The Issues of Hyperbilirubinemia

PEDIATRICS ◽  
1995 ◽  
Vol 96 (3) ◽  
pp. 543-543
Author(s):  
Daniel S. Seidman ◽  
David K. Stevenson

"Tis with our judgments as our watches, none go just alike, yet each believes his own." Alexander Pope An Essay on Criticism, 1711. The practice parameter published recently by the American Academy of Pediatrics Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia1 introduces clearly the major points for which a consensus exists between experts: 1. "Factors influencing bilirubin toxicity to the brain cells of newborn infants are complex and incompletely understood." 2. "It is not known at what bilirubin concentration or under what circumstances significant risk of brain damage occurs or when the risk of damage exceeds the risk of treatment."

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 823-824
Author(s):  
RONALD L. POLAND

In this issue of Pediatrics, Newman and Maisels1 have given us a thorough and thoughtful review of current knowledge about the toxicity of bilirubin in term, otherwise healthy, newborn infants and have concluded that there is little evidence that bilirubin toxicity can be predicted from the concentration of bilirubin in the serum. They propose that we worry about bilirubin less in this population and treat hyperbilirubinemia only if it reaches much higher concentrations than the traditional 20 mg/dL. Their conclusions and recommendations are very reasonable given that the serum bilirubin concentration is the primary predictive measure for bilirubin neurotoxicity available to us.


1995 ◽  
Vol 16 (9) ◽  
pp. 323-324

Any practitioner who has struggled for years with the dilemma of the jaundiced newborn baby will welcome the practice parameter on hyperbilirubinemia prepared by the American Academy of Pediatrics (AAP).1 Similarly, Gartner's review article on neonatal jaundice, which incorporates the recommendations of the practice parameter, should bring even more joy to the clinician seeking practical guidance.2 Is it too good to be true? Just when an area of clinical confusion appears to be clarified by not one but two guidelines, confusion returns in the form of discrepancies between the two articles. As some alert readers have pointed out, Gartner's main table (Table 1) contains several numbers that differ from those in the corresponding table of the practice parameter (Table 2).


Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
David H Cribbs ◽  
Giselle Passos ◽  
Vitaly Vasilevko

Hypertension is a major risk factor for intracerebral hemorrhage (ICH), and the accumulation of amyloid-beta (Aβ) in the cerebrovascular system, cerebral amyloid angiopathy (CAA), is also a significant risk factor for intracerebral hemorrhage ICH. Currently, there are no animal studies demonstrating a direct involvement of hypertension in the accumulation of Alzheimer’s disease-like pathology. To address this issue we have developed several mouse models that combine hypertension protocols with amyloid precursor protein (APP) transgenic mice (Tg2576), which accumulate significant CAA in the large cerebral vessels and the meninges by 18 months of age. The goal of this study was to determine the effect of acute and chronic hypertension on ICH in wildtype and a transgenic mouse model overexpressing a mutant human amyloid precursor protein (Tg2576 mice) associated with early onset AD and CAA. Fifteen-month-old Tg2576 mice and non-transgenic (nTg) littermates were treated with an angiotensin II (AngII) infusion (1000 ng/kg/min) and L-NAME (100 mg/kg/day) in drinking water to produce chronic hypertension. One week later, transient acute hypertension was induced by daily AngII injections (0.5 μg/g, s.c., twice daily) to produce ICH. A similar increase in mean blood pressure was observed in Tg2576 and nTg mice when evaluated 2 weeks after initiation of treatment. However Tg2576 mice had a higher incidence of signs of stroke compared with nTg littermates (P > 0.05). These data suggest that the accumulation of Aβ in the brain has an important role in development of ICH. Moreover, there was robust glial activation and increase in CAA in the gray matter of Tg2576 mice showing that hypertension may affect gray as well as white matter in the brain. Further studies may provide insights into the hypertension-induced changes in the cerebral vascular system that initiated the increase in CAA. The accumulation of Aβ in the cerebrovascular system is a significant risk factor for intracerebral hemorrhage (ICH), and has been linked to endothelial transport failure and blockage of perivascular drainage. While management of hypertension and atherosclerosis can reduce the incidence of ICH, there are currently no approved therapies for attenuating CAA.


PEDIATRICS ◽  
1989 ◽  
Vol 84 (6) ◽  
pp. A45-A45
Author(s):  
Student

If kernicterus develops in an infant due to high serum bilirubin, low reserve albumin, and acidosis, bilirubin acid will also be deposited in the skin. In consequence, it seems possible that the yellow colour of the skin is correlated with that of the brain, to the extent that bilirubin deposition in the skin has occurred by precipitation of bilirubin acid. If so, the intensity of the yellow colour of the skin may be a somewhat better predictor of brain damage than the serum bilirubin concentration and measurement of the colour of the skin may theoretically be of clinical utility.


2013 ◽  
Vol 47 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Sławomir Blamek ◽  
Dawid Larysz ◽  
Leszek Miszczyk ◽  
Adam Idasiak ◽  
Adam Rudnik ◽  
...  

Abstract Background. The treatment of large arteriovenous malformations (AVMs) or AVMs involving eloquent regions of the brain remains a challenge. For inoperable lesions, observation, volume-staged radiosurgery or hypofractionated stereotactic radiotherapy (HFSRT) are proposed. The aim of our study was to assess the safety and efficiency of HFSRT for large AVMs located in eloquent areas of the brain. Materials and methods. An analysis of records of 49 patients irradiated for cerebral AVMs with a mean dose of 19.9 Gy (12-28 Gy) delivered in 2-4 fractions with planned gap (at least one week) between fractions. Actuarial obliteration rates and annual bleeding hazard were calculated using Kaplan-Meier survival analysis and life tables. Results. Annual bleeding hazard rates were 4.5% and 1.6% after one and two years of the follow-up, respectively. Actuarial total obliteration rates were 7%, 11%, and 21% and total response rate (total and partial obliterations) 22%, 41%, and 55% after one, two and three years of the follow-up, respectively. There was a trend towards larger total obliteration rate in patients irradiated with fraction dose ≥ 8 Gy and total dose > 21 Gy for lesions of volume ≤ 8.18 cm3 which was not observed in case of partial obliterations. Conclusions. HFSRT results with relatively low obliteration rate but is not associated with a significant risk of permanent neurological deficits if both total and fraction doses are adjusted to size and location of the lesion. Predictive factors for total and partial obliterations can be different; this observation, however, is not firmly supported and requires further studies.


2017 ◽  
Vol 1 (3) ◽  
Author(s):  
Vito Di Maio ◽  
Francesco Ventriglia ◽  
Silvia Santillo

Synaptic transmission is the basic mechanism of information transfer between neurons not only in the brain, but along all the nervous system. In this review we will briefly summarize some of the main parameters that produce stochastic variability in the synaptic response. This variability produces different effects on important brain phenomena, like learning and memory, and, alterations of its basic factors can cause brain malfunctioning.


2015 ◽  
Vol 143 (11-12) ◽  
pp. 701-706 ◽  
Author(s):  
Monica Hăşmăşanu ◽  
Sorana Bolboacă ◽  
Tudor Drugan ◽  
Melinda Matyas ◽  
Gabriela Zaharie

Introduction. Linear growth failure is caused by multiple factors including parental factors. Objective. The aim of this study was to evaluate parental risk factors for intrauterine growth restriction (IUGR) on a population of Romanian newborn infants in a tertiary level maternity facility for a period of 2.5 years. Methods. A retrospective matched case-control study was conducted in the Emergency County Hospital of Cluj-Napoca, a university hospital in North-Western Romania. The sample was selected from 4,790 infants admitted to the Neonatal Ward at 1st Gynecology Clinic between January 2012 and June 2014. Results. The age of mothers was significantly lower in the IUGR group compared to controls (p=0.041). A significantly higher percentage of mothers had hypertension in the IUGR group compared to those in the control group (p<0.05). No other significant differences were identified with regard to the investigated characteristics of mothers between IUGR infants compared to controls (p>0.13). The age of fathers of infants with IUGR proved significantly lower compared to controls (p=0.0278). The analysis of infants? comorbidities revealed no significant difference between groups for respiratory distress, hyperbilirubinemia, hypocalcaemia, and heart failure (p>0.27). Intracranial hemorrhage, necrotizing enterocolitis and hypoglycemia were significantly higher in the IUGR group compared to controls. The logistic regression identified hypertension as a significant risk factor for IUGR (OR=2.4, 95% CI [1.3-4.5]). Conclusion. Although the age of the mothers and fathers proved significantly lower in the IUGR group compared to controls, only hypertension in the mothers proved significant risk factors for IUGR.


Author(s):  
Nikhil Deo ◽  
Gajanan Pisulkar ◽  
Suvarn Gupta ◽  
Kiran Saoji

Introduction: Total hip arthroplasty has been successful in relieving pain arising from hip joint diseases and maintains functional stability of hip joint. Instability can be rephrased as subluxation or dislocation of femoral head from the acetabulum. The study has been undertaken to find out causes related to instability after Total Hip Replacement (THR). Aim: To evaluate preoperative, intraoperative and postoperative risk factors influencing instability after THR. Materials and Methods: This retrospective study was carried out from June 2013 to June 2019. Preoperative, postoperative and six months follow-up data was recorded in the questionnaire. A total of eight patients were included in the group having postoperative dislocation and 122 patients were in normal THR group. Clinical outcome was measured using Harris Hip score. Data analysis was done by using Statistical Package for the Social Sciences (SPSS) software version 17.0 and parametric tests like paired t-test, Analysis of Variance (ANOVA) were used. Results: Majority of the patients in the study were in the age group of 31-40 years and 41-50 years (27.69% each) with total mean age of 41.14±12.40 years. About 77.69% were male and 22.31% were female. Mean Harris hip score of the total population was 74.73±5.35. Dislocation post THR was observed in 8 (6.15%) and all these patients were males. Six (75%) patients in hip dislocation group were chronic alcoholics while 41 (33.61%) in non-dislocation group were alcoholics and incidence of dislocation and alcoholism was statistically significant. Capsulectomy was done in 50% patients of hip dislocation group and 16.39% of non-dislocation group thus capsulectomy appears as a significant risk factor for postoperative hip dislocation. Conclusion: The incidence of hip instability after THR was 6.15%. Alcohol addiction was identified as a statistically significant independent preoperative risk factor. It was observed that capsulectomy was a significant risk factor for hip dislocation.


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