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Bhutani VK, Wong RJ, Turkewitz D, Rauch DA, Mowitz ME, Barfield WD. Phototherapy to Prevent Severe Neonatal Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation: Technical Report. Pediatrics 2024; 154:e2024068026. [PMID: 39183672 DOI: 10.1542/peds.2024-068026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVE To summarize the principles and application of phototherapy consistent with the current 2022 American Academy of Pediatrics "Clinical Practice Guideline Revision for the Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation." METHODS Relevant literature was reviewed regarding phototherapy devices in the United States, specifically those that incorporate blue to blue-green light-emitting diode, fluorescent, halogen, or fiberoptic light sources, and their currently marketed indications. RESULTS The efficacy of phototherapy devices varies widely because of nonstandardized use of light sources and configurations and irradiance meters. In summary, the most effective and safest devices have the following characteristics: (1) incorporation of narrow band blue-to-green light-emitting diode lamps (∼460-490 nm wavelength range; 478 nm optimal) that would best overlap the bilirubin absorption spectrum; (2) emission of irradiance of at least 30 µW/cm2/nm (in term infants); and (3) illumination of the exposed maximal body surface area of an infant (35% to 80%). Furthermore, accurate irradiance measurements should be performed using the appropriate irradiance meter calibrated for the wavelength range delivered by the phototherapy device. CONCLUSIONS With proper administration of effective phototherapy to an infant without concurrent hemolysis, total serum or plasma bilirubin concentrations will decrease within the first 4 to 6 hours of initiation safely and effectively.
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Affiliation(s)
- Vinod K Bhutani
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ronald J Wong
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David Turkewitz
- Pediatric Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Daniel A Rauch
- Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack Meridian Children's Health, Hackensack, New Jersey
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2
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Butt H, Rich C, Webb J. Management of severe hemolytic disease of the fetus and newborn due to maternal anti-Rh17: Using incompatible blood. Pediatr Blood Cancer 2024:e31264. [PMID: 39129129 DOI: 10.1002/pbc.31264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Accepted: 07/26/2024] [Indexed: 08/13/2024]
Affiliation(s)
- Henna Butt
- Pediatric Hematology, Children's National Hospital, Washington, District of Columbia, USA
| | - Colleen Rich
- Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Jennifer Webb
- Pediatric Hematology, Children's National Hospital, Washington, District of Columbia, USA
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Demirel HN, Ozumut SS, Ovalı HF. Continuous versus intermittent phototherapy in treatment of neonatal jaundice: a randomized controlled trial. Eur J Pediatr 2024; 183:3389-3396. [PMID: 38767694 DOI: 10.1007/s00431-024-05610-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
Phototherapy (PT) is a widely used treatment for neonatal jaundice, yet the ideal model of application remains controversial. In this study, the effects of continuous phototherapy (CPT) and intermittent phototherapy (IPT) models were compared in the treatment of neonatal indirect hyperbilirubinemia (IHB) and whether IPT is a superior modality is investigated. Single-centre parallel randomized controlled open label trial. A computer-based table of random numbers was used to allocate treatments. Newborns ≥ 34 weeks' gestation who received phototherapy in our neonatal intensive care unit (NICU) between July 2022 and April 2023 were included. CPT was applied continuously for 6 h, and IPT was applied as 2 cycles of 1 h on and 2 h off in a 6-h session. Rebound TSB was measured 8 h after phototherapy was stopped in both groups. Phototherapy duration, TSB reduction rate and rebound bilirubin rate were compared between intervention groups. One hundered and four neonates met the inclusion criteria during the study period. CPT and IPT were each used in 52 newborns. Demographic characteristics of the study groups, including sex, mode of delivery, birth weight, admission weight, age at postnatal presentation, diet, discharge weight, and history of PT in siblings, were similar (p > 0.05). The most common cause of IHB in both groups was ABO incompatibility. The median phototherapy time was 12 h (6-15) in the CPT group and 4 h (2-4) in the IPT group (p < 0.001). The mean rate of bilirubin decrease was 1.12 ± 0.73 mg/dl/h in those who underwent IPT and 0.51 ± 0.33 mg/dl/h in those who underwent CPT (p < 0.001). The mean rebound bilirubin rate 8 h after phototherapy was 0.08 ± 0.28 mg/dl/h in the CPT group, and -0.01 ± 0.17 mg/dl/h in the IPT group (p = 0.039). The length of hospital stay was longer in the CPT group (p = 0.032). Skin rash, diarrhoea and increased body temperature were less frequent in the IPT group (p < 0.001). CONCLUSIONS In this study, IPT was found to be at least as effective as CPT in reducing total serum bilirubin. Even though the duration of PT is shorter in IPT, the slower rate of rebound bilirubin, shorter hospital stays and lower incidence of side effects indicated that intermittent phototherapy is superior to continuous phototherapy. Choosing IPT over CPT is a more rational approach in neonatal jaundice. CLINICALTRIALS gov Identifier: NCT06386731 (registered retrospectively on 23/04/2024) What is Known: • PT is common used in the treatment of neonatal jaundice. • There is no standard model of application for PT. WHAT IS NEW • The IPT model is as effective as CPT. • Newborns are discharged faster with IPT.
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Affiliation(s)
- Hande Nur Demirel
- Goztepe Prof. Dr Suleyman Yalcın City Hospital, Department of Paediatrics, Barbaros Mah, Ardic sokak Kentplus F3/23, 34746, Atasehir, Istanbul, Turkey
| | - Sibel Sevuk Ozumut
- Goztepe Prof. Dr Suleyman Yalcın City Hospital, Department of Paediatrics, Barbaros Mah, Ardic sokak Kentplus F3/23, 34746, Atasehir, Istanbul, Turkey.
| | - Husnu Fahri Ovalı
- Istanbul Medeniyet University, Goztepe Prof. Dr Suleyman Yalcın City Hospital, Department of Paediatrics and Neonatology, Istanbul, Turkey
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Wang Z, Pang S, Liu X, Dong Z, Tian Y, Ashrafizadeh M, Rabiee N, Ertas YN, Mao Y. Chitosan- and hyaluronic acid-based nanoarchitectures in phototherapy: Combination cancer chemotherapy, immunotherapy and gene therapy. Int J Biol Macromol 2024; 273:132579. [PMID: 38795895 DOI: 10.1016/j.ijbiomac.2024.132579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
Cancer phototherapy has been introduced as a new potential modality for tumor suppression. However, the efficacy of phototherapy has been limited due to a lack of targeted delivery of photosensitizers. Therefore, the application of biocompatible and multifunctional nanoparticles in phototherapy is appreciated. Chitosan (CS) as a cationic polymer and hyaluronic acid (HA) as a CD44-targeting agent are two widely utilized polymers in nanoparticle synthesis and functionalization. The current review focuses on the application of HA and CS nanostructures in cancer phototherapy. These nanocarriers can be used in phototherapy to induce hyperthermia and singlet oxygen generation for tumor ablation. CS and HA can be used for the synthesis of nanostructures, or they can functionalize other kinds of nanostructures used for phototherapy, such as gold nanorods. The HA and CS nanostructures can combine chemotherapy or immunotherapy with phototherapy to augment tumor suppression. Moreover, the CS nanostructures can be functionalized with HA for specific cancer phototherapy. The CS and HA nanostructures promote the cellular uptake of genes and photosensitizers to facilitate gene therapy and phototherapy. Such nanostructures specifically stimulate phototherapy at the tumor site, with particle toxic impacts on normal cells. Moreover, CS and HA nanostructures demonstrate high biocompatibility for further clinical applications.
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Affiliation(s)
- Zheng Wang
- Department of Neurosurgery, Liaocheng Traditional Chinese Medicine Hospital, Liaocheng 252000, Shandong, PR China
| | - Shuo Pang
- Department of Urinary Surgery, Jinan Third People's Hospital, Jinan, Shandong 250101, PR China
| | - Xiaoli Liu
- Department of Dermatology, First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Zi Dong
- Department of Gastroenterology, Lincang People's Hospital, Lincang, China
| | - Yu Tian
- School of Public Health, Benedictine University, Lisle, United States
| | - Milad Ashrafizadeh
- Department of General Surgery, Institute of Precision Diagnosis and Treatment of Digestive System Tumors, Carson International Cancer Center, Shenzhen University General Hospital, Shenzhen University, Shenzhen, Guangdong 518055, China; International Association for Diagnosis and Treatment of Cancer, Shenzhen, Guangdong 518055, China; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250000, China.
| | - Navid Rabiee
- Department of Biomaterials, Saveetha Dental College and Hospitals, SIMATS, Saveetha University, Chennai, 600077 India
| | - Yavuz Nuri Ertas
- Department of Biomedical Engineering, Erciyes University, Kayseri 38039, Türkiye; ERNAM-Nanotechnology Research and Application Center, Erciyes University, Kayseri 38039, Türkiye; UNAM-National Nanotechnology Research Center, Bilkent University, Ankara 06800, Türkiye.
| | - Ying Mao
- Department of Oncology, Suining Central Hospital, Suining City, Sichuan, China.
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Alemu BK, Lee MW, Leung MBW, Lee WF, Wang Y, Wang CC, Lau SL. Preventive effect of prenatal maternal oral probiotic supplementation on neonatal jaundice (POPS Study): A protocol for the randomised double-blind placebo-controlled clinical trial. BMJ Open 2024; 14:e083641. [PMID: 38851232 PMCID: PMC11163667 DOI: 10.1136/bmjopen-2023-083641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 05/21/2024] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION Neonatal jaundice is a common and life-threatening health problem in neonates due to overaccumulation of circulating unconjugated bilirubin. Gut flora has a potential influence on bilirubin metabolism. The infant gut microbiome is commonly copied from the maternal gut. During pregnancy, due to changes in dietary habits, hormones and body weight, maternal gut dysbiosis is common, which can be stabilised by probiotics supplementation. However, whether probiotic supplements can reach the baby through the mother and reduce the incidence of neonatal jaundice has not been studied yet. Therefore, we aim to evaluate the effect of prenatal maternal probiotic supplementation on the incidence of neonatal jaundice. METHODS AND ANALYSIS This is a randomised double-blind placebo-controlled clinical trial among 94 pregnant women (47 in each group) in a tertiary hospital in Hong Kong. Voluntary eligible participants will be recruited between 28 and 35 weeks of gestation. Computer-generated randomisation and allocation to either the intervention or control group will be carried out. Participants will take either one sachet of Vivomixx (450 billion colony-forming units per sachet) or a placebo per day until 1 week post partum. Neither the study participants nor researchers will know the randomisation and allocation. The intervention will be initiated at 36 weeks of gestation. Neonatal bilirubin level will be measured to determine the primary outcome (hyperbilirubinaemia) while the metagenomic microbiome profile of breast milk and maternal and infant stool samples as well as pregnancy outcomes will be secondary outcomes. Binary logistic and linear regressions will be carried out to assess the association of the microbiome data with different clinical outcomes. ETHICS AND DISSEMINATION Ethics approval is obtained from the Joint CUHK-NTEC Clinical Research Ethics Committee, Hong Kong (CREC Ref: 2023.100-T). Findings will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NCT06087874.
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Affiliation(s)
- Bekalu Kassie Alemu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
- Department of Midwifery, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - May Wing Lee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Maran Bo Wah Leung
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Wing Fong Lee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Yao Wang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
- Institute of Health Sciences, The Chinese University, Hong Kong, Hong Kong SAR
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
- School of Biomedical Sciences, Joint Laboratory for Reproductive Medicine, The Chinese University, Hong Kong, Hong Kong SAR
| | - So Ling Lau
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
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Abrams M, Gosselin K, Roth CK, Hoffman N. A Randomized Trial Comparing NeoLight Skylife and Blanket Phototherapy in Newborn Indirect Hyperbilirubinemia. Clin Pediatr (Phila) 2024; 63:774-778. [PMID: 37522330 DOI: 10.1177/00099228231190120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
This investigation aimed to assess the safety and efficacy of NeoLight's Skylife phototherapy device for the treatment of hyperbilirubinemia. A prospective, two-arm, randomized, unblinded controlled investigation compared total serum bilirubin (TSB) levels at baseline and discharge for a new phototherapy device (Skylife) with an existing phototherapy treatment in newborn infants. The repeated-measures analysis of variance (RM-ANOVA) indicated a significant main effect for the treatment condition, F(1, 54) = 4.041, P = .049. Post hoc findings showed that the Skylife group had significantly lower TSB levels following treatment (n = 28, Mean = 11.36, SD = 1.69) compared with the standard of care group (n = 28, Mean = 12.37, SD = 2.08), t(54) = 2.01, P = .049). The Skylife phototherapy device was as effective as the currently used therapy, with a shift toward a more rapid decline in bilirubin levels. Using this device may potentially decrease the length of therapy and hospitalization.Clinical Trial Registration Comparison of Phototherapy Using Neolight Skylife Versus Standardized Phototherapy for Hyperbilirubinemia in Newborns is registered at clinicaltrials.gov as NCT03599258.
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Affiliation(s)
- Matthew Abrams
- HonorHealth Research Institute, Scottsdale, AZ, USA
- Mednax Inc., Sunrise, FL, USA
- Arizona Neonatology, Phoenix, AZ, USA
| | - Kevin Gosselin
- HonorHealth Research Institute, Scottsdale, AZ, USA
- AriTex, Chandler, AZ, USA
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7
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Kuitunen I, Nikkilä A, Kiviranta P, Jääskeläinen J, Auvinen A. Risk of childhood neoplasms related to neonatal phototherapy- a systematic review and meta-analysis. Pediatr Res 2024:10.1038/s41390-024-03191-7. [PMID: 38615073 DOI: 10.1038/s41390-024-03191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 04/15/2024]
Abstract
CONTEXT Observational studies have shown conflicting results as to whether exposure to neonatal phototherapy is associated with increased rates of childhood cancer. OBJECTIVE To describe the rates of childhood neoplasms and cancer after neonatal phototherapy. DATA SOURCES The CENTRAL, PubMed, Scopus, and Web of Science databases. STUDY SELECTION Observational studies regardless of design were included. DATA EXTRACTION The data were extracted by one author and validated by another. The risk-of-bias assessment was performed using the ROBINS-E and Joanna Briggs Institute critical appraisal tools. RESULTS Six cohort and 10 case-control studies were included. The overall risk of bias was high in seven and low in nine studies. In cohort studies, the odds ratio (OR) was increased for hematopoietic cancer (1.44; confidence interval [CI]: 1.16-1.80) and solid tumors (OR: 1.18; CI: 1.00-1.40). In case-control studies, the OR was 1.63 (CI: 0.99-2.67) for hematopoietic cancers and 1.18 (CI: 1.04-1.34) for solid tumors. CONCLUSIONS Children with a history of neonatal phototherapy had increased risk of hematopoietic cancer and solid tumors. The evidence quality was limited due to the high risk of bias and potential residual confounding. IMPACT STATEMENT Exposure to neonatal phototherapy increased later risk of hematopoietic cancer and solid tumors. This is the most comprehensive study on the association between phototherapy and cancer, but the evidence quality was limited due risk of bias and residual confounding. Future large scale well conducted studies are still needed to better estimate the association and.
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Affiliation(s)
- Ilari Kuitunen
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland.
- Kuopio University Hospital, Department of Pediatrics, Kuopio, Finland.
| | - Atte Nikkilä
- Tampere University, Faculty of Medicine and Health Technologies, Tampere, Finland
- Kanta-Häme Central Hospital, Department of Pediatrics, Hämeenlinna, Finland
| | - Panu Kiviranta
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland
- Kuopio University Hospital, Department of Pediatrics, Kuopio, Finland
- The Finnish Medical Society Duodecim, Helsinki, Finland
| | - Johanna Jääskeläinen
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland
| | - Anssi Auvinen
- Tampere University, Faculty of Social Sciences, Department of Epidemiology, Tampere, Finland
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8
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Mujawar T, Sevelda P, Madea D, Klán P, Švenda J. A Platform for the Synthesis of Oxidation Products of Bilirubin. J Am Chem Soc 2024; 146:1603-1611. [PMID: 38165253 PMCID: PMC10797625 DOI: 10.1021/jacs.3c11778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
Bilirubin is the principal product of heme catabolism. High concentrations of the pigment are neurotoxic, yet slightly elevated levels are beneficial. Being a potent antioxidant, oxidative transformations of bilirubin occur in vivo and lead to various oxidized fragments. The mechanisms of their formation, intrinsic biological activities, and potential roles in human pathophysiology are poorly understood. Degradation methods have been used to obtain samples of bilirubin oxidation products for research. Here, we report a complementary, fully synthetic method of preparation. Our strategy leverages repeating substitution patterns in the parent tetracyclic pigment. Functionalized ready-to-couple γ-lactone, γ-lactam, and pyrrole monocyclic building blocks were designed and efficiently synthesized. Subsequent modular combinations, supported by metal-catalyzed borylation and cross-coupling chemistries, translated into the concise assembly of the structurally diverse bilirubin oxidation products (BOXes, propentdyopents, and biopyrrins). The discovery of a new photoisomer of biopyrrin A named lumipyrrin is reported. Synthetic bilirubin oxidation products made available in sufficient purity and quantity will support future in vitro and in vivo investigations.
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Affiliation(s)
- Taufiqueahmed Mujawar
- Department
of Chemistry, Faculty of Science, Masaryk
University, Kamenice 5, Brno 625 00, Czech Republic
| | - Petr Sevelda
- Department
of Chemistry, Faculty of Science, Masaryk
University, Kamenice 5, Brno 625 00, Czech Republic
| | - Dominik Madea
- Department
of Chemistry, Faculty of Science, Masaryk
University, Kamenice 5, Brno 625 00, Czech Republic
- RECETOX,
Faculty of Science, Masaryk University, Kamenice 5, Brno 625 00, Czech Republic
| | - Petr Klán
- Department
of Chemistry, Faculty of Science, Masaryk
University, Kamenice 5, Brno 625 00, Czech Republic
- RECETOX,
Faculty of Science, Masaryk University, Kamenice 5, Brno 625 00, Czech Republic
| | - Jakub Švenda
- Department
of Chemistry, Faculty of Science, Masaryk
University, Kamenice 5, Brno 625 00, Czech Republic
- International
Clinical Research Center, St. Anne’s
University Hospital, Pekařská 53, Brno 656 91, Czech Republic
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Zhang W, Dong J. Suppressing epithelial-mesenchymal-transition blue light therapy for reducing macrophage-mediated cancerous pulmonary fibrosis: An in-vitro study. JOURNAL OF BIOPHOTONICS 2023; 16:e202300253. [PMID: 37589213 DOI: 10.1002/jbio.202300253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023]
Abstract
Lung cancer is the leading killer among all types of cancer globally. As a key factor, epithelial-mesenchymal transition (EMT) plays a crucial role in pathological fibrosis and lung cancer metastasis. This study endeavors to investigate the effect of blue light at specific wavelengths of 405 nm and 415 nm (54 J/cm2 ) on EMT induced by TGF-β1 in A549 cells. The results revealed that the blue light irradiation reduced the morphological characteristics of EMT in the A549 cells, and cell-to-cell connections were weakened significantly. Molecular analysis showed upregulation of epithelial marker E-cadherin and downregulation of EMT marker vimentin. Additionally, exposure to blue light irradiation at 405 nm and 415 nm significantly decelerated the ability of invasion and migration. Moreover, cell viability was also investigated. Based on these findings, blue light can serve as a useful therapeutic option for inhibiting EMT in cases of lung cancer and fibrotic lung disease.
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Affiliation(s)
- Wenjun Zhang
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Jianfei Dong
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
- School of Future Science and Engineering, Soochow University, Suzhou, China
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Shoris I, Gover A, Toropine A, Iofe A, Zoabi-Safadi R, Tsuprun S, Riskin A. "Light" on Phototherapy-Complications and Strategies for Shortening Its Duration, A Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1699. [PMID: 37892362 PMCID: PMC10605061 DOI: 10.3390/children10101699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/01/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
Neonatal hyperbilirubinemia is an extremely common metabolic complication of the neonatal period which may be associated with bilirubin encephalopathy and even death. Adverse neurological consequences are preventable if a timely diagnosis and treatment are provided. Phototherapy is usually the preferred option to decrease hyperbilirubinemia. Although considered to be safe, evidence in recent years has shown that this treatment may not be free of side effects and short- and long-term unfavorable outcomes. These are usually mild or rare, but should be decreased or avoided if possible. Many useful complementary measures and treatments have been described that could shorten the duration of exposure to phototherapy. However, there is no current unequivocal recommendation to use any of the methods presented in this review. Our review aims to depict the wide range of possible complementary treatments to phototherapy, and to provide the scientific and clinical evidence available regarding their usefulness. It is essential that, while utilizing the full potential of phototherapy to treat hyperbilirubinemia, caregivers are aware of its side effects and possible inherent dangers, and seek ways to minimize the exposure to phototherapy to what is really needed for the newborn. Further studies are needed to clarify the preferred complementary treatments that could reduce the duration of exposure to phototherapy without impairing its effectiveness.
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Affiliation(s)
- Irit Shoris
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
| | - Ayala Gover
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
| | - Arina Toropine
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
| | - Adir Iofe
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
| | - Rasha Zoabi-Safadi
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
| | - Svetlana Tsuprun
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
| | - Arieh Riskin
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
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Cruz ÁB, de Brito LG, Leal PVB, Dos Santos Ramos WT, Pereira DH. Intramolecular hydrogen bonds interactions in the isomers of the bilirubin molecule: DFT and QTAIM analysis. J Mol Model 2023; 29:318. [PMID: 37718354 DOI: 10.1007/s00894-023-05720-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023]
Abstract
CONTEXT Bilirubin is an important molecule, used as a marker of some liver diseases, and it can also be toxic and cause jaundice, especially in newborns. The main treatment for neonatal jaundice is phototherapy with blue light, which is still widely studied because the photophysical processes involved are not fully understood. METHODS Calculations based on the density functional theory (DFT) at M062X/6-31G(d,p) level were performed in order to evaluate the structural, electronic, and topological properties of bilirubin isomers. It was found that the ZZ conformation can form a greater number of hydrogen bonds, which gives the isomer greater energy stabilization compared to the other ZE, EZ, and EE isomers, and that the EE isomer is the conformer with the lowest energy of stabilization. The hydrogen bonds were characterized by the quantum theory of atoms in molecules (QTAIM) and for the ZZ isomer four hydrogen bonds (HBs) were found classified as intermediate, ∇2ρ(r) > 0, H(r) > 0. The ZE, EZ, and EE isomers show weak HBs, ∇2ρ(r) > 0, H(r) > 0.
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Affiliation(s)
- Állefe Barbosa Cruz
- Collegiate of Exact Sciences and Biotechnology, Federal University of Tocantins, 77.402-970, Gurupi, Tocantins, Brazil
- Graduate Program in Chemistry, Federal University of Tocantins, 77.402-970, Gurupi, Tocantins, Brazil
| | - Lívia Gabriela de Brito
- Institute of Engineering, Science and Technology, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Janaúba, MG, 39440-000, Brazil
| | - Paulo Vitor Brandão Leal
- Institute of Engineering, Science and Technology, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Janaúba, MG, 39440-000, Brazil
| | - Welyson Tiano Dos Santos Ramos
- Institute of Engineering, Science and Technology, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Janaúba, MG, 39440-000, Brazil
- Graduate Program On Computacional Modeling and Systems, Universidade Estadual de Montes Claros, Montes Claros, MG, 39401-089, Brazil
| | - Douglas Henrique Pereira
- Collegiate of Exact Sciences and Biotechnology, Federal University of Tocantins, 77.402-970, Gurupi, Tocantins, Brazil.
- Graduate Program in Chemistry, Federal University of Tocantins, 77.402-970, Gurupi, Tocantins, Brazil.
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12
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Abstract
Endogenous photosensitizers play a critical role in both beneficial and harmful light-induced transformations in biological systems. Understanding their mode of action is essential for advancing fields such as photomedicine, photoredox catalysis, environmental science, and the development of sun care products. This review offers a comprehensive analysis of endogenous photosensitizers in human skin, investigating the connections between their electronic excitation and the subsequent activation or damage of organic biomolecules. We gather the physicochemical and photochemical properties of key endogenous photosensitizers and examine the relationships between their chemical reactivity, location within the skin, and the primary biochemical events following solar radiation exposure, along with their influence on skin physiology and pathology. An important take-home message of this review is that photosensitization allows visible light and UV-A radiation to have large effects on skin. The analysis presented here unveils potential causes for the continuous increase in global skin cancer cases and emphasizes the limitations of current sun protection approaches.
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Affiliation(s)
- Erick L Bastos
- Department of Fundamental Chemistry, Institute of Chemistry, University of São Paulo, 05508-000 São Paulo, São Paulo, Brazil
| | - Frank H Quina
- Department of Fundamental Chemistry, Institute of Chemistry, University of São Paulo, 05508-000 São Paulo, São Paulo, Brazil
- Department of Chemical Engineering, Polytechnic School, University of São Paulo, 05508-000 São Paulo, São Paulo, Brazil
| | - Maurício S Baptista
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, 05508-000 São Paulo, São Paulo, Brazil
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13
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Solis-Garcia G, Raghuram K, Augustine S, Ricci MF, St-Hilaire M, Louis D, Makary H, Yang J, Shah PS. Hyperbilirubinemia Among Infants Born Preterm: Peak Levels and Association with Neurodevelopmental Outcomes. J Pediatr 2023; 259:113458. [PMID: 37172811 DOI: 10.1016/j.jpeds.2023.113458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To describe the distribution of peak bilirubin levels among infants born before 29 weeks of gestation in the first 14 days of life and to study the association between quartiles of peak bilirubin levels at different gestational ages and neurodevelopmental outcomes. STUDY DESIGN Multicenter, retrospective, nationwide cohort study of neonatal intensive care units in the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network, including neonates born preterm at 220/7 to 286/7 weeks of gestation born between 2010 and 2018. Peak bilirubin levels were recorded during the first 14 days of age. Main outcome was significant neurodevelopmental impairment, defined as cerebral palsy with Gross Motor Function Classification System ≥3, or Bayley III-IV scores of <70 in any domain, or visual impairment, or bilateral hearing loss requiring hearing aids. RESULTS Among 12 554 included newborns, median gestational age was 26 weeks (IQR 25-28) and birth weight was 920 g (IQR 750-1105 g). The median peak bilirubin values increased as gestational age increased (112 mmol/L [6.5 mg/dL] at 22 weeks and 156 mmol/L [9.1 mg/dL] at 28 weeks). Significant neurodevelopmental impairment was identified in 1116 of 6638 (16.8%) of children. Multivariable analyses identified an association between peak bilirubin in the highest quartile and neurodevelopmental impairment (aOR 1.27, 95% CI 1.01-1.60) and receipt of hearing aid/cochlear implant (aOR 3.97, 95%CI: 2.01-7.82) compared with the lowest quartile. CONCLUSION In this multicenter cohort study, peak bilirubin levels in neonates of <29 weeks of gestation increased with gestational age. Peak bilirubin values in the highest gestational age-specific quartile were associated with significant neurodevelopmental and hearing impairments.
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Affiliation(s)
- Gonzalo Solis-Garcia
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada; Integrated Neonatal Perinatal Fellowship Program, University of Toronto, Toronto, Ontario, Canada
| | - Kamini Raghuram
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Sajit Augustine
- Department of Pediatrics, Windsor Regional Hospital, University of Windsor, Windsor, Ontario, Canada
| | - M Florencia Ricci
- Division of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marie St-Hilaire
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Deepak Louis
- Division of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hala Makary
- Department of Pediatrics, Dr Everett Chalmers Hospital, Fredericton, New Brunswick, Canada
| | - Junmin Yang
- Mother-Infant Care and Research Center, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada; Mother-Infant Care and Research Center, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
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14
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Teng Y, Li Z, Liu J, Teng L, Li H. Proliferation inhibition and apoptosis of liver cancer cells treated by blue light irradiation. Med Oncol 2023; 40:227. [PMID: 37410177 DOI: 10.1007/s12032-023-02096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
Blue light (BL) irradiation has been a potentially efficient treatment for many kinds of tumors. In this study, a BL irradiation (centered at 453 nm in wavelength) was proposed to treat the common human liver cancer cell lines of SMMC-7721 and HepG2, examined by means of flow cytometry, western blot, fluorescence microscope assay. In comparison to control groups, the apoptosis and proliferation inhibition of both BL-treated cells are expressively enhanced by mitochondrial apoptosis. The mechanism of apoptosis is related to the more production of reactive oxygen species (ROS) induced by BL and the corresponding changes in the expression of apoptosis-related Bcl-2, Bax and Bad proteins. In addition, the migration rate of the cancer cells could be reduced after BL irradiation. These results demonstrate that introducing BL irradiation is helpful to establish an effective and low toxicity strategy for the clinical treatment of liver tumors.
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Affiliation(s)
- Yun Teng
- State Key Lab of Superhard Materials, College of Physics, Jilin University, Changchun, 130012, People's Republic of China
| | - Zhige Li
- School of Life Sciences, Jilin University, Changchun, 130012, People's Republic of China
| | - Junsong Liu
- State Key Lab of Superhard Materials, College of Physics, Jilin University, Changchun, 130012, People's Republic of China.
| | - Lesheng Teng
- School of Life Sciences, Jilin University, Changchun, 130012, People's Republic of China.
| | - Hongdong Li
- State Key Lab of Superhard Materials, College of Physics, Jilin University, Changchun, 130012, People's Republic of China.
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15
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Lovera LA, Torres J, García-Perdomo HA. Effectiveness and safety of prophylactic phototherapy to prevent jaundice in premature newborns: Systematic review and meta-analysis. J Child Health Care 2023:13674935231187716. [PMID: 37402472 DOI: 10.1177/13674935231187716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
To determine the effectiveness and safety of prophylactic phototherapy compared with conventional phototherapy for the prevention of neonatal jaundice. We included clinical trials comparing prophylactic phototherapy to conventional phototherapy to prevent jaundice in premature newborns. We searched Embase, MEDLINE, LILACS, Central, and others. The statistical analysis was performed in RevMan (Review Manager 5.3). Outcomes were analyzed according to the type of variable: risk difference (RD) and mean difference (MD). A random effects model was used due to heterogeneity. We reported results in forest plots. Risk of bias was evaluated, and a sensitivity analysis was made. 1127 articles were found, and six studies (2332 patients) were included in the meta-analysis. Five studies evaluated the need for exchange transfusion as the primary outcome RD -0.01, 95% CI [-0.05 to 0.03]. One study evaluated bilirubin encephalopathy RD -0.04, 95% CI [-0.09 to 0.00]. Five studies evaluated the duration of phototherapy, MD 38.47, 95% CI [1.28 to 55.67]. Four studies evaluated levels of bilirubin (MD -1.23, 95% CI [-2.25 to -0.21]. Two studies evaluated mortality, RD 0.01, 95% CI [-0.03 to 0.04]. As a conclusion, compared to conventional phototherapy, prophylactic phototherapy decreases the last measured level of bilirubin, as well as the probability of neurodevelopmental disturbances. However, it increases phototherapy duration.
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Affiliation(s)
- Luis A Lovera
- School of Nursing, Care Research Group, Universidad del Valle, Cali, Colombia
| | - Javier Torres
- Department of Pediatrics, School of Medicine, INSIDE Research Group, Universidad del Valle, Cali, Colombia
| | - Herney A García-Perdomo
- Division of Urology/Urooncology, Department of Surgery, School of Medicine, UROGIV Research Group, Universidad del Valle, Cali, Colombia
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16
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Li Z, Li Z, Wang J. Visualization of Phototherapy Evolution by Optical Imaging. Molecules 2023; 28:molecules28103992. [PMID: 37241733 DOI: 10.3390/molecules28103992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Phototherapy, including photodynamic therapy (PDT) and photothermal therapy (PTT), is a non-invasive and effective approach used for cancer treatment, in which phototherapeutic agents are irradiated with an appropriate light source to produce cytotoxic reactive oxygen species (ROS) or heat to ablate cancer cells. Unfortunately, traditional phototherapy lacks a facile imaging method to monitor the therapeutic process and efficiency in real time, usually leading to severe side effects due to high levels of ROS and hyperthermia. To realize precise cancer treatment methods, it is highly desired to develop phototherapeutic agents possessing an imaging ability to evaluate the therapeutic process and efficacy in real time during cancer phototherapy. Recently, a series of self-reporting phototherapeutic agents were reported to monitor PDT and PTT processes by combining optical imaging technologies with phototherapy. Due to the real-time feedback provided by optical imaging technology, therapeutic responses or dynamic changes in the tumor microenvironment could be evaluated in a timely manner, thereby achieving personalized precision treatment and minimizing toxic side effects. In this review, we focus on the advances in the development of self-reporting phototherapeutic agents for a cancer phototherapy evaluation based on optical imaging technology to realize precision cancer treatments. Additionally, we propose the current challenges and future directions of self-reporting agents for precision medicine.
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Affiliation(s)
- Zhiheng Li
- College of Materials and Chemical Engineering, Zhengzhou University of Light Industry, Zhengzhou 450002, China
| | - Zheng Li
- Wuhan Academy of Agricultural Sciences, Wuhan 430072, China
| | - Jie Wang
- The Key Lab of Health Chemistry & Molecular Diagnosis of Suzhou, College of Chemistry, Chemical Engineering & Materials Science, Soochow University, Suzhou 215123, China
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17
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Meena JS, Choi SB, Jung SB, Kim JW. Electronic textiles: New age of wearable technology for healthcare and fitness solutions. Mater Today Bio 2023; 19:100565. [PMID: 36816602 PMCID: PMC9932217 DOI: 10.1016/j.mtbio.2023.100565] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 01/30/2023] Open
Abstract
Sedentary lifestyles and evolving work environments have created challenges for global health and cause huge burdens on healthcare and fitness systems. Physical immobility and functional losses due to aging are two main reasons for noncommunicable disease mortality. Smart electronic textiles (e-textiles) have attracted considerable attention because of their potential uses in health monitoring, rehabilitation, and training assessment applications. Interactive textiles integrated with electronic devices and algorithms can be used to gather, process, and digitize data on human body motion in real time for purposes such as electrotherapy, improving blood circulation, and promoting wound healing. This review summarizes research advances on e-textiles designed for wearable healthcare and fitness systems. The significance of e-textiles, key applications, and future demand expectations are addressed in this review. Various health conditions and fitness problems and possible solutions involving the use of multifunctional interactive garments are discussed. A brief discussion of essential materials and basic procedures used to fabricate wearable e-textiles are included. Finally, the current challenges, possible solutions, opportunities, and future perspectives in the area of smart textiles are discussed.
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Affiliation(s)
- Jagan Singh Meena
- Research Center for Advanced Materials Technology, Core Research Institute, Sungkyunkwan University, Suwon, Republic of Korea
| | - Su Bin Choi
- Department of Smart Fab Technology, Sungkyunkwan University, Suwon, Republic of Korea
| | - Seung-Boo Jung
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Jong-Woong Kim
- Department of Smart Fab Technology, Sungkyunkwan University, Suwon, Republic of Korea
- School of Mechanical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
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18
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Gottimukkala SB, Lobo L, Gautham KS, Bolisetty S, Fiander M, Schindler T. Intermittent phototherapy versus continuous phototherapy for neonatal jaundice. Cochrane Database Syst Rev 2023; 3:CD008168. [PMID: 36867730 PMCID: PMC9979775 DOI: 10.1002/14651858.cd008168.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
BACKGROUND Phototherapy is a widely accepted, effective first-line therapy for neonatal jaundice. It is traditionally used continuously but intermittent phototherapy has been proposed as an equally effective alternative with practical advantages of improved maternal feeding and bonding. The effectiveness of intermittent phototherapy compared with continuous phototherapy is unknown. OBJECTIVES To assess the safety and effectiveness of intermittent phototherapy compared with continuous phototherapy. SEARCH METHODS Searches were conducted on 31 January 2022 in the following databases: CENTRAL via CRS Web, MEDLINE and Embase via Ovid. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. SELECTION CRITERIA We included RCTs, cluster-RCTs and quasi-RCTs comparing intermittent phototherapy with continuous phototherapy in jaundiced infants (both term and preterm) up to the age of 30 days. We compared intermittent phototherapy with continuous phototherapy by any method and at any dose and duration as defined by the authors. DATA COLLECTION AND ANALYSIS Three review authors independently selected trials, assessed trial quality and extracted data from included studies. We performed fixed-effect analyses and expressed treatment effects as mean difference (MD), risk ratio (RR) and risk difference (RD) with 95% confidence intervals (CIs). Our primary outcomes of interest were rate of decline of serum bilirubin, and kernicterus. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 12 RCTs (1600 infants) in the review. There is one ongoing study and four awaiting classification. There was little or no difference between intermittent phototherapy and continuous phototherapy with respect to rate of decline of bilirubin in jaundiced newborn infants (MD -0.09 micromol/L/hr, 95% CI -0.21 to 0.03; I² = 61%; 10 studies; 1225 infants; low-certainty evidence). One study involving 60 infants reported no incidence of bilirubin induced brain dysfunction (BIND). It is uncertain whether either intermittent or continuous phototherapy reduces BIND because the certainty of this evidence is very low. There was little or no difference in treatment failure (RD 0.03, 95% CI 0.08 to 0.15; RR 1.63, 95% CI 0.29 to 9.17; 1 study; 75 infants; very low-certainty evidence) or infant mortality (RD -0.01, 95% CI -0.03 to 0.01; RR 0.69, 95% CI 0.37 to 1.31 I² = 0%; 10 studies, 1470 infants; low-certainty evidence). AUTHORS' CONCLUSIONS: The available evidence detected little or no difference between intermittent and continuous phototherapy with respect to rate of decline of bilirubin. Continuous phototherapy appears to be more effective in preterm infants, however, the risks of continuous phototherapy and the potential benefits of a slightly lower bilirubin level are unknown. Intermittent phototherapy is associated with a decrease in the total number of hours of phototherapy exposure. There are theoretical benefits to intermittent regimens but there are important safety outcomes that were inadequately addressed. Large, well designed, prospective trials are needed in both preterm and term infants before it can be concluded that intermittent and continuous phototherapy regimens are equally effective.
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Affiliation(s)
| | - Lisha Lobo
- Central Coast Health District, Gosford, Australia
| | | | | | | | - Tim Schindler
- Newborn Care, Royal Hospital for Women, Randwick, Australia
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19
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Demirtas MS, Erdal H. Evaluation of thiol-disulfide homeostasis and oxidative stress parameters in newborns receiving phototherapy. J Investig Med 2023; 71:183-190. [PMID: 36803043 DOI: 10.1177/10815589221140594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of our study was to evaluate oxidative stress and thiol-disulfide homeostasis in term newborns receiving phototherapy. The study was planned as a single-blind, intervention study in a single center with level 3 neonatal intensive care unit to investigate the effect of phototherapy on the oxidative system in term newborns with hyperbilirubinemia. Neonates with hyperbilirubinemia were treated with total body exposure phototherapy technique for 18 h using a Novos® device. Blood samples of 28 term newborns were taken before and after phototherapy. Total and native thiol, total antioxidant status (TAS) and total oxidant status (TOS), and oxidative stress index (OSI) levels were measured. The 28 newborn patients included 15 (54%) males and 13 (46%) females with a mean birthweight of 3080.1 ± 366.5 g. Native and total thiol levels were found to be decreased in patients receiving phototherapy (p = 0.021, p = 0.010). Besides, significantly lower TAS and TOS levels were found after phototherapy (p < 0.001, p < 0.001). We found that decreased thiol levels were related to increased oxidative stress. We also determined significantly the lower bilirubin levels after phototherapy (p < 0.001). In conclusion, we found that phototherapy treatment induced decreased oxidative stress associated with hyperbilirubinemia in neonates. Thiol-disulfide homeostasis can be used as a marker of oxidative stress due to hyperbilirubinemia in the early period.
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Affiliation(s)
- Mehmet Semih Demirtas
- Department of Pediatrics, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Huseyin Erdal
- Department of Medical Genetics, Faculty of Medicine, Aksaray University, Aksaray, Turkey
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20
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Kim HJ, Sritandi W, Xiong Z, Ho JS. Bioelectronic devices for light-based diagnostics and therapies. BIOPHYSICS REVIEWS 2023; 4:011304. [PMID: 38505817 PMCID: PMC10903427 DOI: 10.1063/5.0102811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/28/2022] [Indexed: 03/21/2024]
Abstract
Light has broad applications in medicine as a tool for diagnosis and therapy. Recent advances in optical technology and bioelectronics have opened opportunities for wearable, ingestible, and implantable devices that use light to continuously monitor health and precisely treat diseases. In this review, we discuss recent progress in the development and application of light-based bioelectronic devices. We summarize the key features of the technologies underlying these devices, including light sources, light detectors, energy storage and harvesting, and wireless power and communications. We investigate the current state of bioelectronic devices for the continuous measurement of health and on-demand delivery of therapy. Finally, we highlight major challenges and opportunities associated with light-based bioelectronic devices and discuss their promise for enabling digital forms of health care.
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Affiliation(s)
| | - Weni Sritandi
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
| | | | - John S. Ho
- Author to whom correspondence should be addressed:
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21
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Abdellatif M, Tawfik GM, Makram AM, Abdelsattar MK, Dobs M, Papadopoulos DN, Hoang-Trong BL, Mostafa EM, Duong PDT, Huy NT. Association between neonatal phototherapy and future cancer: an updated systematic review and meta-analysis. Eur J Pediatr 2023; 182:329-341. [PMID: 36352244 DOI: 10.1007/s00431-022-04675-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/11/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022]
Abstract
Phototherapy is the main treatment of neonatal hyperbilirubinemia to prevent encephalopathy. It is generally believed to be safe; however, some studies have shown it might be associated with cancer development. In this systematic review and meta-analysis, we aimed to assess the effect of neonatal phototherapy on future cancer risk. A systematic search in 13 databases was conducted in December 2018 and updated in August 2022 to identify studies that report cancer development after exposure to phototherapy. Throughout the study period, regular manual searches were also conducted to include new studies. A meta-analysis using R programming language was done in which the odds ratios (ORs) with 95% confidence intervals (CIs) were estimated and pooled using the reported adjusted and unadjusted data. Fifteen studies were included. A statistically significant association was detected between neonatal phototherapy and any type of cancer (OR 1.24; 95% CI 1.1, 1.4), any hematopoietic cancer (OR 1.49; 95% CI 1.17, 1.91), any leukemia (OR 1.35; 95% CI 1.08, 1.67), and myeloid leukemia (OR 2.86; 95% CI 1.4, 5.84). The other investigated cancers (lymphoid leukemia, Hodgkin's lymphoma, kidney cancer, nervous system cancer, and skin cancer) were not associated with phototherapy. Conclusions: Phototherapy may carry a possible risk of future cancers. Future research is needed to quantify the magnitude of the cancer risk. These future studies should consider predictors of preterm birth or exclude premature babies from their analysis. What is Known • There were various reports about the possible association between phototherapy in neonates and the increased risk of cancer in the future. What is New • A statistically significant association between phototherapy and various hematopoietic cancers (especially myeloid leukemia) was recorded. • The effect of the duration of phototherapy on the increased risk of hematopoietic cancers is yet unclear.
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Affiliation(s)
| | - Gehad Mohamed Tawfik
- Online Research Club, Nagasaki, Japan.,.,Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abdelrahman M Makram
- Online Research Club, Nagasaki, Japan.,.,Faculty of Medicine, October 6 University, Giza, Egypt.,School of Public Health, Imperial College London, London, UK
| | | | - Monica Dobs
- Online Research Club, Nagasaki, Japan.,.,Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Dimitrios N Papadopoulos
- Online Research Club, Nagasaki, Japan.,.,Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Bao-Long Hoang-Trong
- Online Research Club, Nagasaki, Japan.,.,Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Esraa Mahmoud Mostafa
- Online Research Club, Nagasaki, Japan.,.,Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Pham Diep Thuy Duong
- Pediatric Department, Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Nguyen Tien Huy
- Online Research Club, Nagasaki, Japan. .,, . .,School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
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22
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Nanoparticles-based phototherapy systems for cancer treatment: Current status and clinical potential. Bioact Mater 2022; 23:471-507. [PMID: 36514388 PMCID: PMC9727595 DOI: 10.1016/j.bioactmat.2022.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/11/2022] Open
Abstract
Remarkable progress in phototherapy has been made in recent decades, due to its non-invasiveness and instant therapeutic efficacy. In addition, with the rapid development of nanoscience and nanotechnology, phototherapy systems based on nanoparticles or nanocomposites also evolved as an emerging hotspot in nanomedicine research, especially in cancer. In this review, first we briefly introduce the history of phototherapy, and the mechanisms of phototherapy in cancer treatment. Then, we summarize the representative development over the past three to five years in nanoparticle-based phototherapy and highlight the design of the innovative nanoparticles thereof. Finally, we discuss the feasibility and the potential of the nanoparticle-based phototherapy systems in clinical anticancer therapeutic applications, aiming to predict future research directions in this field. Our review is a tutorial work, aiming at providing useful insights to researchers in the field of nanotechnology, nanoscience and cancer.
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23
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Chen M, Li P, Wang R, Xiang Y, Huang Z, Yu Q, He M, Liu J, Wang J, Su M, Zhang M, Jian A, Ouyang J, Zhang C, Li J, Dong M, Zeng S, Wu J, Hong P, Hou C, Zhou N, Zhang D, Zhou H, Tao G. Multifunctional Fiber-Enabled Intelligent Health Agents. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2200985. [PMID: 35820163 DOI: 10.1002/adma.202200985] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/31/2022] [Indexed: 06/15/2023]
Abstract
The application of wearable devices is promoting the development toward digitization and intelligence in the field of health. However, the current smart devices centered on human health have disadvantages such as weak perception, high interference degree, and unfriendly interaction. Here, an intelligent health agent based on multifunctional fibers, with the characteristics of autonomy, activeness, intelligence, and perceptibility enabling health services, is proposed. According to the requirements for healthcare in the medical field and daily life, four major aspects driven by intelligent agents, including health monitoring, therapy, protection, and minimally invasive surgery, are summarized from the perspectives of materials science, medicine, and computer science. The function of intelligent health agents is realized through multifunctional fibers as sensing units and artificial intelligence technology as a cognitive engine. The structure, characteristics, and performance of fibers and analysis systems and algorithms are reviewed, while discussing future challenges and opportunities in healthcare and medicine. Finally, based on the above four aspects, future scenarios related to health protection of a person's life are presented. Intelligent health agents will have the potential to accelerate the realization of precision medicine and active health.
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Affiliation(s)
- Min Chen
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- State Key Laboratory of Material Processing and Die & Mould Technology, School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Pan Li
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Rui Wang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Yuanzhuo Xiang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Zhiheng Huang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Qiao Yu
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Muyao He
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Jia Liu
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Jiaxi Wang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Minyu Su
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Manni Zhang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Aijia Jian
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Jingyu Ouyang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Chenxi Zhang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Jing Li
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Mengxue Dong
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Shaoning Zeng
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Jiawei Wu
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Ping Hong
- Beijing Sport University, Beijing, 100091, P. R. China
| | - Chong Hou
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Optics and Electronic Information, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Ning Zhou
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Dingyu Zhang
- Hubei Provincial Health and Health Committee, Wuhan, Hubei, 430015, P. R. China
| | - Huamin Zhou
- State Key Laboratory of Material Processing and Die & Mould Technology, School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Guangming Tao
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- State Key Laboratory of Material Processing and Die & Mould Technology, School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
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Choi S, Jeon Y, Kwon JH, Ihm C, Kim SY, Choi KC. Wearable Photomedicine for Neonatal Jaundice Treatment Using Blue Organic Light-Emitting Diodes (OLEDs): Toward Textile-Based Wearable Phototherapeutics. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2204622. [PMID: 36310107 PMCID: PMC9762290 DOI: 10.1002/advs.202204622] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Neonatal jaundice is a very common disease in newborns and can lead to brain damage or death in severe cases. Phototherapy with light-emitting diode (LED) arrays is widely used as the easiest and fastest way to relieve jaundice in newborns, but it has distinct disadvantages such as loss of water in the patient, damage to the retina, and separation from parents. In this paper, a novel light source-based phototherapy for neonatal jaundice is proposed using a textile-based wearable organic light-emitting diode (OLED) platform that can move flexibly and conform to the curvature of the human body. The soft and flexible textile-based blue OLED platform is designed to have a peak wavelength of 470 nm, suitable for jaundice treatment, and shows performance (>20 µW cm-2 nm- 1 ) suitable for intensive jaundice treatment even at low voltage (<4.0 V). The textile-based OLEDs fabricated in this study exhibit an operating reliability of over 100 h and low-temperature operation (<35 °C). The results of an in vitro jaundice treatment test using a large-area blue OLED confirm that the bilirubin level decreases to 12 mg dL-1 with 3 h of OLED irradiation.
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Affiliation(s)
- Seungyeop Choi
- School of Electrical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141Republic of Korea
| | - Yongmin Jeon
- Department of Biomedical EngineeringGachon UniversitySeongnam13120Republic of Korea
| | - Jeong Hyun Kwon
- Department of Display and Semiconductor EngineeringSUN MOON UniversityChoongcheongnam‐doAsan31460Republic of Korea
| | - Chunhwa Ihm
- Department of Laboratory MedicineDaejeon Eulji Medical CenterEulji University School of MedicineDaejeon35233Republic of Korea
| | - Seung Yeon Kim
- Department of PediatricsNowon Eulji Medical CenterEulji University School of MedicineSeoul01830Republic of Korea
| | - Kyung Cheol Choi
- School of Electrical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141Republic of Korea
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25
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JAVORKA K, NANDRÁZ̄IOVÁ L, UHRÍKOVÁ Z, CZIPPELOVÁ B, MAŤAS̄OVÁ K, JAVORKA M, ZIBOLEN M. Cardiovascular changes during phototherapy in newborns. Physiol Res 2022; 71:S179-S186. [PMID: 36647906 PMCID: PMC9906667 DOI: 10.33549/physiolres.935002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Phototherapy is the most effective non-invasive method of neonatal hyperbilirubinemia treatment. Application of this method can be associated with side effects including changes in the cardiovascular system. During phototherapy, the primary effects in the cardiovascular system include cutaneous vasodilation leading to skin hyperperfusion and subsequent redistribution of blood. The increased blood flow through the skin is associated with increased transepidermal water loss. Further effects include an increase in cerebral blood flow. Redistribution of blood to the cutaneous bed is compensated by hypoperfusion in the splanchnic area (mostly postprandial) and a significant reduction of the renal blood flow. Regarding closure/reopening of the ductus arteriosus, the results suggest that that phototherapy does not affect ductal patency. During phototherapy the cardiac output can be slightly reduced due to a decreased stroke volume, especially in preterm newborns. Systemic blood pressure is decreased and heart rate is elevated in both preterm and term newborns during phototherapy. The heart rate variability is slightly reduced. Symbolic dynamics analysis of the short-term HRV showed that during phototherapy the activity of the ANS regulating the heart rate is shifted towards the dominancy of the sympathetic activity. The responses in the cardiovascular system of premature/mature newborns without other pathology confirm a well physiologically functioning control of this system, even under specific conditions of phototherapy.
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Affiliation(s)
- Kamil JAVORKA
- Department of Physiology, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovak Republic
| | - Lucia NANDRÁZ̄IOVÁ
- Clinic of Neonatology, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital, Martin, Slovak Republic
| | - Zuzana UHRÍKOVÁ
- Clinic of Neonatology, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital, Martin, Slovak Republic
| | - Barbora CZIPPELOVÁ
- Biomedical Centre Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovak Republic
| | - Katarína MAŤAS̄OVÁ
- Clinic of Neonatology, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital, Martin, Slovak Republic
| | - Michal JAVORKA
- Department of Physiology, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovak Republic
| | - Mirko ZIBOLEN
- Clinic of Neonatology, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital, Martin, Slovak Republic
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26
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Network Pharmacology-Based Analysis on the Potential Biological Mechanisms of Yinzhihuang Oral Liquid in Treating Neonatal Hyperbilirubinemia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1672670. [PMID: 36248427 PMCID: PMC9556251 DOI: 10.1155/2022/1672670] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022]
Abstract
Objective Neonatal hyperbilirubinemia is caused by the excessive production of bilirubin and decreased excretion ability in the neonatal period. It leads to a concentration of blood bilirubin that exceeds a certain threshold. Yinzhihuang oral liquid (YZH) is a traditional Chinese medicine mixture used in the treatment of neonatal hyperbilirubinemia in China. This article systematically explores the pharmacological mechanisms by which YZH acts in the treatment of neonatal hyperbilirubinemia through network pharmacology at the molecular level. Methods We adopted the method of network pharmacology, which includes active component prescreening, target gene prediction, gene enrichment analysis, and network analysis. Results According to the network pharmacological analysis, 8 genes (STAT3, AKT1, MAPK14, JUN, TP53, MAPK3, ESR1, and RELA) may be targets of YZH in the treatment of neonatal hyperbilirubinemia. In addition, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses showed that YZH may regulate antioxidation, modulate lipid metabolism, and have anti-infective properties. Conclusion In this study, the pharmacological action and molecular mechanisms of YZH were predicted as a whole. It was found that YZH is a promising drug for treating oxidative stress due to bilirubin, as it reduces immunosuppression and helps to eliminate virus infection.
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27
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Photo-regulated self-assembly and photo-tailored drug-release kinetics from a polymeric supramolecular nanocage. Eur Polym J 2022. [DOI: 10.1016/j.eurpolymj.2022.111494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Kemper AR, Newman TB, Slaughter JL, Maisels MJ, Watchko JF, Downs SM, Grout RW, Bundy DG, Stark AR, Bogen DL, Holmes AV, Feldman-Winter LB, Bhutani VK, Brown SR, Maradiaga Panayotti GM, Okechukwu K, Rappo PD, Russell TL. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics 2022; 150:188726. [PMID: 35927462 DOI: 10.1542/peds.2022-058859] [Citation(s) in RCA: 131] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Thomas B Newman
- Departments of Epidemiology & Biostatistics and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | | | - M Jeffrey Maisels
- Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Jon F Watchko
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen M Downs
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - Randall W Grout
- Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana
| | - David G Bundy
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Debra L Bogen
- Allegheny County Health Department, Pittsburgh, Pennsylvania
| | - Alison Volpe Holmes
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Lori B Feldman-Winter
- Department of Pediatrics, Division of Adolescent Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Vinod K Bhutani
- Department of Pediatrics, Neonatal and Developmental Medicine Stanford University School of Medicine, Stanford, California
| | | | - Gabriela M Maradiaga Panayotti
- Division of Primary Care, Duke Children's Hospital and Health Center, Duke University Medical Center, Durham, North Carolina
| | - Kymika Okechukwu
- Department of Quality, American Academy of Pediatrics, Itasca, Illinois
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29
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Barclay E, Ojo I, Hake A, Oyenuga A, Satrom K, Lund T, Oyenuga M, Slusher T, Gbadero D. Neonatal Jaundice: Knowledge and Practices of Healthcare Providers and Trainees in Southwest Nigeria. Am J Trop Med Hyg 2022; 107:328-335. [PMID: 35895425 PMCID: PMC9393447 DOI: 10.4269/ajtmh.21-0588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 03/14/2022] [Indexed: 08/03/2023] Open
Abstract
Severe neonatal jaundice (SNNJ) is a leading cause of neonatal morbidity and mortality in low- and middle-income countries (LMICs). Risk mitigation and management modalities for SNNJ have led to marked reduction in complications in high-income countries but not in LMICs likely in part due to knowledge gaps among healthcare providers. This study, a cross-sectional study conducted in Ogbomosho, Nigeria, aimed to identify SNNJ knowledge and practices among Nigerian healthcare providers/trainees. Healthcare providers/trainees completed a structured questionnaire. Healthcare providers/trainees included are nurse midwives (33.4%), nurses (18.6%), nursing students (15.2%), traditional birth attendants (TBAs) (12.7%), physicians (10.2%), and medical students (9.9%). Most physicians were aware of the common causes of SNNJ; however, knowledge deficits in other groups were notable. Despite most providers endorsing that glucose-6-phosphate dehydrogenase deficiency can cause SNNJ (91% of physicians, 60% of nurses, 71% of midwives, 81% of medical students, 43% of nursing students, 7% of TBAs), very few providers recognized that it is common, ranging from 3% in nurses up to a high of 47% among medical students. Gaps in provider knowledge regarding preventative measures and sequela were also noted. These data identified significant knowledge gaps regarding the etiology of SNNJ among healthcare providers/trainees, which can lead to missed opportunities in effective prevention and treatment. These deficits must be addressed if we are to eliminate tragic and preventable complications from SNNJ in Nigeria and other LMICs.
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Affiliation(s)
- Eta Barclay
- Department of Hospital Medicine, Children’s Minnesota, Minneapolis, Minnesota
| | - Ifelayo Ojo
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, Minnesota
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Anne Hake
- U.S. Centers for Disease Control, Atlanta, Georgia
| | - Abayomi Oyenuga
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Katherine Satrom
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Troy Lund
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Mosunmoluwa Oyenuga
- Department of Internal Medicine, SSM Health St. Mary’s Hospital, St. Louis, Missouri
| | - Tina Slusher
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, Minnesota
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
- Department of Pediatrics, Bowen University Teaching Hospital, Ogbomosho, Nigeria
| | - Daniel Gbadero
- Department of Pediatrics, Bowen University Teaching Hospital, Ogbomosho, Nigeria
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Coquery SS, Georges A, Cortey A, Floch C, Avran D, Gatbois E, Mehler-Jacob C, de Stampa M. Discharge of newborns with risk factors of severe hyperbilirubinemia: description of a hospital at home-based care monitoring and phototherapy. Eur J Pediatr 2022; 181:3075-3084. [PMID: 35695955 DOI: 10.1007/s00431-022-04461-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/03/2022]
Abstract
Neonatal jaundice is common and associated with delay in hospital discharge and risk of neurological sequelae if not treated. The objectives of the study were to report on our experience of the monitoring and treatment of neonatal jaundice in a home care setting and its feasibility and safety for neonates with high risk of severe hyperbilirubinemia. The 2-year study has been led in the greater Paris University Hospital At Home (Assistance Publique-Hôpitaux de Paris). The device of the intervention was the Bilicocoon® Bag, a light-emitting diode sleeping bag worn by the neonate when the total serum bilirubin value exceeds intensive phototherapy threshold, according to the guidelines from the American Academy of Pediatrics. One hundred and thirty-nine neonates had participated in the intervention and 39 (28%) were treated by phototherapy at home, as continuation of inpatient phototherapy or started at home. Seventy-five percent of the sample had more than two risk factors for development of severe hyperbilirubinemia. Twenty five percent of the cohort who received phototherapy at home had lower gestational age (p < 0.014) and had younger age at discharge from maternity (p < 0.09). Median length of stay in hospital at home was 5 days. Two patients needed readmission in conventional hospital (1%) for less than 24 h. In multivariate model, the length of stay decreased with the higher gestational age (p < 0.001) and increased significantly with the older age at discharge, the birth weight < 10th percentile, and a treatment by phototherapy at home. Conclusion: Hospital at home, which is a whole strategy using an effective and convenient phototherapy device combined with a specialized medical follow-up, could be an alternative to conventional hospitalization for neonates at high risk of severe jaundice. The maternity discharge is facilitated, the mother-infant bonding can be promoted, and the risk of conventional rehospitalization is minimal, while guaranteeing the safety of this specific care. What is Known: • Managing neonatal jaundice is provided in conventional hospital with phototherapy. • Neonatal jaundice increases the risk of prolonged hospitalization or readmission. What is New: • Phototherapy is feasible in hospital at home for neonates with high risk of severe hyperbilirubinemia. • The care pathway of neonates from conventional hospital to hospital at home is described.
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Affiliation(s)
- Sarah Spyridakis Coquery
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Alexandre Georges
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Anne Cortey
- Assistance Publique Hôpitaux de Paris (AP-HP), Centre National de Référence en Hémobiologie Périnatale (CNRHP), 26 avenue du Dr Arnold-Netter, 75571, Paris, France
| | - Corinne Floch
- Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - David Avran
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Edith Gatbois
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Claire Mehler-Jacob
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Matthieu de Stampa
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France. .,Unité Mixte de Recherche (UMR), UVSQ, 1018 INSERM, Paris, France.
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31
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Uchida Y, Takahashi Y, Morimoto Y, Greimel P, Tosaki A, Kumagai A, Nishikubo T, Miyawaki A. Noninvasive monitoring of bilirubin photoisomer excretion during phototherapy. Sci Rep 2022; 12:11798. [PMID: 35821401 PMCID: PMC9276810 DOI: 10.1038/s41598-022-16180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/06/2022] [Indexed: 11/09/2022] Open
Abstract
Lumirubin is the most prevalently excreted hydrophilic bilirubin photoisomer in phototherapy for neonatal jaundice caused by excess hydrophobic unconjugated bilirubin (ZZ-bilirubin). We developed a simple method to estimate the amount of lumirubin by monitoring the reverse photoisomerization of lumirubin to ZZ-bilirubin. Although lumirubin formation was long considered irreversible, exposure to blue light in the presence of the fluorescent protein UnaG, which binds specifically and tightly to ZZ-bilirubin, enables the reverse photoisomerization of lumirubin. This reaction was first detected using a fluorescence assay of neonatal urine sampled during phototherapy and purified lumirubin. The phenomenon of reverse photoisomerization of lumirubin was validated using liquid chromatography–mass spectrometry, which confirmed that lumirubin is reconverted to ZZ-bilirubin in the presence of UnaG. Analyses of 20 urine samples from 17 neonates revealed a significant correlation (correlation coefficient [r] = 0.978; 95% confidence interval 0.867–0.979; P < .001) between lumirubin and ZZ-bilirubin concentration before and after reverse photoisomerization. In general, the rate of photo-reconversion of lumirubin to ZZ-bilirubin is approximately 40%. In conclusion, we demonstrate here that lumirubin can be photo-reconverted to ZZ-bilirubin via exposure to blue light in the presence of UnaG. Utilizing this approach, urinary lumirubin levels can be estimated using an easy-to-perform fluorescence assay.
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Affiliation(s)
- Yumiko Uchida
- Division of Neonatal Intensive Care, Maternal, Fetal and Neonatal Medical Center, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
| | - Yukihiro Takahashi
- Division of Neonatal Intensive Care, Maternal, Fetal and Neonatal Medical Center, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Yukihiro Morimoto
- R&D Division, Ushio Inc., Himeji, Japan.,SANKEN, Osaka University, Osaka, Japan
| | - Peter Greimel
- Cell Function Dynamics, Brain Science Institute, RIKEN, Wako, Japan
| | - Asako Tosaki
- Cell Function Dynamics, Brain Science Institute, RIKEN, Wako, Japan
| | - Akiko Kumagai
- Cell Function Dynamics, Brain Science Institute, RIKEN, Wako, Japan
| | - Toshiya Nishikubo
- Division of Neonatal Intensive Care, Maternal, Fetal and Neonatal Medical Center, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Atsushi Miyawaki
- Cell Function Dynamics, Brain Science Institute, RIKEN, Wako, Japan
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32
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Sabzevari F, Sinaei R, Bahmanbijari B, Dehghan Krooki S, Dehghani A. Is neonatal phototherapy associated with a greater risk of childhood cancers? BMC Pediatr 2022; 22:356. [PMID: 35729528 PMCID: PMC9215034 DOI: 10.1186/s12887-022-03412-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Neonatal phototherapy (NNPT) has long been used as an effective and relatively safe method of treating neonatal hyperbilirubinemia. Considering the subsequent evidence of long-term impacts of NNPT such as malignancies, this study was conducted to evaluate the relationship between NNPT and childhood cancers. Methods This case-control study assessed 116 children up to 4 years old with every kind of cancer referred to the Oncology department of Afzalipour hospital, Kerman, Iran, from 2011 to 18. Moreover, 116 pediatric patients without cancer hospitalized at the same Center were included after sex and age matching as the control group. The history of phototherapy and its duration were evaluated in these two groups. Results We found no association between the NNPT and malignancies in children. However, high intensive phototherapy was higher historically among affected cancerous patients than in non-cancerous cases without any statistically significant difference (25% vs 19%; P = 0.26). Maternal educational level and history of maternal infection during pregnancy, which initially appeared to be two factors associated with malignancy in single variable regression analyses, were not significant based on the adjusted models. Conclusions The results did not show a positive correlation between NNPT and childhood cancers, which may partly be due to the relatively small sample size of the study. However, some other evidence is worrisome enough that NNPT should not be considered risk-free. Additional multi-centric studies should be undertaken to specify that phototherapy is really safe. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03412-0.
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Affiliation(s)
- Fatemeh Sabzevari
- Department of Pediatrics, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Sinaei
- Department of Pediatrics, School of medicine, Kerman University of Medical Sciences, Kerman, Iran. .,Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran. .,Department of Pediatrics, School of Medicine, Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.
| | - Bahareh Bahmanbijari
- Department of Pediatrics, School of medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Simin Dehghan Krooki
- Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Azam Dehghani
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Bugaiski-Shaked A, Shany E, Mesner O, Sergienko R, Wainstock T. Association Between Neonatal Phototherapy Exposure and Childhood Neoplasm. J Pediatr 2022; 245:111-116. [PMID: 35120988 DOI: 10.1016/j.jpeds.2022.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/08/2022] [Accepted: 01/26/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To study the association between phototherapy for the treatment of neonatal jaundice and the risk of childhood neoplasms. STUDY DESIGN This population-based retrospective cohort study included all infants born at ≥32 weeks of gestation at a single medical center between 1988 and 2018. The incidence of neoplastic diseases was compared between infants exposed to phototherapy and those unexposed. Kaplan-Meier curves and log-rank tests were used for cumulative incidence comparison, and multivariable Cox and Weibull survival analysis were used to adjust for confounding or clinically significant variables. RESULTS The study population included 342 172 infants, of whom 18 797 (5.5%) were exposed to phototherapy. The median duration of follow-up was 9.5 years (range, birth to 18 years). Phototherapy was associated with a significantly increased risk for childhood malignancies and benign tumors (preterm birth and maternal age-adjusted hazard ratio, 1.89 [95% CI, 1.35-2.67] for malignancies and 1.27 [95% CI, 1.02-1.57] for benign tumors) Specifically, phototherapy was associated with hematopoietic cancers and leukemia (hazard ratio, 2.29 [95% CI, 1.48-3.54; P < .01] for hematopoietic cancers and 2.51 [95% CI, 1.52-4.14; P < .001] for leukemia), but not with solid tumors and lymphoma. CONCLUSIONS Phototherapy may be associated with a slightly increased childhood risk of neoplasm. It is important to strictly follow phototherapy treatment guidelines to minimize unnecessary exposure.
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Affiliation(s)
- Adva Bugaiski-Shaked
- Obstetrics and Gynecology Division, Soroka University Medical Center, Be'er- Sheva, Israel.
| | - Eilon Shany
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Neonatal Department, Soroka University Medical Center, Be'er- Sheva, Israel
| | - Oded Mesner
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Neonatal Department, Soroka University Medical Center, Be'er- Sheva, Israel
| | - Ruslan Sergienko
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Medical Computing Unit, School of Public Health, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Tamar Wainstock
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Department of Public Health, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
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Abstract
Neonatal hyperbilirubinemia (NH) is a common phenomenon. In most cases, NH is benign and transient. However, in severe NH cases, neonates can develop encephalopathy and kernicterus. With appropriate screening and treatment, these adverse sequelae can be prevented. This article aims to provide the reader with an in-depth understanding of (1) bilirubin metabolism, (2) risk factors for severe NH, (3) NH screening and treatment, (4) various etiologies of severe NH, and (5) consequences of severe, untreated NH. [Pediatr Ann. 2022;51(6):e219-e227.].
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Theoretical (DFT) study on the hydroxylation mechanism of Sn(IV)porphyrin: How does Sn(IV)porphyrin inhibit heme oxygenase catalysis function. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2021.132097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chang PW, Schroeder AR, Lucas BP, McDaniel CE. Impact of Diagnostic Criteria on UTI Prevalence in Young Infants With Jaundice: A Meta-analysis. Hosp Pediatr 2022; 12:425-440. [PMID: 35322269 DOI: 10.1542/hpeds.2021-006382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Previously reported prevalence of urinary tract infections (UTIs) in infants with jaundice range from <1% to 25%. However, UTI criteria are variable and, as demonstrated in a meta-analysis on UTI prevalence in bronchiolitis, disease prevalence is greatly impacted by disease definition. The objective of this study was to conduct a systemic review and meta-analysis examining the impact of including positive urinalysis (UA) results as a diagnostic criterion on the estimated UTI prevalence in young infants with jaundice. METHODS The data sources used were Medline (1946-2020) and Ovid Embase (1976-2020) through January 2020 and bibliographies of retrieved articles. We selected studies reporting UTI prevalence in young infants with jaundice. Data were extracted in accordance with meta-analysis of observational studies in epidemiology guidelines. Random-effects models produced a weighted pooled event rate with 95% confidence intervals (CI). RESULTS We screened 526 unique articles by abstract and reviewed 53 full-text articles. We included 32 studies and 16 contained UA data. The overall UTI prevalence in young infants with jaundice from all 32 studies was 6.2% (95% CI, 3.9-8.9). From the 16 studies with UA data, the overall UTI prevalence was 8.7% (95% CI, 5.1-13.2), which decreased to 3.6% (95% CI, 2.0-5.8) with positive UA results included as a diagnostic criterion. CONCLUSIONS The estimated UTI prevalence in young infants with jaundice decreases substantially when UA results are incorporated into the UTI definition. Due to the heterogeneity of study subjects' ages and definitions of jaundice, positive UA results, and UTI, there is uncertainty about the exact prevalence and about which infants with hyperbilirubinemia warrant urine testing.
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Affiliation(s)
- Pearl W Chang
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Alan R Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Brian P Lucas
- Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Corrie E McDaniel
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
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Thukral A, Deorari A, Chawla D. Periodic change of body position under phototherapy in term and preterm neonates with hyperbilirubinaemia. Cochrane Database Syst Rev 2022; 3:CD011997. [PMID: 35235686 PMCID: PMC8890478 DOI: 10.1002/14651858.cd011997.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Phototherapy is the mainstay of treatment of neonatal hyperbilirubinaemia. Periodic change in position of the neonate under phototherapy (from supine to prone or lateral positions) may improve the efficiency of phototherapy by hastening the access of phototherapy light to bilirubin deposited in different parts of the skin and subcutaneous tissue. OBJECTIVES To evaluate the effects of periodic change of body position during phototherapy as compared to no prescribed change in body position, on serum total bilirubin level and duration of treatment in neonates with unconjugated hyperbilirubinaemia during the first 28 days of life. Secondary objectives of the review included evaluation of the efficacy of periodic change of body position on the need for or number of exchange transfusions, incidence of bilirubin-induced neurological damage (BIND), side effects of phototherapy, and sudden infant death syndrome (SIDS). SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to run comprehensive searches in the Cochrane Central Register of Controlled Trials (CENTRAL; 2021, Issue 3) in the Cochrane Library and Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions on 5 March 2021. We also searched clinical trials databases and the reference lists of included studies and relevant reviews for randomised controlled trials (RCTs) and quasi-RCTs. SELECTION CRITERIA We included RCTs and quasi-RCTs if they enrolled neonates (term and preterm) of either gender with unconjugated hyperbilirubinaemia requiring phototherapy and compared periodic change of the body position of the infant under phototherapy with no prescribed change in body position. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data, consulting with a third review author in the case of disagreement. We used standard Cochrane methodological procedures, including assessing the risk of bias of included studies. We used the GRADE approach to assess the certainty of evidence. Primary outcomes were the duration of phototherapy and rate of fall of serum bilirubin at 24 hours. Secondary outcomes included the need for exchange transfusion, number of exchange transfusions, incidence of BIND, and SIDS. MAIN RESULTS We included five studies (343 neonates) with an overall high risk of bias in the review. The body position under phototherapy was changed every two hours or every two-and-a-half hours in two studies each, and every three hours in one study. Three of the five studies included healthy term neonates, whilst the other two studies also included preterm neonates (≥ 33 weeks' gestation); however, separate data about review outcomes in preterm neonates were not available. Periodic change in body position may lead to little or no difference in the duration of phototherapy (mean difference (MD) 1.71 hours, 95% confidence interval (CI) -3.17 to 6.59 hours; I² = 58%; 4 studies, 231 participants; low certainty evidence). Only one study reported the rate of fall of serum total bilirubin at 24 hours of starting the phototherapy. Periodic change in body position may lead to little or no difference in the rate of fall of serum total bilirubin at 24 hours (MD 0.02 mg/dL/h, 95% CI -0.02 to 0.06 mg/dL/h; 1 study, 100 participants; low certainty evidence). We downgraded the certainty of evidence to low due to risk of bias and imprecision. None of the included studies reported the need for or number of exchange transfusions, incidence of BIND, or SIDS. Lack of separate data precluded subgroup analysis. AUTHORS' CONCLUSIONS The available evidence is insufficient to determine the effects of periodic change of body position compared with no prescribed change of body position under phototherapy. There is low certainty evidence that there may be little or no difference in the duration of phototherapy and rate of fall in bilirubin at 24 hours of starting phototherapy between periodic change in body position and no prescribed change of body position under phototherapy in term and preterm neonates. None of the included studies reported the effect of change of position on the need for or number of exchange transfusions, incidence of BIND, or SIDS. One study is awaiting classification and could not be included in the review. Further studies are needed to evaluate the effect of periodic change in body position under phototherapy, especially in neonates with haemolytic hyperbilirubinaemia and in very preterm neonates. The results of this systematic review apply mainly to neonates born at late-preterm or term gestation receiving phototherapy for non-haemolytic hyperbilirubinaemia.
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Affiliation(s)
- Anu Thukral
- Department of Pediatrics, Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital, New Delhi, India
| | - Ashok Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
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Keum H, Yoo D, Jon S. Photomedicine based on heme-derived compounds. Adv Drug Deliv Rev 2022; 182:114134. [PMID: 35122881 DOI: 10.1016/j.addr.2022.114134] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/16/2021] [Accepted: 01/30/2022] [Indexed: 02/08/2023]
Abstract
Photoimaging and phototherapy have become major platforms for the diagnosis and treatment of various health complications. These applications require a photosensitizer (PS) that is capable of absorbing light from a source and converting it into other energy forms for detection and therapy. While synthetic inorganic materials such as quantum dots and gold nanorods have been widely explored for their medical diagnosis and photodynamic (PDT) and photothermal (PTT) therapy capabilities, translation of these technologies has lagged, primarily owing to potential cytotoxicity and immunogenicity issues. Of the various photoreactive molecules, the naturally occurring endogenous compound heme, a constituent of red blood cells, and its derivatives, porphyrin, biliverdin and bilirubin, have shown immense potential as noteworthy candidates for clinically translatable photoreactive agents, as evidenced by previous reports. While porphyrin-based photomedicines have attracted significant attention and are well documented, research on photomedicines based on two other heme-derived compounds, biliverdin and bilirubin, has been relatively lacking. In this review, we summarize the unique photoproperties of heme-derived compounds and outline recent efforts to use them in biomedical imaging and phototherapy applications.
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Validation of published rebound hyperbilirubinemia risk prediction scores during birth hospitalization after initial phototherapy: a retrospective chart review. Pediatr Res 2022; 91:888-895. [PMID: 33824457 DOI: 10.1038/s41390-021-01478-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hyperbilirubinemia commonly affects newborns and may lead to neurotoxicity if untreated. Neonates can experience rebound hyperbilirubinemia (RHB), defined as elevated bilirubin levels requiring re-initiation of treatment. Although studies have formulated risk prediction scores, they lack external validation. In this study, we examine the discrimination and calibration performance of risk prediction scores for RHB, to provide external validation. METHODS We reviewed charts of neonates born ≥35 weeks of gestation between January 2015 and December 2019 receiving phototherapy at birth hospitalization. We plotted predicted probabilities against observed outcome proportions to assess model calibration and evaluated discrimination using area under the receiver operating characteristic (AUROC) curves. Odds ratios (ORs) were estimated to evaluate variables associated with RHB. RESULTS Of the 271 infants identified, 24% developed RHB. Two- and three-variable prediction scores had lower discrimination in our cohort with AUROC of 0.662 (95% CI 0.590-0.735) and 0.691 (95% CI, 0.619-0.763) compared to 0.876 (95% CI 0.854-0.899) and 0.881 (95% CI 0.859-0.903), respectively, in the published studies. Estimated ORs confirm associations between RHB and variables included in prediction scores. CONCLUSIONS Current prediction models for RHB have unclear clinical utility in our patient population. Additional studies are required to further validate these scores. IMPACT Describes performance characteristics of two- and three-variable risk prediction scores that lack external validation beyond the initial study cohort. Our findings suggest unclear clinical utility in our clinical population of neonates during birth hospitalization, with lower performance of these prediction scores than observed in the derivation cohort. Odds ratios estimated by logistic regression in our study cohort provide further evidence that variables in published risk prediction scores are associated with rebound hyperbilirubinemia. Further studies are required to externally validate these risk prediction scores and to assess their generalizability.
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Intensive phototherapy vs. exchange transfusion for the treatment of neonatal hyperbilirubinemia. Chin Med J (Engl) 2022; 135:598-605. [PMID: 35274627 PMCID: PMC8920423 DOI: 10.1097/cm9.0000000000001962] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia. Methods: This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment. Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years. Results: A total of 1164 patients were included in this study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group. Conclusions: In this study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.
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Ramachandran RM, Srinivasan R. Clinical Profile and Outcome Following Exchange Transfusion for Neonatal Jaundice in a Tertiary Care Centre. J Trop Pediatr 2022; 68:6515780. [PMID: 35084035 DOI: 10.1093/tropej/fmac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Phototherapy has reduced the need for exchange transfusion (ET) to manage jaundiced neonates. Hence there are concerns about increased risk of complication due to lack of opportunity to sustain skills in performing ET. We studied the complications and treatment outcomes of neonates treated for jaundice with ET. METHODOLOGY A retrospective observational study was conducted from June 2013 to June 2020 in a tertiary care hospital in India. All neonates treated with ET for jaundice were included. RESULTS Twenty-eight neonates underwent 31 ET during the study period. Their mean gestational age and birth weight were 37 weeks and 3200 g, respectively. Predisposing factor for jaundice observed were Coomb's positive status (11), hepatosplenomegaly suggesting hemolysis (3), cephalhematoma (2) and birth asphyxia (1). Abnormal neurological status before ET was seen in seven neonates. Adverse clinical events that happened during or within 8 h after ET were desaturation (4), tachycardia (3), tachypnea (2), bradycardia (2), shock (2) and temperature instability (2). One neonate developed acute kidney injury after ET and required peritoneal dialysis. Abnormal lab parameters observed during or within 8 h after ET were hypocalcemia (20), anemia (8), hypokalemia (7), hypernatremia (3), thrombocytopenia (3) and hyperkalemia (2). Post ET sepsis was seen in five neonates: two had only blood culture positive sepsis, two had bone and joint infection and one had liver abscess. CONCLUSION The neonates undergoing ET are at high risk of developing complications which may be life threatening. Hence careful monitoring during the procedure is needed.
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Affiliation(s)
- Rajashree M Ramachandran
- Department of Pediatrics, PSG Institute of Medical Science & Research, Coimbatore, Tamil Nadu 641004, India
| | - Ramesh Srinivasan
- Department of Pediatrics, PSG Institute of Medical Science & Research, Coimbatore, Tamil Nadu 641004, India
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Kuitunen I, Kiviranta P, Sankilampi U, Renko M. Ursodeoxycholic acid as adjuvant treatment to phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis. World J Pediatr 2022; 18:589-597. [PMID: 35689782 PMCID: PMC9376150 DOI: 10.1007/s12519-022-00563-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/26/2022] [Indexed: 10/26/2022]
Abstract
BACKGROUND Neonatal hyperbilirubinemia is observed in most newborns, and 5-15% of neonates require phototherapy. Phototherapy is effective but often prolongs hospitalization and has both short-term and potential long-term harms. The aim of this systematic review and meta-analysis was to evaluate the role of ursodeoxycholic acid (UDCA) combined with phototherapy in neonatal hyperbilirubinemia. METHODS A literature search was conducted on September 1, 2021; 590 studies were screened, and 17 full texts were assessed by two authors. We included randomized controlled trials with or without placebo intervention. Primary outcomes were changes in total bilirubin levels at 24 hours and phototherapy duration. We calculated mean differences with 95% confidence intervals (CI). RESULTS Six studies with 880 neonates were included. Of these studies, only two used a placebo-controlled double-blinded design. The overall risk of bias was high in one and moderate in four of the included studies. The mean decrease in the total bilirubin level during the first 24 hours was 2.06 mg/dL (95% CI 0.82-3.30; six studies) greater in the UDCA treatment group. The phototherapy duration was 19.7 hours (95% CI 10.4-29.1; five studies) shorter in the UDCA treatment group. CONCLUSIONS We found low-quality evidence that UDCA as an adjuvant to phototherapy seems to decrease total bilirubin faster and shorten phototherapy duration compared to standard treatment. Further studies are needed to confirm the efficacy, acute and long-term outcomes, and safety before implementing UDCA as an adjuvant to phototherapy in neonatal hyperbilirubinemia.
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Affiliation(s)
- Ilari Kuitunen
- Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland. .,Department of Pediatrics, Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland.
| | - Panu Kiviranta
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland ,grid.410705.70000 0004 0628 207XDepartment of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Ulla Sankilampi
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland ,grid.410705.70000 0004 0628 207XDepartment of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Marjo Renko
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland ,grid.410705.70000 0004 0628 207XDepartment of Pediatrics, Kuopio University Hospital, Kuopio, Finland
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Dam-Vervloet AJ, Bosschaart N, van Straaten HLM, Poot L, Hulzebos CV. Irradiance footprint of phototherapy devices: a comparative study. Pediatr Res 2022; 92:453-458. [PMID: 34728809 PMCID: PMC9522581 DOI: 10.1038/s41390-021-01795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/13/2021] [Accepted: 10/04/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Phototherapy (PT) is the standard treatment of neonatal unconjugated hyperbilirubinemia. The irradiance footprint, i.e., the illuminated area by the PT device with sufficient spectral irradiance, is essential for PT to be effective. Irradiance footprint measurements are not performed in current clinical practice. We describe a user-friendly method to systematically evaluate the high spectral irradiance (HSI) footprint (illuminated area with spectral irradiance of ≥30 μW cm-2 nm-1) of PT devices in clinical practice. MATERIALS AND METHODS Six commercially available LED-based overhead PT devices were evaluated in overhead configuration with an incubator. Spectral irradiance (µW cm-2 nm-1) and HSI footprint were measured with a radiospectrometer (BiliBlanket Meter II). RESULTS The average measured spectral irradiance ranged between 27 and 52 μW cm-2 nm-1 and HSI footprint ranged between 67 and 1465 cm2, respectively. Three, two, and one PT devices out of six covered the average BSA of an infant born at 22, 26-32, and 40 weeks of gestation, respectively. CONCLUSION Spectral irradiance of LED-based overhead PT devices is often lower than manufacturer's specifications, and HSI footprints not always cover the average BSA of a newborn infant. The proposed measurement method will contribute to awareness of the importance of irradiance level as well as footprint measurements in the management of neonatal jaundice. IMPACT While a sufficient spectral irradiance footprint is essential for PT to be effective, some PT devices have spectral irradiance footprints that are too small to cover the entire body surface area (BSA) of a newborn infant. This study introduces a user-friendly, accessible method to systematically evaluate the spectral irradiance level and footprint of PT devices. This study supports awareness on the role of the spectral irradiance footprint in the efficacy of PT devices. Irradiance footprint can be easily measured during phototherapy with the proposed method.
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Affiliation(s)
- Alida J. Dam-Vervloet
- grid.452600.50000 0001 0547 5927Medical Physics Department, Isala Hospital, Zwolle, The Netherlands
| | - Nienke Bosschaart
- grid.6214.10000 0004 0399 8953Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - Lieke Poot
- grid.452600.50000 0001 0547 5927Medical Physics Department, Isala Hospital, Zwolle, The Netherlands
| | - Christian V. Hulzebos
- grid.4494.d0000 0000 9558 4598Neonatology Department, UMCG, Groningen, The Netherlands
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Lahmann JM, Faase RA, Leu HY, Jacques SL, Scottoline B, Schilke KF, Baio JE, Higgins AZ. Microfluidic photoreactor to treat neonatal jaundice. BIOMICROFLUIDICS 2021; 15:064104. [PMID: 34853627 PMCID: PMC8616629 DOI: 10.1063/5.0066073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
While in most cases, jaundice can be effectively treated using phototherapy, severe cases require exchange transfusion, a relatively risky procedure in which the neonate's bilirubin-rich blood is replaced with donor blood. Here, we examine extracorporeal blood treatment in a microfluidic photoreactor as an alternative to exchange transfusion. This new treatment approach relies on the same principle as phototherapy but leverages microfluidics to speed up bilirubin removal. Our results demonstrate that high-intensity light at 470 nm can be used to rapidly reduce bilirubin levels without causing appreciable damage to DNA in blood cells. Light at 470 nm was more effective than light at 505 nm. Studies in Gunn rats show that photoreactor treatment for 4 h significantly reduces bilirubin levels, similar to the bilirubin reduction observed for exchange transfusion and on a similar time scale. Predictions for human neonates demonstrate that this new treatment approach is expected to exceed the performance of exchange transfusion using a low blood flow rate and priming volume, which will facilitate vascular access and improve safety.
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Affiliation(s)
- John M. Lahmann
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Ryan A. Faase
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Hsuan Yu Leu
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Steven L. Jacques
- Department of Bioengineering, University of Washington, Seattle, Washington 98105, USA
| | - Brian Scottoline
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - Kate F. Schilke
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Joe E. Baio
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Adam Z. Higgins
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
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Research progress of azido-containing Pt(IV) antitumor compounds. Eur J Med Chem 2021; 227:113927. [PMID: 34695775 DOI: 10.1016/j.ejmech.2021.113927] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 12/11/2022]
Abstract
Cancer is a long-known incurable disease, and the medical use of cisplatin has been a significant discovery. However, the side-effects of cisplatin necessitate the development of new and improved drug. Therefore, in this study, we focused on the photoactivatable Pt(IV) compounds Pt[(X1)(X2)(Y1)(Y2)(N3)2], which have a completely novel mechanism of action. Pt(IV) can efficiently overcome the side-effects of cisplatin and other drugs. Here, we have demonstrated, summarized and discussed the effects and mechanism of these compounds. Compared to the relevant articles in the literature, we have provided a more detailed introduction and a made comprehensive classification of these compounds. We believe that our results can effectively provide a reference for the development of these drugs.
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Souley Dosso Y, Greenwood K, Harrold J, Green JR. RGB-D scene analysis in the NICU. Comput Biol Med 2021; 138:104873. [PMID: 34600329 DOI: 10.1016/j.compbiomed.2021.104873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/20/2022]
Abstract
Continuity of care is achieved in the neonatal intensive care unit (NICU) through careful documentation of all events of clinical significance, including clinical interventions and routine care events (e.g., feeding, diaper change, weighing, etc.). As a step towards automating this documentation process, we propose a scene recognition algorithm that can automatically identify key features in a single image of the patient environment, paired with a rule-based sentence generator to caption the scene. Color and depth video were obtained from 29 newborn patients from the Children's Hospital of Eastern Ontario (CHEO) using an Intel RealSense SR300 RGB-D camera and manual bedside event annotation. Image processing techniques are implemented to classify two lighting conditions: brightness level and phototherapy. A deep neural network is developed for three image classification tasks: on-going intervention, bed occupancy, and patient coverage. Transfer learning is leveraged in the feature extraction layers, such that weights learned from a generic data-rich task are applied to the clinical domain where data collection is complex and costly. Different depth fusion techniques are implemented and compared among classification tasks, where the depth and color data are fused as an RGB-D image (image fusion) or separately at various layers in the network (network fusion). Promising results were obtained with >84% sensitivity and >73% F1 measure across all context variables despite the large class imbalance. RGBD-based models are shown to outperform RGB models on most tasks. In general, a 4-channel image fusion and network fusion at the 11th layer of the VGG-16 architecture were preferred. Ultimately, achieving complete scene understanding through multimodal computer vision could form the basis for a semi-automated charting system to assist clinical staff.
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Affiliation(s)
- Yasmina Souley Dosso
- Department of Systems and Computer Engineering, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Kim Greenwood
- Department of Mechanical Engineering, Faculty of Engineering, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON, K1N 6N5, Canada; Clinical Engineering, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - JoAnn Harrold
- Neonatology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - James R Green
- Department of Systems and Computer Engineering, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada.
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Iskander I, Abdelmonem S, El Houchi S, Mandour I, Aly H. Intensive phototherapy and oxidant-antioxidant status in infants with jaundice. Early Hum Dev 2021; 161:105465. [PMID: 34517206 DOI: 10.1016/j.earlhumdev.2021.105465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Conventional phototherapy converts unconjugated bilirubin to its oxidation products and consequently causes oxidative stress with lipid peroxidation products. New devices that deliver intensive phototherapy are efficacious in treating severe hyperbilirubinemia and minimizing the need for exchange transfusions. However, the oxidative stress status when using these devices has not been explored. Therefore, we aimed to study the impact of using intensive phototherapy on the oxidant-antioxidant status in severely jaundiced neonates. STUDY DESIGN This prospective case-control study included term newborns admitted with severe hyperbilirubinemia managed with intensive phototherapy. Baseline oxidant-antioxidant concentrations were compared to healthy controls and re-measured after 8 h of intensive phototherapy exposure. RESULTS The study included 40 cases with severe jaundice and 40 non-jaundiced apparently normal controls. Total serum bilirubin at enrollment was 23.4 ± 4.2 mg/dl that significantly decreased after 8 h of therapy to 15.4 ± 3.4 mg/dl (p < 0.001). The decline of total serum bilirubin was 1 mg/dl/h. Bilirubin: albumin ratio decreased from 3.45 ± 0.28 to 2.7 ± 0.21 (p < 0.001). Total antioxidant capacity (TAC), superoxide dismutase (SOD), malondialdehyde (MDA), and total oxidative stress (TOS) concentrations were lower in cases (p < 0.001, p < 0.001, p = 0.049, and p < 0.001 respectively) compared to controls. Following 8 h of intensive phototherapy, further decline of TAC (p = 0.016) with increased concentrations of TOS (p = 0.005) were noted. SOD and MDA did not change. CONCLUSIONS Although efficacious, intensive phototherapy was associated with increased oxidative stress. The clinical correlates for harms related to such oxidative stress need further studying.
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Affiliation(s)
- Iman Iskander
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt
| | - Samira Abdelmonem
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt
| | - Salma El Houchi
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt
| | - Iman Mandour
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, United States of America.
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The Effects of Bilirubin and Lumirubin on the Differentiation of Human Pluripotent Cell-Derived Neural Stem Cells. Antioxidants (Basel) 2021; 10:antiox10101532. [PMID: 34679668 PMCID: PMC8532948 DOI: 10.3390/antiox10101532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
The ‘gold standard’ treatment of severe neonatal jaundice is phototherapy with blue–green light, which produces more polar photo-oxidation products that are easily excreted via the bile or urine. The aim of this study was to compare the effects of bilirubin (BR) and its major photo-oxidation product lumirubin (LR) on the proliferation, differentiation, morphology, and specific gene and protein expressions of self-renewing human pluripotent stem cell-derived neural stem cells (NSC). Neither BR nor LR in biologically relevant concentrations (12.5 and 25 µmol/L) affected cell proliferation or the cell cycle phases of NSC. Although none of these pigments affected terminal differentiation to neurons and astrocytes, when compared to LR, BR exerted a dose-dependent cytotoxicity on self-renewing NSC. In contrast, LR had a substantial effect on the morphology of the NSC, inducing them to form highly polar rosette-like structures associated with the redistribution of specific cellular proteins (β-catenin/N-cadherin) responsible for membrane polarity. This observation was accompanied by lower expressions of NSC-specific proteins (such as SOX1, NR2F2, or PAX6) together with the upregulation of phospho-ERK. Collectively, the data indicated that both BR and LR affect early human neurodevelopment in vitro, which may have clinical relevance in phototherapy-treated hyperbilirubinemic neonates.
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So V, Khurshid F. Treatment practices and implementation of guidelines for hyperbilirubinemia and rebound hyperbilirubinemia. J Neonatal Perinatal Med 2021; 15:335-343. [PMID: 34542033 DOI: 10.3233/npm-210781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hyperbilirubinemia (HB), defined as elevated total serum bilirubin (TSB) levels, commonly affects neonates and requires prompt treatment to prevent neurological complications. Up to 10%of neonates experience rebound hyperbilirubinemia (RHB), requiring re-initiation of treatment. Unfortunately, treatment guidelines lack practical recommendations surrounding subthreshold phototherapy, treatment termination, and RHB investigations. We examined local management practices for HB and RHB treatment in a well newborn nursery. As a secondary aim, we investigated the association between treatment practices and RHB rates. METHODS Retrospective chart review identified neonates treated for hyperbilirubinemia between January 2015 and December 2019 during their birth hospitalization at a tertiary care centre. Standardized data collection sheets were used to record treatment parameters. RESULTS Over the 5-year period, there were 9683 births and 305 (3.15%) neonates received phototherapy. Of the treated cases, 20-25%were subthreshold to practice guideline values. Upon treatment termination 25-55%of cases had TSB levels within 3 mg/dL, which may increase the risk of RHB. In our cohort, 20.3%of treated cases experienced one episode of RHB and 3.9%experienced two episodes of RHB. Although clinicians evaluated neonates for RHB 0-12 hours following treatment termination prior to discharge, many cases were identified in outpatient settings and required re-admission for phototherapy. CONCLUSION When managing HB and RHB, treatment practices such as when to terminate treatment in relation to threshold values, and timing of RHB investigations, are largely inconsistent amongst clinicians. Future studies are required to better understand the landscape of hyperbilirubinemia treatment beyond initiation of phototherapy.
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Affiliation(s)
- V So
- Department of Pediatrics, School of Medicine, Queen's University, Kingston, Ontario, Canada.,Queen's School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - F Khurshid
- Department of Pediatrics, School of Medicine, Queen's University, Kingston, Ontario, Canada
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Gottimukkala SB, Sethuraman G, Kitchanan S, Pathak S. Comparison of efficacy, safety & satisfaction of intermittent versus continuous phototherapy in hyperbilirubinaemic newborns ≥35 week gestation: A randomized controlled trial. Indian J Med Res 2021; 153:446-452. [PMID: 34380790 PMCID: PMC8354053 DOI: 10.4103/ijmr.ijmr_2156_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives Phototherapy (PT) has become the standard of care for treating neonatal jaundice. This study was aimed to find out if intermittent PT (IPT) results in comparable rate of fall of bilirubin level to continuous PT (CPT) and results in lesser side effects and better acceptance. Methods In this non-inferiority trial, 174 neonates ≥35 wk gestation and >2000 g with jaundice requiring PT were randomized to receive either IPT (one hour on and two hours off) or CPT (with minimum interruptions for feeding) after device stratification [light-emitting diode (LED) or compact fluorescent light (CFL)]. Bilirubin was checked 12th hourly, and calcium, vitamin D and nitric oxide (NO) levels were analyzed along with the clinical side effects and nursing and maternal satisfaction scores (CTRI Registration No. CTRI/2018/01/011072). Results The rate of fall of bilirubin was similar in both the CPT and IPT groups [0.16 (0.10, 0.22) vs. 0.13 (0.09, 0.20) mg/dl/h, P=0.22]. The median difference with 95 per cent confidence interval of 0.03 (0.03, 0.03) mg/dl was also within the pre-defined inferiority limits. There was no significant change in the duration of PT and side effects such as fall in calcium levels, rise in vitamin D and NO levels or the clinical side effects. Maternal satisfaction favoured the IPT group, but the nurses opined that IPT was difficult to implement. Subgroup analysis for PT devices used showed that efficacy of both CFL and LED devices was equivalent. Interpretation & conclusions IPT was non-inferior to CPT in reducing bilirubin levels in ≥35 wk neonates, irrespective of device used, and also mothers reported better satisfaction with IPT. Although IPT appears promising, CPT does not increase clinical and biochemical side effects compared to IPT.
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Affiliation(s)
| | - Giridhar Sethuraman
- Department of Neonatology, Chettinad Hospital & Research Institute, Chennai, Tamil Nadu, India
| | - Srinivasan Kitchanan
- Department of Neonatology, Chettinad Hospital & Research Institute, Chennai, Tamil Nadu, India
| | - Surajit Pathak
- Department of Allied Health Sciences, Chettinad Hospital & Research Institute, Chennai, Tamil Nadu, India
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