that the overall experience was good and 98% would choose HPT if they had their time all over again.ConclusionOur programme suggests that HPT for neonatal jaundice can be carried out in a select group of infants. It helps in providing holistic family-centred care and is viewed positively by families.

EFFECT OF PHOTOTHERAPY ON SERUM CALCIUM LEVELS IN NEONATAL JAUNDICE

2021 ◽  
pp. 17-19
Author(s):  
Aradhana Gupta ◽  
Anand Kumar Bhardwaj ◽  
Anisha Aggarwal ◽  
Gauri Chauhan
Keyword(s):  
Serum Calcium ◽  
Neonatal Intensive Care ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Calcium Supplementation ◽  
Clinical Signs ◽  
Total Serum ◽  
Medical Sciences ◽  
Term Neonates ◽  
Unconjugated Hyperbilirubinemia

Background :To study the effect of phototherapy on serum calcium levels in neonates with unconjugated hyperbilirubinemia. Methods : This hospital based longitudinal interventional study was conducted on 100 neonates with neonatal hyperbilirubinemia admitted to Neonatal Intensive Care Unit at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. Total serum bilirubin and serum calcium levels of each participants were checked before and at the end of phototherapy. Neonates were also checked for the clinical signs of hypocalcemia i.e. jitteriness, irritability, lethargy, and convulsions. Results : Atotal of 100 neonates with neonatal jaundice were included with 55% boys and 45 % girls whose mean age was 3.0 ± 0.95 days. Mean S.Bilirubin level before phototherapy was 13.92 ± 2.32 mg/dl which was reduced to 8.87 ± 2.18 mg/dl. S.Calcium levels pre-phototherapy were 8.66 ± 0.65 mg/dl which were reduced to 7.94 ± 1.05 mg/dl. It was found that 32% of the participants in total exhibited symptoms related to hypocalcemia. More term neonates (56.3%) experienced symptoms related to hypocalcemia compared to pre-terms (43.8%). Conclusion : It can be deduced that phototherapy induced hypocalcemia is a signicant concern and hence, neonates requiring phototherapy may be considered for calcium supplementation.

Effect of Addition of Probiotics to Standard Treatment on Neonatal Jaundice

2021 ◽  
Vol 17 (2) ◽  
pp. 199-203
Author(s):  
Tehreem Afzal ◽  
Naveed Butt ◽  
Shahzad Munir ◽  
Nazish Zia
Keyword(s):  
Bilirubin Level ◽  
Neonatal Jaundice ◽  
Standard Treatment ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Combination Group ◽  
Medical Institute ◽  
Significant Difference ◽  
The Mean ◽  
Time Required

Objective: To compare the mean change in the bilirubin levels with addition of probiotics to standard treatment for the management of neonatal jaundice. Methodology: The randomized controlled trial was undertaken at the Neonatal Intensive Care Unit of the Paediatrics Department, Federal Government Polyclinic (Post Graduate Medical Institute), Islamabad from 1st April to 30th September 2019.  Neonates with hyperbilirubinemia requiring phototherapy were randomly divided into two groups, each having 30 patients. Group A received probiotics along with phototherapy while group B received phototherapy alone. Primary outcome was serum total bilirubin, which was calculated on 0, 1 and 3 days of treatment. Duration of phototherapy and patient's outcome was also recorded. Data was analyzed statistically using SPSS v. 23. Results: The mean serum bilirubin level after 24 hours was 14.27 ± 4.35 mg/dl in combination group while 16.43 ± 4.36 mg/dl in phototherapy group (p > 0.05). After 48 hours, the mean serum bilirubin level was 12.37 ± 3.33 mg/dl in combination group while 14.09 ± 3.60 mg/dl in phototherapy group (p > 0.05). After 72 hours, the mean serum bilirubin level was 11.09 ± 2.87 mg/dl in combination group while 11.72 ± 2.96 mg/dl in phototherapy group (p > 0.05). The mean time required of blue light phototherapy was 43.47 ± 20.71 hours in combination group while 61.53 ±28.27 hours in phototherapy group (p < 0.05). All neonates were discharged. Conclusion: Addition of probiotics to standard treatment decreased the time required for the phototherapy in neonatal jaundice. However no statistically significant difference was seen in the bilirubin levels between the two groups.

Neonatal Jaundice—A Comparison between Intravenous Oxytocin and Oral Prostaglandin E2

1976 ◽  
Vol 4 (4) ◽  
pp. 241-246 ◽  
Author(s):  
D I Conway ◽  
M D Read ◽  
C Bauer ◽  
R H Martin
Keyword(s):  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Active Agent ◽  
Serum Bilirubin Level ◽  
Significant Rise ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Prostaglandin E ◽  
Total Serum Bilirubin Level ◽  
Spontaneous Onset

The total serum bilirubin levels at two and occasionally five days after birth were studied in 162 infants whose mothers received either intravenous oxytocin or oral Prostaglandin E2 during labour, and the results were compared with those obtained in forty-two control patients. Following labour of spontaneous onset, whether the mother received intravenous oxytocin or oral Prostaglandin E2, neonatal total serum bilirubin levels were not different from those in controls. After induction by amniotomy and an active agent, higher mean total serum bilirubin levels were found in infants whose mothers received intravenous oxytocin than in those given oral Prostaglandin E2; a significant rise in the total serum bilirubin level appeared to occur when mothers received a total of more than 12,000 milliunits of oxytocin or more than 4,000 milliunits per kg birthweight of the infant.

scholarly journals Learning from claims: hyperbilirubinaemia and kernicterus

2018 ◽  
Vol 104 (2) ◽  
pp. F202-F204 ◽  
Author(s):  
Janet M Rennie ◽  
Jeanette Beer ◽  
Michele Upton
Keyword(s):  
Cerebral Palsy ◽  
Bilirubin Level ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Sufficient Information ◽  
Haemolytic Disease ◽  
Total Cost ◽  
Abo Incompatibility ◽  
Extremely Preterm

We examined claims made against the National Health Service (NHS) involving neonatal jaundice in order to determine whether there were lessons that could be learnt from common themes.This was a retrospective anonymised study using information from the NHS Resolution database for 2001–2011.Twenty cases (16 males) had sufficient information for analysis. Fifteen had confirmed cerebral palsy and two young children had damage to the globus pallidus without confirmed CP. In three cases, the outcome was uncertain. Two were extremely preterm, five were born at 34–36 weeks’ gestation. Jaundice was typically present very early in life; in four cases, it was noted at less than 24hours of age, and in 14 cases, it was first noted on the second to third day. There was a lag between recognition and readmission, with a range of 26–102 hours. The peak serum bilirubin level was over 600 µmol/L in all the babies born at term. An underlying diagnosis was found in all but two; six had glucose-6-phosphatase deficiency (one also had Gilbert’s syndrome); five were diagnosed with ABO incompatibility; three with Rh haemolytic disease; one with spherocytosis and three preterm. The total cost of these claims by August 2017 was almost £150.5 million. This figure is likely to rise.These data show that, in the group who litigate, babies who develop kernicterus generally have an underlying diagnosis. We recommend adherence to theNational Institute for Health and Care Excellence guideline that recommends measuring the bilirubin level within 6 hours in all babies who are visibly jaundiced.

Prevalence and Etiology of Neonatal Jaundice in a Tertiary Care Hospital

2021 ◽  
Vol 18 (2) ◽  
pp. 35-38
Author(s):  
Niraj Acharya ◽  
Chandra Prasad Paneru
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
College Teaching ◽  
Total Serum ◽  
Common Cause ◽  
Medical College

Introduction: Neonatal jaundice is a major clinical condition worldwide occurring in upto 60% of term and 80% preterm newborn in the first week of life. Neonatal jaundice is defined as total serum bilirubin level above 7 mg/dl. Aims:  This study was done to find out the prevalence and etiology of neonatal jaundice in neonates admitted to Neonatal Intensive Care Unit (NICU) of Nepalgunj Medical College Teaching Hospital (NGMCTH) Kohalpur, Banke. Methods: It was a prospective cross sectional hospital based study conducted from November 2018 to November 2019 in Neonatal Intensive Care Unit of Nepalgunj Medical College Teaching Hospital. All neonates with clinical jaundice and hyperbilirubinemia with total serum bilirubin of ≥7 mg/dl were subjected to complete history taking, through physical examination and investigations. Results: Out of 892 neonates who developed clinical jaundice, 640 neonates whose parents gave consent were included in the study. The prevalence of neonatal jaundice was found to be 39.85% with male to female ratio of 1.79:1. In the present study pathological jaundice was seen in 74.94% whereas physiological jaundice in 23.66%. Among the various etiologies of pathological jaundice, neonatal sepsis (44.52%) was found to be the most common cause followed by ABO incompatibility (12.18%) and Rh incompatibility (7.03%). Conclusion: The prevalence of neonatal jaundice in present study was 39.85% and the most common cause was neonatal sepsis .The prevalence of jaundice was more in preterm than in term neonates. Neonatal jaundice is very common morbidity in NICU especially in preterm babies.

scholarly journals Frequency of Hyperbilirubinemia at 72 Hours of Life in Term Newborns with a High-Intermediate Risk Serum Bilirubin Level At 48 Hours of Life

2018 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Bilirubin Level ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Early Recognition ◽  
Serum Bilirubin Level ◽  
University Hospital ◽  
Total Serum ◽  
Intermediate Risk ◽  
Risk Zone ◽  
Term Newborns

Neonatal jaundice is common in newborns affecting over half (50-60%) of all babies in the first week of life. Severe jaundice can result into significant morbidity in the form of kernicterus. Early screening along with, quick treatment of neonatal jaundice helps to reduce the risk of developing severe hyperbilirubinemia, hence Kernicterus. There is strong evidence that screening newborns with hour-specific serum bilirubin level measurements can help in identifying risk of developing hyperbilirubinemia in newborns. There is insufficient data from developing countries regarding hyperbilirubinemia and newborns with and without underlying risk factors for hyperbilirubinemia. This cross sectional study will help the physician to anticipate and manage newborns with high-intermediate zone total serum bilirubin (TSB) and will also help to established specific management guideline for these newborns to prevent bilirubin induced neurological damage (BIND). All term newborns of either gender (fulfilling inclusion criteria) with TSB level at high-intermediate risk zone at 48 hours of life, born at Aga Khan University Hospital were included in this study. Their demographics were recorded in structured proforma. Results were collected and analyzed by SPSS software, version 20.0. A total of 173 newborns were enrolled. There was a female predilection 56.6% (n=98). One-third of the newborns having TSB in high-intermediate risk zone at 48 hours of life progressed to level of significant hyperbilirubinemia requiring treatment (31.2%; n=54). Those who required phototherapy had the mean rate of rise of 5.00 mg/dL/day (0.20 mg/dL/ hr). For future implementations we recommended that early recognition, monitoring and early treatment of neonatal hyperbilirubinemia may help in reducing morbidity. Neonates with high-intermediate risk serum bilirubin level should be followed at 24 hours intervel for assessment and possible treatment.

scholarly journals Validity of Bilirubin Measured by Biliscan (Smartphone Application) in Neonatal Jaundice – An Observational study

2021 ◽  
Vol 41 (1) ◽  
pp. 93-98
Author(s):  
Swapna Lingaldinna ◽  
Kalyan Chakravarthy Konda ◽  
Narahari Bapanpally ◽  
Madireddy Alimelu ◽  
Himabindu Singh ◽  
...  
Keyword(s):  
Observational Study ◽  
Neonatal Intensive Care ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Tertiary Care ◽  
Smartphone Application ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Non Invasive ◽  
Gestational Age At Birth

Introduction: Bilirubin is a frequently ordered investigation in neonatal intensive care units and out-patient practice during follow- up. The gold standard for its estimation is serum bilirubin which is invasive resulting in parenteral apprehension, pain, discomfort and iatrogenic anaemia in a neonate, while the non-invasive measurement by transcutaneous bilirubinometer is not available in all the centres because of its cost. Biliscan is a smartphone application that uses a phone’s inbuilt camera and a colour calibration card to detect neonatal jaundice. We compared bilirubin measured by Biliscan with reference to serum bilirubin among neonates admitted to a tertiary care centre. Methods: We conducted an observational study from June-2019 to September-2019 at a tertiary care centre in Hyderabad, India. Inborn neonates (greater than > 35 weeks gestational age at birth, and less than a week old) who required bilirubin estimation, underwent both invasive serum sampling and non-invasive estimation by Biliscan. Photograph of the baby’s chest was captured using the colour calibration card of the Biliscan application. Bilirubin values derived from the Biliscan application were compared to those derived from blood samples. Results: A total of 143 neonates were enrolled. The mean bilirubin value estimated by serum sampling was 11.9 g/dl against 13.1 g/dl of that derived from smartphone application. Biliscan and serum bilirubin showed moderate agreement with a correlation coefficient of 0.6. Bland- Altman plot constructed showed bias of 1.1 with the limits of agreement ranging from -3 to +5.3. Biliscan had a good sensitivity of 90% in identifying high levels of serum bilirubin (> 95th percentile on Bhutani nomogram). Conclusion: Biliscan application is a non-invasive, real-time, inexpensive and an easily available method that cannot replace serum bilirubin, however can complement and has the potential to help in screening neonates thus facilitating recognition of jaundice early and minimising the number of invasive pricks.

scholarly journals Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e048145
Author(s):  
Gary L Darmstadt ◽  
Davidson H Hamer ◽  
John B Carlin ◽  
Prakash M Jeena ◽  
Eduardo Mazzi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Sensitivity And Specificity ◽  
Low Income ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Observational Cohort Study ◽  
Visual Estimation ◽  
La Paz ◽  
Observational Cohort

ObjectiveDetermine the sensitivity and specificity of neonatal jaundice visual estimation by primary healthcare workers (PHWs) and physicians as predictors of hyperbilirubinaemia.DesignMulticentre observational cohort study.SettingHospitals in Chandigarh and Delhi, India; Dhaka, Bangladesh; Durban, South Africa; Kumasi, Ghana; La Paz, Bolivia.ParticipantsNeonates aged 1–20 days (n=2642) who presented to hospitals for evaluation of acute illness. Infants referred for any reason from another health facility or those needing immediate cardiopulmonary resuscitation were excluded.Outcome measuresInfants were evaluated for distribution (head, trunk, distal extremities) and degree (mild, moderate, severe) of jaundice by PHWs and physicians. Serum bilirubin level was determined for infants with jaundice, and analyses of sensitivity and specificity of visual estimations of jaundice used bilirubin thresholds of >260 µmol/L (need for phototherapy) and >340 µmol/L (need for emergency intervention in at-risk and preterm babies).Results1241 (47.0%) neonates had jaundice. High sensitivity for detecting neonates with serum bilirubin >340 µmol/L was found for ‘any jaundice of the distal extremities (palms or soles) OR deep jaundice of the trunk or head’ for both PHWs (89%–100%) and physicians (81%–100%) across study sites; specificity was more variable. ‘Any jaundice of the distal extremities’ identified by PHWs and physicians had sensitivity of 71%–100% and specificity of 55%–95%, excluding La Paz. For the bilirubin threshold >260 µmol/L, ‘any jaundice of the distal extremities OR deep jaundice of the trunk or head’ had the highest sensitivity across sites (PHWs: 58%–93%, physicians: 55%–98%).ConclusionsIn settings where serum bilirubin cannot be measured, neonates with any jaundice on the distal extremities should be referred to a hospital for evaluation and management, where delays in serum bilirubin measurement and appropriate treatment are anticipated following referral, the higher sensitivity sign, any jaundice on the distal extremities or deep jaundice of the trunk or head, may be preferred.

scholarly journals Transcutaneous billirubinometry to estimate total serum bilirubin in neonatal jaundice

2017 ◽  
Vol 57 (1) ◽  
pp. 8 ◽  
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.

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