Association of Neonatal Jaundice with Gut Dysbiosis Characterized by Decreased Bifidobacteriales

Neonatal jaundice, caused by excess serum bilirubin levels, is a common condition in neonates. Imbalance in the gut microbiota is believed to play a role in the development of neonatal jaundice. Thus, we aimed to reveal the gut microbiota characteristics in neonates with jaundice. 16S rRNA gene sequencing was performed on stool samples collected on day 4 from 26 neonates with jaundice (serum total bilirubin > 15.0 mg/dL) and 17 neonates without jaundice (total serum bilirubin < 10.0 mg/dL). All neonates were born full term, with normal weight, by vaginal delivery, and were breastfed. Neonates who were administered antibiotics, had serum direct bilirubin levels above 1 mg/dL, or had conditions possibly leading to hemolytic anemia were excluded. The median serum bilirubin was 16.0 mg/dL (interquartile range: 15.5–16.8) and 7.4 mg/dL (interquartile range: 6.8–8.3) for the jaundice and non-jaundice groups, respectively. There was no difference in the alpha diversity indices. Meanwhile, in the jaundice group, linear discriminant analysis effect size revealed that Bifidobacteriales were decreased at the order level, while Enterococcaceae were increased and Bifidobacteriaceae were decreased at the family level. Bifidobacteriaceae may act preventatively because of their suppressive effect on beta-glucuronidase, leading to accelerated deconjugation of conjugated bilirubin in the intestine. In summary, neonates with jaundice had dysbiosis characterized by a decreased abundance of Bifidobacteriales.

Cord Bilirubin Value as a Predictor of Significant Hyperbilirubinemia in Abo Incompatiblity

Background: Hyperbilirubinemia is a condition in which the blood contains too much bilirubin and producing jaundice (yellow coloring of the eyes and skin). Low bilirubin levels in newborns are common and do not pose any problems; they will resolve on their own within the first week of life. Studying the cord bilirubin levels in new born babies is significant to predict the risk of abo incompatiblity. Methods: A total of 129 babies born to O blood group mother were included in the study. Out of which 111 babies were with risk of ABO incompatibility. Among them 17 babies developed pathological hyperbilirubinemia. None of the 0 positive babies developed pathological hyperbilirubinemia. Results: The peak bilirubin level was attained on 3rd and 4th day for all the babies and was taken as the outcome measure and cord serum bilirubin was taken as the predictive factor. The incidence of pathological hyperbilirubinemia is 13.2%. The mode of delivery had no positive association with the development of pathological hyperbilirubinemia. Male babies had positive ociation for pathological hyperbilirubinemia without any statistical significance. Incidence of pathological hyperbilirubinemia is higher in babies with a birth weight of <3 kg. Conclusion: A cord bilirubin value of 2.65 mg/dL can be used as a cut off for predicting pathological hyperbilirubinemia. Infants with bilirubin level more than the cutoff values were subjected to early intervention with complete recovery. None of the babies had developed encephalopathy and its sequelae.

Association of Serum Bilirubin and Functional Variants of Heme Oxygenase 1 and Bilirubin UDP-Glucuronosyl Transferase Genes in Czech Adult Patients with Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disorder worldwide. The aim of our study was to assess the role of bilirubin, and the heme oxygenase 1 (HMOX1) and bilirubin UDP-glucuronosyl transferase (UGT1A1) promoter gene variants, which are involved in bilirubin homeostasis, in the NAFLD development in adult patients. The study was performed on 84 patients with NAFLD and 103 age/sex-matched controls. Routine biochemistry, inflammatory markers, adipokines, and the fibrosis/steatohepatitis stage were determined in the NAFLD patients. The (GT)n/(TA)n dinucleotide variations in HMOX1/UGT1A1 gene promoters, respectively, were analyzed by fragment analysis. Compared to controls, serum bilirubin concentrations in NAFLD patients tended to be decreased, while the prevalence of phenotypic Gilbert syndrome was significantly low. Genetic variations in HMOX1 and UGT1A1 gene promoters did not differ between NAFLD patients and controls, and no relationship was found in the NAFLD patients between these gene variants and any of the laboratory or histological parameters. In conclusion, metabolism of bilirubin is dysregulated in NAFLD patients, most likely due to increased oxidative stress, since frequencies of the major functional variants in the HMOX1 or UGT1A1 gene promoters did not have any effect on development of NAFLD in adult patients.

Effectiveness of short duration phototherapy in government hospital setup

Background: Neonatal hyperbilirubinemia is most common presentation of neonates. Phototherapy remains standard treatment for neonatal hyperbilirubinemia. Overcrowding in government hospital makes it difficult to give phototherapy for more than 1-2 days. The objectives of the study were to determine the effectiveness of short duration of phototherapy in treating hyperbilirubinemia and to determine the risk of rebound hyperbilirubinemia.Methods: Study was hospital based retrospective study. The study place was GIMS kalaburagi. The study was conducted from September 2019 to December 2019. All healthy full-term neonates with serum bilirubin above cut off range according to (American academy of pediatrics) nomogram were included in the study. Requirement of phototherapy was decided on serum bilirubin levels as per AAP (American academy of pediatrics) nomogram. Phototherapy was used as treatment modality.Results: Total 110 neonates were included in the study. Total of 56 neonates (50.9%) required 1 day of phototherapy to fall within normal limits for discharge and 46 neonates (41.8%) required 2 days of phototherapy to fall within normal limits for discharge with a significant p<0.05. Rebound hyperbilirubinemia requiring repeat phototherapy was seen in 6(10%) neonates who were discharged after 1 day of phototherapy and in 5 neonates (10%) who were discharged after 1 day of phototherapy with a p value of 0.05.Conclusions: Short duration phototherapy is the effective means of treatment for most neonates in government hospital set up. Serum bilirubin has to be reviewed during follow up to assess rebound hyperbilirunemia.

Routine blood report and common laboratory parameters in COVID-19: Experience from Bangladesh

Background: The present study aimed to describe the association of hematological parameters and common clinico-epidemiological features wit hdisease severity among COVID-19 patients. Methods: This is a hospital based observational study done in Dhaka Medical College Hospital from 01 July 2020 to 15 September 2020. Findings from hematological tests along with patient clinic-pathological features were recorded from a total of 309 COVID-19 patients. All the data were analyzed by SPSS 23.0 software. Results: Among the studied hematological parameters hemoglobin percentage, total WBC count, lymphocyte percentage, platelet count, CRP, serum ferritin, d-dimer, and ESRwere significantly associated with disease severity (p<0.05). Association was found between disease severity and other biochemical markers, such as AST, ALT, LDH, and serum bilirubin. Conclusion: With limited resources these cheap, yet highly indicative biochemical markers could be used to assess, treat, and prognose COVID-19 patients in Bangladesh. J MEDICINE 2021; 22: 132-138

Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort study

ObjectiveDetermine the sensitivity and specificity of neonatal jaundice visual estimation by primary healthcare workers (PHWs) and physicians as predictors of hyperbilirubinaemia.DesignMulticentre observational cohort study.SettingHospitals in Chandigarh and Delhi, India; Dhaka, Bangladesh; Durban, South Africa; Kumasi, Ghana; La Paz, Bolivia.ParticipantsNeonates aged 1–20 days (n=2642) who presented to hospitals for evaluation of acute illness. Infants referred for any reason from another health facility or those needing immediate cardiopulmonary resuscitation were excluded.Outcome measuresInfants were evaluated for distribution (head, trunk, distal extremities) and degree (mild, moderate, severe) of jaundice by PHWs and physicians. Serum bilirubin level was determined for infants with jaundice, and analyses of sensitivity and specificity of visual estimations of jaundice used bilirubin thresholds of >260 µmol/L (need for phototherapy) and >340 µmol/L (need for emergency intervention in at-risk and preterm babies).Results1241 (47.0%) neonates had jaundice. High sensitivity for detecting neonates with serum bilirubin >340 µmol/L was found for ‘any jaundice of the distal extremities (palms or soles) OR deep jaundice of the trunk or head’ for both PHWs (89%–100%) and physicians (81%–100%) across study sites; specificity was more variable. ‘Any jaundice of the distal extremities’ identified by PHWs and physicians had sensitivity of 71%–100% and specificity of 55%–95%, excluding La Paz. For the bilirubin threshold >260 µmol/L, ‘any jaundice of the distal extremities OR deep jaundice of the trunk or head’ had the highest sensitivity across sites (PHWs: 58%–93%, physicians: 55%–98%).ConclusionsIn settings where serum bilirubin cannot be measured, neonates with any jaundice on the distal extremities should be referred to a hospital for evaluation and management, where delays in serum bilirubin measurement and appropriate treatment are anticipated following referral, the higher sensitivity sign, any jaundice on the distal extremities or deep jaundice of the trunk or head, may be preferred.

Importance of Bile Composition for Diagnosis of Biliary Obstructions

Determination of the cause of a biliary obstruction is often inconclusive from serum analysis alone without further clinical tests. To this end, serum markers as well as the composition of bile of 74 patients with biliary obstructions were determined to improve the diagnoses. The samples were collected from the patients during an endoscopic retrograde cholangiopancreatography (ERCP). The concentration of eight bile salts, specifically sodium cholate, sodium glycocholate, sodium taurocholate, sodium glycodeoxycholate, sodium chenodeoxycholate, sodium glycochenodeoxycholate, sodium taurodeoxycholate, and sodium taurochenodeoxycholate as well as bile cholesterol were determined by HPLC-MS. Serum alanine aminotransferase (ALT), aspartate transaminase (AST), and bilirubin were measured before the ERCP. The aim was to determine a diagnostic factor and gain insights into the influence of serum bilirubin as well as bile salts on diseases. Ratios of conjugated/unconjugated, primary/secondary, and taurine/glycine conjugated bile salts were determined to facilitate the comparison to literature data. Receiver operating characteristic (ROC) curves were determined, and the cut-off values were calculated by determining the point closest to (0,1). It was found that serum bilirubin was a good indicator of the type of biliary obstruction; it was able to differentiate between benign obstructions such as choledocholithiasis (at the concentration of >11 µmol/L) and malignant changes such as pancreatic neoplasms or cholangiocarcinoma (at the concentration of >59 µmol/L). In addition, it was shown that conjugated/unconjugated bile salts confirm the presence of an obstruction. With lower levels of conjugated/unconjugated bile salts the possibility for inflammation and, thus, neoplasms increase.

Role of Probiotics in Neonates with Hyperbilirubinemia Receiving Phototherapy

Study Objectives: To compare the mean duration of phototherapy in neonates with hyperbilirubinemia receiving phototherapy with vs. without probiotics. Study Design and Settings: It was a randomized controlled trial carried at Department of Pediatrics, DHQ Hospital Kasur from Jan 2021 to June 2021. Patients and Methods: The present research involved 94 neonates of both genders aged between 2 to 28 days of life diagnosed of neonatal hyperbilirubinemia (serum bilirubin level ≥15mg/dL and direct bilirubin level ≤1.5 mg/dL). These neonates were allocated into two groups randomly. Neonates in Group-I were given probiotics along with conventional treatment of phototherapy whereas neonates in Group-II received conventional phototherapy alone. Study outcome was described in terms of mean duration of phototherapy (phototherapy was stopped when serum bilirubin level was less than 10 mg/dl during the first week and less than 11 mg/dl after the first week) which was recorded and compared between the groups. An informed written consent was taken from parents of every neonate. Results of the Study: The mean age of the neonates was 6.54±4.96 days while the mean gestational age was 37.31±2.04 weeks. There were 55 (58.5%) baby boys and 39 (41.5%) baby girls with a boys to girls ratio of 1.4:1. The mean weight of the neonates was 2.89±0.49 Kg while the mean serum bilirubin level upon admission was 16.73±1.19 mg/dl. The mean duration of phototherapy was significantly shorter in neonates receiving probiotics along with phototherapy as compared to phototherapy alone (3.13±0.92 vs. 3.81±1.12 days; p=0.002). Similar significant difference was observed across various subgroups based on age, gender, gestational age, weight and serum bilirubin level upon admission. Conclusion: Addition of probiotics to conventional practice of phototherapy alone in jaundiced neonates was found to hasten the recovery evident from significant reduction in the mean duration of phototherapy advocating its routine use in future practice. Keywords: Neonatal Hyperbilirubinemia, Phototherapy, Probiotics

A Comparative Analysis of Intermittent and Continuous Phototherapy in Patients with Neonatal Jaundice

Aim: To compare the outcome of intermittent phototherapy versus continuous phototherapy in treatment of neonatal jaundice. Study Design: Randomized clinical trial (RCT). Place and Duration: This study was conducted at Department of pediatrics, neonatal ward, Liaquat university hospital Hyderabad/Jamshoro, from 8 January to 7 July 2020 Methodology: There were 222 neonate with jaundice, which were randomly allocated into two groups. One hundred and one neonates were in group “A” who received continuous phototherapy while 111 neonates were treated with intermittent phototherapy called group B. Phototherapy units were identical regarding their manufacture and radiance with 5 blue light tubes at a distance of 15-20 cm above neonate that produced the irradiance of 20µW/cm2/nm at 420-470 nm. Serum bilirubin levels were measured every 12 hourly after starting phototherapy up to 48 hours. SPSS version 22 was used for data analysis. Results: The average age of the neonates was 2.23±1.45 days. In this study, the reduction of bilirubin level in both groups after 12, 24, 36, 48 hours of phototherapy and at the time of discharge was not different between groups. Conclusion: Intermittent and continuous phototherapies were found to be equally effective. Because of its additional benefits, intermittent phototherapy can be adopted as a routine procedure instead of continuous phototherapy in neonatal care units, however, it needs to be confirmed by large scale RCTs.