A study on effect of phototherapy on platelet count in neonates with unconjugated hyperbilirubinemia: a hospital based prospective observational study

Background: Thrombocytopenia as a side effect of phototherapy has not been mentioned in standard literature and textbooks. Though there are few studies in this regard, but results are conflicting. Aims and Objective: Hence, the present study is undertaken to find out whether any significant change in platelet count occurs following phototherapy, and if there be any, to see whether the changes are transient or not. Materials and Methods: This prospective and observational study was carried out over a period of one and half years (1st March 2019 to 31st August 2020) on 190 new-borns admitted with idiopathic unconjugated hyperbilirubinemia needing phototherapy through consecutive enrolment. Serum bilirubin (total, conjugated and unconjugated) and platelet count were done before initiation and just after completion of phototherapy, and seven days after completion of phototherapy. Appropriate statistical tests were used to make statistical comparisons with a p-value of < 0.05 taken as significant. Results: Among 190 neonates, 108(56.8%) were male and 82(43.2%) were female; 90(47.4%) were preterm and 100(52.6%) were term. Mean birth weight was (2.4725 ± 0.4782) kg. Mean gestational age was (36.4316 ± 2.4802) weeks. Mean haemoglobin level was (17.3816± 1.0784) gm/dl. Mean age at presentation was (4.5737± 1.5811) days. Mean total serum bilirubin (TSB) before initiation, after completion, and 7 days after completion of phototherapy were (17.8595 ± 3.7034) mg/dl, (8.1726 ± 2.2586) mg/dl and (5.7279± 1.5918) mg/dl respectively. The mean duration of phototherapy required was (48.1895 ± 13.6054) hours. Mean platelet count before initiation and just after completion of phototherapy were (2,49,321.0526± 89,460.2101)/μL and (2,22,436.8421 ± 88,538.7173)/μL respectively. Mean platelet count 7days after completion of phototherapy was (2,46,210.5263 ± 87,442.3038)/μL. Decrease in platelet count just after completion of phototherapy was statistically significant. Fifty-nine (31.1%) out of 190 neonates developed mild thrombocytopenia (100000- <150000/μL) just after completion of phototherapy, but none developed moderate or severe thrombocytopenia. None having thrombocytopenia manifested with clinical bleed. Platelet count raised near to pre-phototherapy level 7 days after completion of phototherapy. Fall in platelet count was found to have a positive association with increased duration of phototherapy and lower gestational age (p<0.0001). However, there was no statistically significant association (p>0.05) between reduction in platelet count with gender. Conclusions: Though the incidence of thrombocytopenia following phototherapy was significant, but it was mostly mild and transient, and clinically insignificant. There was significant association between decrease of platelet count with duration of phototherapy and lower gestational age.

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Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study

International Surgery Journal ◽

10.18203/2349-2902.isj20171138 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1341 ◽

Cited By ~ 1

Author(s):

Sadhan Kumar Cheekuri ◽

Alok Mohanty ◽

T. Ganesh ◽

R. Kannan ◽

Robinson Smile

Keyword(s):

Observational Study ◽

Acute Appendicitis ◽

Serum Bilirubin ◽

Clinical Signs ◽

Signs And Symptoms ◽

Complicated Appendicitis ◽

Total Serum ◽

P Value ◽

Predictive Capacity ◽

Computed Tomography Scanning

Background: Appendicitis is the most common acute abdominal condition requiring emergency surgery, with a lifetime risk of 6%. Appendectomy continues to be one of the commonest procedures in general surgery, accounts for approximately 1% of all surgical operation. Despite the increased use of ultrasonography, computed tomography scanning and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%). The aim of this study was to whether Serum Bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis and if so, does it have the predictive capacity to warn us about complicated appendicitis.Methods: This was prospective observational study done in Mahatma Gandhi Medical College and Research Institute, Pondicherry between November 2014 and August 2016. About 110 patients of acute appendicitis who had undergone appendicectomy were studied. Data was collected and analyzed critically.Results: Males 66 (60%) outnumbered females 44 (40%) and overall mean age was 26.61±12.37 years. Of the 110 patients, 9% were normal appendix, 59.09% were confirmed as acute appendicitis while 31.81% were diagnosed with complicated appendicitis on biopsy. The Sensitivity and Specificity of serum bilirubin as a marker in predicting Acute appendicitis and complicated appendicitis was 47.6% and 90.9% respectively. Similarly, the Positive predicative value and Negative predicative value for the same was 88.5% and 61.5% respectively with odds ratio 12.4 with significant p value <0.0001.Conclusions: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia should be identified as having a higher probability of complicated appendicitis. Hence, serum bilirubin levels have a predictive potential for the diagnosis of severity of acute appendicitis and need for early appendicectomy. If total serum bilirubin is added to already existing laboratory tests, then the diagnosis of complicated appendicitis in clinically suspected cases can be made with fair degree of accuracy, the need for CECT and MRI can be reduced and unnecessary delay in appendicectomy can be avoided.

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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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Association between Thyroid Proﬁle and Serum Bilirubin Levels in Term Neonates on Day 3 of Life

Asian Journal of Clinical Pediatrics and Neonatology ◽

10.47009/ajcpn.2020.8.2.8 ◽

2020 ◽

Vol 8 (2) ◽

pp. 42-45

Author(s):

Prahlad Kadambi ◽

MA Ramprakash ◽

Gandi Soujanya ◽

L Sushanth Prabhath Reddy

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Serum Bilirubin ◽

Positive Association ◽

Serum Levels ◽

Total Serum ◽

Term Neonates ◽

The Mean ◽

Thyroid Profile ◽

Serum Tsh

Background: Neonatal indirect hyperbilirubinemia is a common clinical scenario that manifests as jaundice in the first week of life. Studies have shown that the physiological peak of serum bilirubin (SBR) levels is highest at 72 hours of life as a result of which SBR is measured at 72 hours of life routinely. The American Academy of Pediatricians (AAP) recommends routine screening for congenital hypothyroidism within the first week of life for all neonates. In common practice, both parameters are assessed simultaneously at 72 hours of life. This study aims to correlate thyroid Profile and serum bilirubin levels assessed in term neonates at 72 hours of life. Subjects and Methods: Our retrospective study included 105 term neonates born through cesarean-section at MMCHRI, Kanchipuram; between August 2018 and August 2019. Pre-term, neonates born to eclamptic, pre-eclamptic, diabetic, hypothyroid, Rh-incompatible mothers were excluded from the study. The data collected included Birth Weight, Gestational Age, Thyroid Profile (T3, T4, TSH), SBR (Total and Direct). Data were analyzed using SPSS v16. Results: The mean gestational age of the study population was 268.05 6.25 days, and mean birth weight was 2.997 0.36 kgs. The mean serum levels of total bilirubin were 11.36 3.52 mg/dl. The mean serum fT3, fT4, TSH levels were 8.17 23.2 pg/ml, 2.16 1.68 ng/dl and 4.07 3.4 mIU/ml respectively. A positive association was noted between serum TSH and total serum bilirubin (r= 0.176, p = 0.067) but not statistically significant. Conclusion: Our study has not shown a significant association between serum TSH and SBRT in term neonates. However, the simultaneous assessment remains practical in practice.

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Phototherapy in Hyperbilirubinemic Neonates; Does it Affect Platelet Count?

Annals of King Edward Medical University ◽

10.21649/akemu.v22i3.1405 ◽

2016 ◽

Vol 22 (3) ◽

Author(s):

Aisha Sajid ◽

Tahir Mahmood ◽

Sohaib Riaz ◽

Saba Ghulam Nabi

Keyword(s):

Platelet Count ◽

Clinical Manifestation ◽

Cross Sectional Study ◽

P Value ◽

Severe Thrombocytopenia ◽

Sectional Study ◽

Cross Sectional ◽

Unconjugated Hyperbilirubinemia ◽

Normal Platelet ◽

Number Of Patients

Objective:Â Â To determine the effect of phototherapy on platelet count in neonates having unconjugated hyperbilirubinemia.Patients and Methods:Â Â This cross sectional study was conducted in the Neonatology unit of a Hospital, Faisalabad during a period of nine months i.e., January to September 2015. All the neonates having unconjugated hyperbilirubinemia and requiring phototherapy with normal initial platelet count were included in the study. Platelet count was evaluated before the start of phototherapy and then during phototherapy at 24 hrs, 48 hrs and 72 hrs interval. Platelet counts were compared after 24, 48 and 72 hours of phototherapy. P value < 0.05 was considered significant.Results:Â Â Total 150 newborns having unconjugated hyperbilirubinemia were included with mean age of 3.95 Â± 1.71days. After 24 hours of phototherapy, about 8.1% of the patients were having severe thrombocytopenia (platelet count < 50 Ã—109/L); this percentage rose to 18.4% after 48 hours and 33.3% after 72 hours of phototherapy. None of the patients developed clinical manifestation of bleeding. The number of patients with normal platelet count (1,50 Ã— 109/L â€“ 400 Ã— 109/L) after 24 hours of continuous phototherapy was 50%, gradually reducing Â to 38% after 48 hours and only 33% after 72 hours of completion of phototherapy(p value < 0.05).Conclusion:Â Â Hyperbilirubinemic neonates undergoing phototherapy had a fall in platelet count without any clinical manifestation of bleeding.Â

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The Analysis of Residents’ Behavior, The Condition of Ratproofing Houses and Their Effects on the Incidence of Leptospirosis Cases in Ponorogo Regency

JURNAL KESEHATAN LINGKUNGAN ◽

10.20473/jkl.v11i3.2019.198-207 ◽

2019 ◽

Vol 11 (3) ◽

pp. 198

Author(s):

Hanifah Agda Nursitasari

Keyword(s):

Protective Factor ◽

Statistical Tests ◽

Positive Association ◽

P Value ◽

Indirect Contact ◽

Running Water ◽

Standing Water ◽

Sewage System ◽

Observation Area ◽

Hands And Feet

Leptospirosis is a disease with high fatality, it is transmitted by animals infected with Leptospira bacteria either through direct or indirect contact. Ponorogo is one of endemic areas to Leptospirosis whereas the incidence of this zoonotic disease reported annually. The purpose of this study was to analyze the behavior of respondents and ratproofing house conditions against the incidence of leptospirosis in Ponorogo Regency. This research was an observational study with case control research design (ratio of 1: 3 with a comparison of the number of cases of 9 participants and control of 27 participants). The data were obtained by observation and interviews using observation sheets and questionnaires as instruments to obtain information about respondents' behavior and the condition of rats-free houses. The results of statistical tests using chi square showed that contact with standing water is significantly associated with the Leptospiroris incidence with OR = 10.0 (p value=0.03, 95% CI = 1,1 – 91,4) and condition of sewage system (SPAL) also significantly associated with OR = 0.10 (p value 0.02;) 95% CI: 0,01 – 0,79). Poor personal habits such as contact with standing water after working has positive association with odds ratio 10 times higher of causing leptospirosis and the condition of house sewage system (SPAL) that are covered by sewage nets to prevent the entry of mice into the house has negative association or a protective factor against the occurrence of leptospirosis. Suggestions that can be given are educating the general public within the observation area about the dangers of leptospirosis and its prevention, improving the diagnostic ability of Leptosirosis in the Primary Health Care (Puskesmas), improving daily residents behavior or habits by rinsing hands and feet in running water using soap, and closing wire gutters to prevent access rat into the house.

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Early Neurodevelopmental Outcome of Neonates with Gestation 35 Weeks or More with Serum Bilirubin in Exchange Range Without Encephalopathy: A Prospective Observational Study

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832/11-t-675 ◽

2021 ◽

Vol 40 (2) ◽

pp. 66-72

Author(s):

Deepak Sharma ◽

Rekha Harish ◽

Anuj Bhatti ◽

Radhika Uppal ◽

Jehangir Naseem

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Serum Bilirubin ◽

Neurodevelopmental Outcome ◽

Total Serum ◽

Impaired Hearing ◽

Motor Delay ◽

Bilirubin Encephalopathy ◽

Neurodevelopmental Impairment ◽

Severe Hyperbilirubinemia

ObjectiveTo describe early neurodevelopment outcomes of neonates with severe hyperbilirubinemia without acute bilirubin encephalopathy (ABE).MethodsNeonates born at gestation ≥35 weeks, admitted to NICU with total serum bilirubin (TSB) in exchange range with no features of ABE, were followed up until the age of 6 months. Infants were assessed for impaired hearing and neurodevelopment at 3 months and 6 months of age.ResultsA total of 59 neonates were enrolled in the study. At 3 months of age, 7.6 percent of neonates were found to have hypotonia and motor delay, whereas 42.3 percent had abnormal brainstem evoked response audiometery. At 6 months, 6.4 percent of neonates were found to have persistent neurodevelopmental impairment.ConclusionSevere hyperbilirubinemia is associated with impaired neurodevelopment and hearing even in infants without ABE. Peak TSB level strongly correlates with abnormal outcomes.

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EFFECT OF PHOTOTHERAPY ON SERUM CALCIUM LEVELS IN NEONATAL JAUNDICE

10.36106/5118478 ◽

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.

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A study of bacterial sepsis and its relation to thrombocytopenia in neonates

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20171722 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1032

Author(s):

Vikram R. Goudar ◽

Gautam Mohan Kabbin ◽

Suhas N. Joshi ◽

Vinod P. Chavan ◽

Shriharsha L. Badiger

Keyword(s):

Platelet Count ◽

Bacterial Growth ◽

White Blood Cells ◽

P Value ◽

Suspected Case ◽

Severe Thrombocytopenia ◽

Bacterial Sepsis ◽

Klebsiella Species ◽

Culture Positivity ◽

District Hospitals

Background: In developing countries like India, the culture facilities are non-existent in most of the district hospitals, so the burden of identification of sepsis lies on hematological investigations like platelet count and white blood cells and very few indian studies have been done to show the association. Objectives: 1) To know the incidence of thrombocytopenia in babies with proven bacterial sepsis. 2) To find, if any, species specific differences in severity and incidence of thrombocytopenia. 3) Clinical outcomes in thrombocytopenic and nonthrombocytopenic septic babies.Methods: It is a prospective observational hospital based study. All the neonates admitted to our NICU with probable sepsis were screened for sepsis and neonates with birth weight of 1000 grams and above with blood and/or Cerebrospinal Fluid (CSF) culture positivity for bacterial growth were recruited during the study period from November 2011 to October 2012. A total of 100 neonates with blood and/or CSF culture positivity for bacterial growth were considered convenient for the study.Results: During the present study period of 1 year we had a total of 960 Neonates admitted to our NICU. 475 neonates were screened for sepsis. A total of 100 neonates with blood and/or CSF culture positivity for bacterial growth were considered for the study. Klebsiella pneumoniae sepsis was the highest contributor to the severe thrombocytopenia category (15 out of 29cases). Out of the 100 cases, 41 had normal platelet count and 59 had thrombocytopenia. Klebsiella positivity was more significantly associated with severe thrombocytopenia than MRCONS positivity or rest of the cultures combined together (p value <0.01). Although there was no significant association between thrombocytopenia and mortality (p=0.176), the proportion of children with severe thrombocytopenia was significantly higher in babies who expired (25% vs 9%) when compared to babies who survived.Conclusions: Our study shows that in our setting bacterial sepsis is significantly complicated by thrombocytopenia. Severe thrombocytopenia in a suspected case of bacterial sepsis might predict Klebsiella species sepsis and hence it may be prudent to start empirical antibiotics covering the Klebsiella species.

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The Effect Of Phototherapy (24 Hours) Towards Jaundice Degrees Of The Newborn In Hospital NICU West Nusa Tenggara Province

Media Keperawatan Indonesia ◽

10.26714/mki.1.2.2018.11-19 ◽

2018 ◽

Vol 1 (2) ◽

pp. 11

Author(s):

Rosalia Selung ◽

Indah Wasliah ◽

Eka Adithya Pratiwi

Keyword(s):

Serum Bilirubin ◽

Rank Correlation ◽

Correlation Coefficients ◽

Bivariate Analysis ◽

Total Serum ◽

Unconjugated Hyperbilirubinemia ◽

Normal Birth ◽

Before And After ◽

Post Test ◽

Study Population

Background: Aximately 60% of normal birth infant become jaundiced in the first week of birth. The incidence of jaundice in the West Nusa Tenggara hospital in 3 years later (2012-2014) there were 1166 cases. Phototherapy of total serum bilirubin (TSB) increased. Clinical trials have validated the efficacy phototherapy in reducing excessive unconjugated hyperbilirubinemia, and its implementation has been drastically confine the use of exchange transfusion (Bhutani, 2011). Objective:The purpose of this study was to determine the degree of jaundice before and after phototherapy, as well as analyze the influence phototherapy before and after the degree of jaundice in the newborn. Method:This type of research is pre-experimental research design using the approach one group pre-test and post-test design. The study population was all jaundice infants who were treated at Hospital NICU room in West Nusa Tenggara Provence in May 2016. The sample was 15 respondents with acsidental sampling techniques. The method of data analysis with descriptive percentage univariate and bivariate analysis with test of rank correlation test (spearman) obtained significance value p = 0.000 < 0.05 and spearman correlation coefficients obtained by value p = 0.025 which means there is a strong correlation between the influence of phototherapy (24 hours) the degree of jaundice in the newborn. Result: The results were obtained degree of jaundice before phototherapy is as many as 9 degree 4 respondents (60%) and as many as 6 degrees five respondents (40%). After 24 hours phototherapy all respondents decreased the degree of jaundice and most have some degreen of jaundice 3 of 10 respondents (66,7%) by 5 respondents (33,3%). Discussion:Recommendations can be given is a gift phototherapy to decrease the degree of jaundice.

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The study of association of fetal and maternal factors in the occurrence of hyperbilirubinemia in early neonatal period

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200764 ◽

2020 ◽

Vol 8 (3) ◽

pp. 967

Author(s):

Megha Goyal ◽

Anshuman Srivastava

Keyword(s):

Serum Bilirubin ◽

Neonatal Morbidity ◽

Total Serum ◽

P Value ◽

Maternal Factors ◽

Chi Square ◽

Oral Contraceptive Pills ◽

Factors Affecting ◽

Nicu Admission ◽

Group B

Background: Hyperbilirubinemia in neonates is considered to be one of the common phenomena which generally occurs during the first week of life and usually leads to NICU admission in both term and preterm new-born babies. It is also regarded as one of the most common causes which leads to neonatal morbidity and mortality.Methods: A total of 100 neonates along with their mothers were enrolled in the study from time period between 2018 to March 2019. Newborns were assessed daily for the jaundice and serum bilirubin levels were done. Various fetal-maternal factors included in proforma were. analysed to find out the association of feto-maternal factors in the occurrence of significant neonatal hyperbilirubinemia. Two groups, group A <15.7 mg/dl and group B>=15.7 mg/dl were taken. For data analysis chi square test is applied and p-value is calculated.Results: Statistically significant association between total serum bilirubin with neonatal factors like birth weight (p<0.014), maturity (p<0.011), period of gestation (p<0.003), and heart rate abnormality (p<0.005) and maternal factors like age in years (p<0.05), oral contraceptive pills use (p<0.005), and anti-epileptics use (p<0.034) were found to be linked to neonatal hyperbilirubinemia.Conclusions: Neonatal jaundice should be considered as the main policy in all health care settings of the country. Therefore, identification of factors affecting the incidence of jaundice can be effective in preventing susceptible predisposing factors in new-borns and high-risk mothers.

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