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Daunov M, Schlosser A, Malay S, Adams J, Clark R, Ferrerosa L, Pateva I. A Description of IVIG Use in Term Neonates with ABO Incompatibility. Am J Perinatol 2024; 41:1761-1766. [PMID: 38286423 DOI: 10.1055/a-2255-8772] [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: 01/31/2024]
Abstract
OBJECTIVE This study aimed to determine if treatment with IVIG of neonates with ABO incompatibility (without Rh incompatibility) results in decreased number of packed red blood cell (pRBC) transfusions and phototherapy use. STUDY DESIGN An Institutional Review Board (IRB)-approved, single-institution retrospective study was conducted. Neonates ≥38 weeks' gestational age born between January 1, 2007, and December 31, 2016, with ABO incompatibility were included. The comparison among groups was performed using chi-square and Fisher's exact tests for categorical variables; continuous variables were assessed by Kruskal-Wallis test. RESULTS Six hundred and sixty-eight neonates with ABO incompatibility met inclusion criteria, 579 were included in the analyses. From these, 431 (74%) neonates had positive Direct Antiglobulin Test (DAT); 98 (17%) received IVIG and 352 (61%) received phototherapy. Thirty-six (6%) neonates received pRBC and 6 (1%) required exchange transfusions. Only 3 (0.5%) infants received pRBC transfusions postdischarge, by 3 months of age. Neonates requiring IVIG had lower initial hemoglobin (13.6 vs. 16.0 g/dL, p ≤ 0.0001) and higher bilirubin at start of phototherapy (9.1 vs. 8.1 mg/dL, p = 0.0064). From the 42 (7%) neonates who received simple and exchange transfusions, IVIG use was not associated with decreased use or number of transfusions (p = 0.5148 and 0.3333, respectively). Newborns with A+ and B+ blood types had comparable initial hemoglobin, DAT positivity, APGAR, and bilirubin. However, infants with B+ blood group were more likely (than A + ) to require phototherapy (p < 0.001), receive IVIG (p = 0.003), and need phototherapy for a longer duration (p = 0.001). CONCLUSION The results of this large retrospective study reveal that giving IVIG to neonates with ABO incompatibility was associated with increased simple or exchange transfusions. Newborns with B+ blood type required more phototherapy and IVIG. Further studies are needed to better stratify neonates who would benefit from IVIG use in order to optimize treatment strategies and avoid unnecessary risks and adverse events. KEY POINTS · IVIG use not associated with decreased use of pRBC or exchanges.. · Phototherapy duration associated with increased IVIG and pRBC use.. · Newborns with B+ blood type had worse hemolytic anemia..
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Affiliation(s)
- Michael Daunov
- Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Andrea Schlosser
- Wexner Medical Center, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | - Sindhoosha Malay
- Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jaclyn Adams
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon
| | | | | | - Irina Pateva
- Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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Hulzebos CV, Camara JE, van Berkel M, Delatour V, Lo SF, Mailloux A, Schmidt MC, Thomas M, Mackay LG, Greaves RF. Bilirubin measurements in neonates: uniform neonatal treatment can only be achieved by improved standardization. Clin Chem Lab Med 2024; 62:1892-1903. [PMID: 39066506 DOI: 10.1515/cclm-2024-0620] [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: 05/18/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024]
Abstract
Measurement of total bilirubin (TBil) concentration in serum is the gold standard approach for diagnosing neonatal unconjugated hyperbilirubinemia. It is of utmost importance that the measured TBil concentration is sufficiently accurate to prevent under treatment, unnecessary escalation of care, or overtreatment. However, it is widely recognized that TBil measurements urgently require improvement in neonatal clinical chemistry. External quality assessment (EQA) programs for TBil assess for differences between laboratories and provide supporting evidence of significant differences between various methods, manufacturers and measurement platforms. At the same time, many countries have adopted or only slightly adapted the neonatal hyperbilirubinemia management guidelines from the USA or UK, often without addressing differences in the methodology of TBil measurements. In this report, we provide an overview of the components of bilirubin that are measured by laboratory platforms, the availability of current reference measurement procedures and reference materials, and the role of EQA surveys in this context. Furthermore, the current status of agreement in neonatal bilirubin against clinical decision thresholds is reviewed. We advocate for enhancements in accuracy and comparability of neonatal TBil measurements, propose a path forward to accomplish this, and reflect on the position of the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Working Group Neonatal Bilirubin (WG-NB) in this matter.
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Affiliation(s)
- Christian V Hulzebos
- Department of Paediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna E Camara
- Chemical Sciences Division, National Institute of Standards and Technology (NIST), Gaithersburg, MD, USA
| | - Miranda van Berkel
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Vincent Delatour
- Laboratoire National de Métrologie et d'Essais (LNE), Paris, France
| | - Stanley F Lo
- Department of Pathology and Laboratory Medicine, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Agnès Mailloux
- Centre National de Référence en Hémobiologie Périnatale, Unit of Biologie, Pole Biology, Hopital Saint Antoine (Public Assistance Hospitals of Paris (AP-HP)), Paris, France
| | | | - Mercy Thomas
- The Royal Children's Hospital, Parkville, VIC, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | | | - Ronda F Greaves
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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Vaubourdolle M, Mailloux A. Issues for standardization of neonatal bilirubinemia: a case of delayed phototherapy initiation. Clin Chem Lab Med 2024; 62:e221-e224. [PMID: 38548373 DOI: 10.1515/cclm-2023-1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/15/2024] [Indexed: 09/08/2024]
Affiliation(s)
- Michel Vaubourdolle
- Department of Biochemistry and Hormonology, DMU of Medical Biology and Genomics (BioGeMH), Hospital Saint-Antoine, AP-HP - Sorbonne University, Paris, France
| | - Agnès Mailloux
- Service of Fetal and Perinatal Hemobiology - National Reference Center in Perinatal Hemobiology (CNRHP), Hospital Saint-Antoine, AP-HP - Sorbonne University, Paris, France
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Thamwiriyakul N, Siripattanapipong P, Bowornkitiwong W, Chaweerat R, Ngerncham S. Validity of transcutaneous bilirubin measurements during and after phototherapy in term and late preterm infants. Eur J Pediatr 2024:10.1007/s00431-024-05724-y. [PMID: 39271553 DOI: 10.1007/s00431-024-05724-y] [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: 03/16/2024] [Revised: 08/03/2024] [Accepted: 08/08/2024] [Indexed: 09/15/2024]
Abstract
The purpose of the study was to investigate correlation and concordance between total serum bilirubin (TSB) and transcutaneous bilirubin measured at covered (TcBC) and uncovered (TcBU) skin during and after discontinuation of phototherapy. A cross-sectional study included ≥ 34 weeks gestation infants requiring phototherapy for neonatal hyperbilirubinemia. In-house, photo-opaque patches were placed on infants' sternums before phototherapy initiation. Simultaneous blood sampling for TSB, TcBC, and TcBU measurements were performed. Among 103 infants included in the final analysis, 70% were full-term. Covering skin during phototherapy resulted in strong TcBC-TSB correlation (r = 0.91, 95% CI 0.87-0.94, P < 0.001) compared to TcBU (r = 0.53, 95% CI 0.37-0.65, P < 0.001), persisting post-phototherapy (r = 0.88, 95% CI 0.82-0.91, P < 0.001). Bland-Altman analysis showed a higher mean difference and wider 95% limits of agreement for TcBU-TSB during phototherapy (-6.3 mg/dL and -11.1 to -1.6) vs TcBC-TSB (0.9 mg/dL and -1.2 to 2.9). Passing-Bablok regression analysis confirmed good agreement between TcBC and TSB. CONCLUSIONS The application of in-house, photo-opaque patches enhanced the correlation and agreement between TcBC and TSB during and after discontinuation of phototherapy. This may prove particularly useful in resource-limited settings where commercial devices are unavailable. WHAT IS KNOWN • Transcutaneous bilirubin measurement has been widely used as a screening method for neonatal hyperbilirubinemia. • The accuracy of transcutaneous bilirubin measurements during and after phototherapy in infants with hyperbilirubinemia has been debated. WHAT IS NEW • Our study demonstrated that utilizing carefully designed photo-opaque patches enhanced the accuracy of transcutaneous bilirubin measurement during and after phototherapy. • Effective in-house alternatives are crucial in resource-limited settings where commercial opaque patches are not always accessible or affordable.
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Affiliation(s)
- Nirucha Thamwiriyakul
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, 10700, Bangkok, Thailand
| | - Pitiporn Siripattanapipong
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, 10700, Bangkok, Thailand
| | - Walaiporn Bowornkitiwong
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, 10700, Bangkok, Thailand
| | - Renoo Chaweerat
- Pediatric Nursing Division, Department of Nursing Siriraj Hospital, 2 Wanglang Road, Bangkoknoi, 10700, Bangkok, Thailand
| | - Sopapan Ngerncham
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, 10700, Bangkok, Thailand.
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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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Yilmaz Yegit C, Yasa B, Ince EZ, Sarac Sivrikoz T, Coban A. An ongoing problem: Rhesus hemolytic disease of the newborn - A decade of experience in a single centre. Pediatr Neonatol 2024; 65:482-486. [PMID: 38490905 DOI: 10.1016/j.pedneo.2024.02.004] [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: 08/17/2023] [Revised: 01/26/2024] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The objectives were to evaluate the descriptive features of newborns with a diagnosis of Rhesus (Rh) hemolytic disease, to determine the morbidity and mortality rates, to evaluate the treatment methods and the factors affecting treatment requirements and clinical outcomes during a ten-year period at a tertiary center. METHODS Newborn infants who had a positive direct Coombs test and/or had a history of intrauterine transfusion (IUT) due to Rh hemolytic disease were included. The data regarding the prenatal, natal and postnatal periods were collected from hospital records. RESULTS A total of 260 neonates were included of which 51.2% were female. The mean ± standard deviation gestational age was 36.9 ± 2.7 weeks. The rate of preterm birth was 41.2%. Of 257 mothers whose obstetric medical history could be accessed, 87.2% were multigravida, whereas 76.3% were multiparous. Among mothers who had a reliable history of anti-D immunoglobulin prophylaxis (n=191), 51.3% had not received anti-D immunoglobulin prophylaxis in their previous pregnancies. The antenatal transfusion rate was 31.7% and the frequency of hydrops fetalis was 8.8%. While combined exchange transfusion (ET) and phototherapy (PT) was performed in 15.4% of the babies, the majority either needed phototherapy only (51.1%) or no treatment (33.5%). The mortality rate was 3.8 % (n = 10), and nine babies out of these 10 were those with severe hydrops fetalis. CONCLUSION This study showed that Rh hemolytic disease is still a major problem in developing countries. Multiple comorbidities may occur in addition to life threatening complications, including hydrops fetalis, anemia and severe hyperbilirubinemia. High rates of multiparity and low rates of anti-D immunoglobulin prophylaxis are potential barriers for the eradication of the disease. It should be remembered that Rh hemolytic disease is a preventable disease in the presence of appropriate antenatal follow-up and care facilities.
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Affiliation(s)
- Cansu Yilmaz Yegit
- Department of Pediatrics, Istanbul University Faculty of Medicine, Istanbul, Turkey.
| | - Beril Yasa
- Department of Pediatrics, Division of Neonatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Elmas Zeynep Ince
- Department of Pediatrics, Division of Neonatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Tugba Sarac Sivrikoz
- Department of Obstetrics and Gynecology, Division of Perinatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Asuman Coban
- Department of Pediatrics, Division of Neonatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
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7
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Nikouei M, Cheraghi M, Mansouri M, Hemmatpour S, Moradi Y. The effect of oral zinc sulfate supplementation on hospitalized infants with hyperbilirubinemia: a double-blind randomized clinical trial. Eur J Pediatr 2024:10.1007/s00431-024-05739-5. [PMID: 39172170 DOI: 10.1007/s00431-024-05739-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/15/2024] [Accepted: 08/17/2024] [Indexed: 08/23/2024]
Abstract
Previous investigations on the impact of oral zinc sulfate treatment on newborns' serum bilirubin levels have produced conflicting results. As a result, the goal of this clinical study was to evaluate how oral zinc sulfate affected the levels of serum bilirubin in term infants who were admitted to the neonatal intensive care unit. The study was conducted at the Neonatal Care Unit of Besat Hospital in Sanandaj, Kurdistan Province, as a double-blind randomized controlled trial. The participants included term infants (37-42 weeks of gestation) who required phototherapy and were admitted to the neonatal intensive care unit. A total of 290 infants were enrolled and randomly divided into two groups. The intervention group received oral zinc sulfate supplementation at a dosage of 1 mg/kg per day in addition to phototherapy, while the placebo group received an equivalent amount of placebo daily. Bilirubin measurements were obtained at the initiation of the intervention and subsequently every 24 h until discharge. The collected data were analyzed using STATA software version 17. After the infants were randomly allocated to the zinc-sulfate and placebo groups, the study outcomes, including the average changes in bilirubin levels after intervention, the hours of phototherapy, and the number of days of hospitalization, were analyzed and compared for a total of 160 infants in the zinc sulfate group and 130 infants in the placebo group. The reduction in bilirubin levels in infants receiving zinc sulfate was (- 3.75 ± 0.19 CI 95% - 4.12, - 3.37) and for placebo group was (- 1.81 ± 0.15 CI 95% - 2.12, - 1.50) 24 h after the intervention. Furthermore, 48 and 72 h following the intervention, bilirubin levels in the intervention group demonstrated a more substantial decline. The zinc sulfate group had a shorter hospital stay (2.13 ± 0.04 vs. 2.83 ± 1.42) and required less phototherapy hours than the placebo group (6.21 ± 2.16 vs. 8.78 ± 1.40). Conclusions: Oral zinc sulfate supplementation in term neonates with hyperbilirubinemia decreased the level of bilirubin levels, duration of phototherapy, and hospital stay. Trial registration: IRCT, IRCT20220806055625N1. Study Registered 25 December 2022, http://irct.ir/trial/66,722 .
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Affiliation(s)
- Maziar Nikouei
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mojtaba Cheraghi
- Cancer and Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Majid Mansouri
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Siros Hemmatpour
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Vidavalur R, Bhutani VK. Managing the Historic Burden of Kernicterus Mortality in India. Indian J Pediatr 2024:10.1007/s12098-024-05227-6. [PMID: 39167302 DOI: 10.1007/s12098-024-05227-6] [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: 03/28/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024]
Abstract
Prevention of neonatal bilirubin injury exemplifies success of systems approach to avert adverse neonatal and childhood outcomes that rely on strategies including prenatal identification of Rhesus sensitization, universal maternal blood typing, risk assessment for neonatal extreme hyperbilirubinemia (EHB), unfettered access to safe, effective phototherapy, and application of patient safety principles. India's diverse landscape suggests varied real-time experiences of neonatal hyperbilirubinemia and consequent infant mortality rates (IMR). Utilizing Global Burden of Disease (GBD) database, the authors examined national and subnational trends, infant mortality timing, and the disease burden from hemolytic and perinatal jaundice over 30 y (1999 to 2019). They also assessed the correlation of EHB-IMR with socio-demographic index and health expenditure per capita, estimating economic losses from EHB-related infant mortality to guide policy decisions at national and state domains. From 1990 to 2019, India delivered 811,078,415 livebirths of which, 1,189,856 infant deaths were due to EHB. EHB-related deaths decreased from 57,773 in 1990 to 19,664 in 2019, a 60% reduction vs. 40% in overall IMR. Early (0-6 d), late (7-27 d), and post-neonatal (28-364 d) deaths accounted for 61%, 34%, and 5% of mortality, respectively. Uttar Pradesh and Bihar contributed to 38% of all EHB deaths. Economic analysis estimate losses between US $7.2 and 11.7 billion for the year 2019 secondary to EHB-related mortality. The present analysis reveals consistent declines across all states to reach current EHB-IMR of 0.8 per 1,000 live-births in India by 2019. Significant economic impact of lost human productivity highlight ongoing need for targeted life-saving public health strategies.
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Affiliation(s)
- Ramesh Vidavalur
- Department of Clinical Pediatrics, Cayuga Medical Center/Weill Cornell Medicine, 101 Dates Drive, Ithaca, NY, 14850, USA.
| | - Vinod K Bhutani
- Stanford University School of Medicine, Lucile Salter Packard Children's Hospital, Stanford, CA, 94305, USA
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Drozdowska-Szymczak A, Łukawska S, Mazanowska N, Ludwin A, Krajewski P. Management and Treatment Outcomes of Hemolytic Disease of the Fetus and Newborn (HDFN)-A Retrospective Cohort Study. J Clin Med 2024; 13:4785. [PMID: 39200927 PMCID: PMC11355461 DOI: 10.3390/jcm13164785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/05/2024] [Accepted: 08/12/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal antibodies attacking fetal blood cell antigens. Despite routine antenatal anti-D prophylaxis, intrauterine transfusions (IUTs) are still needed in some HDFN cases. Methods: We conducted a retrospective cohort study on newborns with HDFN born in the 1st Department of Obstetrics and Gynecology of the Medical University of Warsaw. We analyzed 274 neonates with HDFN, identifying 46 who required IUT due to fetal anemia and 228 who did not. The laboratory results, management, and outcomes were compared between these groups. Results: Comparative analysis showed that newborns treated with IUT were more likely to have significant anemia, hyperbilirubinemia, and iron overload, indicated by a high ferritin concentration. These neonates more often required top-up transfusions, phototherapy, intravenous immunoglobulin infusions, and exchange transfusions. The length of stay was longer for newborns who received IUT. Conclusions: HDFN requiring IUT is associated with a greater number of complications in the neonatal period and more often requires additional treatment compared to HDFN not requiring IUT.
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Affiliation(s)
- Agnieszka Drozdowska-Szymczak
- Department of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland; (A.D.-S.); (P.K.)
| | - Sabina Łukawska
- Department of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland; (A.D.-S.); (P.K.)
| | - Natalia Mazanowska
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland;
| | - Artur Ludwin
- Department of Obstetrics and Gynecology, Medical University of Warsaw, Pl. Starynkiewicza 1/3, 02-015 Warsaw, Poland;
| | - Paweł Krajewski
- Department of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland; (A.D.-S.); (P.K.)
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An L, Lukac PJ, Kulkarni D. Clinical Decision Support Tool to Promote Adoption of New Neonatal Hyperbilirubinemia Guidelines. Appl Clin Inform 2024; 15:751-755. [PMID: 38897228 PMCID: PMC11390172 DOI: 10.1055/a-2348-3958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE This study aimed to increase the adoption of revised newborn hyperbilirubinemia guidelines by building a clinical decision support (CDS) tool into templated notes. METHODS We created a rule-based CDS tool that correctly populates the phototherapy threshold from more than 2,700 possible values directly into the note and guides clinicians to an appropriate follow-up plan consistent with the new recommendations. We manually reviewed notes before and after CDS tool implementation to evaluate new guidelines adherence, and surveys were used to assess clinicians' perceptions. RESULTS Postintervention documentation showed a decrease in old risk stratification methods (48 to 0.4%, p < 0.01) and an increase in new phototherapy threshold usage (39 to 95%, p < 0.01) and inclusion of follow-up guidance (28 to 79%, p < 0.01). Survey responses on workflow efficiency and satisfaction did not significantly change after CDS tool implementation. CONCLUSION Our study details an innovative CDS tool that contributed to increased adoption of newly revised guidelines after the addition of this tool to templated notes.
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Affiliation(s)
- Lucia An
- Department of Pediatrics at UCLA Mattel Children's Hospital, Los Angeles, California, United States
| | - Paul J Lukac
- Department of Pediatrics and Office of Health Informatics and Analytics, University of California, Los Angeles, California, United States
| | - Deepa Kulkarni
- Department of Pediatrics at UCLA Mattel Children's Hospital, Los Angeles, California, United States
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Mei L, Gu N, Zhou Y, Wang Z, Yang L, Chen L, Li C, Dai Y. Effect of administration routes of oxytocin on hemoglobin in neonates with delayed umbilical cord clamping: a multi-centre randomized controlled clinical trial. Arch Gynecol Obstet 2024; 310:991-999. [PMID: 38753205 PMCID: PMC11258157 DOI: 10.1007/s00404-024-07543-w] [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: 02/21/2024] [Accepted: 04/29/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE To evaluate the effect of intravenous infusion versus intramyometrial injection of oxytocin on hemoglobin levels in neonates with delayed umbilical cord clamping during cesarean section. METHODS The multi-centre randomized controlled trial was performed at three hospitals from February to June 2023. Women with term singleton gestations scheduled for cesarean delivery were allocated to receive an intravenous infusion of 10 units of oxytocin or a myometrial injection of 10 units of oxytocin during the surgery. The primary outcome was neonatal hemoglobin at 48 to 96 h after birth. Secondary outcomes were side-effects of oxytocin, postpartum haemorrhage, phototherapy for jaundice, feeding at 1 month, maternal and neonatal morbidity and re-admissions. RESULTS A total of 360 women were randomized (180 women in each group). The mean neonatal hemoglobin did not show a significant difference between the intravenous infusion group (194.3 ± 21.7 g/L) and the intramyometrial groups (195.2 ± 24.3 g/L) (p = 0.715). Secondary neonatal outcomes, involving phototherapy for jaundice, feeding at 1 month and neonatal intensive care unit admission were similar between the two groups. The maternal outcomes did not differ significantly between the two groups, except for a 200 mL higher intraoperative infusion volume observed in the intravenous group compared to the intramyometrial group. CONCLUSION Among women undergoing elective cesarean delivery of term singleton pregnancies, there was no significant difference in neonatal hemoglobin at 48 to 96 h after birth between infants with delayed cord clamping, whether the oxytocin was administrated by intravenous infusion or intramyometrial injection. TRIAL REGISTRATION Chinese Clinical trial registry: ChiCTR2300067953 (1 February 2023).
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Affiliation(s)
- Lu Mei
- Department of Obstetrics and Gynaecology, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
- Department of Obstetrics and Gynaecology, Nanjing Jiangning Hospital of Chinese Medicine, Nanjing, 211100, China
| | - Ning Gu
- Department of Obstetrics and Gynaecology, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Yan Zhou
- Department of Obstetrics and Gynaecology, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Zhiqun Wang
- Department of Obstetrics and Gynaecology, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Ling Yang
- Department of Neonatology, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Li Chen
- Department of Obstetrics and Gynaecology, Yangzhong People's Hospital, Yangzhong, 212200, China
| | - Chunxia Li
- Department of Obstetrics and Gynaecology, Nanjing Jiangning Hospital of Chinese Medicine, Nanjing, 211100, China
| | - Yimin Dai
- Department of Obstetrics and Gynaecology, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China.
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12
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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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13
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Amin SB. Exchange Transfusions in Late Preterm and Term Neonates with Acute Bilirubin Encephalopathy. J Pediatr 2024; 271:114074. [PMID: 38677628 DOI: 10.1016/j.jpeds.2024.114074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Sanjiv B Amin
- Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Mount Pleasant, MI; Department of Pediatrics, Sir Ganga Ram Hospital, Delhi, India
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14
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Najib KS, Ostovar L, Rezaei M, Barzegar H. Developmental outcome of neonates underwent exchange transfusion due to hyperbilirubinemia: A single-center experience. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:209. [PMID: 39297125 PMCID: PMC11410165 DOI: 10.4103/jehp.jehp_895_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 07/23/2023] [Indexed: 09/21/2024]
Abstract
BACKGROUND Exchange transfusion due to hyperbilirubinemia is performed in neonates with signs of encephalopathy or if the level of bilirubin is more than the exchange threshold and not responding to intensive phototherapy. Bilirubin passage through the blood-brain barrier can cause injury to different sites of the brain and may have long-life effects. In this study, we aimed to evaluate the neonates who underwent exchange transfusion and investigated their developmental problems. By recognizing their developmental delay, we can recommend screening time and early occupational therapy if needed. METHODS AND MATERIAL This is a retrospective study on neonates who underwent exchange transfusion due to hyperbilirubinemia in Namazi and Hafez hospitals, in Shiraz, Iran, between 2016 and 2021. The exclusion criteria were the unwillingness of the parents to participate in the study or incomplete data. Children who died were also excluded from the study. Demographic and clinical data were obtained from hospital records. Children were invited to the clinic for examination, and development was assessed by Ages and Stages Questionnaires (ASQ). All neonates had done auditory brainstem response. The result was obtained. Quantitative data are reported as mean standard deviation (SD) and qualitative data with frequency and percentage. Spearman's correlation coefficient and Chi-square test were used, and the P value was significant below 0.05. RESULTS Eighty-seven neonates were enrolled. Forty-nine (56.3%) were female, and 38 (43.7%) were male. Glucose-6-phosphate dehydrogenase(G6PD) deficiency was the most prevalent hematologic cause of hyperbilirubinemia (23%). Auditory disorder, speech disorder, motor disorder, and encephalopathy were seen in four (4.6%), two (2.3%), three (3.4%), and four infants (4.6%), respectively. CONCLUSION Bilirubin neurotoxicity can cause developmental impairment including auditory, speech, and motor disorders besides encephalopathy. Early recognition and proper early intervention can lead to better outcomes for the child, family, and society.
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Affiliation(s)
- Khadije Sadat Najib
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Ostovar
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Rezaei
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamide Barzegar
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Lançoni SS, Albuquerque JP, Nakato AM, Souza de Nieto GCE, Tkac CM, Sigwalt MF, Nohama P, Souto LRT, Nassif PAN. Placental and Neonatal Serum Leptin Levels in Premature Infants After Phototherapy: Are They Determining Factors for the Safe Indication of Passive Exercises? J Multidiscip Healthc 2024; 17:3091-3100. [PMID: 38974370 PMCID: PMC11227856 DOI: 10.2147/jmdh.s458528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose To analyze leptin levels in placental tissue and premature infants undergoing phototherapy and to evaluate the potential for prescribing passive exercise after phototherapy in this population. Patients and Methods This analytical, longitudinal, prospective cohort study included 108 parturients and their respective premature infants. Variables examined included weight, gestational age, body mass index, sex, serum leptin levels in placental tissue, serum bilirubin levels, and reticulocyte count. Results When comparing each group to a leptin threshold, statistically significant differences were observed at all evaluated time points for placental leptin levels (p < 0.001). Additionally, reticulocyte count decreased in relation to rebound time (p < 0.004). No correlations were found between leptin/bilirubin levels, leptin/reticulocytes, onset of nutrition, and BMI/leptin levels. Conclusion The findings regarding leptin levels suggest that prescribing passive exercises to premature infants undergoing phototherapy may be feasible because this intervention did not increase leptin levels.
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Affiliation(s)
- Samira Said Lançoni
- Graduate Program in Principles of Surgery, Faculdade Evangélica Mackenzie do Paraná, Curitiba, Paraná, Brasil
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Jocilene Pedroso Albuquerque
- Graduate Program in Principles of Surgery, Faculdade Evangélica Mackenzie do Paraná, Curitiba, Paraná, Brasil
- Hospital Universitário Evangélico Mackenzie, Curitiba, Paraná, Brasil
| | - Adriane Muller Nakato
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | | | - Cláudio Marcelo Tkac
- School of Medicine and Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Marcos Fabiano Sigwalt
- Graduate Program in Principles of Surgery, Faculdade Evangélica Mackenzie do Paraná, Curitiba, Paraná, Brasil
- Hospital Universitário Evangélico Mackenzie, Curitiba, Paraná, Brasil
| | - Percy Nohama
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | | | - Paulo Afonso Nunes Nassif
- Graduate Program in Principles of Surgery, Faculdade Evangélica Mackenzie do Paraná, Curitiba, Paraná, Brasil
- Hospital Universitário Evangélico Mackenzie, Curitiba, Paraná, Brasil
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16
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Al-Bedaywi RRR, Salameh KMK, Abedin S, Viswanathan B, Khedr AA, Habboub LHM. Glucose-6-phosphate dehydrogenase deficiency and neonatal indirect hyperbilirubinemia: a retrospective cohort study among 40,305 consecutively born babies. J Perinatol 2024; 44:1035-1041. [PMID: 38480787 PMCID: PMC11226391 DOI: 10.1038/s41372-024-01927-1] [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: 11/15/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND AND OBJECTIVE Glucose-6-phosphate dehydrogenase deficiency (G6PDD) being highly prevalent in the Middle East, the primary objective was to estimate the incidence of neonatal jaundice among G6PD-deficient neonates and to explore its association with various risk factors. METHODS This retrospective cohort study includes 7 years data of neonates diagnosed with G6PDD between 1st January 2015, and 30 September 2022, from Al Wakra Hospital, HMC Qatar. RESULTS Among the 40,305 total births, 1013 had G6PDD with an incidence of 2.51%. Of all the G6PDD babies, 24.6% (249/1013) received phototherapy and three babies required exchange transfusion. Statistically significant associations were noted between the need for phototherapy and gestational age, gestational age groups, birth weight, and birth weight groups, but logistic regression analysis showed significant association for phototherapy only with the gestational age group. CONCLUSION Universal screening and proper follow-up is essential for G6PDD as it plays crucial role in neonatal jaundice.
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Affiliation(s)
| | | | - Sarfrazul Abedin
- Department of Neonatology, AlWakra hospital, Hamad Medical Corporation, Doha, Qatar
| | - Brijroy Viswanathan
- Department of Neonatology, AlWakra hospital, Hamad Medical Corporation, Doha, Qatar
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17
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Iyer NS, Mossayebi MH, Gao TJ, Haizler‐Cohen L, Di Mascio D, McLaren RA, Al‐Kouatly HB. Glucose-6-phosphate dehydrogenase deficiency as a cause for nonimmune hydrops fetalis and severe fetal anemia: A systematic review. Mol Genet Genomic Med 2024; 12:e2491. [PMID: 39041728 PMCID: PMC11264253 DOI: 10.1002/mgg3.2491] [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: 11/05/2023] [Revised: 06/20/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive disorder that predisposes individuals to hemolysis due to an inborn error of metabolism. We performed a systematic literature review to evaluate G6PD deficiency as a possible etiology of nonimmune hydrops fetalis (NIHF) and severe fetal anemia. METHODS PubMed, OVID Medline, Scopus, and clinicaltrials.gov were queried from inception until 31 April 2023 for all published cases of NIHF and severe fetal anemia caused by G6PD deficiency. Keywords included "fetal edema," "hydrops fetalis," "glucose 6 phosphate dehydrogenase deficiency," and "fetal anemia." Cases with workup presuming G6PD deficiency as an etiology for NIHF and severe fetal anemia were included. PRISMA guidelines were followed. RESULTS Five cases of G6PD-related NIHF and one case of severe fetal anemia were identified. Four fetuses (4/6, 66.7%) were male and two fetuses (2/6, 33.3%) were female. Mean gestational age at diagnosis of NIHF/anemia and delivery was 32.2 ± 4.9 and 35.7 ± 2.4 weeks, respectively. Four cases (66.7%) required a cordocentesis for fetal transfusion, and two cases (33.3%) received blood transfusions immediately following delivery. Among the four multigravida cases, two (50%) noted previous pregnancies complicated by neonatal anemia. When reported, the maternal cases included two G6PD deficiency carrier patients and two G6PD-deficient patients. Exposures to substances known to cause G6PD deficiency-related hemolysis occurred in 3/6 (50%) cases. CONCLUSION Six cases of NIHF/severe fetal anemia were associated with G6PD deficiency. While G6PD deficiency is an X-linked recessive condition, female fetuses can be affected. Fetal G6PD deficiency testing can be considered if parental history indicates, particularly if the standard workup for NIHF is negative.
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Affiliation(s)
- Neel S. Iyer
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Matthew H. Mossayebi
- Department of Obstetrics and GynecologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Tracy J. Gao
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Lylach Haizler‐Cohen
- Department of Obstetrics and GynecologyMedStar Washington Hospital CenterWashingtonDCUSA
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological SciencesSapienza University of RomeRomeItaly
| | - Rodney A. McLaren
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Huda B. Al‐Kouatly
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
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18
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Schutzman DL, Kuter N, Salvador A, Wyatt D, Snijder J, Peregrino M, Basu R, Irigoyen M. Newborn Weight Loss Tool and Readmission for Hyperbilirubinemia. Am J Perinatol 2024; 41:1373-1378. [PMID: 36580979 DOI: 10.1055/s-0042-1759603] [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: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to determine if the Newborn Weight Loss Tool (NEWT) can predict hospital readmission due to hyperbilirubinemia. STUDY DESIGN This is a case-control study of 93 newborns and 186 controls ≥35 weeks' gestation. All were discharged from the Mother-Baby unit of an urban academic center and subsequently readmitted for hyperbilirubinemia. Controls were matched for date of birth, gestational age, and Bhutani risk zone. All infants were screened for hyperbilirubinemia prior to discharge and managed according to American Academy of Pediatrics guidelines in place at the time. Chi-square, Fisher's exact test, and multivariate analysis were utilized as appropriate. RESULTS There was no significant difference between the groups for a NEWT < 50% at discharge. More cases than controls breastfed. A significantly greater percentage of cases had NEWT > 50% at readmission than discharge. NEWT > 90% was moderately associated with readmission for hyperbilirubinemia (p = 0.081). CONCLUSION NEWT provides a more nuanced assessment of weight loss following birth and can aid in highlighting newborns at risk for readmission due to hyperbilirubinemia. KEY POINTS · Weight loss is a risk factor for readmission after birth.. · NEWT is a more nuanced assessment of weight loss.. · NEWT > 90% is associated with readmission for jaundice..
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Affiliation(s)
- David L Schutzman
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Nazli Kuter
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Agnes Salvador
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Dorothy Wyatt
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Juan Snijder
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
- Department of Hematology-Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Manuel Peregrino
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Rhea Basu
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
- Division of Neonatology, Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matilde Irigoyen
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
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19
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Mannan J, Amin SB. Effect of chest shielding during phototherapy for hyperbilirubinemia on symptomatic patent ductus arteriosus - a double-blind randomized placebo-controlled trial. Pediatr Res 2024:10.1038/s41390-024-03310-4. [PMID: 38909157 DOI: 10.1038/s41390-024-03310-4] [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: 02/16/2024] [Revised: 05/06/2024] [Accepted: 05/15/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Meta-analysis of randomized trials suggests that phototherapy is associated with patent ductus arteriosus (PDA). We hypothesized that chest shielding during phototherapy would decrease the incidence of symptomatic PDA (sPDA) compared to sham shielding. METHODS A single center, double-blind, randomized, placebo-controlled trial was performed to evaluate the effect of chest shielding during phototherapy on sPDA in infants ≤ 29 weeks gestational age (GA) or with birth weight (BW) ≤ 1000 g. Infants were randomized to either chest shield (with aluminum foil, intervention group) or sham shield (without aluminum foil, control group) during phototherapy. The primary outcome was sPDA during the period 24 h after phototherapy initiation until 3 days after phototherapy cessation. RESULTS 160 infants were randomized with 10 infants withdrawn from each group due to shield placement after phototherapy initiation. Of 140 infants analyzed, the mean GA and BW was 26.6 weeks and 872 g, respectively. There was no difference in the incidence of sPDA between the intervention (n = 70) and control group (n = 70) (10% vs 11%, respectively, adjusted odds ratio 0.78, 95% CI:0.33-1.82; p = 0.57). CONCLUSIONS Chest shielding during phototherapy had no effect on sPDA in infants ≤ 29 weeks GA or with BW ≤ 1000 g. TRIAL REGISTRATION http://clinicaltrials.gov , Identifier: NCT02552927. IMPACT Meta-analysis of randomized clinical trials suggests that chest shielding during phototherapy used for hyperbilirubinemia may decrease the incidence of patent ductus arteriosus. The effect of chest shielding during phototherapy on symptomatic patent ductus arteriosus has not been evaluated in a double-blind randomized trial. In this double-blind, randomized, placebo-controlled trial, chest shielding during phototherapy was not associated with a decreased incidence of symptomatic patent ductus arteriosus in premature infants.
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Affiliation(s)
- Javed Mannan
- Department of Pediatrics, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Sanjiv B Amin
- Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
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20
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Slemmer A, Klamer B, Schmerge C, Lauden S, Texler C, Fennell M, Lowing D, Leyenaar JK, Bode RS. Comparing Outcomes Between Direct and ED Admissions for Neonatal Hyperbilirubinemia. Hosp Pediatr 2024; 14:421-429. [PMID: 38766712 DOI: 10.1542/hpeds.2023-007527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES Pediatric direct admissions (DA) have multiple benefits including reduced emergency department (ED) volumes, greater patient and provider satisfaction, and decreased costs without compromising patient safety. We sought to compare resource utilization and outcomes between patients with a primary diagnosis of neonatal hyperbilirubinemia directly admitted with those admitted from the ED. METHODS Single-center, retrospective study at a large, academic, free-standing children's hospital (2017-2021). Patients were between 24 hours and 14 days old with a gestational age of ≥35 weeks, admitted with a primary diagnosis of neonatal hyperbilirubinemia. Outcomes included length of stay (LOS), time to clinical care, resource utilization, NICU transfer, and 7-day readmission for phototherapy. RESULTS A total of 1098 patients were included, with 276 (25.1%) ED admissions and 822 (74.9%) DAs. DAs experienced a shorter median time to bilirubin level collection (1.9 vs 2.1 hours, P = .003), received less intravenous fluids (8.9% vs 51.4%, P < .001), had less bilirubin levels collected (median of 3.0 vs 4.0, P < .001), received phototherapy sooner (median of 0.8 vs 4.2 hours, P < .001), and had a shorter LOS (median of 21 vs 23 hours, P = .002). One patient who was directly admitted required transfer to the NICU. No differences were observed in the 7-day readmission rates for phototherapy. CONCLUSIONS Directly admitting patients for the management of neonatal hyperbilirubinemia is a preferred alternative to ED admission as our study demonstrated that DAs had a shorter time to clinical care, shorter LOS, and less unnecessary resource utilization with no difference in 7-day readmissions for phototherapy.
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Affiliation(s)
- Ashleigh Slemmer
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Brett Klamer
- Biostatistics Resource at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio &The Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Christine Schmerge
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Stephanie Lauden
- Department of Pediatrics, The University of Colorado, Denver, Colorado
| | - Cara Texler
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Meghan Fennell
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Dena Lowing
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - JoAnna K Leyenaar
- Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Ryan S Bode
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Center for Clinical Excellence at Nationwide Children's Hospital, Columbus, Ohio
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Hemmati F, Mahini SM, Bushehri M, Asadi AH, Barzegar H. Exchange Transfusion Trends and Risk Factors for Extreme Neonatal Hyperbilirubinemia over 10 Years in Shiraz, Iran. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:384-393. [PMID: 38952637 PMCID: PMC11214680 DOI: 10.30476/ijms.2023.99176.3123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/14/2023] [Accepted: 09/28/2023] [Indexed: 07/03/2024]
Abstract
Background Exchange transfusion (ET) is an effective treatment for acute bilirubin encephalopathy and extreme neonatal hyperbilirubinemia (ENH). It can reduce mortality and morbidity. This study aimed to investigate the trends and risk factors of ENH requiring ET in hospitalized neonates in Iran. Methods A retrospective analysis of medical records of neonates who underwent ET due to ENH was conducted from 2011 to 2021, in Shiraz, Iran. Clinical records were used to gather demographic and laboratory data. The quantitative data were expressed as mean±SD, and qualitative data was presented as frequency and percentage. P<0.05 was considered statistically significant. Results During the study, 377 ETs were performed for 329 patients. The annual rate of ET decreased by 71.2% during the study period. The most common risk factor of ENH was glucose-6-phosphate dehydrogenase (G6PD) deficiency (35%), followed by prematurity (13.06%), ABO hemolytic disease (7.6%), sepsis (6.4%), Rh hemolytic disease (6.08%), and minor blood group incompatibility (3.34%). In 28.52% of the cases, the cause of ENH was not identified. 17 (5.1%) neonates had acute bilirubin encephalopathy, of whom 6 (35.29%) had G6PD deficiency, 6 (35.29%) had ABO incompatibility, and 2 (11.76%) had Rh incompatibility. Conclusion Although the rate of ET occurrence has decreased, it seems necessary to consider different risk factors and appropriate guidelines for early identification and management of neonates at risk of ENH should be developed. The findings of the study highlighted the important risk factors of ENH in southern Iran, allowing for the development of appropriate prevention strategies.
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Affiliation(s)
- Fariba Hemmati
- Neonatal Research Center, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Moein Mahini
- Neonatal Research Center, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrnoosh Bushehri
- Neonatal Research Center, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Hossein Asadi
- Neonatal Research Center, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamide Barzegar
- Neonatal Research Center, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
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22
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Cheng X, Lin B, Yang Y, Yu Y, Fu Y, Yang C. End-tidal carbon monoxide concentrations measured within 48 hours of birth predict hemolytic hyperbilirubinemia. J Perinatol 2024; 44:897-901. [PMID: 38627593 DOI: 10.1038/s41372-024-01967-7] [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: 03/03/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVES To determine, among neonates at-risk for hyperbilirubinemia, whether measuring end-tidal carbon monoxide concentration (ETCOc) twice before 48 hours could identify those who would develop hyperbilirubinemia and differentiate hemolytic vs. non-hemolytic causes. METHODS Prospective study on neonates meeting criteria "at-risk for hyperbilirubinemia." Routine bilirubin measurements and 10-day follow-up were used to categorize neonates as; (1) normal (no hyperbilirubinemia, all bilirubins <95th percentile of Bhutani nomogram), (2) having hemolytic hyperbilirubinemia (bilirubin ≥95th percentile, DAT+, elevated retic, or G6PD+), or (3) having non-hemolytic hyperbilirubinemia. RESULTS 386 neonates were enrolled. 321 (83%) did not develop hyperbilirubinemia and 65 (17%) did, of which 29 were judged hemolytic and 36 non-hemolytic. High ETCOc differentiated the hemolytic group (p < 0.001). First-day ETCOc correlated with bilirubin and with reticulocyte count (r = 0.896 and 0.878) and sensitivity and specificity for predicting hyperbilirubinemia were excellent (83% and 95%). CONCLUSIONS ETCO measurement in the first 48 hours after birth predicts hemolytic hyperbilirubinemia.
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Affiliation(s)
- Xiaoqin Cheng
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Bingchun Lin
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Yong Yang
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Yanliang Yu
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Yongping Fu
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Chuanzhong Yang
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China.
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Hanford J, McQuay C, Vachharajani A, Obi O, Anders A. Reducing Procedural Pain and Avoiding Peripheral Intravenous Catheters by Implementing a Feeding Protocol for Late Preterm Infants: A Quality Improvement Project. Adv Neonatal Care 2024; 24:219-226. [PMID: 38241696 DOI: 10.1097/anc.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Late preterm births account for a large portion of preterm births, yet the optimal method of nutrition and enteral feeding in this population remains unclear and often involves intravenous (IV) fluids. PURPOSE To develop and implement a late preterm feeding protocol in order to decrease the necessity of IV access, decrease the use of starter parenteral nutrition (PN), and reduce the pain endured by an infant in the neonatal intensive care unit. METHODS The Plan-Do-Study-Act quality improvement model was utilized as a framework for the implementation of this quality improvement project. A literature review was conducted and subsequently, a feeding protocol was developed and included the more judicious use of starter PN. This protocol was implemented, evaluated, and adopted. A second Plan-Do-Study-Act cycle was completed with the addition of an auto-text reminder incorporated into admission notes in the electronic medical record. RESULTS The implementation of the protocol significantly reduced placement of IV access and the use of starter (PN) in late preterm infants without considerable differences in balancing measures. The percentage of infants who received peripheral IV access declined considerably from 70% to 42% ( P = .0017) subsequently, less pain endured by the infants. There was a decrease in the initiation of starter PN from 55% to 7% ( P < .00001). IMPLICATIONS FOR PRACTICE Administering enteral feedings on admission to stable, late preterm infants reduced the need for peripheral IV access and thus decreased pain from this procedure.
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Affiliation(s)
- Jennifer Hanford
- Neonatal Intensive Care Unit, University of Missouri Healthcare, Women's Hospital, Columbia
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Daggle L, Sharma N, Setiady I, Leonard K. Management of Neonatal Hyperbilirubinemia: Shedding Light on the American Academy of Pediatrics 2022 Clinical Practice Guideline Revision. Pediatr Ann 2024; 53:e208-e216. [PMID: 38852082 DOI: 10.3928/19382359-20240407-02] [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: 06/10/2024]
Abstract
Neonatal hyperbilirubinemia is one of the most common conditions managed by pediatricians. Although many infants are affected, most will experience complete resolution without complication. Acute bilirubin encephalopathy and kernicterus are rare yet debilitating sequelae of severe hyperbilirubinemia that can be avoided through careful monitoring and treatment with phototherapy. Appropriate management of neonatal hyperbilirubinemia must balance the risks of these severe conditions with the effects of overtreatment. Released in 2022, the American Academy of Pediatrics revised the clinical practice guideline for the management of hyperbilirubinemia, which aims to provide that balance through updates to the previous guideline. This article will provide the reader with (1) an evidence-based harm and benefit analysis of the guideline, (2) an overview of key changes and clarifications made in the new guideline, and (3) a practical summary of guideline updates. [Pediatr Ann. 2024;53(6):e208-e216.].
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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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Drozdowska-Szymczak A, Mazanowska N, Pomianek T, Ludwin A, Krajewski P. Incidence and Risk Factors of Cholestasis in Newborns with Hemolytic Disease-A Case-Control Study. J Clin Med 2024; 13:3190. [PMID: 38892901 PMCID: PMC11172419 DOI: 10.3390/jcm13113190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/25/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: One of the rare causes of cholestasis may be hemolytic disease of the fetus and newborn (HDFN). Methods: We retrospectively analyzed 88 medical records of HDFN newborns with cholestasis and 186 records of children with HDFN without cholestasis and conducted an observational, case-control, retrospective study. Results: Factors influencing the risk of cholestasis were lower gestational age at birth (36.83 ± 1.9 vs. 37.57 ± 1.8, p = 0.002), Rh or Kidd HDFN (80.7% vs. 53.2%), and the need for intrauterine transfusion (27.3 vs. 11.8%). The subjects had lower hemoglobin concentrations at birth (14.01 ± 3.8 vs. 16.39 ± 2.8 g/dL) and during whole hospital stay, higher cord blood total bilirubin concentration (4.26 ± 1.8 vs. 2.39 ± 1.4 mg/dL), higher maximum bilirubin concentration (15.27 ± 5.8 vs. 10.24 ± 3.4 mg/dL), and more frequent liver ultrasound abnormalities (19.9 vs. 6.3%). They also required more extended hospitalization due to higher rates of postnatal blood transfusion (33 vs. 3.8%), more frequent need for exchange transfusion (8.8% vs. 2.2%), more extended time and higher risk of phototherapy (94.3 vs. 59.1%), and higher usage of immunoglobulins (55.7 vs. 8.1%), parenteral nutrition (45.5 vs. 12.9%), and antibiotics (14.8 vs. 4.8%). Conclusions: The risk factors for cholestasis in children with HDFN are lower gestational age at delivery, Rh and Kidd serological type of HDFN, and the need for intrauterine transfusions.
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Affiliation(s)
- Agnieszka Drozdowska-Szymczak
- Department of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland; (A.D.-S.); (T.P.); (P.K.)
| | - Natalia Mazanowska
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Tomasz Pomianek
- Department of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland; (A.D.-S.); (T.P.); (P.K.)
| | - Artur Ludwin
- Department of Obstetrics and Gynecology, Medical University of Warsaw, Pl. Starynkiewicza 1/3, 02-015 Warsaw, Poland;
| | - Paweł Krajewski
- Department of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland; (A.D.-S.); (T.P.); (P.K.)
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Okwundu CI, Bhutani VK, Uthman OA, Smith J, Olowoyeye A, Fiander M, Wiysonge CS. Transcutaneous bilirubinometry for detecting jaundice in term or late preterm neonates. Cochrane Database Syst Rev 2024; 5:CD011060. [PMID: 38804265 PMCID: PMC11131145 DOI: 10.1002/14651858.cd011060.pub2] [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: 05/29/2024]
Abstract
BACKGROUND The American Academy of Pediatrics and the Canadian Paediatric Society both advise that all newborns should undergo bilirubin screening before leaving the hospital, and this has become the standard practice in both countries. However, the US Preventive Task Force has found no strong evidence to suggest that this practice of universal screening for bilirubin reduces the occurrence of significant outcomes such as bilirubin-induced neurologic dysfunction or kernicterus. OBJECTIVES To evaluate the effectiveness of transcutaneous screening compared to visual inspection for hyperbilirubinemia to prevent the readmission of newborns (infants greater than 35 weeks' gestation) for phototherapy. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, ICTRP, and ISRCTN in June 2023. We also searched conference proceedings, and the reference lists of included studies. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-randomized, cluster-randomized, or prospective cohort studies with control arm that evaluated the use of transcutaneous bilirubin (TcB) screening for hyperbilirubinemia in newborns before hospital discharge. DATA COLLECTION AND ANALYSIS We used standard methodologic procedures expected by Cochrane. We evaluated treatment effects using a fixed-effect model with risk ratio (RR) and 95% confidence intervals (CI) for categorical data and mean, standard deviation (SD), and mean difference (MD) for continuous data. We used the GRADE approach to evaluate the certainty of evidence. MAIN RESULTS We identified one RCT that met our inclusion criteria. The study included 1858 African newborns at 35 weeks' gestation or greater who were receiving routine care at a well-baby nursery, and were randomly recruited prior to discharge to undergo TcB screening. The study had good methodologic quality. TcB screening versus visual assessment of hyperbilirubinemia in newborns: - probably reduces readmission to the hospital for hyperbilirubinemia (RR 0.25, 95% CI 0.14 to 0.46; P < 0.0001; moderate-certainty evidence); - may have little or no effect on the rate of exchange transfusion (RR 0.20, 95% CI 0.01 to 14.16; low-certainty evidence); - probably increases the number of newborns who require phototherapy prior to discharge (RR 2.67, 95% CI 1.56 to 4.55; moderate-certainty evidence). - may have little or no effect on the rate of acute bilirubin encephalopathy (RR 0.33, 95% CI 0.01 to 8.18; low-certainty evidence). The study did not evaluate or report cost of care. AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests that TcB screening probably reduces hospital readmission for hyperbilirubinemia compared to visual inspection. Low-certainty evidence also suggests that TcB screening may have little or no effect on the rate of exchange transfusion compared to visual inspection. However, moderate-certainty evidence suggests that TcB screening probably increases the number of newborns that require phototherapy before discharge compared to visual inspection. Low-certainty evidence suggests that TcB screening may have little or no effect on the rate of acute bilirubin encephalopathy compared to visual inspection. Given that we have only identified one RCT, further studies are necessary to determine whether TcB screening can help to reduce readmission and complications related to neonatal hyperbilirubinemia. In settings with limited newborn follow-up after hospital discharge, identifying newborns at risk of severe hyperbilirubinemia before hospital discharge will be important to plan targeted follow-up of these infants.
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Affiliation(s)
- Charles I Okwundu
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Vinod K Bhutani
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford School of Medicine, Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Johan Smith
- Department of Paediatrics and Child Health, Stellenbosch University, Faculty of Health Sciences, Stellenbosch, South Africa
| | - Abiola Olowoyeye
- Phoenix Children's Hospital and University of Arizona College of Medicine, Phoenix, Arizona, USA
| | | | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Smith M, Ridgway A, Mullikin D. Neonatal Hyperbilirubinemia Admissions Following Clinical Practice Guideline Implementation. Mil Med 2024; 189:e1259-e1262. [PMID: 37975240 DOI: 10.1093/milmed/usad427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/08/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Treatment of neonatal hyperbilirubinemia remains one of the most common reasons for readmission following delivery. Revised clinical practice guidelines (CPGs) for the treatment of neonatal hyperbilirubinemia were published on August 5, 2022. This report describes the preliminary outcomes following implementation of the new CPGs at Tripler Army Medical Center. MATERIALS AND METHODS A retrospective chart review was performed for the 12 months prior to implementation and the 5 months post implementation. RESULTS Bilirubin admissions decreased from 15.6% of total admissions during the 12 months prior to the new guidelines (69/441) to 4.1% of admissions (8/194) during the 5 months after implementation of the new guidelines (P < 0.001). This corresponds to a 74% reduction (risk ratio = 0.26, 95% confidence interval [CI] 0.13 to 0.54). The decrease in admissions was found to correlate to greater than $140,000 in annual savings. CONCLUSION Adhering to the revised CPGs has the potential to increase resource availability at a time when nursing shortages and financial instability are impacting health care systems nationwide. No short-term adverse events were noted; however, long-term follow up will be needed.
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Affiliation(s)
- Morgan Smith
- Pediatric Residency Program, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Austin Ridgway
- Pediatric Residency Program, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Dolores Mullikin
- Pediatric Residency Program, Tripler Army Medical Center, Honolulu, HI 96859, USA
- Pediatric Faculty, The University of Uniformed Services, Bethesda, MD 20814, USA
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Imamura T, Kanai Y, Yamaguchi S, Namai Y. New Roles for Albumin/Globulin Ratio in the Early-Onset Hyperbilirubinemia among Infants Born Weighing 1,000 to 2,499 Grams. Am J Perinatol 2024; 41:e69-e75. [PMID: 35613928 DOI: 10.1055/s-0042-1749387] [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: 11/01/2022]
Abstract
INTRODUCTION Early-onset hyperbilirubinemia (EOH) is a clinical issue for premature infants. We predicted that EOH management would be improved by fast results from common laboratory tests. Total serum bilirubin (TSB) level and the albumin/globulin ratio may contribute to improving the management of EOH. OBJECTIVE The aim of the study is to examine the relationship between EOH and perinatal variables among infants born weighing 1,000 to 2,499 g. STUDY DESIGNS A single center study was undertaken at Ohta Nishinouchi Hospital between April 1, 2016 and January 31, 2022, using blood samples prospectively collected from infants admitted to the neonatal intensive care unit that were assessed by univariate analyses and multivariate logistic regression analysis. Due to a correlation between gestational age (GA) and birth weight (BW), each variable was entered separately into Model 1 (including GA) and 2 (including BW). RESULTS A total of 508 infants were analyzed (270 in the non EOH group and 238 in the EOH group). No infants experienced feto-maternal transfusion syndrome or hemolytic diseases such as blood type (ABO or Rh) incompatibility or glucose-6-phosphate dehydrogenase deficiency during perinatal period. Significant relationships were observed between EOH and BW (p <0.01, odds ratio [OR], 0.997; 95% confidence interval [CI], 0.996-0.997), albumin (p <0.01, OR, 0.278; 95% CI, 0.129-0.599), albumin/globulin ratio (p <0.01, OR, 2.695; 95% CI, 1.378-5.270), TSB (p <0.01, OR, 2.774; 95% CI, 1.795-4.287), and antenatal corticoid therapy (p = 0.02, OR, 1.852; 95% CI, 1.108-3.097) in Model 2. Per receiver operating characteristic curves, an albumin/globulin ratio of 1.84 could predict EOH at a sensitivity of 50.0% and specificity of 75.6% (AUC = 0.652, p <0.01, 95% CI, 0.603-0.700). CONCLUSION Albumin/globulin ratio among infants born weighing 1,000 to 2,499 g may be a useful indicator of EOH. KEY POINTS · Early-onset hyperbilirubinemia (EOH) is a clinical issue for premature infants.. · EOH management expected to be improved through the use of common laboratory tests.. · Albumin/globulin ratio among low birth weight infants may be a useful indicator of EOH..
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Affiliation(s)
- Takashi Imamura
- Department of Pediatrics, Ohta General Hospital Foundation Ohta Nishinouchi Hospital, Koriyama City, Fukushima, Japan
| | - Yuji Kanai
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Shuhei Yamaguchi
- Department of Pediatrics, Ohta General Hospital Foundation Ohta Nishinouchi Hospital, Koriyama City, Fukushima, Japan
| | - Yoshiyuki Namai
- Department of Pediatrics, Ohta General Hospital Foundation Ohta Nishinouchi Hospital, Koriyama City, Fukushima, Japan
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Ahmadipour S, Mardani M, Mohsenzadeh A, Baharvand P, Nazeri MG. The Lowering of Bilirubin Levels in Full-Term Newborns by the Effect of Combined Massage Therapy and Phototherapy Practice. Am J Perinatol 2024; 41:e3420-e3424. [PMID: 30999382 DOI: 10.1055/s-0039-1685493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Various therapeutic treatments have been prescribed for decreasing the bilirubin level. Massage therapy is one of the neonate treatments for jaundice. The aim of this study is to investigate the effects of combined massage therapy and phototherapy on neonatal jaundice. STUDY DESIGN This study was performed at Shahid Madani Hospital in the city of Khorramabad in 2016, where 83 healthy full-term infants were enrolled. They were selected through convenience sampling and then were randomly assigned to the intervention and control groups. The control group (n = 43) received phototherapy, whereas infants in the intervention group (n = 40) received 4 days of massage and phototherapy. The serum bilirubin level, frequency of stooling and amount of urination, duration of hospitalization, and feeding frequency were analyzed using SPSS by descriptive and analytical statistics (mixed regression models). RESULTS Baseline levels of bilirubin were similar between the two groups (p > 0.05). The bilirubin level was measured as 13.4 ± 0.7 mg/dL in the intervention group on day 1. It stood at 14.4 ± 1.5 mg/dL in the control group, which was not statistically significantly different. However, the mean bilirubin level was decreased on day 4 of hospitalization to 7.4 ± 0.56 mg/dL and 9.0 ± 2.3 mg/dL, showing a significant difference decrease in the intervention and control group (p < 0.05), respectively. CONCLUSION Intervention had a significant role in decreasing the bilirubin level, amount of urination, and duration of hospitalization of full-term infants suffering from hyperbilirubinemia.
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Affiliation(s)
- Shokoufeh Ahmadipour
- Faculty of Medicine, Department of Pediatrics, Lorestan University of Medical Sciences, Khorramabad, Iran
- Fellowship of Pediatrics Gastroenterology, Pediatric Gastroenterology and Hepatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Mardani
- Department of Health & Nutrition, Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Azam Mohsenzadeh
- Faculty of Medicine, Department of Pediatrics, Lorestan University of Medical Sciences, Khorramabad, Iran
- Immunology, Asthma and Allergy Research Institute, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parastoo Baharvand
- Department of Community Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Ghaed Nazeri
- Faculty of Medicine, Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
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Villarreal-Martínez L, Torres-Sánchez KA, Ibarra-Ramírez M, Martínez-Garza LE, Villarreal-Martínez DZ, Viera DAG, Herrera MDCR, O-Castillo M, Bautista-Gómez AJ, Martínez AG, de la Garza JFM. Prevalence of Glucose-6-Phosphate Dehydrogenase Deficiency in Newborns in Northeast Mexico. Am J Perinatol 2024; 41:e573-e576. [PMID: 35977713 DOI: 10.1055/a-1926-0075] [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: 01/24/2023]
Abstract
OBJECTIVE Glucose-6-phosphate dehydrogenase deficiency (G6PDd) is the most common enzymatic disease worldwide and the prevalence is not well established because of the lack of screening. This study aimed to estimate the prevalence of G6PDd in a Hispanic population from Northeast Mexico. STUDY DESIGN In this retrospective study, a database was used to analyze the G6PDd in neonates included in the expanded newborn metabolic screening of inherited metabolic disorders during a period of 4 years through the GSP Neonatal G6 kit (PerkinElmer). RESULTS Among 96,152 (48,462 male) neonates screened for G6PD enzyme activity, a total of 566 (0.58%) cases were deficient for G6PD. Of those 566 patients, 469 (82.8%) attended the second test and the other 97 (17.2%) patients were lost. Of those 469 who did attend, 384 (81.9%) neonates were deficient in the second test and 85 (18.1%) were normal. With the data collected, 384 neonates were confirmed with G6PDd, 348 (88.6%) were male and 36 (11.4%) patients were female. The calculated prevalence for this population was 0.72 cases per 100 male newborns. CONCLUSION The prevalence of G6PDd in the Northeastern Mexican population is high. Since migration is increasing in the United States, pediatricians should be aware of the need to search for G6PDd in newborns and the wide clinical manifestations they can present. KEY POINTS · The calculated prevalence of glucose-6-phosphate dehydrogenase deficiency in Northeast Mexico is 3.99 cases per 1,000 newborns.. · Glucose-6-phosphate dehydrogenase deficiency screenings should be included in all newborn metabolic screenings.. · Glucose-6-phosphate dehydrogenase deficiency is a common erythroenzymopathy that must be addressed as a public health concern. To anticipate clinical complications, target population monitoring is required..
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Affiliation(s)
- Laura Villarreal-Martínez
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Katia A Torres-Sánchez
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Marisol Ibarra-Ramírez
- Genetics Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Laura E Martínez-Garza
- Genetics Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Daniel Z Villarreal-Martínez
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Daniel A G Viera
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - María Del C R Herrera
- Genetics Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Miguel O-Castillo
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Andrea J Bautista-Gómez
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Adrián G Martínez
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Juan F M de la Garza
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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Champion ML, Jauk VC, Biggio JR, Sychowski JM, Tita AT, Harper LM. Early Gestational Diabetes Screening Based on ACOG Guidelines. Am J Perinatol 2024; 41:e641-e647. [PMID: 35973791 DOI: 10.1055/a-1925-1134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE A recent randomized controlled trial suggested that early gestational diabetes mellitus (GDM) screening in patients with obesity (body mass index [BMI] ≥30 kg/m2) does not improve perinatal outcomes. The American College of Obstetrics and Gynecology currently recommends early screening for gestational diabetes in patients who are overweight with one or more additional risk factors. We evaluated the effect of screening based on the number of additional risk factors for development of gestational diabetes. STUDY DESIGN This was a secondary analysis of a multicenter randomized controlled trial of obese patients with singleton nonanomalous fetuses comparing early (14-20 weeks' gestation) with routine (24-28 weeks' gestation) GDM screening. Exclusion criteria were pregestational diabetes, major medical illnesses, bariatric surgery, chronic steroid use, and prior cesarean. Early versus routine GDM screening groups were compared and stratified by the number of additional risk factors for GDM (0, 1, 2, and ≥3). The primary outcome was an adverse perinatal composite outcome composed of: macrosomia, primary cesarean delivery, hypertensive disorders of pregnancy, shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia. Analyses examined effects of early versus routine screening by the number of additional risk factors and their possible interaction on the incidences of the primary outcome and GDM. RESULTS Of 913 patients, 5% had 0, 52% had 1, 33% had 2, and 10% had ≥3 additional risk factors. Baseline characteristics, including the number and type of risk factors, were similar between early and routine screening groups. Breslow-Day test for interaction between early versus routine screening and the number of additional risk factors was not significant for either the primary outcome (p = 0.37) or the diagnosis of GDM (p = 0.28). The incidence of GDM and the adverse perinatal composite outcome increased as the number of risk factors increased (p < 0.001). CONCLUSION In patients with BMI ≥30 kg/m2 and additional risk factors, early GDM screening does not prevent adverse outcomes. KEY POINTS · The ACOG currently recommends early screening for gestational diabetes if patients have risk factors.. · Even in patients with multiple risk factors, early screening for GDM does not improve outcomes.. · Patients with three or more risk factors may have worse outcomes if they undergo early screening..
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Affiliation(s)
- Macie L Champion
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Victoria C Jauk
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Joseph R Biggio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health System, New Orleans, Louisiana
| | - Jeff M Sychowski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T Tita
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Lorie M Harper
- Department of Women's Health, The University of Texas at Austin Dell Medical School, Austin, Texas
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Nasief H, Alaifan MA, Tamur S, Khadawardi K, Bahauddin AA, Ahmed A, Ahmad S, Singh R, Alhussaini BH, Hassan A. Effectiveness of phototherapy with and without probiotics for the treatment of indirect hyperbilirubinaemia in preterm neonates: a randomised controlled trial. Paediatr Int Child Health 2024; 44:24-29. [PMID: 38482867 DOI: 10.1080/20469047.2024.2328416] [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: 10/09/2023] [Accepted: 03/05/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Raised serum bilirubin levels can cause kernicterus, and premature infants are at increased risk owing to metabolic immaturity. The standard treatment for neonatal jaundice is phototherapy, but probiotics alone can reduce the duration of phototherapy and hospitalisation. OBJECTIVES To determine the effectiveness of phototherapy with and without probiotics for the treatment of indirect hyperbilirubinaemia in preterm neonates. PATIENTS AND METHODS The open-labelled randomised controlled trial was conducted from January 2022 to January 2023 in the neonatal unit of the University of Lahore Teaching Hospital, Pakistan. A total of 76 preterm neonates who fulfilled the selection criteria were included and divided into two groups. Both groups received standard phototherapy. In Group B, a probiotic (Saccharomyces boulardii) 125 mg, twice daily, orally (in 5 cc of whichever milk the infant was receiving) was given until discharge from hospital. The primary outcome measurements were the duration of phototherapy and the length of hospitalisation. RESULTS The mean (SD) duration of phototherapy was 36.55 (14.25) hours in Group A and 24.61 (9.25) hours in Group B (p <0.05). The mean (SD) duration of hospital stay was 47.36 (16.51) hours in Group A and 33.13 (8.93) hours in Group B (p <0.05). CONCLUSION Oral probiotics (Saccharomyces boulardii) have a significant effect on the duration of phototherapy for neonatal hyperbilirubinaemia, and they decrease the chances of nosocomial infection. Exploration of clinical outcomes by investigating faecal flora and undertaking large randomised controlled trials of various probiotics are needed. ABBREVIATIONS ABE: acute bilirubin encephalopathy; CNS: central nervous system; GA: gestational age; IVIG: intravenous immunoglobulin; KSD: kernicterus; NNU: neonatal unit; RCT: randomised controlled trial; S. boulardii: Saccharomyces boulardii.
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Affiliation(s)
- Hisham Nasief
- Departments of Obstetrics and Gynecology and Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Meshari A Alaifan
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shadi Tamur
- Department of Pediatrics, College of Medicine, Taif University, Saudi Arabia
| | - Khalid Khadawardi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ammar A Bahauddin
- Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Aijaz Ahmed
- National Institute of Child Health, Karachi, Pakistan
| | - Sarfraz Ahmad
- Departments of Paediatrics and Neonatology, Dr Sulaiman al Habib Hospital, Dubai, United Arab Emirates
| | - Rajinder Singh
- Departments of Paediatrics and Neonatology, Dr Sulaiman al Habib Hospital, Dubai, United Arab Emirates
| | - Bakr H Alhussaini
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amber Hassan
- Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
- System Medicine, Translational Neuroscience Laboratory, CEINGE Biotecnologie Avanzate, Naples, Italy
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Cheraghi M, Nikouei M, Mansouri M, Hemmatpour S, Moradi Y. Effect of vitamin E supplementation on bilirubin levels in infants with hyperbilirubinemia: a double-blind randomized clinical trial. Clin Exp Pediatr 2024; 67:249-256. [PMID: 38549357 PMCID: PMC11065639 DOI: 10.3345/cep.2023.01312] [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: 09/20/2023] [Revised: 12/09/2023] [Accepted: 02/01/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND The effect of vitamin E supplementation on bilirubin levels in infants was previously explored, but the results were inconclusive. PURPOSE To examine the effect of vitamin E supplementation on bilirubin levels in term infants in the neonatal intensive care unit (NICU). METHODS This interventional double-blind randomized clinical trial was conducted in the Sanandaj Besat Hospital NICU. Enrolled newborns were between 37 and 42 weeks and 6 days of gestation and required phototherapy according to American Academy of Pediatrics clinical guidelines. A total of 138 infants were randomly assigned to vitamin E (n=68) or placebo (n=70) groups. In addition to phototherapy, the vitamin E group received 0.5 mL (5 IU) of supplemental vitamin E daily, whereas the placebo group received 0.5 mL of oral dextrose daily. STATA 17 was used for the data analysis. RESULTS Changes in bilirubin levels at 24 hours postintervention did not differ significantly from baseline in either group. Vitamin E supplementation did not significantly reduce total bilirubin levels at 24 hours postintervention (mean difference [MD], -0.18; P=0.204; 95% confidence interval [CI], -1.39 to 1.02). However, the vitamin E group exhibited lower total bilirubin levels than the placebo group at 48 hours postintervention (MD, 0.18; P=0.365; 95% CI, -0.89 to 1.27) and 72 hours (MD, 0.36; P=0.356; 95% CI, -2.34 to 1.61), although the differences were not statistically significant. A subgroup analysis revealed that female infants experienced a greater reduction in total bilirubin levels than male infants. CONCLUSION Infants administered vitamin E versus placebo demonstrated similar reductions in bilirubin levels and hospital stays. Although the average bilirubin changes did not differ significantly between groups, the vitamin E group showed a more noticeable reduction over time, indicating a positive effect of vitamin E supplementation on serum bilirubin reduction. Trial registration: IRCT20220806055625N2 (registered December 26, 2022; http://irct.ir/trial/67135).
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Affiliation(s)
- Mojtaba Cheraghi
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Maziar Nikouei
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Majid Mansouri
- Department of Pediatric, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Siros Hemmatpour
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Paopongsawan P, Kiatchoosakun P, Jirapradittha J, Chopchoen M. Prevalence of Glucose-6-Phosphate Dehydrogenase Deficiency in Male Newborn Infants and Its Relationship with Neonatal Jaundice in Thailand. Am J Perinatol 2024; 41:e1631-e1638. [PMID: 37068513 DOI: 10.1055/s-0043-1768234] [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: 04/19/2023]
Abstract
OBJECTIVE The study aimed to explore the prevalence of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency among male newborn infants in northeastern Thailand and its relationship with neonatal jaundice (NJ). STUDY DESIGN This prospective cohort study included male newborn infants with gestational age (GA) ≥35 weeks born between July 1, 2019, and March 1, 2021. Cord blood was sent for G-6-PD fluorescent spot test (FST) and results were reported as normal, partial, or complete deficiency. Infants with NJ would have blood tested for total serum bilirubin (TSB) level and other possible causes of NJ. Duration of phototherapy, length of hospital stays, and complications were documented. RESULTS There were 922 male infants included in this study with 854 (93.1%) term and 63 (6.9%) preterm infants. FST showed 132 infants (14.4%) had G-6-PD deficiency. Incidence of NJ was significantly higher among infants with G-6-PD deficiency compared with infants with normal G-6-PD level (47.7 vs. 25.8%; relative risk [RR]: 2.62, 95% confidence interval [CI]: 1.79-3.82; p < 0.001). Regardless of G-6-PD level, preterm infants had significantly higher incidence of NJ than term infants (52.4 vs. 27.3%; RR: 2.93, 95% CI: 1.75-4.92; p < 0.001). Duration of phototherapy was significantly longer in infants with G-6-PD deficiency with NJ but hospital stays were similar. Infants with combined G-6-PD deficiency and other causes of hemolysis did not have higher TSB level than infants with isolated G-6-PD deficiency. Risk factors associated with NJ were G-6-PD deficiency and preterm infants, whereas more advance GA was associated with reduced risk for NJ. CONCLUSION G-6-PD deficiency and preterm infants were important risk factors for NJ. Routine G-6-PD screening, close monitoring for signs of NJ in infant with risks, and appropriate parental counseling should be implemented. KEY POINTS · G-6-PD deficiency increases risk of neonatal jaundice.. · Preterm infants have higher risk for neonatal jaundice.. · G-6-PD deficiency does not link with severe jaundice..
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Affiliation(s)
| | - Pakaphan Kiatchoosakun
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Junya Jirapradittha
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Mukrawee Chopchoen
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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García Vázquez J, González Vilaplana P, Portolés Morales M, Escrig Fernández R. Modification of the management of neonatal hyperbilirubinemia: changes towards improving the quality of care. An Pediatr (Barc) 2024; 100:378-379. [PMID: 38677886 DOI: 10.1016/j.anpede.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/24/2024] [Indexed: 04/29/2024] Open
Affiliation(s)
- Jesús García Vázquez
- Servicio de Pediatría, Hospital Universitario y Politécnico la Fe, Valenia, Spain
| | | | | | - Raquel Escrig Fernández
- Sección de Maternidad, Servicio de Neonatología, Hospital Univesitario y Politécnico la Fe, Valencia, Spain
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Tang TH, Guo CY, Li XY, Hu YX, Liu WK, Yu MX. Effect of Anti-D titers in RhD-negative pregnant women on fetuses and newborns: A retrospective study. Pediatr Neonatol 2024; 65:288-292. [PMID: 37957047 DOI: 10.1016/j.pedneo.2023.03.015] [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: 01/25/2022] [Revised: 08/27/2022] [Accepted: 03/28/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Transplacental-derived anti-D IgG in RhD-negative pregnant women can trigger an immune response to Rh D-positive red cells in fetuses and newborns. We assessed the effect of anti-D titers in RhD-negative pregnant women on fetuses and newborns. METHODS The clinical data of 142 singleton RhD-sensitized pregnancies were retrospectively collected. The pregnant women received routine prenatal care and the newborns had standard care. Based on the tertile categories of the pregnancies, the maximum titers of anti-D IgG in the pregnant women were divided into three groups ranging from low to high as follows: low-titer group (anti-D titer: 1:4-1:128, n = 57); medium-titer group (anti-D titer: 1:256-1:512, n = 50); and high-titer group (anti-D titer: 1:1024-1:4096, n = 35). RESULTS The frequencies of major neonatal complications did not significantly differ among the three groups. The high-titer group had the highest frequency of pregnancies requiring intrauterine transfusion (IUT) and number of IUTs among the three groups. The high-titer group had a significantly higher frequency of newborns treated with top-up transfusion, number of top-up transfusions, frequency of newborns treated with exchange transfusion (ET), and number of ETs when compared to the low-titer group. CONCLUSION Higher anti-D titers in RhD-negative pregnant women predict more severe fetal and neonatal hemolytic anemia. Increasing maternal anti-D titers results in an increased need for IUTs, and neonatal top-up transfusions and ETs. Methods for reducing titers of anti-D IgG in RhD-sensitized pregnant women warrants further investigation.
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Affiliation(s)
- Tong-Hui Tang
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Chu-Yi Guo
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Xiao-Yu Li
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Yi-Xin Hu
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Wang-Kai Liu
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China.
| | - Mu-Xue Yu
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China.
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Morimoto D, Washio Y, Fukuda K, Sato T, Okamura T, Watanabe H, Yoshimoto J, Tanioka M, Tsukahara H. Machine Learning to Improve Accuracy of Transcutaneous Bilirubinometry. Neonatology 2024:1-8. [PMID: 38684146 DOI: 10.1159/000535970] [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: 06/20/2023] [Accepted: 12/15/2023] [Indexed: 05/02/2024]
Abstract
INTRODUCTION This study aimed to develop models for predicting total serum bilirubin by correcting errors of transcutaneous bilirubin using machine learning based on neonatal biomarkers that could affect spectrophotometric measurements of tissue bilirubin. METHODS This retrospective study included infants born at our hospital (≥36 weeks old, ≥2,000 g) between January 2020 and December 2022. Infants without a phototherapy history were included. Robust linear regression, gradient boosting tree, and neural networks were used for machine learning models. A neural network, inspired by the structure of the human brain, was designed comprising three layers: input, intermediate, and output. RESULTS Totally, 683 infants were included. The mean (minimum-maximum) gestational age, birth weight, participant age, total serum bilirubin, and transcutaneous bilirubin were 39.0 (36.0-42.0) weeks, 3,004 (2,004-4,484) g, 2.8 (1-6) days of age, 8.50 (2.67-18.12) mg/dL, and 7.8 (1.1-18.1) mg/dL, respectively. The neural network model had a root mean square error of 1.03 mg/dL and a mean absolute error of 0.80 mg/dL in cross-validation data. These values were 0.37 mg/dL and 0.28 mg/dL, smaller compared to transcutaneous bilirubin, respectively. The 95% limit of agreement between the neural network estimation and total serum bilirubin was -2.01 to 2.01 mg/dL. Unnecessary blood draws could be reduced by up to 78%. CONCLUSION Using machine learning with transcutaneous bilirubin, total serum bilirubin estimation error was reduced by 25%. This integration could increase accuracy, lessen infant discomfort, and simplify procedures, offering a smart alternative to blood draws by accurately estimating phototherapy thresholds.
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Affiliation(s)
- Daisaku Morimoto
- Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan,
| | - Yosuke Washio
- Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kana Fukuda
- Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takeshi Sato
- Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tomoka Okamura
- Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hirokazu Watanabe
- Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Junko Yoshimoto
- Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Maki Tanioka
- Clinical AI Human Resources Development Program, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hirokazu Tsukahara
- Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Chou HH, Huang LC, Shen SP, Tsai ML, Chang YC, Lin HC. Neonatal jaundice is associated with increased risks of congenital anomalies of the kidney and urinary tract and concomitant urinary tract infection. Sci Rep 2024; 14:9520. [PMID: 38664452 PMCID: PMC11045864 DOI: 10.1038/s41598-024-59943-2] [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: 10/07/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The link between neonatal jaundice and urinary tract infection (UTI) remains debated, with congenital kidney and urinary tract anomalies (CAKUT) potentially playing a role. This population-based study aimed to analyze the correlations between neonatal jaundice, CAKUT, and concomitant UTI. The study cohort consisted of 2,078,122 live births from 2004 to 2014. We linked several population-based datasets in Taiwan to identify infants with unexplained neonatal jaundice and their mothers. The primary outcome was the rate of CAKUT occurring within 3 years after delivery, and the presence of concomitant UTI during neonatal jaundice hospitalization. Infants with neonatal jaundice had a significantly higher risk of CAKUT (adjusted odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.11-1.39) during early childhood. Among the subtypes of CAKUT, obstructive uropathy, vesicoureteral reflux and other CAKUT were associated with an increased risk of neonatal jaundice. Infants who underwent intensive phototherapy, had a late diagnosis (> 14 days of postnatal age) or underwent a prolonged duration of phototherapy (> 3 days) exhibited a higher risk of concomitant UTI compared to other infants with jaundice. Our findings indicate a notable association between neonatal jaundice and increased risks of UTIs in the context of CAKUT. This study underscore the importance of vigilant monitoring and timely interventions for neonates presenting with jaundice, while acknowledging the complexity and variability in the progression of CAKUT and its potential connection to UTIs.
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Affiliation(s)
- Hsin-Hsu Chou
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Lin-Chih Huang
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Shang-Po Shen
- Division of Neonatology, China Medical University Children's Hospital, China Medical University, No. 2 Yuh Der Road, Taichung, 404, Taiwan
| | - Ming-Luen Tsai
- Division of Neonatology, China Medical University Children's Hospital, China Medical University, No. 2 Yuh Der Road, Taichung, 404, Taiwan
| | - Yu-Chia Chang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, No. 500, Lioufeng Road., Wufeng, Taichung, 41354, Taiwan.
- Department of Long-Term Care, College of Health and Nursing, National Quemoy University, Kinmen County, Taiwan.
| | - Hung-Chi Lin
- Division of Neonatology, China Medical University Children's Hospital, China Medical University, No. 2 Yuh Der Road, Taichung, 404, Taiwan.
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
- Asia University Hospital, Asia University, Taichung, Taiwan.
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Sarathy L, Chou JH, Romano-Clarke G, Darci KA, Lerou PH. Bilirubin Measurement and Phototherapy Use After the AAP 2022 Newborn Hyperbilirubinemia Guideline. Pediatrics 2024; 153:e2023063323. [PMID: 38482582 DOI: 10.1542/peds.2023-063323] [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] [Accepted: 12/20/2023] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Guidelines for the management of neonatal hyperbilirubinemia have helped to reduce rates of significant hyperbilirubinemia. However, recent evidence suggesting overtreatment and potential harms of phototherapy have informed the American Academy of Pediatrics clinical practice guideline revision and the accompanying increase in phototherapy thresholds. These changes are predicted to safely reduce overuse; however, to date, the exact effect of these guidelines has not been established. METHODS We conducted a retrospective study of newborns born at ≥35 weeks' gestation across a network of 8 hospitals between January 2022 and June 2023. Outcomes included rates of phototherapy and total serum bilirubin (TSB) measurements before and after guideline publication, as well as clinical outcomes, including length of stay, readmissions, and duration of phototherapy. RESULTS In our cohort of >22 000 newborns, we observed a 47% decrease in phototherapy utilization, from 3.9% to 2.1% (P < .001). TSB measurements were reduced by 23%, from 712 to 551 measurements per 1000 newborns (P < .001), without an increase in outpatient TSB measurements. We did not observe an increase in readmissions receiving phototherapy, and length of stay increased by only 1 hour (P < .001). CONCLUSIONS Our study reveals that the publication of the updated American Academy of Pediatrics 2022 hyperbilirubinemia guidelines has likely yielded a significant reduction in phototherapy use and serum bilirubin measurement. Dedicated quality improvement initiatives may help determine which implementation strategies are most effective. Further population-level studies are needed to confirm safety with ongoing guideline uptake.
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Affiliation(s)
- Leela Sarathy
- Mass General for Children, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Joseph H Chou
- Mass General for Children, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Giuseppina Romano-Clarke
- Mass General for Children, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Katherine A Darci
- Mass General for Children, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Paul H Lerou
- Mass General for Children, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
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Bhutani VK, Vidavalur R, Wong RJ. Advances to diminish global newborn kernicterus mortality. J Perinatol 2024; 44:493-500. [PMID: 38151598 DOI: 10.1038/s41372-023-01862-7] [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: 09/22/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE Initiatives, "Every Newborn Action Plans" and "Sustainable Developmental Goals," are profoundly shaping global infant mortality trends. Concurrently, professional organizations recommended curricula to prevent extreme hyperbilirubinemia (EHB) sequelae. Therefore we assessed if these efforts have successfully decreased EHB-related mortality over time. STUDY DESIGN We used the Global Burden of Diseases 2019 database to determine neonatal and infant mortality and the burden of kernicterus from 1990-2019. RESULTS Globally, kernicterus accounted for 2.8 million infant deaths and trended downwards significantly from 1990 to 2019. By 2019, kernicterus-related mortality was 4 and 293 per million livebirths in high (HICs) and low income countries (LICs), respectively. 82% of deaths occurred in LICs and lower-middle income-countries. Average declines of mortality rates were 6.2% and 3.0% for HICs and LICs, respectively. CONCLUSIONS Kernicterus-related mortality has been effectively reduced to <5 per million in HICs. Skills and knowledge transfer can potentially transform frontline services to bridge discordant kernicteric outcomes worldwide.
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Affiliation(s)
- Vinod K Bhutani
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Ramesh Vidavalur
- Department of Neonatology, Cayuga Medical Center of Ithaca, Ithaca, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Ronald J Wong
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Vallamkonda N, Bandyopadhyay T, Maria A. A Study of General Movement Assessment and Its Association With Neurodevelopmental Outcome at Age 12 to 15 Months Among Term Neonates With Hyperbilirubinemia. Pediatr Neurol 2024; 153:77-83. [PMID: 38341950 DOI: 10.1016/j.pediatrneurol.2023.12.030] [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: 02/11/2023] [Revised: 09/12/2023] [Accepted: 12/31/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND To determine the association between optimality score at term age and age three to five months and neurodevelopmental outcome among neonates with hyperbilirubinemia. METHODS Fifty infants with and without hyperbilirubinemia were enrolled. The motor repertoires of the infants were evaluated through general movement assessment (GMA) at term age and three to five months post-term. The association between the General Movement Optimality Score (GMOS), Motor Optimality Score (MOS), and Development Assessment Scale for Indian Infants (DASII) at age 12 to 15 months was also assessed. RESULTS During term age, the median GMOS was significantly lower among infants in the study group when compared with the control group (40 [29 to 42] vs 42 [42 to 42], P < 0.001). However, at age three to five months, there was no significant difference between the groups. Significantly higher number of neonates had abnormal motor repertoire at term age and age three to five months in the study group when compared with the control group (18 [36%] vs 2 [4%], P = 0.001, at term age and 6 [12.2%] vs 1 [2%], P =0.04, at age three to five months). Among neonates with hyperbilirubinemia, the median GMOS and MOS were significantly lower at term age and age three to five months in infants with motor and mental developmental quotient scores <85 when compared with ≥85. CONCLUSIONS GMA including GMOS and MOS performed in neonates with hyperbilirubinemia during the neonatal period and early infancy is associated with neurodevelopmental outcomes in the first year of life. GMA can help initiate early intervention in such neonates.
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Affiliation(s)
- Nagaratna Vallamkonda
- Early Interventionist, Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, New Delhi, India
| | - Tapas Bandyopadhyay
- Associate Professor, Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, New Delhi, India
| | - Arti Maria
- Professor, Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, New Delhi, India.
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Li R, Li T, Yan X, Feng J, Yu Z, Chen C. Efficacy of home phototherapy versus inpatient phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis. Ital J Pediatr 2024; 50:37. [PMID: 38433210 PMCID: PMC10910825 DOI: 10.1186/s13052-024-01613-0] [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: 09/28/2023] [Accepted: 02/24/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Home phototherapy (HPT) remains a contentious alternative to inpatient phototherapy (IPT) for neonatal hyperbilirubinemia. To guide evidence-based clinical decision-making, we conducted a meta-analysis of randomized clinical trials (RCTs) and cohort studies and assessed the comparative risks and benefits of HPT and IPT. METHODS PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure Database, Wanfang Database, Chinese Science and Technique Journals Database, ClinicalTrials.gov, and International Clinical Trial Registry Platform trial were searched from inception until June 2, 2023. We included RCTs and cohort studies and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Study quality was assessed with the Cochrane Collaboration Risk of Bias tool and the Newcastle-Ottawa scale. The outcome measures were phototherapy duration, daily bilirubin level reduction, exchange transfusion, hospital readmission, parental stress scale, and complications. We used fixed- or random-effects meta-analysis models, assessed heterogeneity (I2), conducted subgroup analyses, evaluated publication bias, and graded evidence quality. RESULTS Nine studies (998 patients) were included (four RCTs, five cohort studies). HPT was associated with longer phototherapy duration (SMD = 0.55, 95% CI: 0.06-1.04, P = 0.03). Cohort study subgroup analysis yielded consistent results (SMD = 0.90; 95% CI: 0.69 to 1.11, P < 0.001, I2 = 39%); the RCTs were not significantly different (SMD = -0.04; 95% CI: -0.15 to 0.08, P = 0.54, I2 = 0%). Hospital readmission was higher with HPT (RR = 4.61; 95% CI: 1.43-14.86, P = 0.01). Daily bilirubin reduction (WMD = -0.12, 95% CI: -0.68 to 0.44, P = 0.68) or complications were not significantly different (RR = 2.29; 95% CI: 0.31-16.60, P = 0.41). The evidence quality was very low. HPT was associated with lower parental stress (SMD = -0.44, 95% CI: -0.71 to -0.16, P = 0.002). None of three included studies reported exchange transfusion. CONCLUSIONS The current evidence does not strongly support HPT efficacy for neonatal hyperbilirubinemia, as high-quality data on long-term outcomes are scarce. Future research should prioritize well-designed, large-scale, high-quality RCTs to comprehensively assess HPT risks and benefits.
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Affiliation(s)
- Rui Li
- Division of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Tingting Li
- Division of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Xudong Yan
- Department of Pediatrics Division of Neonatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Jing Feng
- Division of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Zhangbin Yu
- Department of Pediatrics Division of Neonatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
| | - Cheng Chen
- Division of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China.
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Elmazzahy EA, El Din ZE, Nessem MA, El Tatawy S. Neurodevelopmental outcome at 6 months of age of full-term neonates with hyperbilirubinemia necessitating exchange transfusion. Early Hum Dev 2024; 190:105969. [PMID: 38341995 DOI: 10.1016/j.earlhumdev.2024.105969] [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: 11/08/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Bilirubin neurotoxicity involves a spectrum of varying severity that could result in adverse long-term sequelae. AIMS To compare the neurodevelopmental outcome of full-term neonates who underwent exchange transfusion with those who did not. STUDY DESIGN A retrospective cohort study. SUBJECTS This study included a retrospective review of records of sixty neonates who were matched in admission ages and serum bilirubin levels and the comparison groups were those who received an exchange transfusion (n = 30) versus those where exchange transfusion was planned, but the bilirubin levels dropped sufficiently during the period where the exchange blood was being prepared (n = 30). History, clinical examination, and laboratory investigations were documented. OUTCOME MEASURES Neurodevelopmental outcome, at 6 months of age, using Bayley scales of infant development was assessed. RESULTS The exchange group had statistically significant lower cognitive scores (p-value 0.005). The higher the rate of bilirubin decline, the better the language and motor scores in the phototherapy group (p-values 0.020 and 0.024 respectively). Infants with longer duration to exchange transfusion had lower cognitive, language, and motor scores (p-values 0.01, 0.001, and 0.003 respectively). CONCLUSIONS Slower rates of bilirubin decline and longer duration before intervention increase the chances of adverse neurodevelopmental outcomes.
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Affiliation(s)
| | - Zahraa Ezz El Din
- Department of Pediatrics, Cairo University Children's Hospital, Cairo, Egypt
| | - Marina Atef Nessem
- Department of Pediatrics, Cairo University Children's Hospital, Cairo, Egypt
| | - Sarah El Tatawy
- Department of Pediatrics, Cairo University Children's Hospital, Cairo, Egypt
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Ercin S, Coskun Y, Kayas K, Kavas N, Gursoy T. Positive Direct Antiglobulin Test: Is It a Risk Factor for Significant Hyperbilirubinemia in Neonates with ABO Incompatibility? Am J Perinatol 2024; 41:505-510. [PMID: 34847590 DOI: 10.1055/a-1709-5036] [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: 10/19/2022]
Abstract
OBJECTIVE ABO blood group (ABO) incompatibility is a common cause of neonatal indirect hyperbilirubinemia. The direct antiglobulin test (DAT) can identify infants developing hemolytic disease. This study aims to evaluate the significance of DAT positivity among neonates with ABO incompatibility. STUDY DESIGN This retrospective study included 820 neonates with blood group A or B who were born to blood group O mothers. The study group consisted of neonates (n = 79) who had positive DAT, and the control group consisted of infants (n = 741) who had negative DAT. Demographic and clinical data of the neonates regarding jaundice were collected and compared statistically. RESULTS The bilirubin level at 24 hours of life (study group: 8 ± 2.6 mg/dL, control group: 6 ± 2.2 mg/dL, p < 0.001) and the highest bilirubin level (study group: 12.7 ± 3.6 mg/dL, control group: 10.4 ± 4.2 mg/dL, p < 0.001) were higher in infants with positive DAT. A total of 37 (46.8%) infants in the study group and 83 (11.2%) infants in the control group received phototherapy (PT) in the nursery (p < 0.001). In neonates with positive DAT, direct bilirubin level, duration of hospitalization, and PT in the nursery were higher (p = 0.002, <0.001, and <0.001, respectively), whereas hemoglobin level was lower (p < 0.001). CONCLUSION In neonates with ABO incompatibility, a positive DAT is a risk factor for developing significant hyperbilirubinemia. Close follow-up of newborn infants with ABO incompatibility is crucial for early detection and treatment of neonatal jaundice to avoid early and late complications. KEY POINTS · The clinical spectrum of ABO incompatibility varies widely.. · The ABO incompatibility with positive DAT are at greater risk for high bilirubin levels.. · Infants with blood group incompatibilities must be monitored closely..
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Affiliation(s)
- Secil Ercin
- Division of Neonatology, Department of Pediatrics, Koc University Hospital, Istanbul, Turkey
| | - Yesim Coskun
- Department of Pediatrics, Koc University Hospital, Istanbul, Turkey
| | - Kalender Kayas
- Department of Pediatrics, Koc University Hospital, Istanbul, Turkey
| | - Nazan Kavas
- Division of Neonatology, Department of Pediatrics, Koc University Hospital, Istanbul, Turkey
| | - Tugba Gursoy
- Division of Neonatology, Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
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Amin SB, Saluja S, Kler N. Unbound Bilirubin and Acute Bilirubin Encephalopathy in Infants Born Late Preterm and Term with Significant Hyperbilirubinemia. J Pediatr 2024; 266:113880. [PMID: 38135027 DOI: 10.1016/j.jpeds.2023.113880] [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: 07/31/2023] [Revised: 11/30/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To compare the association of unbound bilirubin (UB), total serum bilirubin (TSB), and bilirubin:albumin molar ratio (BAMR) with acute bilirubin encephalopathy (ABE), as assessed by bilirubin-induced neurologic dysfunction (BIND) score, in infants with significant hyperbilirubinemia (TSB ≥20 mg/dL or underwent exchange transfusion). STUDY DESIGN In this prospective cohort study, infants ≥34 weeks of gestational age with significant hyperbilirubinemia during the first 2 postnatal weeks were eligible, unless they had craniofacial malformations, chromosomal disorders, TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus and herpes simplex) infections, surgery, or a family history of congenital deafness. TSB, serum albumin, and UB were measured at hospital admission using the colorimetric, bromocresol green, and modified peroxidase method, respectively. Infants were evaluated on admission for ABE using a standardized neurologic examination and assigned a BIND score by trained physicians. Infants with a total BIND score of 0 were deemed to not have ABE, whereas those with a score ≥1 were deemed to have ABE. RESULTS A total of 151 infants were studied, among whom 37 (24.5%) had ABE. Of these, 19 had mild ABE (BIND score 1-3) and 18 had moderate-to-severe ABE (BIND score 4-9). On logistic regression, UB, but not TSB or BAMR, was associated with ABE (aOR 1.64; 95% CI 1.17-2.3). On ordered logistic regression, UB, but not TSB or BAMR, was associated with severity of ABE (aOR 1.76; 95% CI 1.28-2.4). CONCLUSIONS Our findings of the association between UB and ABE indicate that BIND scoring may be useful for evaluation of ABE in infants ≥34 weeks of gestational age.
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Affiliation(s)
- Sanjiv B Amin
- Department of Pediatrics, Central Michigan University, Mount Pleasant, MI; Department of Pediatrics, Sir Ganga Ram Hospital, Delhi, India.
| | - Satish Saluja
- Department of Pediatrics, Sir Ganga Ram Hospital, Delhi, India
| | - Neelam Kler
- Department of Pediatrics, Sir Ganga Ram Hospital, Delhi, India
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Ouerradi N, Ayyad A, Messaoudi S, Amrani R. Forgoing Exchange Transfusion in Neonatal Hyperbilirubinemia: A Single-Center Retrospective Cohort Study. Cureus 2024; 16:e56749. [PMID: 38650795 PMCID: PMC11033529 DOI: 10.7759/cureus.56749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Unconjugated hyperbilirubinemia is part of the everyday life of the neonatal period as it reflects the adaptation of the metabolism of bilirubin. The neonatal hyperbilirubinemia usually resolves spontaneously, but it can also be the cause of an acute or chronic encephalopathy known as kernicterus. Regardless of the cause, the goal of therapy is to prevent this neurotoxicity while not causing undue harm. Phototherapy and, if it is unsuccessful, exchange transfusion (ECT) remain the primary treatment modalities used to keep the maximal total serum bilirubin (TSB) below pathologic levels. MATERIALS AND METHODS This is a descriptive retrospective cohort study of 69 live neonates hospitalized in the Department of Neonatology and Neonatal Resuscitation of Mohammed VI University Hospital with unconjugated hyperbilirubinemia requiring ECT and treated with intensive phototherapy instead, spanning five years from March 2016 to March 2021. We aim to demonstrate the effectiveness of phototherapy in achieving prolonged reduction of bilirubin levels and the prevention of neurological complications and to compare our results with those in the literature. RESULTS The use of intensive phototherapy in the treatment of neonatal unconjugated hyperbilirubinemia is very effective in lowering total serum bilirubin when its level is in the range of exchange transfusion, and it has succeeded in preventing the neurological complications of severe hyperbilirubinemia. CONCLUSION Through this study, it can be seen that phototherapy is an efficacious, simpler, and less hazardous alternative to exchange transfusion in achieving a sustained reduction of bilirubin levels and preventing neurological complications.
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Affiliation(s)
- Nourelhouda Ouerradi
- Neonatology and Neonatal Resuscitation, Mohammed First University Faculty of Medicine, Oujda, MAR
| | - Anass Ayyad
- Neonatology and Neonatal Resuscitation, Mohammed First University Faculty of Medicine, Oujda, MAR
| | - Sahar Messaoudi
- Neonatology and Neonatal Resuscitation, Mohammed First University Faculty of Medicine, Oujda, MAR
| | - Rim Amrani
- Neonatology and Neonatal Resuscitation, Mohammed First University Faculty of Medicine, Oujda, MAR
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Drozdowska-Szymczak A, Proczka J, Mazanowska N, Ludwin A, Krajewski P. Severe Cholestasis in Neonates with Hemolytic Disease of the Fetus and Newborn-A Case Report. J Clin Med 2024; 13:1272. [PMID: 38592131 PMCID: PMC10932254 DOI: 10.3390/jcm13051272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Hemolytic disease of the fetus and newborn (HDFN) may cause severe cholestasis with direct bilirubin concentrations reaching up to 50 times the upper limit of normal. This case report describes twins whose highest direct bilirubin concentrations were 32.2 mg/dL and 50.2 mg/dL, with no significant signs of hepatic impairment. The index pregnancy was complicated by Rhesus factor immunization with anti-D antibodies present in maternal serum, which caused fetal anemia requiring intrauterine blood transfusions. Complementary tests demonstrated Rhesus D alloimmunization as the sole cause of cholestasis. To the best of our knowledge, this is the first study to describe such elevated direct bilirubin concentrations caused by HDFN.
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Affiliation(s)
- Agnieszka Drozdowska-Szymczak
- Department of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Julia Proczka
- Department of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Natalia Mazanowska
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Artur Ludwin
- Department of Obstetrics and Gynecology, Medical University of Warsaw, Pl. Starynkiewicza 1/3, 02-015 Warsaw, Poland
| | - Paweł Krajewski
- Department of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
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Dam-Vervloet AJ, Morsink CF, Krommendijk ME, Nijholt IM, van Straaten HLM, Poot L, Bosschaart N. Skin color influences transcutaneous bilirubin measurements: a systematic in vitro evaluation. Pediatr Res 2024:10.1038/s41390-024-03081-y. [PMID: 38368497 DOI: 10.1038/s41390-024-03081-y] [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: 10/03/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Concerns have been raised about the effect of skin color on the accuracy of transcutaneous bilirubin (TcB) measurements, a widely used method for hyperbilirubinemia diagnosis in newborns. Literature is inconclusive, with both reported under- and overestimations of the TcB with increasing skin pigmentation. Therefore, the influence of skin color on TcB measurements was systematically evaluated in a controlled, in vitro setting. METHODS A bilirubin meter (JM-105) was evaluated on layered phantoms that mimic neonatal skin with varying dermal bilirubin concentrations (0-250 µmol/L) and varying epidermal melanosome volume fractions (0-40%; light-dark skin color). RESULTS TcB measurements were influenced by skin pigmentation. Larger mimicked melanosome volume fractions and higher bilirubin levels led to larger underestimations of the measured TcB, compared to an unpigmented epidermis. In the in vitro setting of this study, these underestimations amounted to 26-132 µmol/L at a TcB level of 250 µmol/L. CONCLUSION This in vitro study provides insight into the effect of skin color on TcB measurements: the TcB is underestimated as skin pigmentation increases and this effect becomes more pronounced at higher bilirubin levels. Our results highlight the need for improved TcB meter design and cautious interpretation of TcB readings on newborns with dark skin. IMPACT Key message: Skin color influences transcutaneous bilirubin measurements: the darker the skin, the larger the underestimation. What this study adds to existing literature: Existing literature is inconclusive regarding the influence of skin color on transcutaneous bilirubin measurements. This study systematically evaluates and clarifies the influence of skin color on transcutaneous bilirubin measurements in a controlled, in vitro setting. IMPACT This study aids to better interpret the measured TcB level in patients with varying skin colors, and is particularly important when using TcB meters on patients with dark skin colors.
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Affiliation(s)
- Alida J Dam-Vervloet
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
- Medical Physics Department, Isala hospital, Zwolle, The Netherlands.
| | - Claudia F Morsink
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Marleen E Krommendijk
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Ingrid M Nijholt
- Innovation & Science Department, Isala hospital, Zwolle, The Netherlands
- Radiology Department, Isala hospital, Zwolle, The Netherlands
| | | | - Lieke Poot
- Medical Physics Department, Isala hospital, Zwolle, The Netherlands
| | - Nienke Bosschaart
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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50
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Jahan F, Parvez SM, Rahman M, Billah SM, Yeasmin F, Jahir T, Hasan R, Darmstadt GL, Arifeen SE, Hoque MM, Shahidullah M, Islam MS, Ashrafee S, Foote EM. Acceptability and operational feasibility of community health worker-led home phototherapy treatment for neonatal hyperbilirubinemia in rural Bangladesh. BMC Pediatr 2024; 24:123. [PMID: 38360716 PMCID: PMC10868082 DOI: 10.1186/s12887-024-04584-7] [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: 08/02/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
There is an unmet need for phototherapy treatment in low- and middle-income countries (LMICs) to prevent disability and death of newborns with neonatal hyperbilirubinemia. Home phototherapy deployed by community health workers (CHWs) in LMICs may help increase access to essential newborn postnatal care in a more acceptable way for families and lead to an increase in indicated treatment rates for newborns with hyperbilirubinemia. We aimed to investigate the operational feasibility and acceptability of a CHW-led home phototherapy intervention in a rural sub-district of Bangladesh for families and CHWs where home delivery was common and a treatment facility for neonatal hyperbilirubinemia was often more than two hours from households. We enrolled 23 newborns who were ≥ 2 kg in weight and ≥ 35 weeks gestational age, without clinical danger signs, and met the American Academy of Pediatric treatment criteria for phototherapy for hyperbilirubinemia. We employed a mixed-method investigation to evaluate the feasibility and acceptability of home phototherapy through surveys, in-depth interviews and focus group discussions with CHWs, mothers, and grandparents. Mothers and family members found home phototherapy worked well, saved them money, and was convenient and easy to operate. CHWs found it feasible to deploy home phototherapy and identified hands-on training, mHealth job aids, a manageable workload, and prenatal education as facilitating factors for implementation. Feasibility and acceptability concerns were limited amongst parents and included: a lack of confidence in CHWs' skills, fear of putting newborn infants in a phototherapy device, and unreliable home power supply. CHW-led home phototherapy was acceptable to families and CHWs in rural Bangladesh. Further investigation should be done to determine the impact of home phototherapy on treatment rates and on preventing morbidity associated with neonatal hyperbilirubinemia. Clinical Trial (CT) registration ID: NCT03933423, full protocol can be accessed at https://doi.org/10.1186/s13102-024-00824-6 . Name of the trial registry: clinicaltrials.gov. Clinical Trial (CT) registration Date: 01/05/2019.
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Affiliation(s)
- Farjana Jahan
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh.
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Sarker Masud Parvez
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Mahbubur Rahman
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
| | - Farzana Yeasmin
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Tania Jahir
- College of Medicine, Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Rezaul Hasan
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Gary L Darmstadt
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Mahbubul Hoque
- Department of Neonatology, Bangladesh, Children Hospital & Institute, Dhaka, Bangladesh
| | | | - Muhammad Shariful Islam
- National Newborn Health Program (NNHP) and Integrated Management of Childhood Illness (IMCI), Directorate General of Health Services, Dhaka, Bangladesh
| | - Sabina Ashrafee
- National Newborn Health Program (NNHP) and Integrated Management of Childhood Illness (IMCI), Directorate General of Health Services, Dhaka, Bangladesh
| | - Eric M Foote
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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