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Goodstein MH, Stewart DL, Keels EL, Moon RY. Transition to a Safe Home Sleep Environment for the NICU Patient. Pediatrics 2021; 148:peds.2021-052046. [PMID: 34155135 DOI: 10.1542/peds.2021-052046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Of the nearly 3.8 million infants born in the United States in 2018, 8.3% had low birth weight (<2500 g [5.5 lb]) and 10% were born preterm (gestational age of <37 completed weeks). Many of these infants and others with congenital anomalies, perinatally acquired infections, and other disease require admission to a NICU. In the past decade, admission rates to NICUs have been increasing; it is estimated that between 10% and 15% of infants will spend time in a NICU, representing approximately 500 000 neonates annually. Approximately 3600 infants die annually in the United States from sleep-related deaths, including sudden infant death syndrome International Classification of Diseases, 10th Revision (R95), ill-defined deaths (R99), and accidental suffocation and strangulation in bed (W75). Preterm and low birth weight infants are particularly vulnerable, with an incidence of death 2 to 3 times greater than healthy term infants. Thus, it is important for health care professionals to prepare families to maintain their infant in a safe sleep environment, as per the recommendations of the American Academy of Pediatrics. However, infants in the NICU setting commonly require care that is inconsistent with infant sleep safety recommendations. The conflicting needs of the NICU infant with the necessity to provide a safe sleep environment before hospital discharge can create confusion for providers and distress for families. This technical report is intended to assist in the establishment of appropriate NICU protocols to achieve a consistent approach to transitioning NICU infants to a safe sleep environment as soon as medically possible, well before hospital discharge.
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Affiliation(s)
- Michael H Goodstein
- Division of Newborn Services, WellSpan Health, York, Pennsylvania .,Department of Pediatrics, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Dan L Stewart
- Department of Pediatrics, Norton Children's and School of Medicine, University of Louisville, Louisville, Kentucky
| | - Erin L Keels
- National Association of Neonatal Nurse Practitioners, National Association of Neonatal Nurses, Chicago, Illinois.,Neonatal Advanced Practice, Nationwide Children's Hospital, Columbus, Ohio
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52
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Sampurna MTA, Mapindra MP, Mahindra MP, Ratnasari KA, Rani SAD, Handayani KD, Angelika D, Harianto A, Utomo MT, Etika R, Sauer PJJ. Kramer Score, an Evidence of Its Use in Accordance with Indonesian Hyperbilirubinemia Published Guideline. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116173. [PMID: 34200369 PMCID: PMC8200974 DOI: 10.3390/ijerph18116173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/11/2021] [Accepted: 05/27/2021] [Indexed: 01/12/2023]
Abstract
Background: In some hospitals in low/middle-income countries, methods to determine the bilirubin level in newborn infants are unavailable and based on a clinical evaluation, namely a clinical score designed by Kramer. In this study, we evaluated if this score can be used to identify those infants that need phototherapy. Method: Infants admitted between November 2018 and June 2019 to three hospitals in Surabaya, Indonesia were included. The jaundice intensity was scored using the Kramer score. Blood was sampled for total serum bilirubin (TSB) measurement. The infants were categorized into Treatment Needed (TN) group when treatment with phototherapy was indicated and the No Treatment Needed (NTN) group when phototherapy was not indicated, based on the Indonesian Guideline for hyperbilirubinemia. Result: A total of 280 infants with a mean birth weight of 2744.6 ± 685.8 g and a gestational age of 37.3 ± 2.3 weeks were included. Twenty-seven of 113 (24%) infants with Kramer score 2 needed phototherapy, compared with 41 of 90 (46%) infants with score 3 and 20 of 28 (71%) of infants with score 4. The percentage of infants that needed phototherapy was higher with decreasing gestational age. Conclusion: The Kramer score is an invalid method to distinguish between those infants needing phototherapy and those infants where this treatment is not indicated.
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Affiliation(s)
- Mahendra Tri Arif Sampurna
- Neonatology Division, Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia; (K.D.H.); (D.A.); (A.H.); (M.T.U.); (R.E.)
- Neonatology Division, Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia
- Correspondence:
| | - Muhammad Pradhika Mapindra
- Neonatal Research Group Surabaya, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia; (M.P.M.); (M.P.M.); (K.A.R.); (S.A.D.R.)
| | - Muhammad Pradhiki Mahindra
- Neonatal Research Group Surabaya, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia; (M.P.M.); (M.P.M.); (K.A.R.); (S.A.D.R.)
| | - Kinanti Ayu Ratnasari
- Neonatal Research Group Surabaya, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia; (M.P.M.); (M.P.M.); (K.A.R.); (S.A.D.R.)
| | - Siti Annisa Dewi Rani
- Neonatal Research Group Surabaya, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia; (M.P.M.); (M.P.M.); (K.A.R.); (S.A.D.R.)
| | - Kartika Darma Handayani
- Neonatology Division, Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia; (K.D.H.); (D.A.); (A.H.); (M.T.U.); (R.E.)
| | - Dina Angelika
- Neonatology Division, Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia; (K.D.H.); (D.A.); (A.H.); (M.T.U.); (R.E.)
| | - Agus Harianto
- Neonatology Division, Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia; (K.D.H.); (D.A.); (A.H.); (M.T.U.); (R.E.)
| | - Martono Tri Utomo
- Neonatology Division, Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia; (K.D.H.); (D.A.); (A.H.); (M.T.U.); (R.E.)
| | - Risa Etika
- Neonatology Division, Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia; (K.D.H.); (D.A.); (A.H.); (M.T.U.); (R.E.)
| | - Pieter J. J. Sauer
- Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands;
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Savedra RML, Fonseca AMT, Silva MM, Bianchi RF, Siqueira MF. White LED phototherapy as an improved treatment for neonatal jaundice. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2021; 92:064101. [PMID: 34243508 DOI: 10.1063/5.0046430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/15/2021] [Indexed: 06/13/2023]
Abstract
With the aim of improving phototherapy for neonatal jaundice (hyperbilirubinemia), this study investigates the degradation of unconjugated bilirubin under irradiance by conventional light and by white, red, green, and blue LED sources in vitro. The absorption spectra of bilirubin under these different light sources are compared. The results demonstrate that white LED phototherapy promotes more efficient bilirubin degradation than conventional blue-light therapy. This study provides a basis for the design of novel phototherapy devices for the treatment of hyperbilirubinemia.
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Affiliation(s)
- R M L Savedra
- Departamento de Física da Universidade Federal de Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - A M T Fonseca
- Departamento de Física da Universidade Federal de Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - M M Silva
- Departamento de Física da Universidade Federal de Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - R F Bianchi
- Departamento de Física da Universidade Federal de Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - M F Siqueira
- Departamento de Física da Universidade Federal de Ouro Preto, Ouro Preto, MG 35400-000, Brazil
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54
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Lecomte F, Thecua E, Ziane L, Deleporte P, Duhamel A, Vamour C, Mordon S, Rakza T. Phototherapy Using a Light-Emitting Fabric (BUBOLight) Device in the Treatment of Newborn Jaundice: Protocol for an Interventional Feasibility and Safety Study. JMIR Res Protoc 2021; 10:e24808. [PMID: 34032584 PMCID: PMC8188309 DOI: 10.2196/24808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Neonatal jaundice is a common condition occurring in 60%-80% of all healthy-term and late-preterm neonates. In the majority of cases, neonatal jaundice resolves spontaneously and causes no harm; however, in some neonates, significant hyperbilirubinemia can develop and lead to kernicterus jaundice, a serious neurological disease. Phototherapy (PT) is the preferred treatment for jaundice; however, to be effective, PT devices need to have a broad light emission surface to generate no or little heat and to provide an optimal wavelength and light intensity (420-490 nm and ≥30 µW/cm²/nm, respectively). Objective This study aimed to investigate the feasibility, safety, and level of satisfaction of parents and health care teams with the BUBOlight device, an innovative alternative to conventional hospital PT, in which luminous textiles have been incorporated in a sleeping bag. Methods This interventional, exploratory, simple group, nonrandomized, single-center trial will be conducted at Lille Hospital. In total, 10-15 neonates and their parents will be included to obtain evaluable data from 10 parent-neonate pairs. Neonates weighing more than 2500 g at birth and born with ≥37 weeks of amenorrhea that required PT in accordance with the guidelines of the National Institute For Health and Clinical Excellence will receive one 4-hour session of illumination. Total serum bilirubin and transcutaneous bilirubin levels were obtained at the start and 2 hours after the end of PT. Cutaneous and rectal temperatures, heart rate, and oxygen saturation will be measured at the beginning and during PT. The number of subjects is therefore not calculated on the basis of statistical assumptions. We aim to obtain a minimum proportion of 90% (ie, 9 of 10) of the neonates included, who have been able to undergo 4-hour PT without unacceptable and unexpected toxicities. We will calculate the mean, median, quartiles, minimum and maximum values of the quantitative parameters, and the frequency of the qualitative parameters. The rate of patients with no unacceptable and unexpected toxicities (ie, the primary endpoint) will be calculated. Results The first patient is expected to be enrolled at the end of 2020, and clinical investigations are intended for up to June 2021. The final results of this study are expected to be available at the end of 2021. Conclusions Our findings will provide insights into the safety and feasibility of a new PT device based on light-emitting fabrics for the treatment of newborn jaundice. This new system, if proven effective, will improve the humanization of neonatal care and help avoid mother-child separation. Trial Registration ClinicalTrials.gov NCT04365998; https://clinicaltrials.gov/ct2/show/NCT04365998 International Registered Report Identifier (IRRID) PRR1-10.2196/24808
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Affiliation(s)
- Fabienne Lecomte
- U1189 - Assisted Laser Therapy and Immunotherapy for Oncology, Univ- Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Elise Thecua
- U1189 - Assisted Laser Therapy and Immunotherapy for Oncology, Univ- Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Laurine Ziane
- U1189 - Assisted Laser Therapy and Immunotherapy for Oncology, Univ- Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Pascal Deleporte
- U1189 - Assisted Laser Therapy and Immunotherapy for Oncology, Univ- Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Alain Duhamel
- EA 2694 - Santé publique: épidémiologie et qualité des soins, Univ- Lille, CHU Lille, F-59000 Lille, France
| | - Clémence Vamour
- Jeanne de Flandre Hospital, Department of Obstetrics, CHU Lille, F-59000 Lille, France
| | - Serge Mordon
- U1189 - Assisted Laser Therapy and Immunotherapy for Oncology, Univ- Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Thameur Rakza
- EA4489, Perinatal Growth and Health, Jeanne de Flandre Hospital, Department of Obstetrics, Univ- Lille, CHU Lille, F-59000 Lille, France
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55
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Bautista M, Griffin A, Hay K, Frakking TT. Association between type of phototherapy management and hospital and patient-related outcomes in neonates with non-haemolytic jaundice at an Australian community hospital. J Paediatr Child Health 2021; 57:702-709. [PMID: 33369815 DOI: 10.1111/jpc.15317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the associations between type of light-emitting diode phototherapy intervention and hospital and patient related outcomes in term neonates with non-haemolytic jaundice. METHODS A retrospective observational study in a community hospital within a disadvantaged area in Australia was conducted. Data was extracted from hospital systems and medical records regarding the use of three types of phototherapy surface-area exposure for term neonates ≤28 days with non-haemolytic neonatal jaundice. Associations between type of phototherapy management and length of stay (LOS), rate of serum bilirubin (SBR) decline and duration of phototherapy were estimated using the general linear mixed model or linear regression. RESULTS Of 102 neonates diagnosed with non-haemolytic jaundice between 1 June 2016 and 31 August 2017, 82 were included in final analyses. Neonates treated for jaundice during their first (birth) admission had a median LOS of 118 h for single-sided and 125 h for maximal double-sided phototherapy. Differences by phototherapy type were not statistically significant (P = 0.06). SBR rate of decline increased as surface-area of phototherapy increased (P < 0.001) with the fastest decline seen in maximal double-sided phototherapy. Estimated duration of phototherapy did not vary by phototherapy type but did vary by age at initiation of phototherapy (P = 0.006), with 16 fewer hours of phototherapy if commenced at ≥72 to <96 h versus ≥24 to 48 h of age (difference -16.4 h, 95% confidence interval -29.1 to -3.7 h). CONCLUSIONS LOS and phototherapy duration were not associated with phototherapy type. Older neonates with neonatal jaundice required shorter phototherapy duration. Double-sided phototherapy was associated with faster reduction in SBR.
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Affiliation(s)
- Manuel Bautista
- Department of Paediatrics, Caboolture Hospital, Queensland Health, Moreton Bay Region, Queensland, Australia.,Northside Clinical School, School of Medicine, The University of Queensland, Moreton Bay Region, Queensland, Australia
| | - Alison Griffin
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Karen Hay
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Thuy T Frakking
- Research Development Unit, Caboolture Hospital, Queensland Health, Moreton Bay Region, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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56
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Shibazaki T, Motoki N, Misawa Y, Ohira S, Inaba Y, Kanai M, Kurita H, Nakazawa Y, Tsukahara T, Nomiyama T. Association between pesticide usage during pregnancy and neonatal hyperbilirubinemia requiring treatment: the Japan Environment and Children's Study. Pediatr Res 2021; 89:1565-1570. [PMID: 32756550 DOI: 10.1038/s41390-020-1100-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 06/26/2020] [Accepted: 07/17/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Maternal exposure to pesticides during pregnancy may cause oxidative hemolysis leading to neonatal hyperbilirubinemia. This investigation examined for associations between maternal use of pesticides or repellents during pregnancy and neonatal hyperbilirubinemia requiring phototherapy. METHODS We used the dataset from the Japan Environment and Children's Study, a large national birth cohort study registered from January 31, 2011 to March 31, 2014. The fixed data of 61,751 live births were used to evaluate the presence of neonatal hyperbilirubinemia and potential confounding factors. We employed multiple logistic regression analysis to identify correlations between the frequency of maternal pesticide or repellent use during pregnancy and clinically relevant neonatal hyperbilirubinemia. RESULTS After controlling for confounding factors, there were significant associations between neonatal hyperbilirubinemia necessitating phototherapy and the frequent use of indoor insecticide spray (OR 1.21, 95% CI 1.05-1.38). For spray- or lotion-type insect repellents, an opposite relationship was observed (more than a few times a week: OR 0.70, 95% CI 0.61-0.81, up to a few times a month: OR 0.84, 95% CI 0.78-0.91). CONCLUSION The frequent use of indoor insecticide spray during pregnancy showed an increased risk of neonatal hyperbilirubinemia requiring phototherapy, which was absent for spray- or lotion-type insect repellents. IMPACT The frequent use of indoor insecticide spray during pregnancy showed an increased risk of neonatal hyperbilirubinemia requiring phototherapy, which was absent for spray- or lotion-type insect repellents. This is the first study examining the effects of maternal exposure to pesticides or repellents on clinically relevant neonatal hyperbilirubinemia using a dataset from a nationwide birth cohort study. This large-scale Japanese cohort study revealed that the frequent use of indoor insecticide spray during pregnancy may increase the risk of neonatal hyperbilirubinemia requiring treatment.
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Affiliation(s)
- Takumi Shibazaki
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.,Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Noriko Motoki
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yuka Misawa
- Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Satoshi Ohira
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.,Department of Obstetrics and Gynecology, Shinshu University of School of Medicine, Matsumoto, Nagano, Japan
| | - Yuji Inaba
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.,Department of Neurology, Nagano Children's Hospital, Azumino, Nagano, Japan
| | - Makoto Kanai
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroshi Kurita
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yozo Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Teruomi Tsukahara
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.,Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tetsuo Nomiyama
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan. .,Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
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57
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Singh A, Francis HW, Smith PB, Clark RH, Greenberg RG. Association between Hyperbilirubinemia and Hearing Screen Failure in the Neonatal Intensive Care Unit in Infants Born Preterm. J Pediatr 2021; 231:68-73. [PMID: 33359471 DOI: 10.1016/j.jpeds.2020.12.059] [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: 07/16/2020] [Revised: 12/12/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To characterize the association between hyperbilirubinemia and a failed newborn hearing screen in infants born at 22-32 weeks of gestation. STUDY DESIGN We included infants with gestational ages of 22-32 weeks who were discharged from neonatal intensive care units in the US from 2002 to 2017 with available newborn hearing screen results obtained after 34 weeks postmenstrual age. We excluded infants with severe birth asphyxia or craniofacial abnormalities. We identified 95 672 infants from 313 neonatal intensive care units. We used multivariable logistic regression to examine the association between maximum total bilirubin at <21 days postnatal age with failed hearing screen, adjusting for important demographic and clinical risk factors. RESULTS The median gestational age and birth weight were 30 weeks (IQR, 28-32 weeks) and 1330 g (IQR, 1010-1630 g), respectively. The median maximum total bilirubin was 8.3 mg/dL (IQR, 6.7-10.0 mg/dL), and 5275 infants (6%) failed their newborn hearing screen. On adjusted analysis, each 1 mg/dL increase in maximum total bilirubin was associated with a small, but significant, increase in odds of a failed hearing screen (OR, 1.03; 95% CI, 1.02-1.04). CONCLUSIONS An increased maximum total bilirubin level was independently associated with hearing screen failure. Further prospective studies are needed to understand whether this increased risk of hearing screen failure translates to increased risk of hearing loss.
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Affiliation(s)
| | - Howard W Francis
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC
| | - P Brian Smith
- Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Reese H Clark
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC.
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58
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Kaplan M, Maisels MJ. Natural history of early neonatal bilirubinemia: a global perspective. J Perinatol 2021; 41:873-878. [PMID: 33398058 DOI: 10.1038/s41372-020-00901-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/07/2020] [Accepted: 12/01/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVE Due to selection bias and other issues, the only available serum bilirubin-based nomogram does not reflect the natural history of early neonatal bilirubinemia. Our objective was to obtain a global picture of the natural history of early post-natal bilirubin trajectories. STUDY DESIGN We pooled readings from 19 published transcutaneous bilirubin nomogram reports including many newborns at multiple sites. We constructed a universal transcutaneous bilirubin nomogram which included the 25th, 50th, 75th, and 95th percentiles from 12 to 120 h. RESULTS The global transcutaneous bilirubin nomogram included >119,000 readings from 44,392 apparently normal, predominantly breastfed newborns ≥35 weeks gestation. The pooled transcutaneous bilirubin trajectories increased during the first 3 post-natal days, and peaked or plateaued between the 3rd and 4th days. CONCLUSIONS We provide the first globally derived transcutaneous bilirubin nomogram that reflects the natural history of early neonatal bilirubinemia in neonates ≥35 weeks gestation.
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Affiliation(s)
- Michael Kaplan
- Emeritus, Department of Neonatology, Shaare Zedek Medical Center; Faculty of Medicine, The Hebrew University, Jerusalem, Israel.
| | - M Jeffrey Maisels
- Department of Pediatrics, Beaumont Children's, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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Wang HQ, Kong EL, Zhang X, Meng XY, Zhang JM, Yu WF, Wu FX. Folic acid alleviates jaundice of phenylhydrazine (PHA)-induced neonatal rats by reducing Lys-homocysteinylation of albumin. Cell Biol Toxicol 2021; 37:679-693. [PMID: 33788065 DOI: 10.1007/s10565-021-09602-3] [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: 06/05/2020] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Abstract
Neonatal jaundice is a common symptom that occurs in neonates during the first month of their life and is generally divided into physiological and pathological subtypes. In serious cases, pathological neonatal jaundice frequently shows complications including seizures, cerebral palsy, and kernicterus. However, due to the unclear pathogenesis of pathological neonatal jaundice, effective drugs for this disease remain unsatisfied. In the present study, we first estimated the protective effects of folic acid (FA) on phenylhydrazine (PHA) or homocysteine (Hcy)-injected neonatal rats (2-3 days aged). Intriguingly, we found that FA significantly decreased the elevated total bilirubin (TBIL) and direct bilirubin (DBIL) concentration, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) activity in PHA- or Hcy-injected rats, indicating that FA improves liver functions. Meanwhile, our results also showed that the plasma Hcy level and N-homocysteinylation (N-Hcy) modification of albumin were significantly elevated in the jaundice rats, which were obviously reversed after FA administration. Furthermore, we identified a novel N-Hcy modification site K545 of human serum albumin (HSA) using LC-MS/MS, and the mutagenesis assay in HEK293 further validated these observations. Besides, we demonstrated that the N-Hcy modification of albumin functionally inhibits the bilirubin-binding ability of albumin without altering its protein level both in vitro and in vivo. Altogether, we highlight a mechanism that FA reduces the plasma Hcy level and thereby enhance the bilirubin-binding ability of albumin, which may provide a novel therapeutic strategy for the treatment of pathological neonatal jaundice.
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Affiliation(s)
- Hong-Qian Wang
- Department of Critical Care Medicine, Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 200438, China.,Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Er-Liang Kong
- Department of Critical Care Medicine, Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 200438, China.,Department of Anesthesiology, The 988th Hospital of Joint Logistic Support Force of PLA, Zhengzhou, 450042, China
| | - Xia Zhang
- Department of Gastrointestinal Endoscopy, Shandong Provincial Qianfoshan Hospital, The First Affiliated with Shandong First Medical University, Jinan, Shandong, 250014, China
| | - Xiao-Yan Meng
- Department of Critical Care Medicine, Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 200438, China
| | - Jin-Min Zhang
- Department of Critical Care Medicine, Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 200438, China
| | - Wei-Feng Yu
- Department of Critical Care Medicine, Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 200438, China. .,Department of Anesthesiology, Ren Ji Hospital of Shanghai Jiao Tong University, Shanghai, 201204, China.
| | - Fei-Xiang Wu
- Department of Critical Care Medicine, Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 200438, China.
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60
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Itoh Y, Hattori M, Wazawa T, Arai Y, Nagai T. Ratiometric Bioluminescent Indicator for Simple and Rapid Diagnosis of Bilirubin. ACS Sens 2021; 6:889-895. [PMID: 33443410 DOI: 10.1021/acssensors.0c02000] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Bilirubin in human blood is highly important as a general index of one's physical condition because its concentration changes under the influence of several diseases. In particular, in newborns, jaundice is one of the most common diseases involving unconjugated bilirubin (UCBR), causing serious symptoms such as nuclear jaundice and deafness. Therefore, a frequent measurement of the UCBR levels in the blood is important. Here, we report a ratiometric bioluminescent indicator, BABI (bilirubin assessment with a bioluminescent indicator), that changes the emission color from blue to green depending on the UCBR concentration in a sample. Owing to the use of a bioluminescence signal that has a higher signal-to-noise ratio than the absorption and fluorescence signal, BABI enables highly sensitive and quantitative detection of UCBR for small blood samples using a smartphone camera. The establishment of a UCBR measurement assay using BABI provides the possibility of a simple and rapid method for blood-based diagnosis using bioluminescent indicators and a versatile mobile device.
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Affiliation(s)
- Yukino Itoh
- Graduate School of Frontier Biosciences, Osaka University, 2-1 Yamadaoka, Suita 565-0871, Japan
| | - Mitsuru Hattori
- The Institute of Scientific and Industrial Research (SANKEN), Osaka University, 8-1 Mihogaoka, Ibaraki 567-0047, Japan
| | - Tetsuichi Wazawa
- The Institute of Scientific and Industrial Research (SANKEN), Osaka University, 8-1 Mihogaoka, Ibaraki 567-0047, Japan
| | - Yoshiyuki Arai
- The Institute of Scientific and Industrial Research (SANKEN), Osaka University, 8-1 Mihogaoka, Ibaraki 567-0047, Japan
| | - Takeharu Nagai
- Graduate School of Frontier Biosciences, Osaka University, 2-1 Yamadaoka, Suita 565-0871, Japan
- The Institute of Scientific and Industrial Research (SANKEN), Osaka University, 8-1 Mihogaoka, Ibaraki 567-0047, Japan
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Dvořák A, Pospíšilová K, Žížalová K, Capková N, Muchová L, Vecka M, Vrzáčková N, Křížová J, Zelenka J, Vítek L. The Effects of Bilirubin and Lumirubin on Metabolic and Oxidative Stress Markers. Front Pharmacol 2021; 12:567001. [PMID: 33746746 PMCID: PMC7969661 DOI: 10.3389/fphar.2021.567001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 01/05/2021] [Indexed: 12/19/2022] Open
Abstract
For severe unconjugated hyperbilirubinemia the gold standard treatment is phototherapy with blue-green light, producing more polar photo-oxidation products, believed to be non-toxic. The aim of the present study was to compare the effects of bilirubin (BR) and lumirubin (LR), the major BR photo-oxidation product, on metabolic and oxidative stress markers. The biological activities of these pigments were investigated on several human and murine cell lines, with the focus on mitochondrial respiration, substrate metabolism, reactive oxygen species production, and the overall effects on cell viability. Compared to BR, LR was found to be much less toxic, while still maintaining a similar antioxidant capacity in the serum as well as suppressing activity leading to mitochondrial superoxide production. Nevertheless, due to its lower lipophilicity, LR was less efficient in preventing lipoperoxidation. The cytotoxicity of BR was affected by the cellular glycolytic reserve, most compromised in human hepatoblastoma HepG2 cells. The observed effects were correlated with changes in the production of tricarboxylic acid cycle metabolites. Both BR and LR modulated expression of PPARα downstream effectors involved in lipid and glucose metabolism. Proinflammatory effects of BR, evidenced by increased expression of TNFα upon exposure to bacterial lipopolysaccharide, were observed in murine macrophage-like RAW 264.7 cells. Collectively, these data point to the biological effects of BR and its photo-oxidation products, which might have clinical relevance in phototherapy-treated hyperbilirubinemic neonates and adult patients.
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Affiliation(s)
- Aleš Dvořák
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Kateřina Pospíšilová
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Kateřina Žížalová
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Nikola Capková
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Lucie Muchová
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Marek Vecka
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia.,4 Department of Internal Medicine, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Nikola Vrzáčková
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Czechia
| | - Jana Křížová
- Department of Paediatrics and Inherited Metabolic Disorders, 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Jaroslav Zelenka
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Czechia
| | - Libor Vítek
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia.,4 Department of Internal Medicine, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
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62
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Jia R, Teng L, Gao L, Su T, Fu L, Qiu Z, Bi Y. Advances in Multiple Stimuli-Responsive Drug-Delivery Systems for Cancer Therapy. Int J Nanomedicine 2021; 16:1525-1551. [PMID: 33658782 PMCID: PMC7920594 DOI: 10.2147/ijn.s293427] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/27/2021] [Indexed: 12/15/2022] Open
Abstract
Nanomedicines afford unique advantages in therapeutic intervention against tumors. However, conventional nanomedicines have failed to achieve the desired effect against cancers because of the presence of complicated physiological fluids and the tumor microenvironment. Stimuli-responsive drug-delivery systems have emerged as potential tools for advanced treatment of cancers. Versatile nano-carriers co-triggered by multiple stimuli in different levels of organisms (eg, extracorporeal, tumor tissue, cell, subcellular organelles) have aroused widespread interest because they can overcome sequential physiological and pathological barriers to deliver diverse therapeutic “payloads” to the desired targets. Furthermore, multiple stimuli-responsive drug-delivery systems (MSR-DDSs) offer a good platform for co-delivery of agents and reversing multidrug resistance. This review affords a comprehensive overview on the “landscape” of MSR-DDSs against tumors, highlights the design strategies of MSR-DDSs in recent years, discusses the putative advantage of oncotherapy or the obstacles that so far have hindered the clinical translation of MSR-DDSs.
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Affiliation(s)
- Ruixin Jia
- College of Pharmacy, Changchun University of Chinese Medicine, Changchun, Jilin, People's Republic of China
| | - Lesheng Teng
- School of Life Science, Jilin University, Changchun, Jilin, People's Republic of China
| | - Lingyu Gao
- College of Pharmacy, Changchun University of Chinese Medicine, Changchun, Jilin, People's Republic of China
| | - Ting Su
- College of Pharmacy, Changchun University of Chinese Medicine, Changchun, Jilin, People's Republic of China
| | - Lu Fu
- College of Life Science, Jilin Agricultural University, Changchun, Jilin, People's Republic of China
| | - Zhidong Qiu
- College of Pharmacy, Changchun University of Chinese Medicine, Changchun, Jilin, People's Republic of China
| | - Ye Bi
- College of Pharmacy, Changchun University of Chinese Medicine, Changchun, Jilin, People's Republic of China.,Practice Training Center, Changchun University of Chinese Medicine, Changchun, Jilin, People's Republic of China
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63
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Xia M, Sui Y, Guo Y, Zhang Y. Aggregation-induced emission enhancement of gold nanoclusters in metal-organic frameworks for highly sensitive fluorescent detection of bilirubin. Analyst 2021; 146:904-910. [PMID: 33355318 DOI: 10.1039/d0an02076a] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A fluorescence analysis method based on gold nanocluster (AuNC) and metal-organic framework (MOF) composite materials (AuNCs@ZIF-8) was established for highly sensitive detection of bilirubin (BR). First, AuNCs@ZIF-8 was successfully obtained by co-precipitation and displayed an aggregation-induced emission enhancement by the confinement effect of the MOFs (i.e., ZIF-8). The product showed approximately 7.0 times enhancement in the quantum yield and longer fluorescence lifetime from 2.29 μs to 11.51 μs compared with AuNCs. When BR combined with the metal node Zn2+ of ZIF-8, the skeleton of the composite was destroyed, leading to a great decrease in the fluorescence intensity by the transformation of the AuNCs from the aggregated state to dispersed state. The linear range for the detection of BR was 0.1-5.0 μM, with the limit of detection (LOD) of 0.07 μM (S/N = 3). The AuNCs@ZIF-8 exhibited a selective response toward BR within 5 min and detected BR in human serum. The long-wavelength emission by AuNCs avoided the interference of the complex biomatrix background fluorescence, indicating their great application prospects for clinical diagnosis.
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Affiliation(s)
- Mengfan Xia
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China. and Key Laboratory of Analytical Chemistry for Life Science of Shaanxi Province, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China
| | - Yucun Sui
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China. and Key Laboratory of Analytical Chemistry for Life Science of Shaanxi Province, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China
| | - Ying Guo
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China. and Key Laboratory of Analytical Chemistry for Life Science of Shaanxi Province, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China
| | - Yaodong Zhang
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China. and Key Laboratory of Analytical Chemistry for Life Science of Shaanxi Province, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an 710119, China
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Aarts L, Ribbers T, Rassouli-Kirchmeier R, van Berkel M. A Discolored Neonate Causes Interference in Laboratory Test Results. J Appl Lab Med 2021; 6:1051-1056. [PMID: 33517426 DOI: 10.1093/jalm/jfaa240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Lonneke Aarts
- RadboudUMC Children's Department, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tessa Ribbers
- RadboudUMC Children's Department, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Miranda van Berkel
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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65
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Nicolas NJ, Duffy MA, Hansen A, Aizenberg J. Inverse Opal Films for Medical Sensing: Application in Diagnosis of Neonatal Jaundice. Adv Healthc Mater 2021; 10:e2001326. [PMID: 33191607 DOI: 10.1002/adhm.202001326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/24/2020] [Indexed: 12/26/2022]
Abstract
A non-invasive, at-home test for neonatal jaundice can facilitate early jaundice detection in infants, improving clinical outcomes for neonates with severe jaundice and helping to prevent the development of kernicterus, a type of brain damage whose symptoms include hearing loss, impairment of cognitive capacity, and death. Here a photonic sensor that utilizes color changes induced by analyte infiltration into a chemically functionalized inverse opal structure is developed. The sensor is calibrated to detect differences in urinary surface tension due to increased bile salt concentration in urine, which is symptomatic of abnormal liver function and linked to jaundice. The correlation between neonatal urinary surface tension and excess serum bilirubin, the physiologic cause of neonatal jaundice, is explored. It is shown that these non-invasive sensors can improve the preliminary diagnosis of neonatal jaundice, reducing the number of invasive blood tests and hospital visits necessary for healthy infants while ensuring that jaundiced infants are treated in a timely manner. The use of inverse opal sensors to measure bulk property changes in bodily fluids can be extended to the detection of several other conditions, making this technology a versatile platform for convenient point-of-care diagnosis.
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Affiliation(s)
| | | | - Anne Hansen
- Harvard Medical School 25 Shattuck St Boston MA 02115 USA
- Boston Children's Hospital 300 Longwood Ave Boston MA 02115 USA
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Kuniyoshi Y, Tokutake H, Takahashi N, Kamura A, Yasuda S, Tashiro M. Regional variation in the development of neonatal hyperbilirubinemia and relation with sunshine duration in Japan: an ecological study. J Matern Fetal Neonatal Med 2021; 35:4946-4951. [PMID: 33455490 DOI: 10.1080/14767058.2021.1873270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Few studies have investigated the regional variations in the development of neonatal hyperbilirubinemia. This study aimed to investigate regional variations in medical costs for neonatal hyperbilirubinemia and the correlations between sunshine duration and medical care costs for neonatal hyperbilirubinemia in an ecological study, using the National Database of Japan. METHODS We obtained data on the annual medical costs for neonatal hyperbilirubinemia, annual live births, and annual sunshine duration in each prefecture from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data, Vital Statistics in Japan, and System of Social and Demographic Statistics Prefectural Data Basic Data from 2014 to 2017. We created choropleth maps showing the regional variations (quartiles) in the annual medical costs for neonatal hyperbilirubinemia per 10 live births and the annual sunshine duration in each prefecture. We used Pearson's correlation coefficients to evaluate the associations between the annual sunshine duration and annual medical care costs for neonatal hyperbilirubinemia per 10 live births in each prefecture. RESULTS The Tohoku region (on the Sea of Japan side) and the Hokuriku region were likely to have higher medical care costs for neonatal hyperbilirubinemia and shorter sunshine duration than the rest of the country. There were weak and negative correlations between the annual sunshine duration and the annual medical care costs for neonatal hyperbilirubinemia. The correlation coefficients ranged from -0.086 to -0.33. CONCLUSION There could be regional variations in the medical care costs for neonatal hyperbilirubinemia in Japan. Short sunshine duration could be a prognostic factor for the development of neonatal hyperbilirubinemia.
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Affiliation(s)
- Yasutaka Kuniyoshi
- Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan
| | - Haruka Tokutake
- Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan
| | - Natsuki Takahashi
- Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan
| | - Azusa Kamura
- Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan
| | - Sumie Yasuda
- Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan
| | - Makoto Tashiro
- Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan
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Wei G, Yang G, Wang Y, Jiang H, Fu Y, Yue G, Ju R. Phototherapy-based combination strategies for bacterial infection treatment. Theranostics 2020; 10:12241-12262. [PMID: 33204340 PMCID: PMC7667673 DOI: 10.7150/thno.52729] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/17/2020] [Indexed: 12/11/2022] Open
Abstract
The development of nanomedicine is expected to provide an innovative direction for addressing challenges associated with multidrug-resistant (MDR) bacteria. In the past decades, although nanotechnology-based phototherapy has been developed for antimicrobial treatment since it rarely causes bacterial resistance, the clinical application of single-mode phototherapy has been limited due to poor tissue penetration of light sources. Therefore, combinatorial strategies are being developed. In this review, we first summarized the current phototherapy agents, which were classified into two functional categories: organic phototherapy agents (e.g., small molecule photosensitizers, small molecule photosensitizer-loaded nanoparticles and polymer-based photosensitizers) and inorganic phototherapy agents (e.g., carbo-based nanomaterials, metal-based nanomaterials, composite nanomaterials and quantum dots). Then the development of emerging phototherapy-based combinatorial strategies, including combination with chemotherapy, combination with chemodynamic therapy, combination with gas therapy, and multiple combination therapy, are presented and future directions are further discussed. The purpose of this review is to highlight the potential of phototherapy to deal with bacterial infections and to propose that the combination therapy strategy is an effective way to solve the challenges of single-mode phototherapy.
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Affiliation(s)
- Guoqing Wei
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, PR China
| | - Guang Yang
- College of Medicine, Southwest Jiaotong University, Chengdu, 610031, PR China
| | - Yi Wang
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, PR China
| | - Hezhong Jiang
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, PR China
| | - Yiyong Fu
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, PR China
| | - Guang Yue
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, PR China
| | - Rong Ju
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, PR China
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Chou JH. Predictive Models for Neonatal Follow-Up Serum Bilirubin: Model Development and Validation. JMIR Med Inform 2020; 8:e21222. [PMID: 33118947 PMCID: PMC7661258 DOI: 10.2196/21222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/03/2020] [Accepted: 09/27/2020] [Indexed: 01/16/2023] Open
Abstract
Background Hyperbilirubinemia affects many newborn infants and, if not treated appropriately, can lead to irreversible brain injury. Objective This study aims to develop predictive models of follow-up total serum bilirubin measurement and to compare their accuracy with that of clinician predictions. Methods Subjects were patients born between June 2015 and June 2019 at 4 hospitals in Massachusetts. The prediction target was a follow-up total serum bilirubin measurement obtained <72 hours after a previous measurement. Birth before versus after February 2019 was used to generate a training set (27,428 target measurements) and a held-out test set (3320 measurements), respectively. Multiple supervised learning models were trained. To further assess model performance, predictions on the held-out test set were also compared with corresponding predictions from clinicians. Results The best predictive accuracy on the held-out test set was obtained with the multilayer perceptron (ie, neural network, mean absolute error [MAE] 1.05 mg/dL) and Xgboost (MAE 1.04 mg/dL) models. A limited number of predictors were sufficient for constructing models with the best performance and avoiding overfitting: current bilirubin measurement, last rate of rise, proportion of time under phototherapy, time to next measurement, gestational age at birth, current age, and fractional weight change from birth. Clinicians made a total of 210 prospective predictions. The neural network model accuracy on this subset of predictions had an MAE of 1.06 mg/dL compared with clinician predictions with an MAE of 1.38 mg/dL (P<.0001). In babies born at 35 weeks of gestation or later, this approach was also applied to predict the binary outcome of subsequently exceeding consensus guidelines for phototherapy initiation and achieved an area under the receiver operator characteristic curve of 0.94 (95% CI 0.91 to 0.97). Conclusions This study developed predictive models for neonatal follow-up total serum bilirubin measurements that outperform clinicians. This may be the first report of models that predict specific bilirubin values, are not limited to near-term patients without risk factors, and take into account the effect of phototherapy.
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Affiliation(s)
- Joseph H Chou
- Massachusetts General Hospital, Boston, MA, United States
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69
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Siddappa AM, Prekker FL, Slusher TM. Improving Effectiveness of Phototherapy in an Academic Center: A Quality Improvement Project. Glob Pediatr Health 2020; 7:2333794X20969275. [PMID: 33195747 PMCID: PMC7605035 DOI: 10.1177/2333794x20969275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/02/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Abstract
Neonatal hyperbilirubinemia is a common cause of delayed discharge and readmissions in our institution. As previously published, the irradiance our phototherapy (PT) units provided was below the irradiance recommended by the AAP for intensive phototherapy (>30 µW/cm2/nm). We measured irradiance delivered by our PT units (Drager 4000) using a standardized footprint grid. By varying number of blue and white fluorescent PT lights, height of PT unit above the neonate and type of bed used (open bassinet versus isolette), we determined the optimal PT arrangement needed to deliver intensive PT (30 µW/cm2/nm). We then developed a standardized, multidisciplinary protocol specifying light arrangement and distance required needed to achieve the desired irradiance level. We were able to show improved irradiance following above changes. Onsite measurement of irradiance provided by local phototherapy units and development of a multidisciplinary, standardized protocol are necessary to assure delivery of recommended levels PT for neonates with hyperbilirubinemia.
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Affiliation(s)
- Ashajyothi M Siddappa
- Hennepin Healthcare, Minneapolis, MN, USA.,University of Minnesota, Minnesota, MN, USA
| | - Frances L Prekker
- Hennepin Healthcare, Minneapolis, MN, USA.,University of Minnesota, Minnesota, MN, USA
| | - Tina M Slusher
- Hennepin Healthcare, Minneapolis, MN, USA.,University of Minnesota, Minnesota, MN, USA
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Madea D, Mahvidi S, Chalupa D, Mujawar T, Dvořák A, Muchová L, Janoš J, Slavíček P, Švenda J, Vítek L, Klán P. Wavelength-Dependent Photochemistry and Biological Relevance of a Bilirubin Dipyrrinone Subunit. J Org Chem 2020; 85:13015-13028. [DOI: 10.1021/acs.joc.0c01673] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Dominik Madea
- Department of Chemistry, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Sadegh Mahvidi
- Department of Chemistry, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - David Chalupa
- Department of Chemistry, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Taufiqueahmed Mujawar
- Department of Chemistry, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Aleš Dvořák
- Institute of Medical Biochemistry and Laboratory Diagnostics, 4th Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Na Bojišti 3, 121 08 Prague 2, Czech Republic
| | - Lucie Muchová
- Institute of Medical Biochemistry and Laboratory Diagnostics, 4th Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Na Bojišti 3, 121 08 Prague 2, Czech Republic
| | - Jiří Janoš
- Department of Physical Chemistry, University of Chemistry and Technology, Technická 5, 16628 Prague 6, Czech Republic
| | - Petr Slavíček
- Department of Physical Chemistry, University of Chemistry and Technology, Technická 5, 16628 Prague 6, Czech Republic
| | - Jakub Švenda
- Department of Chemistry, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Libor Vítek
- Institute of Medical Biochemistry and Laboratory Diagnostics, 4th Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Na Bojišti 3, 121 08 Prague 2, Czech Republic
| | - Petr Klán
- Department of Chemistry, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
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Sampurna MT, Etika R, Utomo MT, Rani SA, Irzaldy A, Irawan ZS, Ratnasari KA, Bos AF. An evaluation of phototherapy device performance in a tertiary health facility. Heliyon 2020; 6:e04950. [PMID: 32995629 PMCID: PMC7502345 DOI: 10.1016/j.heliyon.2020.e04950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/18/2020] [Accepted: 09/11/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION A range of phototherapy devices are commercially available. The American Academy of Pediatrics (2004) recommends routine intensity measurement of phototherapy devices to ensure that babies affected by hyperbilirubinemia receive effective phototherapy. OBJECTIVE The aims of this study were to calculate the irradiance decay velocity of phototherapy devices used in a tertiary care hospital to evaluate whether current maintenance procedures for phototherapy devices are effective, and to contribute to the improvement of a standardized maintenance procedure in daily practice, thus helping to ensure that all babies affected by hyperbilirubinemia receive prompt treatment. METHODS This research represents a prospective observational study conducted at Dr. Soetomo Academic Teaching Hospital in Surabaya, Indonesia from February 2019-July 2019. The intensities of 11 phototherapy devices were measured at specific times using a Bili Blanket Meter II. We calculated the Δ irradiance differences in μW/cm2/nm and calculated them as velocity μW/cm2/nm/hour of use. RESULTS Among the 11 phototherapy devices included in this study, nine were fluorescent and two were light-emitting diode (LED) machines. The mean (standard deviation) irradiance decay velocity of the fluorescent lamps was 0.02 (±0.03) μW/cm2/nm/hour of use, while that of the LED lamps was 0.015 (±0.007) μW/cm2/nm/hour of use. The fastest irradiance decay velocity was 0.08 μW/cm2/nm/hour of use, while the slowest irradiance decay velocity was <0.01 μW/cm2/nm/hour of use, both of which were from fluorescent-based devices. There was one fluorescent-based device that provided an intensity lower than the therapeutic level. CONCLUSION Irradiance decay occurred in all phototherapy device lamps. It is important to perform routinely intensity measurements, regardless of manufacturer recommendations, to avoid ineffective phototherapy resulting from intensities lower than the required therapeutic levels.
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Affiliation(s)
- Mahendra T.A. Sampurna
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Risa Etika
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Martono T. Utomo
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Siti A.D. Rani
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Abyan Irzaldy
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Zahra S. Irawan
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Kinanti Ayu Ratnasari
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Arend F. Bos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
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Hansen TWR, Wong RJ, Stevenson DK. Molecular Physiology and Pathophysiology of Bilirubin Handling by the Blood, Liver, Intestine, and Brain in the Newborn. Physiol Rev 2020; 100:1291-1346. [PMID: 32401177 DOI: 10.1152/physrev.00004.2019] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Bilirubin is the end product of heme catabolism formed during a process that involves oxidation-reduction reactions and conserves iron body stores. Unconjugated hyperbilirubinemia is common in newborn infants, but rare later in life. The basic physiology of bilirubin metabolism, such as production, transport, and excretion, has been well described. However, in the neonate, numerous variables related to nutrition, ethnicity, and genetic variants at several metabolic steps may be superimposed on the normal physiological hyperbilirubinemia that occurs in the first week of life and results in bilirubin levels that may be toxic to the brain. Bilirubin exists in several isomeric forms that differ in their polarities and is considered a physiologically important antioxidant. Here we review the chemistry of the bilirubin molecule and its metabolism in the body with a particular focus on the processes that impact the newborn infant, and how differences relative to older children and adults contribute to the risk of developing both acute and long-term neurological sequelae in the newborn infant. The final section deals with the interplay between the brain and bilirubin and its entry, clearance, and accumulation. We conclude with a discussion of the current state of knowledge regarding the mechanism(s) of bilirubin neurotoxicity.
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Affiliation(s)
- Thor W R Hansen
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ronald J Wong
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David K Stevenson
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Van Rostenberghe H, Ho JJ, Lim CH, Abd Hamid IJ. Use of reflective materials during phototherapy for newborn infants with unconjugated hyperbilirubinaemia. Cochrane Database Syst Rev 2020; 7:CD012011. [PMID: 32609375 PMCID: PMC7390477 DOI: 10.1002/14651858.cd012011.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Phototherapy is a well-established effective therapy for treating babies with significant neonatal jaundice. Studies have shown that increasing light intensity will increase its efficiency. A potentially inexpensive and easy way of increasing the intensity of light on the body of the infant may be to hang reflective materials from the sides of phototherapy units. OBJECTIVES To assess the effects of reflective materials in combination with phototherapy compared with phototherapy alone for unconjugated hyperbilirubinaemia in neonates. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 11), in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R); and the Cumulative Index of Nursing and Allied Health Literature (CINAHL), on 1 November 2019. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials if the participants, who were term or preterm infants, received phototherapy with curtains made of reflective materials of any type in the treatment arm, and if those in the comparison arm received similar phototherapy without curtains or other intensified phototherapy, such as a double bank of lights. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS Of 15 studies identified, we included 12 (1288 babies) in the review - 11 comparing phototherapy with reflective materials and phototherapy alone, and one comparing a single phototherapy light bank with reflective materials with double phototherapy. All reflective materials consisted of curtains on three or four sides of the cot and were made of white plastic (five studies), white linen (two studies), or aluminium (three studies); materials were not specified in two studies. Only 11 studies (10 comparing reflective materials versus none and one comparing reflective curtains and a single bank of lights with a double (above and below) phototherapy unit) provided sufficient data to be included in the meta-analysis. Two excluded studies used the reflective materials in a way that did not meet our inclusion criteria, and we excluded one study because it compared four different phototherapy interventions not including reflective materials. The risk of bias of included studies was generally low, but all studies had high risk of performance bias due to lack of blinding of the intervention. Three studies (281 participants) reported a decline in serum bilirubin (SB) (μmol/L) at four to eight hours (mean difference (MD) -14.61, 95% confidence interval (CI) -19.80 to -9.42; I² = 57%; moderate-certainty evidence). Nine studies (893 participants) reported a decline in SB over 24 hours and showed a faster decline in SB in the intervention group, but heterogeneity (I² = 97%) was too substantial to permit a meaningful estimate of the actual effect size (very low-certainty evidence). Subgroup analysis by type of reflective material used did not explain the heterogeneity. Exchange transfusion was reported by two studies; both reported none in either group. Four studies (466 participants) reported the mean duration of phototherapy, and in each of these studies, it was reduced in the intervention group but there was substantial heterogeneity (I² = 88%), precluding meaningful meta-analysis of data. The only two studies that reported the mean duration of hospital stay in hours showed a meaningful reduction (MD -41.08, 95% CI -45.92 to -36.25; I² = 0; moderate-certainty evidence). No studies reported costs of the intervention, parental or medical staff satisfaction, breastfeeding outcomes, or neurodevelopmental follow-up. The only study that compared use of curtains with double phototherapy reported similar results for both groups. Studies that monitored adverse events did not report increased adverse events related to the use of curtains, including acute life-threatening events, but other rarer side effects could not be excluded. AUTHORS' CONCLUSIONS Moderate-certainty evidence shows that the use of reflective curtains during phototherapy may result in greater decline in SB. Very low-certainty evidence suggests that the duration of phototherapy is reduced, and moderate-certainty evidence shows that the duration of hospital stay is also reduced. Available evidence does not show any increase in adverse events, but further studies are needed.
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Affiliation(s)
- Hans Van Rostenberghe
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Jacqueline J Ho
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
| | - Choo Hau Lim
- Paediatrics, Hospital Pulau Pinang, Pulau Pinang, Malaysia
| | - Intan Juliana Abd Hamid
- Regenerative Medicine Cluster, Advanced Medical and Dentistry Institute, USM, Kepala Batas, Malaysia
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Garg BD, Bansal A, Kabra NS. Role of Kangaroo Mother Care in the Management of Neonatal Hyperbilirubinemia in Both Term and Preterm Neonates: A Systematic Review. J Perinat Educ 2020; 29:123-133. [PMID: 32760181 PMCID: PMC7360130 DOI: 10.1891/j-pe-d-18-00043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neonatal hyperbilirubinemia (NNH) is the most common clinical sign seen in neonatal practice. Kangaroo mother care (KMC), a new strategy has been tried for the management of hyperbilirubinemia. AIMS To evaluate the role of KMC for reduction of bilirubin and duration of phototherapy in term and preterm neonates. METHOD The literature search was done for various randomized control trials by searching the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, ongoing clinical trials and abstracts of conferences. RESULTS This review included five RCTs that fulfilled inclusion criteria. Out of five trials, two trials reported a significant reduction in bilirubin and three trials reported a significant reduction in duration of phototherapy. CONCLUSION KMC may be a novel strategy in the management of NNH. However, due to small sample size and heterogeneity between the trials, the current evidence is not sufficient. Hence, large trials with adequate sample sizes are needed.
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A Quantitative In Vitro Potency Assay for Adeno-Associated Virus Vectors Encoding for the UGT1A1 Transgene. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2020; 18:250-258. [PMID: 32637454 PMCID: PMC7327880 DOI: 10.1016/j.omtm.2020.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/29/2020] [Indexed: 12/20/2022]
Abstract
Potency assessment of clinical-grade vector lots is crucial to support adeno-associated virus (AAV) vector release and is required for future marketing authorization. We have developed and validated a cell-based, quantitative potency assay that detects both transgenic expression and activity of an AAV8-hUGT1A1 vector, which is currently under clinical evaluation for the treatment of Crigler-Najjar syndrome. Potency of AAV8-hUGT1A1 was evaluated in vitro. After transduction of human hepatoma 7 (Huh7) cells, transgene-positive cells were quantified using flow cytometry and transgenic activity by a bilirubin conjugation assay. The in vitro potency of various AAV8-hUGT1A1 batches was compared with their potency in vivo. After AAV8-hUGT1A1 transduction, quantification of UGT1A1-expressing cells shows a linear dose-response relation (R2 = 0.98) with adequate intra-assay and inter-day reproducibility (coefficient of variation [CV] = 11.0% and 22.6%, respectively). In accordance, bilirubin conjugation shows a linear dose-response relation (R2 = 0.99) with adequate intra- and inter-day reproducibility in the low dose range (CV = 15.7% and 19.7%, respectively). Both in vitro potency assays reliably translate to in vivo efficacy of AAV8-hUGT1A1 vector lots. The described cell-based potency assay for AAV8-hUGT1A1 adequately determines transgenic UGT1A1 expression and activity, which is consistent with in vivo efficacy. This novel approach is suited for the determination of vector lot potency to support clinical-grade vector release.
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77
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Hegyi T, Chefitz D, Weller A, Huber A, Carayannopoulos M, Kleinfeld A. Unbound bilirubin measurements in term and late-preterm infants. J Matern Fetal Neonatal Med 2020; 35:1532-1538. [PMID: 32366186 DOI: 10.1080/14767058.2020.1761318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Hyperbilirubinemia occurs in over 80% of newborns, and severe bilirubin toxicity can lead to neurological dysfunction and death. Unbound bilirubin (Bf) levels predict the risk of neurodevelopmental handicap, although total serum bilirubin (TSB) is used to manage care.Objective: To measure Bf levels in healthy infants, its relationship to TSB, and its response to phototherapy. We hypothesize unexpectedly high Bf levels, poor correlation with TSB and unpredictable response to phototherapy.Design/methods: Healthy infants were studied with simultaneous TSB and Bf measurements. The clinical data recorded included ethnicity, gender, birth weight, gestational age, and mode of delivery, Apgar scores, breast/formula feeds, and phototherapy.Results: One hundred thirty-two infants (3248.9 ± 509.2g, GA 38.7 ± 1.4 weeks), at mean age of the initial sample of 28.5 ± 15.6 h, had a TSB of 7.9 ± 2.7 mg/dl, and a Bf of 5.2 ± 3.2 nM. The correlation between Bf and TSB was significant but not between Bf and TSB for TSB >12 mg/dl. Bf >11nm were in 22.7% and >17 nM in 3.8% of infants. Post-phototherapy TSB and Bf levels were similar to those before treatment.Conclusions: The relationship between TSB and Bf in healthy infants is complex, with the inability of one to predict the other's level in infants with elevated TSB. The mechanism of bilirubin-related neurotoxicity suggests that the management of jaundice in healthy infants requires Bf measurements. Management of jaundice with TSB may result in more infants exposed to phototherapy. However, unexpected elevations of Bf occur in an apparently healthy population.
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Affiliation(s)
- Thomas Hegyi
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers, The State University of NJ, New Brunswick, NJ, USA
| | - Dalya Chefitz
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers, The State University of NJ, New Brunswick, NJ, USA
| | - Alan Weller
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers, The State University of NJ, New Brunswick, NJ, USA
| | | | - Mary Carayannopoulos
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers, The State University of NJ, New Brunswick, NJ, USA
| | - Alan Kleinfeld
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers, The State University of NJ, New Brunswick, NJ, USA
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Choo YM, Springer S, Yip KX, Ahmad Kamar A, Wong EH, Lee SWH, Lai NM. High- versus low-dose conventional phototherapy for neonatal jaundice. Hippokratia 2020. [DOI: 10.1002/14651858.cd003308.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Yao Mun Choo
- Department of Paediatrics; University of Malaya; Kuala Lumpur Malaysia
| | | | - Ke Xin Yip
- Department of Paediatrics; University of Malaya Medical Centre; Kuala Lumpur Malaysia
| | | | - Eng Hwa Wong
- School of Medicine; Taylor's University; Subang Jaya Malaysia
| | | | - Nai Ming Lai
- School of Medicine; Taylor's University; Subang Jaya Malaysia
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Hara T, Hiratsuka T, Etoh T, Itai Y, Kono Y, Shiroshita H, Shiraishi N, Inomata M. Intraperitoneal Phototherapy Suppresses Inflammatory Reactions in a Surgical Model of Peritonitis. J Surg Res 2020; 252:231-239. [PMID: 32299011 DOI: 10.1016/j.jss.2020.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/29/2020] [Accepted: 03/09/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Standard treatment for diffuse peritonitis due to colorectal perforation may be insufficient to suppress inflammatory reaction in sepsis. Thus, developing new treatments is important. This study aimed to examine whether intraperitoneal irradiation by artificial sunlight suppresses inflammatory reaction in a lipopolysaccharide (LPS)-induced peritonitis model after surgical treatments. MATERIALS AND METHODS Mice were divided into naive, nontreatment (NT), and phototherapy (PT) groups. In the latter two groups, LPS was intraperitoneally administered to induce peritonitis and removed by intraperitoneal lavage after laparotomy. The PT group was irradiated with artificial sunlight intraperitoneally. We evaluated the local and systemic inflammatory reactions. Murine macrophages were irradiated with artificial sunlight after stimulation by LPS, and cell viability and expression of tumor necrotizing factor-α (TNF-α) were evaluated. RESULTS As a local inflammatory reaction, the whole cell count, the expression of interleukin-6 and TNF-α in the intra-abdominal fluid, and the peritoneal thickness were significantly lower in the PT group than in the NT group. As a systematic inflammatory reaction, the expression of serum TNF-α, granulocyte macrophage colony-stimulating factor, monocyte chemotactic protein-1, macrophage inflammatory protein (MIP)-1α, and MIP-1β were significantly lower in the PT group than in the NT group. Irradiation by artificial sunlight suppressed the expression of TNF-α in murine macrophages without affecting cell viability. CONCLUSIONS Intraperitoneal irradiation by artificial sunlight could suppress local and systemic inflammatory reactions in the LPS-induced peritonitis murine model. These effects may be associated with macrophage immune responses.
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Affiliation(s)
- Takao Hara
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
| | - Takahiro Hiratsuka
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yusuke Itai
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan; Department of Diagnostic Pathology, Oita University Faculty of Medicine, Oita, Japan
| | - Yohei Kono
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hidefumi Shiroshita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Norio Shiraishi
- Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Oita, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
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80
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Auger N, Ayoub A, Lo E, Healy-Profitós J, Luu TM. Reply to: Phototherapy and childhood cancer: Shared risk factors? Int J Cancer 2020; 146:2063-2065. [PMID: 31593611 DOI: 10.1002/ijc.32702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.,Institut national de santé publique du Québec, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.,Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Ernest Lo
- Institut national de santé publique du Québec, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Jessica Healy-Profitós
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.,Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Thuy Mai Luu
- Division of General Pediatrics, Department of Pediatrics, Sainte-Justine Hospital Centre, University of Montreal, Montreal, QC, Canada
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81
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Ma Y, Zhang Y, Cai S, Han Z, Liu X, Wang F, Cao Y, Wang Z, Li H, Chen Y, Feng X. Flexible Hybrid Electronics for Digital Healthcare. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1902062. [PMID: 31243834 DOI: 10.1002/adma.201902062] [Citation(s) in RCA: 147] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/28/2019] [Indexed: 05/25/2023]
Abstract
Recent advances in material innovation and structural design provide routes to flexible hybrid electronics that can combine the high-performance electrical properties of conventional wafer-based electronics with the ability to be stretched, bent, and twisted to arbitrary shapes, revolutionizing the transformation of traditional healthcare to digital healthcare. Here, material innovation and structural design for the preparation of flexible hybrid electronics are reviewed, a brief chronology of these advances is given, and biomedical applications in bioelectrical monitoring and stimulation, optical monitoring and treatment, acoustic imitation and monitoring, bionic touch, and body-fluid testing are described. In conclusion, some remarks on the challenges for future research of flexible hybrid electronics are presented.
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Affiliation(s)
- Yinji Ma
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, China
| | - Yingchao Zhang
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, China
| | - Shisheng Cai
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, China
| | - Zhiyuan Han
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, China
| | - Xin Liu
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, China
| | - Fengle Wang
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, China
| | - Yu Cao
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, China
| | - Zhouheng Wang
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, China
| | - Hangfei Li
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, China
| | - Yihao Chen
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, China
| | - Xue Feng
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, China
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Aronson SJ, Veron P, Collaud F, Hubert A, Delahais V, Honnet G, de Knegt RJ, Junge N, Baumann U, Di Giorgio A, D'Antiga L, Ginocchio VM, Brunetti-Pierri N, Labrune P, Beuers U, Bosma PJ, Mingozzi F. Prevalence and Relevance of Pre-Existing Anti-Adeno-Associated Virus Immunity in the Context of Gene Therapy for Crigler-Najjar Syndrome. Hum Gene Ther 2020; 30:1297-1305. [PMID: 31502485 PMCID: PMC6763963 DOI: 10.1089/hum.2019.143] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Adeno-associated virus (AAV) vector-mediated gene therapy is currently evaluated as a potential treatment for Crigler–Najjar syndrome (CN) (NCT03466463). Pre-existing immunity to AAV is known to hinder gene transfer efficacy, restricting enrollment of seropositive subjects in ongoing clinical trials. We assessed the prevalence of anti-AAV serotype 8 (AAV8) neutralizing antibodies (NAbs) in subjects affected by CN and investigated the impact of low NAb titers (<1:5) on liver gene transfer efficacy in an in vivo passive immunization model. A total of 49 subjects with a confirmed molecular diagnosis of CN were included in an international multicenter study (NCT02302690). Pre-existing NAbs against AAV8 were detected in 30.6% (15/49) of screened patients and, in the majority of positive cases, cross-reactivity to AAV2 and AAV5 was detected. To investigate the impact of low NAbs on AAV vector-mediated liver transduction efficiency, adult wild-type C57BL/6 mice were passively immunized with pooled human donor-derived immunoglobulins to achieve titers of up to 1:3.16. After immunization, animals were injected with different AAV8 vector preparations. Hepatic vector gene copy number was unaffected by low anti-AAV8 NAb titers when column-purified AAV vector batches containing both full and empty capsids were used. In summary, although pre-existing anti-AAV8 immunity can be found in about a third of subjects affected by CN, low anti-AAV8 NAb titers are less likely to affect liver transduction efficiency when using AAV vector preparations manufactured to contain both full and empty capsids. These findings have implications for the design of liver gene transfer clinical trials and for the definition of inclusion criteria related to seropositivity of potential participants.
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Affiliation(s)
- Sem J Aronson
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Aurélie Hubert
- Department of Hereditary Diseases of Hepatic Metabolism, Hôpital Antoine Béclère, Clamart, France
| | | | | | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Norman Junge
- Department of Paediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany.,Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ulrich Baumann
- Department of Paediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany.,Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Angelo Di Giorgio
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo D'Antiga
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Virginia M Ginocchio
- Telethon Institute of Genetics & Medicine (TIGEM), Pozzuoli, Italy.,Department of Translational Medicine, Federico II University of Naples, Naples, Italy
| | - Nicola Brunetti-Pierri
- Telethon Institute of Genetics & Medicine (TIGEM), Pozzuoli, Italy.,Department of Translational Medicine, Federico II University of Naples, Naples, Italy
| | - Philippe Labrune
- Department of Hereditary Diseases of Hepatic Metabolism, Hôpital Antoine Béclère, Clamart, France
| | - Ulrich Beuers
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Piter J Bosma
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Jašprová J, Dvořák A, Vecka M, Leníček M, Lacina O, Valášková P, Zapadlo M, Plavka R, Klán P, Vítek L. A novel accurate LC-MS/MS method for quantitative determination of Z-lumirubin. Sci Rep 2020; 10:4411. [PMID: 32157102 PMCID: PMC7064611 DOI: 10.1038/s41598-020-61280-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/21/2020] [Indexed: 02/07/2023] Open
Abstract
Although phototherapy (PT) is a standard treatment for neonatal jaundice, no validated clinical methods for determination of bilirubin phototherapy products are available. Thus, the aim of our study was to establish a such method for clinical use. To achieve this aim, a LC-MS/MS assay for simultaneous determination of Z-lumirubin (LR) and unconjugated bilirubin (UCB) was conducted. LR was purified after irradiation of UCB at 460 nm. The assay was tested on human sera from PT-treated neonates. Samples were separated on a HPLC system with a triple quadrupole mass spectrometer detector. The instrument response was linear up to 5.8 and 23.4 mg/dL for LR and UCB, respectively, with submicromolar limits of detection and validity parameters relevant for use in clinical medicine. Exposure of newborns to PT raised serum LR concentrations three-fold (p < 0.01), but the absolute concentrations were low (0.37 ± 0.16 mg/dL), despite a dramatic decrease of serum UCB concentrations (13.6 ± 2.2 vs. 10.3 ± 3.3 mg/dL, p < 0.01). A LC-MS/MS method for the simultaneous determination of LR and UCB in human serum was established and validated for clinical use. This method should help to monitor neonates on PT, as well as to improve our understanding of both the kinetics and biology of bilirubin phototherapy products.
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Affiliation(s)
- Jana Jašprová
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Aleš Dvořák
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marek Vecka
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Leníček
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Petra Valášková
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Miloš Zapadlo
- Department of Pediatrics and Neonatology, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Richard Plavka
- Department of Pediatrics and Neonatology, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Klán
- Department of Chemistry and Recetox, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Libor Vítek
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic. .,4th Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
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84
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Hudson JA, Charron E, Maple B, Krom M, Heavner-Sullivan SF, Mayo RM, Dickes L, Rennert L. Baby-Friendly Hospital Initiative Is Associated with Lower Rates of Neonatal Hyperbilirubinemia. Breastfeed Med 2020; 15:176-182. [PMID: 31934778 DOI: 10.1089/bfm.2019.0220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The Baby-Friendly Hospital Initiative (BFHI) advances practices that support exclusive breastfeeding. BFHI practices are associated with increased breastfeeding rates, however, other patient outcomes are not well described. This study examined the association of BFHI practices with hyperbilirubinemia and phototherapy between groups of newborns born before and after BFHI implementation at an urban, tertiary academic medical center in South Carolina. Materials and Methods: We conducted a retrospective study of healthy, term newborns born between July and September 2011 (n = 956), before BFHI implementation, and newborns born during the same period in 2013 (n = 1,131) after BFHI implementation. Primary outcomes were neonatal hyperbilirubinemia, phototherapy treatment, and hospital readmissions for hyperbilirubinemia within 30 days of discharge. We compared rates of outcomes between the study groups using unadjusted and adjusted odds ratios (OR). Results: Among newborns born before versus after BFHI implementation, 20.3% versus 6.98% were diagnosed with hyperbilirubinemia (p < 0.001), 5.75% versus 1.95% received phototherapy (p < 0.001), and 0.31% versus 0.35% were readmitted to the hospital for hyperbilirubinemia within 30 days (p = 0.88). In adjusted analyses, newborns born after BFHI implementation were significantly less likely to develop neonatal hyperbilirubinemia (OR 0.28 [95% confidence intervals; CI 0.20-0.37]) and receive phototherapy treatment (OR 0.27 [95% CI 0.15-0.49]) than newborns born before BFHI implementation. Conclusions: Implementation of BFHI practices is associated with significant decreases in neonatal hyperbilirubinemia and phototherapy without affecting readmission rates. Exclusive breastfeeding has traditionally been considered a risk factor for the development of neonatal jaundice. This study demonstrates that BFHI practices may mitigate that risk.
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Affiliation(s)
- Jennifer A Hudson
- Department of Pediatrics, Prisma Health Upstate, Greenville, South Carolina
| | - Elizabeth Charron
- Department of Public Health Sciences and Recreation and Tourism Management, Clemson University, Clemson, South Carolina
| | - Britni Maple
- Department of Pediatrics, Prisma Health Upstate, Greenville, South Carolina
| | - Mark Krom
- Department of Pediatrics, Prisma Health Upstate, Greenville, South Carolina
| | - Smith F Heavner-Sullivan
- Department of Public Health Sciences and Recreation and Tourism Management, Clemson University, Clemson, South Carolina
| | - Rachel M Mayo
- Department of Public Health Sciences and Recreation and Tourism Management, Clemson University, Clemson, South Carolina
| | - Lori Dickes
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, South Carolina
| | - Lior Rennert
- Department of Public Health Sciences and Recreation and Tourism Management, Clemson University, Clemson, South Carolina
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85
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Hansen TWR, Maisels MJ, Ebbesen F, Vreman HJ, Stevenson DK, Wong RJ, Bhutani VK. Sixty years of phototherapy for neonatal jaundice - from serendipitous observation to standardized treatment and rescue for millions. J Perinatol 2020; 40:180-193. [PMID: 31420582 DOI: 10.1038/s41372-019-0439-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/04/2019] [Accepted: 05/23/2019] [Indexed: 11/09/2022]
Abstract
A breakthrough discovery 60 years ago by Cremer et al. has since changed the way we treat infants with hyperbilirubinemia and saved the lives of millions from death and disabilities. "Photobiology" has evolved by inquiry of diverse light sources: fluorescent tubes (wavelength range of 400-520 nm; halogen spotlights that emit circular footprints of light; fiberoptic pads/blankets (mostly, 400-550 nm range) that can be placed in direct contact with skin; and the current narrow-band blue light-emitting diode (LED) light (450-470 nm), which overlaps the peak absorption wavelength (458 nm) for bilirubin photoisomerization. Excessive bombardment with photons has raised concerns for oxidative stress in very low birthweight versus term infants treated aggressively with phototherapy. Increased emphasis on prescribing phototherapy as a "drug" that is dosed cautiously and judiciously is needed. In this historical review, we chronicled the basic to the neurotoxic components of severe neonatal hyperbilirubinemia and the use of standardized interventions.
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Affiliation(s)
- Thor Willy Ruud Hansen
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Jeffrey Maisels
- Department of Pediatrics, Oakland University William Beaumont School of Medicine, Beaumont Children's Hospital, Royal Oak, MI, USA
| | - Finn Ebbesen
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark.,Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Hendrik J Vreman
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Ronald J Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Vinod K Bhutani
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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86
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Kato S, Iwata O, Yamada Y, Kakita H, Yamada T, Nakashima H, Sugiura T, Suzuki S, Togari H. Standardization of phototherapy for neonatal hyperbilirubinemia using multiple-wavelength irradiance integration. Pediatr Neonatol 2020; 61:100-105. [PMID: 31473126 DOI: 10.1016/j.pedneo.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/10/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Phototherapy with radiation of 460-490 nm wavelengths provides the most potent therapeutic effect for neonatal jaundice. However, the efficacy of phototherapy has been estimated using single-wavelength detectors with sensitivity at approximately 460 nm. Cyclobilirubin formation capacity (CFC), which comprises the sum of the irradiance values from three wavelengths multiplied by their specific coefficients, has been proposed as an alternative marker to evaluate the efficacy of phototherapy. This study aimed to test whether two types of phototherapy devices with distinct spectral characteristics provide similar therapeutic effects on adjustment of device-to-patient distances to deliver similar CFCs. METHODS Using a three-wavelength spectroradiometer, CFCs and footprints of the light-emitting diode and fluorescent tube devices were assessed. Having determined the device-specific distances that ensured similar CFCs, 32 newborn infants, requiring phototherapy for hyperbilirubinemia, were randomized into the light-emitting diode and fluorescent tube groups. The total serum bilirubin levels before and after phototherapy were assessed. RESULTS The light-emitting diode and fluorescent tube devices had comparable CFCs at distances of 60 and 50 cm, respectively. Phototherapy reduced the total serum bilirubin levels from 18.1 to 14.6 mg/dL and from 19.1 to 15.1 mg/dL in the light-emitting diode and fluorescent tube groups, respectively. The two groups did not differ significantly with respect to the patients' clinical backgrounds, serum bilirubin levels, or changes before and after phototherapy. CONCLUSION At similar CFCs, the two phototherapy devices reduced the total serum bilirubin levels by comparable amounts. Hence, determining CFCs may help predict phototherapy efficacy. This may ensure better safety and greater efficacy of the treatment for newborn infants.
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Affiliation(s)
- Shin Kato
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
| | - Osuke Iwata
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yasumasa Yamada
- Department of Neonatology, Aichi Human Service Center Central Hospital, 713-8 Jinya-cho, Kasugai 480-0304, Japan
| | - Hiroki Kakita
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takaharu Yamada
- Department of Pediatrics, Kainan Hospital, 396 Minamihonda, Maegasu-cho, Yatomi 498-8502, Japan
| | - Hideyuki Nakashima
- Department of Pediatrics, Seirei-Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu 433-8558, Japan
| | - Tokio Sugiura
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Satoshi Suzuki
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-Cho, Kita-ku, Nagoya 462-8508, Japan
| | - Hajime Togari
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan; Department of Pediatrics, Nagoya City West Medical Center, 1-1-1 Hirate-Cho, Kita-ku, Nagoya 462-8508, Japan
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87
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Venkatesh HA, Gupta A. The utility of blood components in the care of sick neonates: An evidence-based review. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2020. [DOI: 10.4103/gjtm.gjtm_21_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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88
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Jenabi E, Bashirian S, Khazaei S. Association between neonatal jaundice and autism spectrum disorders among children: a meta-analysis. Clin Exp Pediatr 2020; 63:8-13. [PMID: 31999913 PMCID: PMC7027343 DOI: 10.3345/kjp.2019.00815] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/03/2019] [Indexed: 11/27/2022] Open
Abstract
Autism spectrum disorder is a common neurodevelopmental disorder with an unknown etiology. The correlation between neonatal jaundice and the risk of developing autism spectrum disorder was investigated previously. Some studies showed significant associations, whereas others demonstrated no association. In this meta-analysis, we pooled the results of observational studies to examine the association between neonatal jaundice and the risk of autism spectrum disorder among children. We identified all studies published through April 2018 by conducting a literature search using Web of Science, PubMed, and Scopus databases as well as the reference lists of the retrieved studies. The pooled odds ratios (ORs), rate ratio (RR), and their 95% confidence intervals (CIs) were calculated as random effect estimates of association among studies. We conducted a subgroup analysis to explore any potential sources of intergroup heterogeneity. The pooled estimates of OR and RR showed a considerable correlation between neonatal jaundice and ASD among children (OR, 1.35; 95% CI, 1.02-1.68) and (RR, 1.39; 95% CI, 1.05-1.74). A larger effect size was shown in the pooled estimated crude OR than in the adjusted OR (1.75 [0.96-2.54] vs. 1.19 [1.07-1.30]). This study showed that neonatal jaundice may be associated with ASD and may increase the risk of ASD among children.
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Affiliation(s)
- Ensiyeh Jenabi
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeid Bashirian
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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89
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Xie Z, Fan T, An J, Choi W, Duo Y, Ge Y, Zhang B, Nie G, Xie N, Zheng T, Chen Y, Zhang H, Kim JS. Emerging combination strategies with phototherapy in cancer nanomedicine. Chem Soc Rev 2020; 49:8065-8087. [DOI: 10.1039/d0cs00215a] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Based on the challenges in single-mode phototherapy, this review summarizes the significant research progress in combinatorial strategies with phototherapy.
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Affiliation(s)
- Zhongjian Xie
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province
- College of Physics and Optoelectronic Engineering, and Otolaryngology Department and Biobank of the First Affiliated Hospital
- Shenzhen Second People's Hospital, Health Science Center
- Shenzhen University
- Shenzhen 518060
| | - Taojian Fan
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province
- College of Physics and Optoelectronic Engineering, and Otolaryngology Department and Biobank of the First Affiliated Hospital
- Shenzhen Second People's Hospital, Health Science Center
- Shenzhen University
- Shenzhen 518060
| | - Jusung An
- Department of Chemistry
- Korea University
- Seoul 02841
- Korea
| | - Wonseok Choi
- Department of Chemistry
- Korea University
- Seoul 02841
- Korea
| | - Yanhong Duo
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province
- College of Physics and Optoelectronic Engineering, and Otolaryngology Department and Biobank of the First Affiliated Hospital
- Shenzhen Second People's Hospital, Health Science Center
- Shenzhen University
- Shenzhen 518060
| | - Yanqi Ge
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province
- College of Physics and Optoelectronic Engineering, and Otolaryngology Department and Biobank of the First Affiliated Hospital
- Shenzhen Second People's Hospital, Health Science Center
- Shenzhen University
- Shenzhen 518060
| | - Bin Zhang
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province
- College of Physics and Optoelectronic Engineering, and Otolaryngology Department and Biobank of the First Affiliated Hospital
- Shenzhen Second People's Hospital, Health Science Center
- Shenzhen University
- Shenzhen 518060
| | - Guohui Nie
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province
- College of Physics and Optoelectronic Engineering, and Otolaryngology Department and Biobank of the First Affiliated Hospital
- Shenzhen Second People's Hospital, Health Science Center
- Shenzhen University
- Shenzhen 518060
| | - Ni Xie
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province
- College of Physics and Optoelectronic Engineering, and Otolaryngology Department and Biobank of the First Affiliated Hospital
- Shenzhen Second People's Hospital, Health Science Center
- Shenzhen University
- Shenzhen 518060
| | - Tingting Zheng
- Shenzhen Key Laboratory for Drug Addiction and Medication Safety
- Department of Ultrasound
- Peking University Shenzhen Hospital
- Shenzhen
- P. R. China
| | - Yun Chen
- Shenzhen Key Laboratory for Drug Addiction and Medication Safety
- Department of Ultrasound
- Peking University Shenzhen Hospital
- Shenzhen
- P. R. China
| | - Han Zhang
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province
- College of Physics and Optoelectronic Engineering, and Otolaryngology Department and Biobank of the First Affiliated Hospital
- Shenzhen Second People's Hospital, Health Science Center
- Shenzhen University
- Shenzhen 518060
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90
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Zakerihamidi M, Boskabadi H, Sezavar M. Evaluation of neonatal jaundice based on the severity of hyperbilirubinemia. J Clin Neonatol 2020. [DOI: 10.4103/jcn.jcn_81_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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91
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Experimental models assessing bilirubin neurotoxicity. Pediatr Res 2020; 87:17-25. [PMID: 31493769 DOI: 10.1038/s41390-019-0570-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/29/2019] [Accepted: 08/16/2019] [Indexed: 02/08/2023]
Abstract
The molecular and cellular events leading to bilirubin-induced neurotoxicity, the mechanisms regulating liver and intestine expression in neonates, and alternative pathways of bilirubin catabolism remain incompletely defined. To answer these questions, researchers have developed a number of model systems to closely recapitulate the main characteristics of the disease, ranging from tissue cultures to engineered mouse models. In the present review we describe in vitro, ex vivo, and in vivo models developed to study bilirubin metabolism and neurotoxicity, with a special focus on the use of engineered animal models. In addition, we discussed the most recent studies related to potential therapeutic approaches to treat neonatal hyperbilirubinemia, ranging from anti-inflammatory drugs, activation of nuclear receptor pathways, blockade of bilirubin catabolism, and stimulation of alternative bilirubin-disposal pathways.
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92
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Gu J, Zhu Y, Zhao J. The efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia: a meta-analysis of randomized controlled studies. J Matern Fetal Neonatal Med 2019; 34:3580-3585. [PMID: 31736410 DOI: 10.1080/14767058.2019.1688295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: The efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia remains controversial. We conduct a systematic review and meta-analysis to explore the influence of intravenous fluid supplementation on treatment efficacy of neonatal hyperbilirubinemia.Methods: We search PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases through June 2019 for randomized controlled trials (RCTs) assessing the efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia. This meta-analysis is performed using the random-effect model.Results: Six RCTs are included in the meta-analysis. Overall, compared with control group for neonatal hyperbilirubinemia, intravenous fluid supplementation is associated with decreased TSB at 8 h (std. MD = -0.82; 95% CI = -1.46 to -0.17; p = .01), 12 h (std. MD = -0.46; 95% CI = -0.81 to -0.10; p = .01), 24 h (std. MD = -0.47; 95% CI = -0.78 to -0.16; p = .003) and 36 h (std. MD = -0.37; 95% CI = -0.73 to -0.02; p = .04), as well as reduced incidence of exchange transfusion (RR = 0.29; 95% CI = 0.14-0.59; p = .0006), but has no significant impact on duration of phototherapy (std. MD = -0.34; 95% CI = -0.88-0.21; p = .22).Conclusions: Intravenous fluid supplementation can provide additional benefits for the treatment of neonatal hyperbilirubinemia.
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Affiliation(s)
- Jing Gu
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Geriatrics, The First Branch of First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Zhu
- Department of Orthorpeadic, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinqiu Zhao
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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93
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Armanian AM, Jahanfar S, Feizi A, Salehimehr N, Molaeinezhad M, Sadeghi E. Prebiotics for the prevention of hyperbilirubinaemia in neonates. Cochrane Database Syst Rev 2019; 8:CD012731. [PMID: 31425619 PMCID: PMC6699678 DOI: 10.1002/14651858.cd012731.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hyperbilirubinaemia occurs in approximately two-thirds of all newborns during the first days of life and is frequently treated with phototherapy. Although generally seen as safe, there is rising concern regarding phototherapy and its potentially damaging effects on DNA and increased side effects particularly for preterm infants. Other methods, such as enteral feeding supplementation with prebiotics, may have an effective use in the management of hyperbilirubinaemia in neonates. OBJECTIVES To determine whether administration of prebiotics reduces the incidence of hyperbilirubinaemia among term and preterm infants compared with enteral supplementation of milk with distilled water/placebo or no supplementation. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), MEDLINE via PubMed (1966 to 14 June 2018), Embase (1980 to 14 June 2018), and CINAHL (1982 to 14 June 2018). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. SELECTION CRITERIA We considered all RCTs that studied neonates comparing enteral feeding supplementation with prebiotics versus distilled water/placebo or no supplementation. DATA COLLECTION AND ANALYSIS Two reviewers screened papers and extracted data from selected papers. We used a fixed-effect method in combining the effects of studies that were sufficiently similar. We then used the GRADE approach to assess the quality of the evidence. MAIN RESULTS Three small studies evaluating 154 infants were included in this review. One study reported a significant reduction in the risk of hyperbilirubinaemia and rate of treatment with phototherapy associated with enteral supplementation with prebiotics (risk ratio (RR) 0.75, 95% confidence interval (95% CI) 0.58 to 0.97; one study, 50 infants; low-quality evidence). Meta-analyses of two studies showed no significant difference in maximum plasma unconjugated bilirubin levels in infants with prebiotic supplementation (mean difference (MD) 0.14 mg/dL, 95% CI -0.91 to 1.20, I² = 81%, P = 0.79; two studies, 78 infants; low-quality evidence). There was no evidence of a significant difference in duration of phototherapy between the prebiotic and control groups, which was only reported by one study (MD 0.10 days, 95% CI -2.00 to 2.20; one study, 50 infants; low-quality evidence). The meta-analyses of two studies demonstrated a significant reduction in the length of hospital stay (MD -10.57 days, 95% CI -17.81 to -3.33; 2 studies, 78 infants; I² = 0%, P = 0.004; low-quality evidence). Meta-analysis of the three studies showed a significant increase in stool frequency in the prebiotic groups (MD 1.18, 95% CI 0.90 to 1.46, I² = 90%; 3 studies, 154 infants; high-quality evidence). No significant difference in mortality during hospital stay after enteral supplementation with prebiotics was reported (typical RR 0.94, 95% CI 0.14 to 6.19; I² = 6%, P = 0.95; 2 studies; 78 infants; low-quality evidence). There were no reports of the need for exchange transfusion and incidence of acute bilirubin encephalopathy, chronic bilirubin encephalopathy, and major neurodevelopmental disability in the included studies. None of the included studies reported any side effects. AUTHORS' CONCLUSIONS Current studies are unable to provide reliable evidence about the effectiveness of prebiotics on hyperbilirubinaemia. Additional large, well-designed RCTs should be undertaken in neonates that compare effects of enteral supplementation with prebiotics on neonatal hyperbilirubinaemia with supplementation of milk with any other placebo (particularly distilled water) or no supplementation.
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Affiliation(s)
- Amir Mohammad Armanian
- Child Growth and Development Research Center, Isfahan University of Medical SciencesDivision of NeonatologyIsfahanIran
| | - Shayesteh Jahanfar
- Central Michigan UniversitySchool of Health SciencesBuilding 2212Mount PleasantMichiganUSA48859
| | - Awat Feizi
- School of Health, Endocrinology and Metabolism Research Center, Isfahan University of Medical SciencesDepartment of Epidemiology and BiostatisticsIsfahanIran
| | - Nima Salehimehr
- Almahdi Mehr Higher Education InstituteDepartment of PsychologyIsfahanIran
| | - Mitra Molaeinezhad
- Isfahan University of Medical SciencesBehavioral sciences Research CentreOstandariIsfahanIran
| | - Erfan Sadeghi
- Isfahan University of Medical SciencesDepartment of Epidemiology and Biostatistics, School of HealthIsfahanIran
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94
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Auger N, Ayoub A, Lo E, Luu TM. Increased risk of hemangioma after exposure to neonatal phototherapy in infants with predisposing risk factors. Acta Paediatr 2019; 108:1447-1452. [PMID: 30681210 DOI: 10.1111/apa.14727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/10/2019] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
Abstract
AIM To determine the relationship between neonatal phototherapy and future risk of clinically significant hemangioma. METHODS We analysed a cohort of 678 879 infants born after 34 weeks gestation comprising 3 975 242 person-years of follow-up over 11 years (2006-2016). The exposure was phototherapy the first 28 days of life. The outcome was hemangioma that required in-hospital treatment during follow-up. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of phototherapy with risk of hemangioma, accounting for preterm birth, low birthweight and congenital anomalies. RESULTS The incidence of hemangioma was greater in neonates who received phototherapy than in untreated infants, but there was no association in adjusted models (HR 1.19, 95% CI 0.89-1.58). Risk of hemangioma was elevated in infants who received phototherapy and were born late preterm (HR 2.35, 95% CI 1.51-3.64), with low birthweight (HR 1.91, 95% CI 1.12-3.24), or with anomalies (HR 5.09, 95% CI 3.42-7.58). Without phototherapy, these three risk factors were more weakly associated with hemangioma. CONCLUSION Neonatal phototherapy in infants with predisposing risk factors may increase the chance of hemangioma, but confirmation in further studies is needed.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre; Montreal QC Canada
- Institut National de Santé Publique du Québec; Montreal QC Canada
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal QC Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre; Montreal QC Canada
- Institut National de Santé Publique du Québec; Montreal QC Canada
| | - Ernest Lo
- Institut National de Santé Publique du Québec; Montreal QC Canada
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal QC Canada
| | - Thuy Mai Luu
- Department of Pediatrics; Sainte-Justine University Hospital Centre; University of Montreal; Montreal QC Canada
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95
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August D, Hitchcock I, Tangney J, Ray RA, Kandasamy Y, New K. Graduated colour tape measure: Development and demonstration of this tool in a case series of neonatal skin injuries. J Tissue Viability 2019; 28:133-138. [DOI: 10.1016/j.jtv.2019.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 11/24/2022]
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96
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Ughasoro MD, Adimorah GN, Chukwudi NK, Nnakenyi ID, Iloh KK, Udemba CE. Reductive effect of ursodeoxycholic acid on bilirubin levels in neonates on phototherapy. Clin Exp Gastroenterol 2019; 12:349-354. [PMID: 31534356 PMCID: PMC6681162 DOI: 10.2147/ceg.s207523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background Phototherapy is paramount in the management of high total serum bilirubin (TSB). Whether its effectiveness can be improved with ursodeoxycholic acid (UDCA) has not been evaluated among newborns of African descent. Methods A double-blind-controlled study was used to evaluate the effect of UDCA on the management of high TSB in neonates. Recruited neonates were categorized into the experimental group (given UDCA plus phototherapy) and the control group (phototherapy and plain syrup), and their TSB and conjugated bilirubin levels were measured. The data were analyzed using SPSS version 20. Statistical significance was set at a p-value of <0.05. Results The mean (SD) percentage reductions in TSB after 24 hrs were 40.73% (18.1) and 10.21% (7.1) in the experimental and control groups, respectively, and the difference was statistically significant (p=0.001). The mean (SD) durations on therapy were 3.0 days (0.58) in the experimental group and 5.5 days (1.35) in the control group (p=0.001). Conclusions Phototherapy is still effective in the management of neonatal hyperbilirubinemia, but inclusion of UDCA accentuates the reductive effect of phototherapy on the TSB in neonates, reducing the duration of treatment and in-patient care.
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Affiliation(s)
| | | | | | | | | | - Charles Ejike Udemba
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Castro A, Zozaya C, Cuesta MT, González M, Villar G, Alcaraz A. Usefulness of transcutaneous bilirubin assessment measured in non-photo-exposed skin to guide the length of phototherapy: an observational study. J Perinat Med 2019; 47:568-573. [PMID: 30998502 DOI: 10.1515/jpm-2018-0429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/26/2019] [Indexed: 11/15/2022]
Abstract
Background Transcutaneous bilirubinometers are a non-invasive tool to estimate serum bilirubin. However, once on phototherapy (PHT) and after PHT, its usefulness is precluded. The objective of this study was to prove the hypothesis that transcutaneous bilirubin (TcB) assessment in a covered skin area during PHT could be used to guide the duration of PHT in term and moderate-late preterm infants with non-isoimmune hyperbilirubinemia. Methods A small area of parasternal skin was covered before starting on PHT. Total serum and TcB (both in exposed and non-exposed areas) were determined before starting treatment, every 12 h once on PHT and 12 h after its discontinuation. Pearson's correlation coefficient and paired mean differences between TcB and total serum bilirubin (TSB) were calculated. Bland-Altman plots were obtained. The percentage of correct treatment decisions made based on non-exposed TcB values was calculated. Results During PHT, there was a relatively good correlation between TSB and non-exposed TcB (0.74) estimates, in contrast to exposed TcB estimates (0.52). However, even when comparing non-exposed TcB with TSB, there was a wide range of agreement limits (-3.8 to 4.6 mg/dL). Decisions based on non-exposed TcB values would have been incorrect in 26.6% of the cases. Conclusion Although there is a relatively strong correlation between total serum and TcB in non-PHT-exposed regions, the difference is not narrow enough to be utilized in guiding clinical decisions on the duration of PHT.
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Affiliation(s)
- Abdón Castro
- Neonatal Unit, Paediatric Service, Hospital Universitario de Getafe, Carretera Madrid - Toledo, Km 12,500, 28905 Getafe, Madrid, Spain
| | - Carlos Zozaya
- Neonatal Unit, Paediatric Service, Hospital Universitario de Getafe, Carretera Madrid - Toledo, Km 12,500, 28905 Getafe, Madrid, Spain
| | - Mª Teresa Cuesta
- Neonatal Unit, Paediatric Service, Hospital Universitario de Getafe, Carretera Madrid - Toledo, Km 12,500, 28905 Getafe, Madrid, Spain
| | - Marina González
- Neonatal Unit, Paediatric Service, Hospital Universitario de Getafe, Carretera Madrid - Toledo, Km 12,500, 28905 Getafe, Madrid, Spain
| | - Gema Villar
- Neonatal Unit, Paediatric Service, Hospital Universitario de Getafe, Carretera Madrid - Toledo, Km 12,500, 28905 Getafe, Madrid, Spain
| | - Andrés Alcaraz
- Neonatal Unit, Paediatric Service, Hospital Universitario de Getafe, Carretera Madrid - Toledo, Km 12,500, 28905 Getafe, Madrid, Spain
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98
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Sampurna MTA, Ratnasari KA, Saharso D, Bos AF, Sauer PJJ, Dijk PH, Hulzebos CV. Current phototherapy practice on Java, Indonesia. BMC Pediatr 2019; 19:188. [PMID: 31176379 PMCID: PMC6555918 DOI: 10.1186/s12887-019-1552-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 05/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background In Indonesia, the burden of severe hyperbilirubinemia is higher compared to other countries. Whether this is related to ineffective phototherapy (PT) is unknown. The aim of this study is to investigate the performance of phototherapy devices in hospitals on Java, Indonesia. Methods In 17 hospitals we measured 77 combinations of 20 different phototherapy devices, with and without curtains drawn around the incubator/crib. With a model to mimic the silhouette of an infant, we measured the irradiance levels with an Ohmeda BiliBlanket Meter II, recorded the distance between device and model, and compared these to manufacturers’ specifications. Results In nine hospitals the irradiance levels were less than required for standard PT: < 10 μW/cm2/nm and in eight hospitals irradiance failed to reach the levels for intensive phototherapy: 30 μW/cm2/nm. Three hospitals provided very high irradiance levels: > 50 μW/cm2/nm. Half of the distances between device and model were greater than recommended. Distance was inversely correlated with irradiance levels (R2 = 0.1838; P < 0.05). The effect of curtains on irradiance levels was highly variable, ranging from − 6.15 to + 15.4 μW/cm2/nm, with a mean difference (SD) of 1.82 (3.81) μW/cm2/nm (P = 0.486). Conclusions In half of the hospitals that we studied on Java the levels of irradiance are too low and, in some cases, too high. Given the risks of insufficient phototherapy or adverse effects, we recommend that manufacturers provide radiometers so hospitals can optimize the performance of their phototherapy devices. Electronic supplementary material The online version of this article (10.1186/s12887-019-1552-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mahendra T A Sampurna
- Department of Pediatrics, Dr. Soetomo General Hospital, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia.
| | - Kinanti A Ratnasari
- Department of Pediatrics, Dr. Soetomo General Hospital, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Darto Saharso
- Department of Pediatrics, Dr. Soetomo General Hospital, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Arend F Bos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter J J Sauer
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Peter H Dijk
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Christian V Hulzebos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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LED-phototherapy does not induce oxidative DNA damage in hyperbilirubinemic Gunn rats. Pediatr Res 2019; 85:1041-1047. [PMID: 30851724 DOI: 10.1038/s41390-019-0367-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/18/2019] [Accepted: 02/26/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Phototherapy (PT) is the standard treatment of neonatal unconjugated hyperbilirubinemia. Fluorescent tube (FT)-emitted PT light is known to induce oxidative DNA damage in neonates. Nowadays, however, FTs have largely been replaced by light-emitting diodes (LEDs) for delivering PT. Until now, it is unknown whether LED-PT causes oxidative DNA damage. We aim to determine whether LED-PT induces oxidative DNA damage in hyperbilirubinemic rats. METHODS Adult Gunn rats, with genetically unconjugated hyperbilirubinemia, received LED-PT in the clinically relevant doses of 10 or 30 µW/cm2/nm. Urine was collected at 0, 24, and 48 h of PT. A group of young Gunn rats received intensive LED-PT of 100 µW/cm2/nm for 24 h. Urine was collected every 8 h and analyzed for the levels of oxidative DNA damage marker 8-hydroxy-2'deoxyguanosine (8-OHdG) and creatinine. DNA damage was evaluated by immunohistochemistry (γH2AX) of skin and spleen samples. RESULTS LED-PT of 10 and 30 µW/cm2/nm did not affect urinary concentrations of 8-OHdG and creatinine or the 8-OHdG/creatinine ratio. Likewise, intensive LED-PT did not affect the 8-OHdG/creatinine ratio or the number of γH2AX-positive cells in the skin or spleen. CONCLUSIONS Our results show that LED-PT does not induce oxidative DNA damage in hyperbilirubinemic Gunn rats either at clinically relevant or intensive dosages.
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Shin KH, Lee HJ, Song D, Lee SM, Kim IS, Kim H, Yang EJ, Park KH. Characteristics of Bilirubin According to the Results of the Direct Antiglobulin Test and Its Impact in Hemolytic Disease of the Newborn. Lab Med 2019; 50:138-144. [PMID: 30192966 DOI: 10.1093/labmed/lmy050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hyperbilirubinemia, which is a sign of hemolytic disease of the newborn (HDN), can irreversibly damage the central nervous system. OBJECTIVES To determine the etiology of HDN in affected patients and characterize the changing pattern of bilirubin using direct antiglobulin testing (DAT). METHODS We collected clinical data from newborns who underwent perinatal DAT and from their mothers, between August 2008 and July 2017. RESULTS Among 303 neonates, 37 (12.2%) showed positive DAT results. The positive predictive values (PPVs) and negative predictive values (NPVs) based on DAT results were 75.7% and 28.9%, respectively, for starting phototherapy. Bilirubin levels increased more rapidly in the DAT-positive group, compared with the DAT-negative group. The initial bilirubin level differed significantly according to the etiology of hyperbilirubinemia. Further, neonates with anti-D showed higher delta bilirubin per day than neonates with other antibodies. CONCLUSION Our results may help to determine the measurement period for bilirubin according to DAT results and etiology.
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Affiliation(s)
- Kyung-Hwa Shin
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, South Korea
| | - Hyun-Ji Lee
- Department of Laboratory Medicine, Biomedical Research Institute Pusan National University Yangsan Hospital, Busan, South Korea
| | - Duyeal Song
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital
| | - Sun-Min Lee
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital
| | - In Suk Kim
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, South Korea
| | - Hyunghoi Kim
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, South Korea
| | - Eu Jeen Yang
- Department of Pediatrics, Pusan National University Hospital
| | - Kyung-Hee Park
- Department of Pediatrics, Pusan National University Hospital
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