A word of caution regarding Ceftriaxone

Ceftriaxone is a well-known antibiotic belonging to the third generation of cephalosporins. This broad-spectrum drug is highly effective against gram negative and gram-positive bacterial infections and is frequently used to treat severe bacterial infections in pediatrics, including disseminated gonococcal infections, sepsis and meningitis. However, concerns have been raised regarding the drug’s safety as it is prone to various side effects like bilirubin encephalopathy, cholestasis, pseudolithiasis and rarely hepatitis and pancreatitis.1 A prospective study in 154 children published in Human and Experimental Toxicology in 2016 further validate this point.2 According to this study, out of 84, 20.9% children treated with ceftriaxone had abnormal biliary sonographic findings and 15.1% had biliary lithiasis whereas cefotaxime was found to be comparatively safer. Worrying facts related to Ceftriaxone should definitely be taken into consideration as ceftriaxone is a standard treatment for several bacterial infections in children and is being prescribed at a regular basis in many countries. In fact, a clinical study performed in a secondary care hospital of Karachi, Pakistan, declared it the most frequently prescribed antibiotic.3 Physicians should prescribe ceftriaxone with caution. Ceftriaxone should be avoided in neonates especially those with hyperbilirubinemia. Caution must be advised for the use of intravenous ceftriaxone with intravenous calcium containing solutions as their concomitant use can lead to life threatening adverse reactions.4 Patient should seek medical help if they experience diarrhea, jaundice, confusion, headache, heart palpitations etc. Similar drugs with a safer adverse effect profile should be considered as a future alternative. Continuous..

Neonatal Jaundice Detection Using a Computer Vision System

Jaundice or Hyperbilirubinemia is a very common condition that affects newborns in their first few weeks of life. The main cause of jaundice is the high level of the bilirubin substance in the blood. As bilirubin is toxic to brain cells, acute bilirubin encephalopathy can occur in cases of extreme jaundice. This condition can result in brain trauma and lead to kernicterus, which causes repetitive and uncontrolled movements, a permanent upward look, and hearing loss. Thus, a timely diagnosis and treatment can help in preventing long-term damage. In this paper, a developed system based on a digital camera was proposed to diagnose and treat jaundice in newborns. The system detects jaundice and determines if the neonate needs treatment based on the analysis obtained from the real-time captured images. The treatment was achieved by using an Arduino Uno microcontroller to drive phototherapy lighting, which has proven to be an efficient treatment method for jaundice. In addition, the proposed system has the ability to send the diagnostic results to the mobile phone of the care provider. The obtained results from 20 infants inside the intensive care unit showed that the proposed system was accurate in terms of detecting jaundice, easy to implement, and affordable.

High levels of unbound bilirubin are associated with acute bilirubin encephalopathy in post-exchange transfusion neonates

Background Although it is known that unbound bilirubin can enter the brain, there is little evidence of its association with the development of acute bilirubin encephalopathy. Here, we investigated this potential relationship in neonates who had undergone exchange transfusion. Methods Data from 46 newborns who underwent exchange transfusion between 2016 and 1-1 to 2018-12-31 at the First People’s Hospital of Changde City in China were analyzed. The unbound bilirubin level was taken as the independent variable and the development of the acute bilirubin encephalopathy as the dependent variable. The covariates were age, birth weight, sex, red blood cell count, blood glucose, hemolytic disease, and whether the infant had received phototherapy. Results The mean age and gestational age of the neonates were 146.5 ± 86.9 h and 38.6 ± 1.3 weeks [38.7(34.6–41.1) weeks] old, respectively; 52.17% were male. Binary logistic regression analysis after adjustment for covariates showed a positive association between the levels of unbound bilirubin and the development of acute bilirubin encephalopathy (odds ratio = 1.41, 95% confidence intervals 1.05–1.91, P = < 0.05). Conclusion There is a significant association between unbound bilirubin levels and the development of acute bilirubin encephalopathy in neonates. Further investigations are required to explore the mechanisms.

Outcome of Neonatal Hyperbilirubinemia from a Tertiary Care Hospital in Eastern Nepal: A Cross-sectional Study

Background: Timely detection and treatment of pathological hyperbilirubinemia in newbornscan prevent acute bilirubin encephalopathy and its consequences. We aimed to identifyitsoccurrence, presentationtime, phototherapyduration, need for exchange transfusion,and outcome. Methods: In this cross-sectional study, we enrolled all the babies admitted for pathological neonatal hyperbilirubinemia in the university hospital ofBPKIHSin a one-yearduration. Babies with life-threatening congenital malformations or conjugated bilirubin >20% of total serum bilirubin or >2 mg/dl were excluded. Obstetric profile of mothers, clinical and laboratory parameters of babies, onset time of pathological jaundice, duration of phototherapy, need for exchange transfusion or intravenous immunoglobulin were recorded. Neonatal outcome was classified as good and poor and its association with potential predictors analyzed. Results: One-hundred and fifty babiesdeveloped neonatal jaundice requiring treatment. The most common causes includedABO and Rh setting. No cause was found in 26 (18%) babies. One-hundred and eight babies (72%) were only managed withphototherapy whereas 42 (28%) required both phototherapy and double volume exchange therapy. The majority (84.5%) had good outcome without any residual neurological deficit at discharge.Babies with total serum bilirubin >20 mg/dl at presentation, duration of phototherapy >44.8 h, ABO setting, hemolysis, and out born statussignificantly developed poor outcome (p < 0.05). Conclusion: About 15% of the babies with hyperbilirubinemia had acute bilirubin encephalopathy at discharge suggestive of poor outcome. Babies with high bilirubin at presentation, longer duration of phototherapy, ABO settings, hemolysis, and out born statusdeveloped poor outcome.

Detecting neonatal acute bilirubin encephalopathy based on T1-weighted MRI images and learning-based approaches

Background Neonatal hyperbilirubinemia is a common clinical condition that requires medical attention in newborns, which may develop into acute bilirubin encephalopathy with a significant risk of long-term neurological deficits. The current clinical challenge lies in the separation of acute bilirubin encephalopathy and non-acute bilirubin encephalopathy neonates both with hyperbilirubinemia condition since both of them demonstrated similar T1 hyperintensity and lead to difficulties in clinical diagnosis based on the conventional radiological reading. This study aims to investigate the utility of T1-weighted MRI images for differentiating acute bilirubin encephalopathy and non-acute bilirubin encephalopathy neonates with hyperbilirubinemia. Methods 3 diagnostic approaches, including a visual inspection, a semi-quantitative method based on normalized the T1-weighted intensities of the globus pallidus and subthalamic nuclei, and a deep learning method with ResNet18 framework were applied to classify 47 acute bilirubin encephalopathy neonates and 32 non-acute bilirubin encephalopathy neonates with hyperbilirubinemia based on T1-weighted images. Chi-squared test and t-test were used to test the significant difference of clinical features between the 2 groups. Results The visual inspection got a poor diagnostic accuracy of 53.58 ± 5.71% indicating the difficulty of the challenge in real clinical practice. However, the semi-quantitative approach and ResNet18 achieved a classification accuracy of 62.11 ± 8.03% and 72.15%, respectively, which outperformed visual inspection significantly. Conclusion Our study indicates that it is not sufficient to only use T1-weighted MRI images to detect neonates with acute bilirubin encephalopathy. Other more MRI multimodal images combined with T1-weighted MRI images are expected to use to improve the accuracy in future work. However, this study demonstrates that the semi-quantitative measurement based on T1-weighted MRI images is a simple and compromised way to discriminate acute bilirubin encephalopathy and non-acute bilirubin encephalopathy neonates with hyperbilirubinemia, which may be helpful in improving the current manual diagnosis.