The Traditional Practices of Mothers in Caring of Neonates Affected by Hyperbilirubinemia

Objectives: The current study aimed to identify the mothers’ traditional practice in caring for newborns with jaundice; we want to determine the association between mothers’ practices and their demographic characteristics. Methods: This cross-sectional study was conducted on 100 mothers from inpatient pediatric wards of Babylon Teaching Hospital for maternal and pediatric care. They were selected by non-probability, purposive sampling method. The study data were collected by a three-part tool: demographic data sheet related to mothers and children, mothers’ knowledge concerning neonatal jaundice, and the mother’s knowledge and home practices concerning neonatal jaundice. The obtained data were analyzed using the SPSS version 22. Results: Most mothers (67%) were younger than 30 years, and 10% had college or institute educational level. Also, 87% of mothers knew that jaundice is a common problem for neonates; 25% did not know that jaundice is abnormal if it occurs within the first 36 hours. About 17% of mothers did not agree that maternal and fetal blood group differences lead to jaundice. Besides, 47% of mothers were uncertain that severe jaundice could lead to deafness, and 78% knew that phototherapy is the treatment for jaundice. Discussion: The majority of respondents in the study were aged 29 years or less. Most of them adopted breast and formula as the type of feeding. The most recognizable outcome of this study was the adequate knowledge and practices of mothers concerning traditional caring for neonates with jaundice.

Neonatal hepatitis in a term newborn: sequelae to in utero COVID-19 infection

Neonatal hepatitis is a common disease entity seen among newborns. It is known as inflammation of liver parenchyma in newborns, specifically in first month of life. Most common cause of neonatal hepatitis is viral infection which infects liver in utero or in postnatal period. Newborns carrying neonatal hepatitis mostly present with jaundice, failure to gain weight and hepatosplenomegaly. Neonatal hepatitis due to in utero COVID infection is diagnosed by conjugated hyperbilirubinemia, raised SGOT and SGPT levels and raised COVID antibody levels. Treatment includes addition of fat-soluble vitamins, phenobarbitone and supportive care. Here author is reporting a rare case of 11 days old newborn with neonatal hepatitis, who presented with severe jaundice (TSB/DB- 44/22) hepatosplenomegaly and hypoxemia with mild respiratory distress. Maternal history revealed high grade fever with low cell count during 5th month of gestation, though COVID RAT was negative and RT-PCR was not done. Baby was managed in NICU with IV antibiotics, IV fluids, oxygen by prongs, oral fat-soluble vitamin supplementation, adequate calorie intake and phenobarbitone. Baby responded very well to the treatment and discharged in healthy condition after 7 days. Paucity of data documenting in utero COVID-19 infection as cause of neonatal hepatitis led us to report this rare case.

Morbidities and Mortality in Patients with Hereditary Thrombotic Thrombocytopenic Purpura

Hereditary thrombotic thrombocytopenic purpura (hTTP) is a rare disorder caused by severe ADAMTS13 deficiency. Major morbidities and death at a young age are common. Although ADAMTS13 replacement can prevent morbidities and death, current regimens of plasma prophylaxis are insufficient. We identified 226 patients with hTTP in 96 reports published from 2001 through 2020. In 202 patients the age at diagnosis was reported; 117 were female, 85 were male. The difference was caused by diagnosis of 34 women during pregnancy, suggesting that many men and nulliparous women are not diagnosed. Eighty-three patients had severe jaundice at birth; hTTP was suspected and effectively treated in only 3 infants. Of the 217 patients who survived infancy, 73 (34%) had major morbidities, defined as stroke, kidney or cardiac injury, that occurred at a median age of 21 years. Sixty-two patients had stroke; 13 strokes occurred in children ≤10 years old. Of the 54 patients who survived their initial major morbidity and were subsequently followed, 37 (69%) had sustained or subsequent major morbidities. Of the 39 patients who were followed past age 40, 20 (51%) had experienced a major morbidity. Compared to age and gender-matched United States population, probability of survival was lower at all ages, beginning at birth. Prophylaxis was initiated in 45 patients with a major morbidity; in 11 (28%) a major morbidity recurred after prophylaxis had begun. Increased recognition of hTTP and more effective prophylaxis begun at a younger age are required to improve health outcomes.

Severe Hemolytic Disease of Newborn Due to Alloimmune Anti-E Antibodies: A Case Report

Hemolytic disease in the newborn (HDN) as a cause of early jaundice is mostly due to Rh (D), ABO incompatibility, and rarely due to other minor blood group incompatibility. We report case of Rh anti-E isoimmunization presenting as significant unconjugated jaundice within the 24 h of life. Baby presented with severe jaundice and anemia on day 1 of life. Baby was treated with intensive phototherapy, double volume exchange transfusion (DVET), and intravenous immunoglobulins. On evaluation, both mother and baby had O positive (Rh) blood group; however, the infant showed evidence of severe hemolysis. Positive direct Coombs test (DCT) and 11 cell antibody panel showed anti-E antibodies. This case highlights the importance of early identification and evaluation of HDN in the absence of Rh(D) and ABO incompatibility and possibility of severe hemolysis in Rh anti-E isoimmunization needing DVET.

Leukocyte chemotactic factor 2 related amyloidosis presented with severe jaundice and hepatic encephalopathy.

One of the most recently identified types is Leukocyte chemotactic factor 2 amyloidosis (LECT 2) which was found to be common in certain ethnic backgrounds. It is suggested that the diagnosis of this type is vital to prevent any therapy-related complications when it is erroneously diagnosed as AL amyloidosis.

One severe case of congenital toxoplasmosis in China with good response to azithromycin

Background Most infants infected with Toxoplasma gondii are completely asymptomatic at birth, yet they may develop ocular and neurological sequelae in the first few months of life. Cases of congenital toxoplasmosis with severe jaundice early after birth combined with pancytopenia and splenomegaly are extremely rare. Here, we report on a rare case of congenital toxoplasmosis presenting with severe jaundice and hemolysis early after birth combined with pancytopenia and splenomegaly. Case presentation A male preterm infant with severe jaundice and splenomegaly was admitted to our department. Laboratory examinations revealed severe hyperbilirubinemia, increased reticulocytes, and pancytopenia. After comprehensive analysis and examination, the final diagnosis was congenital toxoplasmosis, and the infant was treated with azithromycin and subsequently trimethoprim-sulfamethoxazole. Regular follow-up revealed congenital toxoplasmosis in both eyes, which was surgically treated, while neurofunctional assessment results were unremarkable. In this case of congenital toxoplasmosis combined with severe jaundice, we treated the infant with two courses of azithromycin, followed by trimethoprim-sulfamethoxazole after the jaundice resolved. Clinical follow-up indicated that this treatment was effective with few side effects; thus, this report may serve as a valuable clinical reference. Conclusions Timely diagnosis and adequate treatment are closely associated with congenital toxoplasmosis-related prognosis. Infants with congenital toxoplasmosis require long-term follow-up, focusing on nervous system development and ophthalmology.

COVID-19: a fatal case of acute liver failure associated with SARS-CoV-2 infection in pre-existing liver cirrhosis

Background The detection of severe acute respiratory syndrome coronavirus (SARS-CoV-2) is challenging, particularly in post-mortem human tissues. However, there is increasing evidence for viral SARS-CoV-2 manifestation in non-respiratory tissues. In this context, it is a current matter of debate, whether SARS-CoV-2 shows hepatotropism. Case presentation Here, we report a case of an 88-year-old women with massive SARS-CoV-2 viremia, severe jaundice and clinical signs of an acute hepatitis, who died within a few days from an acute liver failure without showing any clinical signs of pneumonia. Autopsy revealed a severe chronic and acute liver damage with bile duct infestation by SARS-CoV-2 that was accompanied by higher expressions of angiotensin-converting enzyme-2 (ACE2), Cathepsin L and transmembrane serine protease 2 (TMPRSS2). Conclusion Our findings indicate an enhanced biliary susceptibility to viral infection with SARS-CoV-2, that might have resulted from pre-existing severe liver damage. Furthermore, our findings emphasize the differential diagnosis of coronavirus disease 2019 (COVID-19)-associated liver failure in the clinical setting of an inexplicable jaundice.

Yellow brains and blue light

Fetal dropsy and neonatal jaundice were well known in the 17th century, but considered to be different diseases. Basal brain ganglia stained yellow were observed by Antoine Dugès in 1821, who also suggested that this finding may be associated with seizures. From observing kernicterus to understanding haemolytic disease of the newborn, 140 years passed, and the entire field of immunology had to develop. Only 25 years passed from understanding isoimmunization to the availability of effective prevention. With exchange transfusions, an effective but risky treatment for haemolytic disease and severe jaundice evolved in the 1940s. With some hesitation in the US, phototherapy followed in the 1950s. Rhesus haemolytic disease was practically eradicated during the 1960s by anti-D immunoglobulin. Kernicterus returned in the 1990s because of lessened awareness, and difficulty in monitoring bilirubin values after early discharge from maternity wards.