Effectiveness of phototherapy with reflecting curtains on neonatal jaundice

Background Although phototherapy has been used in clinical practice for 40 years, there is still much debate on how to provide the most efficacious phototherapy. Phototherapy with white reflecting curtains may increase the average spectral irradiance provided, as well as decrease serum bilirubin concentrations at a faster rate in neonates with jaundice.Objective To determine if adding low cost, white, reflecting curtains to a standard phototherapy unit can increase the effectiveness of phototherapy for neonatal jaundice.Methods A randomized, controlled, open trial was conducted at H. Adam Malik and Pirngadi Hospitals, Medan, from May to December 2009. The criteria for inclusion in the study were full term newborns with neonatal jaundice presenting in their first week of life. Single phototherapy with white curtains hanging from the sides of the phototherapy unit (study group, n=30) was compared to single phototherapy without curtains (control group, n=30). The primary outcomes measured were the mean difference in total serum bilirubin levels and average spectral irradiation levels measured at baseline, and after 12 hours and 24 hours of phototherapy.Results The sum of average spectral irradiance in the curtained phototherapy unit was significantly higher than that of the standard phototherapy unit without curtains (P < 0.05). The decrease of total serum bilirubin levels after 12 and 24 hours of phototherapy was significantly greater in the study group (3.71 and 9.7 mg/dl, respectively) than in the control group (0.1 and 3.8 mg/dl, respectively), both P <0.05.Conclusion White, reflecting curtains in phototherapy units was significantly more effective than phototherapy without curtains for treatment of neonatal jaundice. [Paediatr Indones. 2011;51:256-61].

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Effectiveness of single and double phototherapy on indirect hyperbilirubinemia in neonates

Paediatrica Indonesiana ◽

10.14238/pi51.6.2011.316-21 ◽

2011 ◽

Vol 51 (6) ◽

pp. 316 ◽

Cited By ~ 1

Author(s):

Nanda Susanti Milyana ◽

Guslihan Dasa Tjipta ◽

Muhammad Ali ◽

Emil Azlin ◽

Bugis Mardina Lubis ◽

...

Keyword(s):

Neonatal Jaundice ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Controlled Trial ◽

Spectral Irradiance ◽

Bilirubin Concentration ◽

Randomized Controlled ◽

Significant Difference ◽

Term Newborns ◽

The Mean

Background Hyperbilirubinemia is a common problem in full term newborns and phototherapy is the most widespread treatment for lowering bilirubin concentration in neonates. Double phototherapy could increase the effectiveness of treatment.Objective To compare the effectiveness of single and double phototherapy and increasing spectral irradiance for decreasing serum bilirubin levels in neonates for indirect hyperbilirubinemia.Methods An open, randomized, controlled trial was conducted at H. Adam Malik and Pirngadi Hospitals, Medan, from May to December 2009. Subjects were divided into two groups, those who received single phototherapy (n=30) and those who received double phototherapy (n=30) treatments. We included term newborns with neonatal jaundice in the first week of life. Serum bilirubin and average spectral irradiation levels were measured at baseline and after 12 hours and 24 hours of phototherapy treatment.Results The mean total bilirubin levels of the single and double phototherapy groups at the beginning of therapy were 17.6 mg/dL (SD1.41) and 17.5 mg/dL (SD 1.32), respectively, with no significant difference between values. During the study period the sum of average spectral irradiance by double phototherapy was significantly higher than that of single phototherapy (P < 0.05). A significantly greater decrease in bilirubin levels was observed in the double phototherapy group at 12 hours and 24 hours of phototherapy compared to the single phototherapy group (P = 0.001).Conclusion Double phototherapy is more effective than single phototherapy in reducing bilirubin levels in jaundiced newborns.

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Urinary N-Acetyl-beta-D-glucosaminidase as an Early Marker for Acute Kidney Injury in Full-Term Newborns with Neonatal Hyperbilirubinemia

Disease Markers ◽

10.1155/2014/315843 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Bangning Cheng ◽

Yulian Jin ◽

Guanghui Liu ◽

Zhiheng Chen ◽

Hongmei Dai ◽

...

Keyword(s):

Acute Kidney Injury ◽

Serum Bilirubin ◽

Kidney Injury ◽

Full Term ◽

Total Serum Bilirubin ◽

Total Serum ◽

Control Group ◽

Term Newborns ◽

Group 3 ◽

Group 2

Purpose. To investigate renal function estimated by markers in full-term newborns with hyperbilirubinemia.Methods. A total of 332 full-term newborns with hyperbilirubinemia and 60 healthy full-term newborns were enrolled. Total serum bilirubin, serum creatinine (Cr), serum blood urea nitrogen (BUN), serum cystatin C (Cys-C), urinary beta-2-microglobulin (β2MG) index, and urinary N-acetyl-beta-D-glucosaminidase (NAG) index were measured before and after treatment. All newborns were divided into three groups according to total serum bilirubin levels: group 1 (221-256), group 2 (256-342), and group 3 (>342).Results. The control group and group 1 did not differ significantly in regard to serum Cr, serum BUN, serum Cys-C, urinaryβ2MG index, and urinary NAG index. Urinary NAG index in group 2 was significantly higher than that in control group (P<0.001). Between control group and group 3, serum Cys-C, urinaryβ2MG index, and urinary NAG index differed significantly. The significant positive correlation between total serum bilirubin and urinary NAG index was found in newborns when total serum bilirubin level was more than 272 μmol/L.Conclusions. High unconjugated bilirubin could result in acute kidney injury in full-term newborns. Urinary NAG might be the suitable marker for predicting acute kidney injury in full-term newborns with hyperbilirubinemia.

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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.

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Efficacy and Safety of Fenofibrate in Uncomplicated Hyperbilirubinemia in Newborn: A Randomized Trial, with a 6-month Follow-up

Asian Journal of Pediatric Research ◽

10.9734/ajpr/2020/v4i230147 ◽

2020 ◽

pp. 37-42

Author(s):

Jayendra R. Gohil ◽

Vishal S. Rathod ◽

Bhoomika D. Rathod

Keyword(s):

Single Dose ◽

Serum Bilirubin ◽

Total Serum Bilirubin ◽

Total Serum ◽

Control Group ◽

Term Neonates ◽

Significant Difference ◽

Group A ◽

Group B

Objective: To study the effect and safety of Fenofibrate in uncomplicated hyperbilirubinemia in newborn with 6-month follow-up. Materials and Methods: This is a randomized controlled clinical trial conducted in 60 normal term neonates admitted for uncomplicated hyperbilirubinemia in NICU at Sir T G Hospital, Bhavnagar from January 2012 to December 2012. The data included: age, sex, total serum bilirubin (TSB), weight and duration of phototherapy. All neonates enrolled in the study received phototherapy. They were divided in two groups of 30 each: control group A and group B receiving Fenofibrate (100 mg/kg single dose). There was statistically insignificant difference between the parameters of age, sex, weight and TSB between the two groups at hospitalization. Data was analyzed by using appropriate statistical methods. Results: Mean values for total serum bilirubin in Fenofibrate group B at 24 and 48 hours after admission were significantly lower than those for control group A (p<0.0001, p=0.0001). There was no significant difference in fall of TSB between 24 and 48 hours. The mean duration of phototherapy in Fenofibrate group (44.8h: 24-72h) was significantly shorter than that in control group (55.2 h: 24‐96 h) (P=0.02). There were no side effects of the drug observed during the study and during 6 months follow up period. Conclusion: Fenofibrate as a single 100 mg/kg dose in healthy full term neonates, is effective and a safe drug (till six-month follow-up) for neonatal hyperbilirubinemia, that can decrease the time needed for phototherapy and hence hospitalization. Effect of a single dose seems to wane after 24 hours.

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A Comparison between Transcutaneous and Total Serum Bilirubin in Healthy-term Greek Neonates with Clinical Jaundice

Prague Medical Report ◽

10.14712/23362936.2014.4 ◽

2014 ◽

Vol 115 (1-2) ◽

pp. 33-42 ◽

Cited By ~ 3

Author(s):

Charalambos Neocleous ◽

Alkistis Adramerina ◽

Stefanos Limnaios ◽

Symeon Symeonidis ◽

Chrysoula Spanou ◽

...

Keyword(s):

Serum Bilirubin ◽

Serum Bilirubin Level ◽

Total Serum Bilirubin ◽

Care Plan ◽

Total Serum ◽

Limited Data ◽

Transcutaneous Bilirubin ◽

Appropriate Care ◽

The Mean ◽

Level Of Agreement

The accuracy of transcutaneous bilirubin meters has been assessed in newborns from various ethnic backgrounds. However, there are limited data on Greek newborns. Our study examined the accuracy of transcutaneous bilirubin measurements in clinically jaundiced healthy-term Greek newborns, using total serum bilirubin as the reference standard, in order to re-evaluate our local guidelines about neonatal jaundice. Clinically jaundiced newborns requiring total serum bilirubin level estimation were recruited prospectively. 368 pairs of total serum bilirubin/transcutaneous bilirubin measurements were taken in 222 newborns, using a direct spectrophotometric device and the BiliCheck device, respectively. The level of agreement between the obtained transcutaneous bilirubin and total serum bilirubin values was assessed. Our data were analysed using the Stata/SE 12.0 (StataCorp LP, USA) statistical programme. The mean (± SD) TSB was 225.4 ± 25.4 μmol/l and the mean (± SD) TcB was 237.9 ± 21.0 μmol/l. The correlation between the values was poor (Pearson’s correlation coefficient 0.439; Lin’s concordance coefficient 0.377 [95% CI 0.301 to 0.453]; P<0.001). The Bland-Altman analysis demonstrated that transcutaneous bilirubin measurements tended to overestimate the total serum bilirubin value (mean difference 12.5 ± 24.9 μmol/l), with wide 95% limits of agreement (–36.2 μmol/l to 61.3 μmol/l). Transcutaneous bilirubin values did not correlate well with total serum bilirubin values, being often imprecise in predicting the actual total serum bilirubin levels. This permits us to continue estimating total serum bilirubin in clinically jaundiced newborns according to our local guidelines, in order to safely decide the appropriate care plan.

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Transcutaneous Bilirubin Measurements Can Be Used to Measure Bilirubin Levels during Phototherapy

International Journal of Pediatrics ◽

10.1155/2018/4856390 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Saad Abdullah Alsaedi

Keyword(s):

Prospective Observational Study ◽

Serum Bilirubin ◽

Linear Regression Analysis ◽

Mean Difference ◽

Total Serum ◽

Term Infants ◽

Transcutaneous Bilirubin ◽

Term Newborns ◽

The Mean ◽

Mean Differences

Objective. To determine whether transcutaneous bilirubin measurements (TcB) before and during phototherapy taken from covered skin during phototherapy correlate with total serum bilirubin (TSB) levels.Study Design. In this prospective observational study, healthy term newborns who required TSB measurements were included. TcB measurements were taken from the forehead before starting and during phototherapy using the BiliChek device. Before starting phototherapy, part of the forehead was covered. Blood for TSB measurement was collected within 5 minutes of TcB measurements. Correlations and mean differences between TcB and TSB before and during phototherapy were calculated.Result. Paired TSB and TcB measurements before and during phototherapy in 151 newborns were performed. The mean gestational age was 38.8 weeks and birth weight was 3.1 kg; 53% were male. Before starting phototherapy, TSB and TcB were183.8±41.6and 190.5 ± 43 μmol/l, respectively. During phototherapy, TSB and TcB were191.8±39.4and187.8±45.3 μmol/l, respectively. Linear regression analysis showed a significant correlation between TcB and TSB before starting phototherapy and during phototherapy (r: 0.85;p<0.001andr: 80.0;p<0.001), respectively. Before starting phototherapy, the mean difference between TSB and TcB was6.2±23.2 μmol/l, with a 95% CI of −39.3 to 51.7 μmol. During phototherapy, the mean difference was −2.8±23.5 μmol/l, with a 95% CI of −48.9 to 43.3 μmol/l.Conclusion. TcB measurements from covered skin in jaundiced term infants during phototherapy correlate with TSB and can be used to monitor bilirubin levels during phototherapy.

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Efficacy of prophylactic phototherapy for prevention of hyperbilirubinemia in very low birth weight newborns

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v6i2.29132 ◽

2016 ◽

Vol 6 (2) ◽

pp. 151

Author(s):

M. A. Mannan ◽

Ismat Jahan ◽

Sadeka Choudhury Moni ◽

Zahidul Hasan ◽

Arjun Chandra Dey ◽

...

Keyword(s):

Clinical Trial ◽

Birth Weight ◽

Exchange Transfusion ◽

Serum Bilirubin ◽

Serum Bilirubin Level ◽

Total Serum Bilirubin ◽

Total Serum ◽

Control Group ◽

P Value ◽

Unconjugated Hyperbilirubinemia

Background: Jaundice is a common clinical condition in newborn occurring in approximately 60% of term and 80% of preterm infants. Unconjugated hyperbilirubinemia is universally common in all preterm infants especially in newborns with very low biLth weight. Low birth weight and premature infants are at major risk for exaggerated hyperbilirubinemia that can lead to bilirubin encephalopathy. Significant heterogeneity in the approach to the treatment of jaundiced neonates exists throughout the world. Phototherapy is the most common treatment for neonatal hyperbilirubinemia and could be most effective in preventing the sequelae of hyperbilirubinemia if initiated prophylactically. This randomized clinical trial has been proposed with the objective of assessing the efficacy of prophylactic photo therapy in preventing significant rise of unconjugated hyperbilirubinemia in premature neonates weighing less than 1500 gram and therefore to decrease the need for exchange transfusion and finally to reduce hospital stay due to hyperbilirubinemia. Methods: This randomized controlled clinical trial enrolled sixty newborns with birth weight less than 1500 gram. They were divided into two groups: 1) Prophylactic group, in whom phototherapy was started within 24 hours of birth and continued for 7 days and 2) Control group in whom therapeutic phototherapy was started considering serum bilirubin level and other clinical conditions as per institutional guidelines. Mean value of total serum bilirubin (TSB), duration of phototherapy, the need for exchange transfusion and duration of hospital stay in both groups were analyzed.Results: The maximum mean TSB level in prophylactic group was observed on 7th day and in control group it was observed on 3rd day of life. The total serum bilirubin levels were significantly lower in the 3rd and 5th days of life in the prophylactic group in comparison to control group (P value 0.001). Total serum bilirubin level exceeded therapeutic range in 6 (21 %) and 14 (50 %) newborns of the prophylactic group and control groups respectively (P value 0.026). No documented side effects of prophylactic phototherapy was observed. Conclusion: The use of prophylactic photo therapy for infants weighing less than 1500 grn is effective and sate when compared to the control group, considering satisfactory maintenance of low total serum bilimbin levels during first 7 days of life.

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Might Bilirubin Serve as a Natural Antioxidant in Response to Neonatal Encephalopathy?

American Journal of Perinatology ◽

10.1055/s-0038-1641746 ◽

2018 ◽

Vol 35 (11) ◽

pp. 1107-1112 ◽

Cited By ~ 4

Author(s):

Alona Bin-Nun ◽

Francis Mimouni ◽

Yair Kasirer ◽

Irina Schors ◽

Michael Schimmel ◽

...

Keyword(s):

Oxidative Stress ◽

Hepatic Injury ◽

Serum Bilirubin ◽

Area Under The Curve ◽

Total Serum ◽

Control Group ◽

Neonatal Encephalopathy ◽

Term Neonates ◽

Serial Serum ◽

The Mean

Background Neonatal asphyxia is often associated with hepatic injury. We hypothesized that this might lead to increased bilirubin concentrations. Study Design Term neonates admitted between January 2015 and April 2017 who remained hospitalized for ≥ 4 days and who had serial serum bilirubin concentrations recorded were divided into those with neonatal encephalopathy (NE) and controls. Serial serum bilirubin concentrations during the first days of life were compared between groups. Results Twenty-nine neonates with NE and 84 age-matched controls were identified. Mean total serum bilirubin concentrations of NE babies were significantly lower than those controls throughout the first days of life. At 96 hours of age, NE serum bilirubin concentrations were 4.5 (3.2, 5.8) versus controls of 10.5 (9.4, 11.5) mg/dL (p < 0.0001). The mean area under the curve (AUC) for the NE group was 268 (215, 321) versus 663 (608, 718), p < 0.0001, for the control group. All of the NE babies remained below the 40th percentile of the Bhutani curve and none required phototherapy. Conclusion Contrary to our hypothesis, bilirubin concentrations in NE infants are significantly lower than expected during the first 4 days postnatally. We speculate that, under conditions of severe oxidative stress, bilirubin is consumed as an antioxidant.

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

Journal of International Medical Research ◽

10.1177/030006057600400406 ◽

1976 ◽

Vol 4 (4) ◽

pp. 241-246 ◽

Cited By ~ 3

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.

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Assessing knowledge and skills of maternity care professionals regarding neonatal hyperbilirubinaemia: a nationwide survey

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03463-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Berthe A. M. van der Geest ◽

Imke M. Theeuwen ◽

Irwin K. M. Reiss ◽

Eric A. P. Steegers ◽

Jasper V. Been

Keyword(s):

Maternity Care ◽

Neonatal Jaundice ◽

Serum Bilirubin ◽

Training Session ◽

Nationwide Survey ◽

Total Serum Bilirubin ◽

Skin Colour ◽

Total Serum ◽

Knowledge And Skills ◽

E Learning

Abstract Background Neonatal hyperbilirubinaemia is a physiologic phenomenon, but, when severe, may cause lifelong disability. Maternity care assistants (MCAs) play an important role in timely recognition of severe neonatal jaundice. We assessed knowledge and skills of MCAs regarding neonatal hyperbilirubinaemia. Methods All Dutch MCAs (n = 9065) were invited to fill out a questionnaire assessing knowledge, expertise, and handling of neonatal jaundice. Additionally, we developed an e-learning and provided training sessions to a subgroup of MCAs (n = 99), and assessed their knowledge on neonatal hyperbilirubinaemia before and after the training. Results One thousand four hundred sixty-five unique online questionnaires were completed (response 16.2%). The median number of correctly answered knowledge questions was 5 (out of six; IQR 1). Knowledge was significantly better when respondents had had in-service training on neonatal hyperbilirubinaemia in the previous year (p = 0.024). Although 82% of respondents felt highly skilled or skilled to assess jaundice, accuracy of estimation of total serum bilirubin levels by assessing skin colour was generally poor and prone to underestimation. Among participants attending a training session, those who completed the e-learning beforehand had higher pre-training scores (5 (IQR 1) vs. 4 (IQR 2); p < 0.001). The median post-training score was higher than pre-training (6 (IQR 1) vs. 5 (IQR 2); p < 0.001). Conclusions Background knowledge of MCAs regarding neonatal hyperbilirubinaemia was adequate, but can be improved by further training. Estimation of total serum bilirubin levels based on skin colour was often inadequate. Approaches to improve timely recognition of jaundiced neonates are needed.

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