scholarly journals Developmental outcome of severe neonatal indirect hyperbilirubinemia

2021 ◽  
Vol 9 (1) ◽  
pp. 1-1
Author(s):  
Manizheh Mostafa Gharehbaghi ◽  
Seifolah Heidatabady ◽  
Masoomeh Ghasempour ◽  
Mahsa Alizade
Keyword(s):  
Exchange Transfusion ◽  
Neonatal Period ◽  
Neurodevelopmental Outcome ◽  
Total Serum ◽  
Term Infants ◽  
Abo Incompatibility ◽  
Ages And Stages Questionnaire ◽  
Classic Form ◽  
Sensory Neural ◽  
Severe Hyperbilirubinemia

Background: Indirect hyperbilirubinemia is one of the most common causes of hospitalization in the neonatal period and its potential association with brain damage is well established. This study was conducted to determine neurodevelopmental outcome of children who had severe indirect hyperbilirubinemia in neonatal period and received intensive phototherapy with or without double volume exchange transfusion for its management. Material & methods: This descriptive analytical study was performed in healthy infants with the history of severe indirect hyperbilirubinemia and need intensive phototherapy with or without exchange transfusion. We invited the enrolled infants at their 2-3 years age. Neurodevelopmental assessment was performed by a trained nurse using Ages and Stages Questionnaire. Results: The mean total serum bilirubin (TSB) of studied children was 26.4±4.1 mg/dl at their neonatal period. The estimated rate of severe hyperbilirubinemia with the TSB of 25-30 mg/dl was 48.7/100,000 live born infants and 11.4 /100,000 for hyperbilirubinemia higher than 30 mg/dl. The most common cause of jaundice in patients with exchange transfusion was ABO incompatibility. At their follow up examination, the classic form of bilirubin induced encephalopathy (Kernicterus) was diagnosed in 3 neonates. Two of them had sensory neural hearing loss too. Eleven children had low score based on ASQ in at least one area. The score was less than 2SD in 3 patients. Conclusion: Severe hyperbilirubinemia and kernicterus is still occurring in term and late pre-term infants. Early detection and management of severe hyperbilirubinemia may improve the neurodevelopmental outcome in high risk infants.

scholarly journals Unconjugated Neonatal Hyperbilirubinemia: Evaluation and Treatment

2020 ◽  
Vol 19 (2) ◽  
pp. 31-40
Author(s):  
Zaid T Yaseen ◽  
◽  
Jalil I Alezzi ◽  
Suad M Khaleel
Keyword(s):  
Exchange Transfusion ◽  
Serum Bilirubin ◽  
Daily Practice ◽  
Cross Sectional Study ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Term Infants ◽  
Cross Sectional ◽  
Unconjugated Hyperbilirubinemia ◽  
Abo Incompatibility

Background: Neonatal jaundice is a common problem with a lot of faults that may happen during its management. Objective:To study the epidemiological features of the unconjugated hyperbilirubinemia(UHB)in Diyala Governorate and discuss the proper lines of therapy, as well as to discuss the daily practice adopted in our hospital, and its complications. Patients and Methods: A cross-sectional study included 100 neonates (term and preterm babies) with unconjugated hyperbilirubinemia aged 0-7 days who were admitted to the Al-Batool Teaching Hospital in Baqubah, Iraq, from 1st February 2018 to the 1st November 2018. Term infants with total serum bilirubin (TSB) ≥ 22mg/dL were treated with exchange transfusion and phototherapy (Group A, 44 neonates). Those with total serum bilirubin levels from 13-<22mg/dL were treated with phototherapy only (Group B, 56 neonates). These decisions were made according to the TSB level and risk factors. Results: Forty-eight percent of neonates had hemolytic causes (Rh-isoimmunization 13%; ABO-incompatibility 10%; G6PD-deficiency 25%). Other include: sepsis 8%; prematurity 33%; congenital CMV infection 1%; and there were 10% had no evidence of hemolysis or other serious problems. The mortality rate was 3.8% of those who had an exchange transfusion. Conclusion: The decision of kind of treatment is dependent on the underlying etiology of unconjugated hyperbilirubinemia. Keywords: Unconjugated hyperbilirubinemia, Neonates, complications

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

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.

Jaundice

2021 ◽  
pp. 257-288
Keyword(s):  
Volume Expansion ◽  
Exchange Transfusion ◽  
Neurological Dysfunction ◽  
Total Serum ◽  
Case Scenario ◽  
Test Volume ◽  
Transcutaneous Bilirubin ◽  
Treatment Thresholds ◽  
Scoring Tool ◽  
Severe Hyperbilirubinemia

The jaundice chapter illustrates how to stabilize newborns with hyperbilirubinemia—a common condition—and avoid their developing severe hyperbilirubinemia. Prevention is accomplished by transcutaneous bilirubin testing, total serum bilirubintests, and the use of nomograms to evaluate risk for hyperbilirubinemia and direct appropriate care. Specific risk factors for jaundice and hyperbilirubinemia, treatment thresholds for phototherapy treatment or exchange transfusion, and a bilirubin-induced neurological dysfunction scoring tool for assessing severity in acute bilirubin encephalopathy cases are included. Related procedures, such as the direct antiglobulin test, volume expansion, and intravenous immunoglobulin administration are described. Focal skills, such as plotting and interpreting the nomograms, are applied in the case scenario.

scholarly journals 19 Treatment of Neonatal Hyperbilirubinemia – Ontario Cohort 2014-2018

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e7-e7
Author(s):  
Saisujani Rasiah ◽  
Thivia Jegathesan ◽  
Douglas Campbell ◽  
Michael Sgro
Keyword(s):  
Exchange Transfusion ◽  
Cochrane Review ◽  
Ivig Therapy ◽  
Population Based ◽  
Significant Rise ◽  
Neonatal Hyperbilirubinemia ◽  
Term Infants ◽  
Near Term ◽  
Almost All ◽  
Severe Hyperbilirubinemia

Abstract Background Serious complications that could result from severe neonatal hyperbilirubinemia include acute and chronic bilirubin encephalopathy. In Ontario, the incidence of severe neonatal hyperbilirubinemia and its associated treatments in term and near-term infants is currently unknown. Although IVIG therapy has been increasingly discussed in the literature, a recent Cochrane review (2018) indicated that there was a lack of evidence for recommending IVIG therapy for routine use. Objectives The purpose of this study was to determine the current incidence of severe neonatal hyperbilirubinemia and its treatments (Intravenous Immunoglobulin (IVIG) therapy, exchange transfusion and phototherapy) most often used in Ontario. Design/Methods A population-based retrospective cohort study of all term and near-term infants (≥ 35 weeks’ gestation) born in Ontario from April 2014 to March 2018 was conducted. National and provincial databases including Better Outcomes Registry Network Ontario (BORN) and Canadian Neonatal Network (CNN) were utilized. Results Data was collected from 533,084 infants born in Ontario over the 4 years. Of the total infants screened, 29,756 (6%) infants were diagnosed with neonatal hyperbilirubinemia. In terms of treatments, 24,646 (83%) infants received phototherapy, 54 (0.18%) infants received an exchange transfusion and 458 (1.5%) infants received IVIG therapy. In Ontario, neonatal hyperbilirubinemia had a statistically significant increase from 2014 to 2018 (P&lt;0.0001). Although phototherapy was used on almost all neonates with hyperbilirubinemia (83%) there was a significant decrease from 2014 to 2018 (from 88% to 80%) (P&lt;0.0001). Of the babies with hyperbilirubinemia in 2014, 71 (1.06%) infants received IVIG therapy and 15 (0.22%) infants received exchange transfusion. Within 4 years, IVIG therapy incidence had a significant increase from 71 (1.06%) infants to 156 (2.04%) infants (P&lt;0.0001), while exchange transfusion remained relatively constant (P=.315). Exchange transfusion rates allows for the prediction that the rate of severe neonatal hyperbilirubinemia is stable in Ontario. Conclusion In conclusion, (severe) hyperbilirubinemia still exists amongst neonates in Ontario, despite the advancements in managing hyperbilirubinemia, indicating the need for better treatments and/or monitoring. There was also a significant rise in the use of IVIG despite the continued debate about its utility. Further research should be conducted nationally to determine the incidence of severe neonatal hyperbilirubinemia and to indicate the usage of IVIG therapy.

scholarly journals Effectiveness of conventional phototherapy, intensive phototherapy and exchange transfusion in treating neonatal jaundice at Fatima Al-Zahra Hospital for maternity and children in Baghdad

2020 ◽  
Vol 16 (2) ◽  
pp. 25-29
Author(s):  
Ahmed Salih Marzoog ◽  
Hussein Naeem Mohammed ◽  
Kholod Dhaher Habib
Keyword(s):  
Exchange Transfusion ◽  
Neonatal Jaundice ◽  
Neonatal Care ◽  
Neonatal Hyperbilirubinemia ◽  
Total Serum ◽  
Common Disease ◽  
Female Ratio ◽  
Abo Incompatibility ◽  
Rh Incompatibility ◽  
Neonatal Care Unit

Background: Neonatal hyperbilirubinemia is a common disease in neonates especially in early days of birth that requires a good and successful treatment for reducing the severity and its complications that can produce important and irreversible effects. Objectives: To evaluate the effectiveness of conventional phototherapy, intensive phototherapy and exchange transfusion on outcomes of neonatal jaundice at Fatima Al-Zahra Hospital for maternity and child care in Baghdad. Patients & Methods: A retrospective study was carried out using medical records of neonates with diagnosis of unconjugated jaundice, admitted in the septic neonatal care unit of Fatima Al-Zahra hospital over 6 months period between 1st May till 31st October 2018. The total serum bilirubin, fractionations and blood group were done in all cases. They treated with conventional phototherapy, intensive phototherapy and exchange transfusion according to the severity of jaundice. Results: Total neonates admitted from 1st may to 31st October 2018 in septic neonatal care unit were 1254, among them 432 (35%) were diagnosed as unconjugated neonatal jaundice “indirect hyperbilirubinemia”. Male: Female ratio (1.4:1), males 256(59.3%), females 176(40.7%). Physiological jaundice was the most common cause 129(29.9%) cases. Prematurity in 104(24.1%) and ABO incompatibility 59(13.7%) while Rh incompatibility 14(3.2%), sepsis 8(1.9%) and unknown causes of jaundice were 118(27.3%) because lack of lab facilities. Conventional phototherapy was the most common kind of treatment in 237(55%) while intensive phototherapy used in 175(40.3%) cases with successful reduction in T.S.B level and the rate of improvement without need for exchange transfusion (92%) (161/175).Only 20(4.5%) cases were treated with exchange transfusion especially for ABO incompatibility 8 (42.1%) cases and Rh incompatibility 4 (21.1%) cases. Most of neonates 429 (99.3%) discharged with complete improvement and only 2 (0.5%) neonates suffered from kernicterus and one death (0.2%). Conclusion: Conventional phototherapy is still the standard treatment of mild to moderate indirect hyperbilirubinemia. Use of intensive phototherapy in the treatment of unconjugated neonatal hyperbilirubinemia is effective in reducing T.S.B level, need for exchange transfusion and hospital staying. Recommendations: provide aseptic neonatal care unit in the hospital with further number of intensive phototherapy devices as it is so effective in treating unconjugated neonatal jaundice and reduces need for exchange transfusion as it is proven in the study.

scholarly journals Report about term infants with severe hyperbilirubinemia undergoing exchange transfusion in Southwestern China during an 11-year period, from 2001 to 2011

PLoS ONE ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. e0179550 ◽  
Author(s):  
Canfeng Yu ◽  
Huifan Li ◽  
Qiannan Zhang ◽  
Huayun He ◽  
Xinhong Chen ◽  
...  
Keyword(s):  
Exchange Transfusion ◽  
Southwestern China ◽  
Term Infants ◽  
Severe Hyperbilirubinemia

scholarly journals Causes of Neonatal Jaundice Requiring Exchange Transfusion

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Hassan Boskabadi ◽  
Gholamali Maamouri ◽  
Maryam Abbasi ◽  
Elahe Heidari
Keyword(s):  
Risk Factors ◽  
Exchange Transfusion ◽  
Neonatal Jaundice ◽  
Serum Bilirubin Level ◽  
Preterm Neonates ◽  
Total Serum ◽  
Cross Sectional ◽  
Abo Incompatibility ◽  
Blood Exchange ◽  
Rh Incompatibility

Background: Neonatal jaundice is highly prevalent in Asia and has serious complications, such as kernicterus. Therefore, it is very important to identify the risk factors of jaundice requiring exchange transfusion since it can be helpful in the prevention of the disease and early diagnosis of its complications. Objectives: The present study aimed to identify the causes of neonatal jaundice requiring blood exchange. Methods: The present cross-sectional study was performed on 251 term and preterm neonates. The studied newborns were 2-14 days old (born at ≥ 35 weeks of gestation) with jaundice and bilirubin of more than 17 mg/dL and received exchange transfusion during 2011 - 2020 in Ghaem teaching hospital, Mashhad, Iran. The required data of the study variables, such as hyperbilirubinemia risk factors, laboratory tests, the documented history of the mothers and neonates, and physical examination results, were collected through a questionnaire and the medical records of the patients. Finally, the collected data were analyzed in SPSS software (version 20). Results: Based on the results, the mean value of the total serum bilirubin level in neonates who received exchange transfusion was 27.53 ± 10.05 mg/dL. The blood types of about 40% of mothers and their neonates were O and A/B, respectively. Moreover, 11.4% of mothers were Rh-negative; however, their neonates were Rh-positive. The results also revealed that the causes of exchange transfusion were unknown, ABO incompatibility, Rh incompatibility, glucose-6-phosphate dehydrogenase deficiency (G6PDD), and sepsis in 52.7 %, 24%, 7.1%, 5.3%, and 5.3% of the neonates, respectively. Conclusions: The findings of this study suggest that after unknown causes, the most common causes of exchange transfusion were ABO incompatibility, Rh incompatibility, G6PDD, and sepsis. Therefore, since most of these causes can be recognized, it is recommended to perform related tests and take related measures in the Midwifery Department of the hospital to prevent the occurrence and exacerbation of jaundice. Moreover, it is recommended to perform an early follow-up after the discharge.

scholarly journals Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia in Neonates from Eastern Part of Nepal

2021 ◽  
Vol 41 (1) ◽  
pp. 67-72
Author(s):  
Sunil Kumar Yadav ◽  
Arun Giri ◽  
Bbita Khanal
Keyword(s):  
Risk Factors ◽  
Gestational Age ◽  
Exchange Transfusion ◽  
Prospective Observational Study ◽  
Neonatal Period ◽  
P Value ◽  
Abo Incompatibility ◽  
Rh Incompatibility ◽  
The Mean ◽  
One Year

Introduction: Neonatal hyperbilirubinemia continues to be the commonest cause of nursery and NICU admissions and readmissions in the neonatal period worldwide. Although most cases are physiological, toxic levels of un-conjugated bilirubin can lead to acute and chronic bilirubin encephalopathy. Hence, this study aimed to study the risk factors for exchange range hyperbilirubinemia in neonates. Methods: This was a hospital-based prospective observational study conducted in a teaching and referral NICU over a period of one year from July 2019 to August 2020. All neonates with diagnosis of hyperbilirubinemia requiring double volume exchange transfusion were included in the study. Risk factors for significant hyperbilirubinemia were analysed with descriptive statistics. P-value of < 0.05 was considered significant wherever applicable. Results: The mean gestational age and birth weight were 38.06 ± 2.13wks and 2611.72 ± 389.39 gm respectively. Fifteen percent of the babies (162) developed hyperbilirubinemia and 28 (17.3%) required double volume exchange transfusion. Among neonates requiring exchange transfusion, 17 were females and 11 were males. Among 28 babies who required DVET, 20 (71.4%) were SGA. ABO incompatibility was present in 14 (50.0%) neonates and Rh incompatibility in 13 (46.4%) neonates. ABO along with Rh incompatibility was present in eight (28.6%) neonates. DCT was positive in six neonates with ABO incompatibility and nine neonates in Rh incompatibility. G6PD deficiency was present in four (14.3%) neonates. Conclusions: The most important risk factors identified were small for gestational age, ABO and Rh incompatibility followed by oxytocin use and sibling treated for jaundice.

Phototherapy in Full-Term Infants with Hemolytic Disease Secondary to ABO Incompatibility

PEDIATRICS ◽  
1984 ◽  
Vol 74 (3) ◽  
pp. 371-374
Author(s):  
Lucy M. Osborn ◽  
Carl Lenarsky ◽  
Raymond C. Oakes ◽  
Michael I. Reiff
Keyword(s):  
Exchange Transfusion ◽  
Full Term ◽  
Hemolytic Disease ◽  
Term Infants ◽  
Abo Incompatibility ◽  
Rh Incompatibility ◽  
Current Guidelines ◽  
Observation Period

Current guidelines for treatment of hemolytic disease of the newborn make no differentiation between ABO and Rh incompatibility. A protocol that prolonged the observation period in full-term, ABO-incompatible infants with positive Coombs' tests who were otherwise healthy was tested. Postponement of treatment made it possible to determine more accurately which infants needed phototherapy. This dramatically decreased the number of infants treated without increasing their risk of requiring exchange transfusion.

Role of Cord Blood Carboxyhemoglobin in Detecting Significant Hyperbilirubinemia in Term Neonates with ABO Alloimmunization

2021 ◽  
Author(s):  
Mahir Tıraş ◽  
Emrah Can ◽  
Şahin Hamilçıkan
Keyword(s):  
Cord Blood ◽  
Total Serum ◽  
Healthy Controls ◽  
Term Neonates ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Positive Direct ◽  
Severe Hyperbilirubinemia

Objective This study aimed to assess whether cord blood carboxyhemoglobin (COHb) levels in jaundiced term neonates with and without a positive direct Coombs test (DCT) and in healthy controls could be used as a predictor of severe hyperbilirubinemia. The percentage of cord blood COHb should be higher among neonates with Coombs-positive ABO hemolytic disease than among those with Coombs-negative ABO incompatibility and higher than that of ABO-compatible control neonates. Study Design This cross-sectional descriptive study of 198 term neonates comprised three subgroups: group I featured 68 DCT-positive ABO-incompatible neonates (ABO + DCT), group II featured 60 DCT-negative ABO-incompatible neonates with hyperbilirubinemia (ABO–DCT), and group III featured 70 healthy controls. COHb was determined by an OSM3 hemoximeter. Results Group I differed from groups II and III for cord blood bilirubin, cord blood hemoglobin, and cord blood hematocrit. Groups I and II had higher mean total serum bilirubin (TSB) levels than group III, while there was no difference in the mean TSB levels between groups I and II. There was no significant difference between the COHb group means for groups I, II, and III (p = 0.98). The area under the receiver operating characteristic curve calculated for group I/group III and group II/group III were found to be 0.62 and 0.54, respectively. Conclusion COHb levels did not prove to be superior to the DCT for predicting the risk of developing severe hyperbilirubinemia in term neonates. Key Points

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