scholarly journals Effect of phototherapy with alumunium foil reflectors on neonatal hyperbilirubinemia

2015 ◽  
Vol 55 (1) ◽  
pp. 18 ◽  
Author(s):  
Tony Ijong Dachlan ◽  
Tetty Yuniati ◽  
Abdurachman Sukadi
Keyword(s):  
Serum Bilirubin ◽  
Aluminum Foil ◽  
Neonatal Hyperbilirubinemia ◽  
Inclusion Criteria ◽  
Term Neonates ◽  
Bilirubin Encephalopathy ◽  
American Academy Of Pediatrics ◽  
Increased Risk ◽  
Common Problems ◽  
The Difference

Background Neonatal hyperbilirubinemia (NH) is one of the most common problems in neonates, but it can be treated with blue light phototherapy. Developing countries with limited medical equipment and funds have difficulty providing effective phototherapy to treat NH, leading to increased risk of bilirubin encephalopathy. Phototherapy with white reflecting curtains can decrease the duration of phototherapy needed to reduce bilirubin levels. Objective To compare the duration of phototherapy needed in neonates with NH who underwent phototherapy with and without aluminum foil reflectors. Methods This open clinical trial was conducted from July to August 2013 at Dr. Hasan Sadikin Hospital, Bandung, Indonesia. The inclusion criteria were term neonates with uncomplicated NH presenting in their first week of life. Subjects were randomized into two groups, those who received phototherapy with or without aluminum foil reflectors. Serum bilirubin is taken at 12th, 24th, 48th hours, then every 24 hours if needed until phototherapy can be stopped according to American Academy of Pediatrics guidelines. The outcome measured was the duration of phototherapy using survival analysis. The difference between the two groups was tested by Gehan method. Results Seventy newborns who fulfilled the inclusion criteria and had similar characteristics were randomized into two groups. The duration of phototherapy needed was significantly less in the group with aluminum foil reflectors than in the group without reflectors [72 vs. 96 hours, respectively, (P<0.01)]. Conclusion The required duration of phototherapy with aluminum foil reflectors is significantly less than that of phototherapy without reflectors, in neonates with NH.

scholarly journals Prediction of neonatal hyperbilirubinemia by cord blood analysis to diagnose subsequent hyperbilirubinemia

2019 ◽  
Vol 6 (4) ◽  
pp. 1658
Author(s):  
S. K. Mahammad Rafi ◽  
Vani Gandikota ◽  
Gangadhar B. Belavadi
Keyword(s):  
Cord Blood ◽  
Predictive Value ◽  
Serum Bilirubin ◽  
Blood Analysis ◽  
Neonatal Hyperbilirubinemia ◽  
Cord Blood Sample ◽  
Female Ratio ◽  
Term Neonates ◽  
Male Female Ratio ◽  
The Difference

Background: the study was aimed to determine the predictive value of cord bilirubin and 24th hour serum bilirubin levels in identifying newborn babies at risk of developing significant hyperbilirubinemia.Methods: A total 300 term neonates with a mean birth weight of 2.58±0.23 kg ranging from 1.92 kg-4.1kg were included in this study. Under strict aseptic precautions cord blood sample were collected from all newborns for analysis of serum bilirubin levels, and haemoglobin levels.Results: The incidence of significant hyperbilirubinemia in this study was 14%. Among jaundiced newborns sex ratio M/F:1.6:1(male female ratio 1.1:1). Mean Cord bilirubin levels in babies who subsequently developed hyperbilirubinemia was 2.798±0.5559 mg/dl and in others were 1.511±0.3260 mg/dl and the difference was statistically significant. There was a statistically significant correlation between cord bilirubin and neonatal jaundice. Cord bilirubin ≥2 mg/dl had good predictive value in identifying newborns who are likely to develop significant hyperbilirubinemia later.Conclusions: Babies with cord blood bilirubin ≥2 mg/dl can be followed up in the hospital for 5 days, the time of peak neonatal hyperbilirubinemia to prevent the babies discharged early and later readmission for neonatal hyperbilirubinemia.

scholarly journals A 6-Day-Old Newborn with Vomiting and Jaundice

2021 ◽  
Vol 6 ◽  
pp. 5-8
Author(s):  
Nkechi Okotcha ◽  
Abbie Biggers ◽  
Jonathan Martin ◽  
Raphael Mattamal
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Serum Bilirubin ◽  
Severe Form ◽  
Intestinal Malrotation ◽  
Term Neonates ◽  
Transcutaneous Bilirubin ◽  
Bilirubin Encephalopathy

Sixty percent of term neonates and 80% of preterms have jaundice within the first week of life. Jaundice can be pathologic or physiologic, indirect, or direct. Indirect jaundice can be neurotoxic at high levels. In its most severe form, this presents as acute bilirubin encephalopathy or kernicterus. Screening for jaundice using a transcutaneous bilirubin check or serum bilirubin has contributed tremendously to the reduction of kernicterus, which ranges from 0.5-1.3/100,000 births. Often, the etiology is easy to decipher. Otherwise, it may be complicated when there are several factors contributing. We present a case of a 6-day-old with jaundice and vomiting who was suffering from intestinal malrotation and a urinary tract infection.

scholarly journals Intestinal NCoR1, a regulator of epithelial cell maturation, controls neonatal hyperbilirubinemia

2017 ◽  
Vol 114 (8) ◽  
pp. E1432-E1440 ◽  
Author(s):  
Shujuan Chen ◽  
Wenqi Lu ◽  
Mei-Fei Yueh ◽  
Eva Rettenmeier ◽  
Miao Liu ◽  
...  
Keyword(s):  
Acid Metabolism ◽  
Serum Bilirubin ◽  
Neonatal Hyperbilirubinemia ◽  
Intestinal Epithelial ◽  
Targeted Deletion ◽  
Bilirubin Encephalopathy ◽  
Intestinal Maturation ◽  
Immunohistochemistry Analysis ◽  
Developmental Maturation ◽  
Target Activation

Severe neonatal hyperbilirubinemia (SNH) and the onset of bilirubin encephalopathy and kernicterus result in part from delayed expression of UDP-glucuronosyltransferase 1A1 (UGT1A1) and the inability to metabolize bilirubin. Although there is a good understanding of the early events after birth that lead to the rapid increase in serum bilirubin, the events that control delayed expression of UGT1A1 during development remain a mystery. HumanizedUGT1(hUGT1) mice develop SNH spontaneously, which is linked to repression of both liver and intestinal UGT1A1. In this study, we report that deletion of intestinal nuclear receptor corepressor 1 (NCoR1) completely diminishes hyperbilirubinemia inhUGT1neonates because of intestinalUGT1A1gene derepression. Transcriptomic studies and immunohistochemistry analysis demonstrate that NCoR1 plays a major role in repressing developmental maturation of the intestines. Derepression is marked by accelerated metabolic and oxidative phosphorylation, drug metabolism, fatty acid metabolism, and intestinal maturation, events that are controlled predominantly by H3K27 acetylation. The control of NCoR1 function and derepression is linked to IKKβ function, as validated inhUGT1mice with targeted deletion of intestinal IKKβ. Physiological events during neonatal development that target activation of an IKKβ/NCoR1 loop in intestinal epithelial cells lead to derepression of genes involved in intestinal maturation and bilirubin detoxification. These findings provide a mechanism of NCoR1 in intestinal homeostasis during development and provide a key link to those events that control developmental repression of UGT1A1 and hyperbilirubinemia.

scholarly journals Glucose-6-Phosphate Dehydrogenase (G6PD) Status in Neonatal Jaundice and its Relationship with Severity of Hyperbilirubinemia

1970 ◽  
Vol 4 (2) ◽  
pp. 71-76
Author(s):  
Nilufa Akhter ◽  
Noorzahan Begum ◽  
Waqar Ahmed Khan
Keyword(s):  
Bilirubin Level ◽  
G6pd Deficiency ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Total Serum ◽  
Control Group ◽  
Term Neonates ◽  
Group A ◽  
The Difference ◽  
Enzyme Deficient

Background: G6PD deficiency is one of the common inherited enzymatic disorder associated with high incidence of severe neonatal hyperbilirubinemia. Objectives: To observe G6PD status in male, term neonates with jaundice and its correlation with serum level of bilirubin. Methods: This cross sectional study was conducted on 90 male, term neonates with jaundice, age ranged from 3 to 12 days (Group B) in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU) between July 2007 to June 2008. On the basis of total serum bilirubin (TSB) level, study group was further divided into B1(TSB <15mg/dl), B2(TSB 15-20mg/dl) and B3 (TSB>20mg/dl). For comparison age and sex matched 30 apparently healthy neonates (Group A) were also included in the study. Erythrocyte G6PD level was measured by Spectrophotometric method by using kit of Randox. Serum bilirubin level was measured by standard laboratory technique. For statistical analysis ANOVA, independent sample "t" test and Pearson's correlation coefficient test were performed as applicable by using SPSS windows version-12. Results: In this study, erythrocyte G6PD levels were significantly lower in moderate (p<0.01) and severe (p<0.001) hyperbilirubinemic group in comparison to that of control group . However, this enzyme level was lower in mild group compared to that of control but the difference was statistically non significant. Again, this enzyme levels were significantly lower in moderate (p<0.05) and severe (p<0.01) group than that of mild group and also between severe and moderate hyperbilirubinemic group (p<0.05). In this study, G6PD enzyme deficient were found in 1(3.33%) and 6(20%) subjects of group B2 and B3 respectively. Though, percentage of the subjects with enzyme deficiency were higher in severe group ( B3 ) compared to that of moderate group( B2 ) but the difference was statistically not significant. However, no enzyme deficient patient were found in control group (A) and mild hyperbilirubinemic group (B1). Serum bilirubin level showed significant (p<0.05) positive (r=+.429) correlation with erythrocyte G6PD level in control group (A). On the other hand, this level was negatively correlated with G6PD enzyme in groups B1 (r= -.127), B2 (r=-.120) and B3 ( r= -.671) but significant negative correlation in group B3 (p<0.01). Conclusion: The results of the study revealed that severity of hyperbilirubinemia depends on degree of G6PD deficiency. Therefore, early detection of this enzymopathy and close surveillance of the affected neonates may be important in reducing the complications of severe hyperbilirubinemia. Key words: Glucose-6-PD, Hyperbilirubinemia, Neonates DOI: 10.3329/jbsp.v4i2.4176 J Bangladesh Soc Physiol. 2009 Dec;4(2): 71-76  

Revisiting ABO incompatibility as a risk factor for significant neonatal hyperbilirubinemia

2019 ◽  
Vol 49 (3) ◽  
pp. 201-204
Author(s):  
Ritika Khurana ◽  
Prerna Batra ◽  
MMA Faridi ◽  
Nirupama Khan
Keyword(s):  
Serum Bilirubin ◽  
Reticulocyte Count ◽  
Primary Objective ◽  
Term Neonates ◽  
Prolonged Hospitalisation ◽  
Abo Incompatibility ◽  
Increased Risk ◽  
Group A ◽  
The Mean ◽  
Prolonged Hospital

Babies with ABO incompatibility are often advised frequent biochemical screening and prolonged hospital stay. Our primary objective of the study was to compare serum bilirubin levels at 48 h and 96 h of age in neonates with and without ABO incompatibility. Our prospective study included neonates with gestation ≥ 34 weeks, with or without ABO incompatibility (92 in each group). A direct Coombs test was performed on cord blood. The mean serum bilirubin and haematocrit levels in both groups at 48 h and 96 h were comparable. The mean reticulocyte count of babies with ABO incompatibility was, however, significantly higher. Late preterm and term neonates with and without ABO incompatibility have similar bilirubin levels and no increased risk of significant hyperbilirubinemia. Prolonged hospitalisation of these neonates appears to be unnecessary.

scholarly journals Adverse Events of Exchange Transfusion in Neonatal Hyperbilirubinemia

2014 ◽  
Vol 34 (1) ◽  
pp. 7-13 ◽  
Author(s):  
M Chitlangia ◽  
GS Shah ◽  
P Poudel ◽  
OP Mishra
Keyword(s):  
Adverse Events ◽  
Respiratory Distress ◽  
Exchange Transfusion ◽  
Serum Bilirubin ◽  
Tertiary Care ◽  
Neonatal Hyperbilirubinemia ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Bilirubin Encephalopathy ◽  
The Common

Introduction: Jaundice is an important problem during neonatal period. When total serum bilirubin (TSB) level exceeds a critical limit, it crosses the blood brain barrier and results into bilirubin encephalopathy. The main aim of therapy for neonatal hyperbilirubinemia is prevention of bilirubin encephalopathy by phototherapy and/or exchange transfusion. The aims of this study were to evaluate the efficacy of exchange transfusion (ET) and observe the adverse events during and following three days of ET in neonates with hyperbilirubinemia. Materials and Method: Hospital based cross-sectional descriptive study. All neonates admitted to neonatal intensive care unit and /or paediatric wards of a tertiary- care centre between September 2010 to March 2012, requiring ET were enrolled. Results: A total of 139 ETs were performed in 120 neonates. The common causes were ABO incompatibility (30.8%), prematurity (30.8%), idiopathic (27.5%), Rh isoimmunization (6.7%) and cephalhematoma (4.2%). Mean pre- ET total serum bilirubin (TSB) was 24.2 mg% dL. There was 58% reduction in TSB in post ET and 31% net reduction in 6 hr post ET. Term and preterm neonates showed equal percentage of TSB reduction. Respiratory distress (10.8%) and bradycardia (6.7%) were the common adverse events during, and hypocalcemia (98.3%) and thrombocytopenia (34.2%) in 3 days following ET. The sick neonates had significantly higher incidence of thrombocytopenia (p= 0.031), respiratory distress (p=0.009), apnea (p<0.001) and cardiorespiratory arrest (p<0.001). Overall mortality was 4.2%, and non-survivors were mostly low birth weight, born outside the present hospital and had higher incidence of adverse events. Conclusion: Exchange transfusion is an effective intervention in reducing the serum bilirubin level. However, these neonates require monitoring of ionised calcium and thrombocytopenia. Sick neonates had higher incidence of adverse events than healthy and close clinical monitoring is needed to improve the outcome. DOI: http://dx.doi.org/10.3126/jnps.v34i1.9030   J Nepal Paediatr Soc 2014;34(1):7-13

scholarly journals Outcome of Neonatal Hyperbilirubinemia from a Tertiary Care Hospital in Eastern Nepal: A Cross-sectional Study

2021 ◽  
Vol 4 (1) ◽  
pp. 37-42
Author(s):  
Shyam Prasad Kafle ◽  
Mukesh Bhatta ◽  
Ramesh Shrestha ◽  
Sarita Sitaula ◽  
Namu Koirala ◽  
...  
Keyword(s):  
Exchange Transfusion ◽  
Serum Bilirubin ◽  
Cross Sectional Study ◽  
Neonatal Hyperbilirubinemia ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Sectional Study ◽  
Cross Sectional ◽  
Bilirubin Encephalopathy ◽  
Poor Outcome

Background: Timely detection and treatment of pathological hyperbilirubinemia in newbornscan prevent acute bilirubin encephalopathy and its consequences. We aimed to identifyitsoccurrence, presentationtime, phototherapyduration, need for exchange transfusion,and outcome. Methods: In this cross-sectional study, we enrolled all the babies admitted for pathological neonatal hyperbilirubinemia in the university hospital ofBPKIHSin a one-yearduration. Babies with life-threatening congenital malformations or conjugated bilirubin >20% of total serum bilirubin or >2 mg/dl were excluded. Obstetric profile of mothers, clinical and laboratory parameters of babies, onset time of pathological jaundice, duration of phototherapy, need for exchange transfusion or intravenous immunoglobulin were recorded. Neonatal outcome was classified as good and poor and its association with potential predictors analyzed.  Results: One-hundred and fifty babiesdeveloped neonatal jaundice requiring treatment. The most common causes includedABO and Rh setting. No cause was found in 26 (18%) babies. One-hundred and eight babies (72%) were only managed withphototherapy whereas 42 (28%) required both phototherapy and double volume exchange therapy. The majority (84.5%) had good outcome without any residual neurological deficit at discharge.Babies with total serum bilirubin >20 mg/dl at presentation, duration of phototherapy >44.8 h, ABO setting, hemolysis, and out born statussignificantly developed poor outcome (p < 0.05). Conclusion: About 15% of the babies with hyperbilirubinemia had acute bilirubin encephalopathy at discharge suggestive of poor outcome. Babies with high bilirubin at presentation, longer duration of phototherapy, ABO settings, hemolysis, and out born statusdeveloped poor outcome.

Ultrasonographic Change in Uterocervical Angle is not a Risk Factor for Preterm Birth in Women with a Short Cervix

2017 ◽  
Vol 34 (11) ◽  
pp. 1058-1064 ◽  
Author(s):  
Kam Szlachetka ◽  
Neil Seligman ◽  
Tara Lynch
Keyword(s):  
Risk Factor ◽  
Retrospective Study ◽  
Preterm Birth ◽  
Primary Outcome ◽  
Cervical Length ◽  
Inclusion Criteria ◽  
Short Cervix ◽  
Increased Risk ◽  
The Difference ◽  
Singleton Pregnancies

Objective To determine if change in uterocervical angle (UCA) is associated with an increased rate of preterm birth (less than 37 weeks) for women with a short cervix. Study Design A retrospective study was performed from January 2013 to March 2016 of singleton pregnancies undergoing universal cervical length screening. The difference between the UCA for the first cervical length ≤ 2.5 cm and last recorded cervical length < 25 weeks was defined as the change in UCA. The primary outcome was the rate of preterm birth at < 37 weeks of gestation. Results A total of 176 women met the inclusion criteria. There was no difference in the rate of preterm birth at < 34 weeks (23.3 vs. 16.7%, p = 0.27) or at < 37 weeks (34.9 vs. 37.8%, p = 0.69) based on a change in UCA (i.e., decreased/no change or increased UCA). However, women with a final UCA ≥105 degrees had an increased risk of preterm birth at less than 34 weeks (24.2 vs. 6.8%, p = 0.01). Conclusion A change in UCA was not associated with an increased risk of preterm birth. Instead, a final absolute UCA ≥ 105 degrees measured < 25 weeks was associated with an increased risk of preterm birth at < 34 weeks of gestation for women with a short cervix ≤ 2.5 cm.

scholarly journals Utility of cord blood bilirubin as a predictors of significant neonatal Hyperbilirubinemia in healthy term neonate

2019 ◽  
Vol 6 (5) ◽  
pp. 2058
Author(s):  
Rajkumar M. Meshram ◽  
Saira Merchant ◽  
Swapnil D. Bhongade ◽  
Sartajbegam N. Pathan
Keyword(s):  
Positive Predictive Value ◽  
Cord Blood ◽  
Negative Predictive Value ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Serum Bilirubin ◽  
Mode Of Delivery ◽  
Neonatal Hyperbilirubinemia ◽  
Term Neonates

Background: Clinical jaundice is evident in more than two-third neonates in their early neonatal life. Early identification of neonates at risk might allow early intervention and prevent complication. Objective of the study was to assess the cord blood bilirubin level as a tool to screen the risk of development of subsequent significant neonatal hyperbilirubinemia in term neonates.Methods: A prospective observational study was conducted over a period of 2 years on 1040 healthy term neonates. Demographic profile, relevant maternal and neonatal information were recorded. Measurement of cord blood bilirubin, blood group/Rh typing and serum bilirubin at the end of 24 & 72 hours was done to predict significant hyperbilirubinemia.Results: Incidence of significant hyperbilirubinemia was 11.53%. Gender, gestational age, mode of delivery and birth weight had no correlation with development of significant jaundice. 800 (76.93%) neonates had cord blood bilirubin level ≤3.0mg/dl and 240 (23.07%) neonate had cord blood bilirubin level >3.0mg/dl. Out of 240 (23.07%) neonates with higher cord bilirubin (>3.0 mg/dl), 108 (45%) had significant hyperbilirubinemia at the end of 24 hours with sensitivity 90.00%, specificity 85.65%, positive predictive value 45.00% and negative predictive value 98.50% while 110 (45.83%) neonates were observed with serum bilirubin >17mg/dl at the end of 72 hours with cord blood bilirubin >3mg/dl with sensitivity 91.67%, specificity 84.52% positive predictive value 45.83% and negative predictive value-98.61% and this difference was statistically significant.Conclusions: Neonates with cord blood bilirubin level ≤3mg/dl can be safely discharged early whereas neonates with bilirubin >3mg/dl will need close follow up to check for development of subsequent significant jaundice. Hence cord blood bilirubin levels help to determine and predict the possibility of significant jaundice among healthy term neonates.

scholarly journals A Nanoceutical Agent for Chemoprevention of Bilirubin Encephalopathy

2021 ◽  
Author(s):  
Aniruddha Adhikari ◽  
Vinod K Bhutani ◽  
Susmita Mondal ◽  
Monojit Das ◽  
Soumendra Darbar ◽  
...  
Keyword(s):  
Serum Bilirubin ◽  
Mixed Valence ◽  
Newborn Infants ◽  
Neonatal Hyperbilirubinemia ◽  
Pharmacokinetic Data ◽  
List Type ◽  
Valence Transition ◽  
Bilirubin Encephalopathy ◽  
Sustainable Action

ABSTRACTBackgroundTargeted degradation of bilirubin in vivo may enable safer and more effective approach to manage incipient bilirubin encephalopathy consequent to severe neonatal hyperbilirubinemia (SNH). This report builds on the use of a spinel structured mixed-valence transition metal oxide (trimanganese tetroxide) nanoparticle duly functionalized with biocompatible ligand citrate (C-Mn3O4 NP) having the ability to degrade bilirubin without photo-activation.MethodThe efficiency of C-Mn3O4 NP in in vivo degradation of serum bilirubin and amelioration of severe bilirubin encephalopathy and associated neurobehavioral changes was evaluated in C57BL/6j animal model of SNH.ResultsOral single dose (0.25 mg kg-1 body weight) of the NPs efficiently reduced serum bilirubin levels (both conjugated and unconjugated) in study mice. It prevents bilirubin-induced neurotoxicity with reduction of SNH as observed by neurobehavioral and movement studies of SNH-mice. Pharmacokinetic data suggests intestinal reabsorption of the NPs and explain sustainable action. Biodistribution, pharmacokinetics, and biocompatibility of the NPs were tested during sub-chronic exposure.ConclusionThus, we report preliminary studies that explore an affordable chemoprevention mechanism to acutely prevent or minimize bilirubin neurotoxicity in newborn infants.IMPACT STATEMENTDespite several attempts, no pharmaco-therapeutics are available for the treatment of severe neonatal hyperbilirubinemia (SNH) and associated neurotoxicity.Our newly developed nanodrug, citrate functionalized Mn3O4 nanoparticles (C-Mn3O4 NPs), can efficiently ameliorate SNH and associated neurotoxicity as investigated in preclinical rodent model.Chemoprevention effect of the nanodrug is found to be safe and sustainable.If successfully translated into clinical trials, C-Mn3O4 NPs could become the first drug to treat SNH.

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