scholarly journals REVIEW OF NEONATAL JAUNDICE AND ITS MANAGEMENT

2018 ◽  
Vol 6 (1) ◽  
pp. 172-176
Author(s):  
Pooja Pattanshetti ◽  
P. K. Dash
Keyword(s):  
Exchange Transfusion ◽  
Serum Bilirubin ◽  
Neonatal Period ◽  
Enterohepatic Circulation ◽  
Hepatic Clearance ◽  
Term Infant ◽  
Common Finding ◽  
Common Disease ◽  
High Dose ◽  
Therapeutic Modalities

Jaundice is the most common finding during neonatal period. It is observed during the 1st week of life in approximately 60% of term infant and 80% of preterm infants. Level of serum bilirubin is not raised that much so as to cause fatal brain damage. It is the most common disease during neonatal period occurring mostly due to increased hemolysis, decreased hepatic clearance, enterohepatic circulation, immaturity, blood group incompatibility and infections. Its management includes 1] Phototherepy 2] Exchange transfusion are two major effective therapeutic modalities available today. Additional options include Pharmacotherapy in the form of phenobarbital and high dose intravenous immunoglobulin.

....Beginning to See the Light

PEDIATRICS ◽  
1985 ◽  
Vol 75 (4) ◽  
pp. 792-795
Author(s):  
M. JEFFREY MAISELS
Keyword(s):  
Randomized Controlled Trial ◽  
Exchange Transfusion ◽  
Serum Bilirubin ◽  
Neonatal Period ◽  
Controlled Trial ◽  
Newborn Infants ◽  
Bilirubin Encephalopathy ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Postmortem Finding

In March 1952, Mollison and Walker1 reported the results of their prospective, randomized, controlled trial on the effect of exchange transfusion v simple transfusion in infants with severe erythroblastosis fetalis. They showed that exchange transfusion led to significantly lower mortality and a much lower incidence of fatal kernicterus. In the interim, numerous published studies have examined the relation between serum bilirubin levels in the neonatal period and the postmortem finding of kernicterus or the presence of later, clinical, bilirubin encephalopathy. With few exceptions, the design of these studies has made interpretation of their results hazardous, if not nugatory.2 We now have a study from the National Institute of Child Health and Human Development (NICHD)3 in which the population is sufficiently large and the study design sufficiently rigorous to permit actual, if tentative, conclusions concerning the effect of a different intervention (phototherapy) upon the immediate and later outcome of jaundiced newborn infants.

scholarly journals Clinico-Laboratory Profile and Immediate Outcomes of Hyperbilirubinemic Babies Admitted in Kanti Children Hospital

1970 ◽  
Vol 30 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Deepeshwara Nepal ◽  
Dinesh Banstola ◽  
Ajaya Kumar Khakal ◽  
Udbhabhat Mishra ◽  
Chandeshawar Maheseth
Keyword(s):  
Exchange Transfusion ◽  
Serum Bilirubin ◽  
Neonatal Period ◽  
Tertiary Care ◽  
Paediatric Hospital ◽  
Study Population ◽  
Laboratory Profile ◽  
Near Term ◽  
Key Words Hyperbilirubinemia ◽  
Rule Out

Introduction: Jaundice is an important problem in the neonatal period especially in the first week of life. Our objective of the study is to find out the immediate outcome of hyperbilirubinemic babies admitted in Kanti Children Hospital. Methodology: This is a retrospective study and carried out in tertiary care paediatric hospital. Results: Altogether 73 babies were enrolled in the study. Male babies outnumbered the female (72.6% vs. 27.4%).Only 2.4% babies were near-term. LBW babies constitute 19.2% of the study population.86.3% of babies also have clinical sepses as defined by WHO criteria. Almost half of the babies have mild hyperbilirubinemia (15-19.9 mg/dl). Most of the babies (94.5%) improved and the mortality was 5.5%. Conclusion: Healthy term babies with a serum bilirubin <17mg/dl should not be admitted for routinely as they do not need phototherapy. Phototherapy is effective in most of the time, but exchange transfusion should also be carried out when phototherapy fails. Causes of hyperbilirubinemia should be searched extensively especially to rule out haemolysis. Key words: hyperbilirubinemia, kernicterus, neonates, phototherapy DOI: 10.3126/jnps.v30i1.2457 Journal of Nepal Paediatric Society Vol.30(1) 2010 31-36

Kernicterus in a Full Term Infant

PEDIATRICS ◽  
1994 ◽  
Vol 93 (6) ◽  
pp. 1003-1006
Author(s):  
Anna A. Penn ◽  
Dieter R. Enzmann ◽  
Jin S. Hahn ◽  
David K. Stevenson
Keyword(s):  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Neonatal Period ◽  
Elevated Serum ◽  
Term Infant ◽  
Full Term ◽  
Bilirubin Concentration ◽  
Term Infants ◽  
Appropriate Treatment ◽  
The Central Nervous System

Neonatal jaundice can represent a benign physiologic process or be the harbinger of serious illness with associated severe neurotoxicity. The neurological manifestations of kernicterus, a condition resulting from the deposition of unconjugated bilirubin in the central nervous system, are rarely seen in modern neonatal care, but jaundice, which reflects elevated serum bilirubin levels, is one of the most common findings in the neonatal period.1 More than half of all term infants will develop some neonatal jaundice and at least 6% will have a serum bilirubin concentration above 12.9 mg/dL.2 The appropriate treatment of hyperbilirubinemia is currently a topic of much debate in pediatrics, particularly treatment of full term infants without risk factors for hemolytic disease.3,4

Probable Graft-vs-Graft Reaction in an Infant After Exchange Transfusion and Marrow Transplantation

PEDIATRICS ◽  
1982 ◽  
Vol 70 (1) ◽  
pp. 43-47
Author(s):  
Brian A. Lauer ◽  
John H. Githens ◽  
Anthony R. Hayward ◽  
Paul D. Conrad ◽  
Richard T. Yanagihara ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Exchange Transfusion ◽  
Unit Group ◽  
Mixed Lymphocyte Culture ◽  
Marrow Transplant ◽  
Lymphocyte Culture ◽  
Term Infant ◽  
High Dose ◽  
Marrow Graft ◽  
High Dose Dexamethasone

A newborn with graft-vs-host (GVH) disease following an exchange transfusion was treated by attempting to eradicate the incompatible graft and to reconstitute the child hematologically and immunologically with a bone marrow transplant. The patient was a female term infant (blood group B, Rh+ Coombs test positive) who received a one-unit group O, Rh- exchange transfusion from an unrelated female donor for hyperbilirubinemia due to ABO incompatibility on day 2. Signs of acute GVH disease began on day 8 and the clinical diagnosis was supported by skin biopsy. With antithymocyte globulin and high dose dexamethasone, the GVH reaction improved somewhat. Cyclophosphamide, 200 mg/kg total dose, was given over four days followed by a marrow graft from a brother who was HLA-A, B identical, and probably also D locus compatible in mixed lymphocyte culture. All signs of GVH resolved with cyclophosphamide treatment and hematologic reconstitution was evident by 14 days after transplant. Two weeks later the GVH reaction and aplastic anemia recurred and Y chromatin was detected in only 6% of marrow cells. The infant died on day 80. Autopsy showed disseminated candidiasis, disseminated cytomegalovirus infection, thymic dysplasia, hypoplastic marrow, and other histopathologic changes consistent with GVH disease. The persistence of female cells in blood and bone marrow and the destruction of the reconstituted marrow suggest that the original incompatible transfusion-derived graft was not eliminated and that it ultimately rejected the histocompatible marrow graft.

Jaundice in the Full-Term Neonate

PEDIATRICS ◽  
1984 ◽  
Vol 73 (4) ◽  
pp. 520-525 ◽  
Author(s):  
Lucy M. Osborn ◽  
Michael I. Reiff ◽  
Roger Bolus
Keyword(s):  
Birth Weight ◽  
Breast Feeding ◽  
Serum Bilirubin ◽  
Neonatal Period ◽  
Serum Bilirubin Level ◽  
Term Infant ◽  
Full Term ◽  
Common Occurrence ◽  
Perinatal Complications ◽  
Breast Fed

Hyperbilirubinemia is the most common problem experienced by the full-term infant in the immediate neonatal period. The development of jaundice was prospectively investigated in 866 newborns. Significant correlations were found between the serum bilirubin level and the method of birth, perinatal complications, blood group incompatibilities, birth weight, and method of feeding. Breast-feeding was highly related to the development of exaggerated jaundice. The most common occurrence of jaundice requiring phototherapy was in breast-feeding infants in whom no cause for the jaundice could be determined. Study findings were most compatible with a theory of relative caloric deprivation as an explanation of the increased incidence of hyperbilirubinemia found in breast-fed newborns.

scholarly journals An Overview of Neonatal Unconjugated Hyperbilirubinemia and It’s Management

2018 ◽  
Vol 42 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Nargis Ara Begum ◽  
Sharmin Afroze
Keyword(s):  
Enterohepatic Circulation ◽  
Age Of Onset ◽  
Hepatic Clearance ◽  
Diagnostic Tools ◽  
Preterm Neonates ◽  
Unconjugated Hyperbilirubinemia ◽  
Therapeutic Modalities ◽  
Bilirubin Encephalopathy ◽  
Pros And Cons

Neonatal hyperbilirubinemia is the most common clinical condition in the newborn requiring hospital readmission. About 60% of term and 80% of preterm infants develop jaundice during 1st week of life. Unconjugated hyperbilirubinemia occurs mostly due to increased hemolysis, decreased hepatic clearance, enterohepatic circulation, immaturity, blood group incompatibility and infections. Evaluation of neonatal jaundice is done based on history, age of onset of jaundice and physical examination findings which is necessary for proper management. Otherwise significant hyperbilirubinemia may endanger life of the baby and may lead to acute and subsequently chronic bilirubin encephalopathy. There are many diagnostic tools those help to detect jaundice such as Kramer’s rule, transcutaneous bilirubinometer, Bilichecker apps and smartphone apps. Besides these BIND score added a new dimension in diagnosis of acute bilirubin encephalopathy which can be confirmed by measuring bilirubin – albumin ratio in blood. Management of unconjugated hyperbilirubinemia includes: Phototherepy, Exchange transfusion are two major effective therapeutic modalities available today. Additional options include Pharmacotherapy in the form of phenobarbital and intravenous immunoglobulin. Each therapy has its pros and cons. Even there is dilemma in many therapeutic conditions like role of prophylactic phototherapy in preterm neonates, role of sunlight etc. As pediatricians have to deal cases with unconjugated hyperbilirubinemia frequently, so an updated knowledge is required. From this concern we reviewed issues on neonatal unconjugated hyperbilirubinemia and compiled for better understanding of the condition.Bangladesh J Child Health 2018; VOL 42 (1) :30-37

FEMALE ENDOCRINE CONTROL MECHANISMS DURING THE NEONATAL PERIOD

1972 ◽  
Vol 70 (2) ◽  
pp. 396-408 ◽  
Author(s):  
K.-D. Schulz ◽  
H. Haarmann ◽  
A. Harland
Keyword(s):  
Protein Synthesis ◽  
Reproductive System ◽  
Rna Synthesis ◽  
Neonatal Period ◽  
High Dose ◽  
Female Reproductive System ◽  
Endocrine Control ◽  
Hypothalamic Region ◽  
Rna And Protein Synthesis ◽  
Physiological Dose

ABSTRACT The present investigation deals with the oestrogen-sensitivity of the female reproductive system during the neonatal period. Newborn female guinea pigs were used as test animals. At different times after a single subcutaneous injection of a physiological dose of 0.1 μg or an unphysiologically high dose of 10 μg 17β-oestradiol/100 g body weight, the RNA- and protein-synthesis was examined in the hypothalamic region, pituitary, cerebral cortex, liver, adrenal gland, ovary and uterus. With a physiological dose an increase in organ weight, protein content, RNA-and protein-synthesis was found only in the uterus. These alterations turned out to be dose-dependent. In addition to the findings in the uterus an inhibition of the aminoacid incorporation rate occurred in the liver following the injection of the high oestradiol dose. As early as 1 hour after the administration of 0.1 μg 17β-oestradiol an almost 100% increase in uterine protein synthesis was detectable. This result demonstrates a high oestrogen-sensitivity of this organ during the neonatal period. All the other organs of the female reproductive system such as the hypothalamus, pituitary and ovary did not show any oestrogen response. Therefore the functional immaturity of the uterus during post partem life is not the result of a deficient hormone sensitivity but is correlated with the absence of a sufficient hormonal stimulus at this time. The investigation on the effects of actinomycin resulted in different reactions in the uterus and liver. In contrast to the liver a paradoxical actinomycin effect was found in the uterus after treatment with actinomycin alone. This effect is characterized by a small inhibition of RNA-synthesis and a 50% increase in protein synthesis. The treatment of the newborn test animals with actinomycin and 17β-oestradiol together abolished the oestrogen-induced stimulation of the uterine RNA-and protein-synthesis. Consequently, the effect of oestrogens during the neonatal period is also connected with the formation of new proteins via an increased DNA-directed RNA-synthesis.

scholarly journals Possible Ibuprofen-Induced Kernicterus in a Near-Term Infant with Moderate Hyperbilirubinemia.

2006 ◽  
Vol 11 (4) ◽  
pp. 245-250
Author(s):  
Peter Gal ◽  
J Laurence Ransom ◽  
Sherri A Davis
Keyword(s):  
Neonatal Intensive Care ◽  
Serum Bilirubin ◽  
Primary Pulmonary Hypertension ◽  
Term Infant ◽  
Auditory Neuropathy ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Albumin Binding ◽  
Unbound Bilirubin ◽  
Near Term

A 36-week gestation newborn was admitted to the neonatal intensive care unit for treatment of primary pulmonary hypertension and possible sepsis. The infant developed hyperbilirubinemia on day 4 of life and peaked on day 5 at a total serum bilirubin of 19 mg/dL. Phototherapy was started on day 4 and continued for 5 days. On day 8 of life, ibuprofen was started for fever; a concurrent total serum bilirubin was 15.7 mg/dL. The subsequent hospital course was uneventful, and discharge occurred on day 22 of life. Because the patient failed a hearing screen at discharge, he was referred for a diagnostic audiology workup. He subsequently failed formal audiometric testing on two occasions one week apart, and was given a diagnosis of auditory dys-synchrony and/or auditory neuropathy, consistent with kernicterus. At 5½ months of age, he was reported to be hypotonic and to have frequent arching movements. Since the total serum bilirubin did not exceed 19 mg/dL, concern was raised that ibuprofen may have caused displacement of bilirubin from its albumin binding site, resulting in kernicterus due to excessive unbound bilirubin concentrations. Ibuprofen should be administered with caution in preterm infants at risk for kernicterus.

HYPERBILIRUBINEMIA AND KERNICTERUS IN SMALL PREMATURE INFANTS

PEDIATRICS ◽  
1970 ◽  
Vol 45 (6) ◽  
pp. 918-925
Author(s):  
Bruce D. Ackerman ◽  
Geraldine Y. Dyer ◽  
Mary M. Leydorf
Keyword(s):  
Birth Weight ◽  
Premature Infant ◽  
Critically Ill ◽  
Premature Infants ◽  
Exchange Transfusion ◽  
Serum Bilirubin ◽  
Maximum Level ◽  
Indirect Bilirubin

Serum bilirubin levels above 15 mg/100 ml occurred in 7 of 54 infants with a birth weight of less than 1,500 gm. Definite or probable kernicterus occurred in five of these seven infants. The maximum level of indirect serum bilirubin in the five infants with kernicterus varied from 18.5 to 20.4 mg/100 ml in three infants and from 22.2 to 23.2 mg/100 ml in two. Exchange transfusions were performed in four of the five infants at levels of 18 to 22 mg/100 ml but were ineffective in preventing kernicterus. Skin hemorrhage appeared to be one of the etiologic factors causing the hyperbilirubinemia in the five infants with kernicterus. Exchange transfusion must be performed at levels of indirect bilirubin below 20 mg/100 ml if death or neurologic damage are to be prevented in the small, critically ill premature infant.

Failure of Strychnine Treatment during the Neonatal Period in Three Finnish Children with Nonketotic Hyperglycinemia

PEDIATRICS ◽  
1980 ◽  
Vol 65 (6) ◽  
pp. 1166-1169
Author(s):  
Lennart von Wendt ◽  
Seppo Similä ◽  
Anna-Liisa Saukkonen ◽  
Maila Koivisto
Keyword(s):  
Sodium Benzoate ◽  
Exchange Transfusion ◽  
Clinical Effect ◽  
Neonatal Period ◽  
Clinical Course ◽  
Severe Form ◽  
Neonatal Onset ◽  
Glycine Level ◽  
Nonketotic Hyperglycinemia ◽  
Severe Type

Three Finnish infants with a severe neonatal-onset-type of nonketotic hyperglycinemia were treated with strychnine nitrate in a daily dosage of 0.2 to 0.9 mg/kg, given orally in four doses. In order to lower the plasma and CSF-glycine concentrations concomitant exchange transfusions (200 to 300 ml/kg of heparinized blood) were carried out in two of these infants. Although the strychnine therapy was started at ages 15, 40, and 62 hours, the strychnine produced no clinical effect, and the exchange transfusion caused only a transient decrease in the plasma glycine level. Despite treatment, the clinical course was the same as in the majority of children with the severe form of the disease—all died within the first ten days of life. Impressive effects of strychnine treatment initiated in two infants at ages 5 and 6½ months, and given in addition to sodium benzoate and anticonvulsants, have been reported. These cases, however, probably represent a less severe type of nonketotic hyperglycinemia. Nevertheless, the therapeutic failure in the present cases probably indicates that strychnine treatment does not solve the therapeutic problems of severe forms of NKH.

Sign in / Sign up

Export Citation Format

Share Document