251
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Berns M. Ätiologie, Pathogenese und Therapie des Ikterus bei Neugeborenen. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-010-2365-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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252
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Abstract
Globally, health care providers worldwide recognize that severe neonatal jaundice is a "silent" cause of significant neonatal morbidity and mortality. Untreated neonatal jaundice can lead to death in the neonatal period and to kernicterus, a major cause of neurologic disability (choreo-athetoid cerebral palsy, deafness, language difficulty) in children who survive this largely preventable neonatal tragedy. Appropriate technologies are urgently needed. These include tools to promote and enhance visual assessment of the degree of jaundice, such as simpler transcutaneous bilirubin measurements and readily available serum bilirubin measurements that could be incorporated into routine treatment and follow-up. Widespread screening for glucose-6-phoshate dehydrogenase deficiency is needed because this is often a major cause of neonatal jaundice and kernicterus worldwide. Recognition and treatment of Rh hemolytic disease, another known preventable cause of kernicterus, is critical. In addition, effective phototherapy is crucial if we are to make kernicterus a "never-event." Finally it is essential that we conduct appropriate population-based studies to accurately elucidate the magnitude of the problem. However, knowledge alone is not sufficient. If we are to implement these and other programs and technologies to relegate severe neonatal jaundice and its sequelae to the history books, screening and interventions must be low cost and technologically appropriate for low and middle income nations.
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Affiliation(s)
- Tina M Slusher
- Center for Global Pediatrics, University of Minnesota, MN 55414, USA.
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253
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Abstract
Extreme neonatal jaundice occurs infrequently but carries a high risk of permanent sequelae (kernicterus) when it does. Rapid therapeutic intervention has the potential to reduce this risk in some infants. Several case reports of infants with acute intermediate to advanced bilirubin encephalopathy shows that reversal may be possible. Phototherapy can be instituted at the flip of a switch, whereas other therapeutic measures necessarily involve delays. Therefore, high-intensity phototherapy must be regarded as an emergency measure in infants presenting with extreme jaundice and even more so in the presence of neurological symptoms. The principal and well-described effect of phototherapy involves conversion of bilirubin IXα (z, z) to more polar isomers, which are excreted in bile and urine. When care is taken to maximize the spectral power of phototherapy lights, and whenever possible with measures added to reduce the enterohepatic circulation of bilirubin, very rapid reductions in total serum bilirubin levels are possible. A hypothesis has been advanced that conversion of bilirubin to more polar photoisomers, which can reach relative concentrations of 20%-25% of total serum bilirubin within 1-2 hours, might have a direct neuroprotective effect. This theory posits that because polar molecules generally require a transporter to cross the blood-brain barrier, bilirubin photoisomers should be less prone to enter the brain. Although this theory has some support in in vitro toxicity studies, the evidence is controversial. Until further experimental support can be gained, photoconversion of bilirubin does not constitute a viable argument against instituting further measures against bilirubin neurotoxicity, such as intravenous immune globulin (when indicated) and exchange transfusion. Conversely, neither is the state of evidence an argument against immediate and effective phototherapy in the medical emergency of extreme neonatal jaundice.
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Affiliation(s)
- Thor Willy Ruud Hansen
- Department of Neonatology, Women's and Children's Division, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
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254
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Bhutani VK, Cline BK, Donaldson KM, Vreman HJ. The need to implement effective phototherapy in resource-constrained settings. Semin Perinatol 2011; 35:192-7. [PMID: 21641494 DOI: 10.1053/j.semperi.2011.02.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Phototherapy is the treatment of choice to reduce the severity of neonatal unconjugated hyperbilirubinemia regardless of its etiology. Its implementation requires a technical framework that conforms to existing evidence-based guidelines that promote its safer and effective use worldwide. Optimal use of phototherapy has been defined by specific ranges of total serum bilirubin thresholds configured to an infant's postnatal age (in hours) and potential risk for bilirubin neurotoxicity. Effective phototherapy implies its use at specific blue light wavelengths (peak emission, 450 ± 20 nm) and emission spectrum (range, 400-520 nm), preferably in a narrow bandwidth that is delivered at an irradiance of ≥30 μW/cm(2)/nm to up to 80% of an infant's body surface area. However, this is often not feasible in clinical settings with limited or constrained resources. To identify and bridge implementation barriers, we propose minimum criteria for device performance for safe and practical use of phototherapy as a prophylactic intervention to prevent severe hyperbilirubinemia.
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Affiliation(s)
- Vinod K Bhutani
- Division of Neonatal-Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA 94304, USA.
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255
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Demirel G, Akar M, Celik IH, Erdeve O, Uras N, Oguz SS, Dilmen U. Single versus multiple dose intravenous immunoglobulin in combination with LED phototherapy in the treatment of ABO hemolytic disease in neonates. Int J Hematol 2011; 93:700-703. [PMID: 21617887 DOI: 10.1007/s12185-011-0853-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/04/2011] [Accepted: 04/05/2011] [Indexed: 11/26/2022]
Abstract
Intravenous immunoglobulin (IVIG) has been found to decrease hemolysis in neonatal jaundice due to blood group incompatibility, but a consensus on its usage has not been reached. We conducted a study to compare single versus multiple dose of IVIG in combination with light emitting diode (LED) phototherapy in patients with neonatal jaundice secondary to ABO blood incompatibility, and compared the efficacy of these treatments with that in a group of patients who received LED phototherapy solely. Thirty-nine term neonates with ABO blood group incompatibility were enrolled in the study. Group I received one dose of IVIG (1 g/kg) and LED phototherapy, and group II two doses of IVIG (1 g/kg) and LED phototherapy, whereas group III received LED phototherapy only. In group I, exchange transfusion was performed in one patient (6%) and in group II in one patient (10%). In the control group, none of the patients required exchange transfusion. Duration of LED phototherapy was 4.3 ± 0.7 days in group I + II (IVIG group), 3.9 ± 0.6 days in group III (P = 0.06). Lowest hematocrit level in group I + II was 35.0 ± 7.8 and group III was 38.9 ± 4.2, this was statistically significant (P = 0.034). IVIG therapy, single or multiple, did not affect exchange transfusion, need of erythrocyte transfusion and hospitalization time when used in combination with LED phototherapy in the treatment of ABO hemolytic jaundice in neonates.
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Affiliation(s)
- Gamze Demirel
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, 06230, Altindag, Ankara, Turkey.
| | - Melek Akar
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, 06230, Altindag, Ankara, Turkey
| | - Istemi Han Celik
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, 06230, Altindag, Ankara, Turkey
| | - Omer Erdeve
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, 06230, Altindag, Ankara, Turkey
| | - Nurdan Uras
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, 06230, Altindag, Ankara, Turkey
| | - Serife Suna Oguz
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, 06230, Altindag, Ankara, Turkey
| | - Ugur Dilmen
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, 06230, Altindag, Ankara, Turkey
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256
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Dani C, Poggi C, Barp J, Romagnoli C, Buonocore G. Current Italian practices regarding the management of hyperbilirubinaemia in preterm infants. Acta Paediatr 2011; 100:666-9. [PMID: 21314845 DOI: 10.1111/j.1651-2227.2011.02172.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To assess the current practices existing in Italy for the management of jaundice in preterm infants as preliminary achievement to a call for national guidelines and establishment of a kernicterus registry. METHODS A questionnaire (in Supporting Information online) was sent to the 109 level III neonatal units in Italy to ascertain existing guidelines for total bilirubin monitoring and treatment of hyperbilirubinaemia in preterm infants and occurrence of kernicterus. RESULTS There was a 61% (67/109) response rate. Eighty-five per cent of responding units had either written guidelines coming from different literature sources or locally developed. The monitoring of bilirubin varied greatly in timing before, during and after jaundice development. Phototherapy and exchange transfusion were given to 56.0 ± 21.0% and 0.2 ± 0.4% of admitted preterm infants in participating centres. Five cases of kernicterus in preterm infants and eleven cases in term infants were documented over the last 10 years. CONCLUSION The management of hyperbilirubinaemia in preterm infants is not uniform in Italy and would benefit from shared national guidance together with establishment of a kernicterus registry to guide therapy.
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MESH Headings
- Bilirubin/blood
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/blood
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/therapy
- Intensive Care Units, Neonatal
- Intensive Care, Neonatal/methods
- Intensive Care, Neonatal/standards
- Italy/epidemiology
- Jaundice, Neonatal/blood
- Jaundice, Neonatal/therapy
- Kernicterus/epidemiology
- Practice Guidelines as Topic
- Registries
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Affiliation(s)
- Carlo Dani
- Section of Neonatology, Department of Surgical and Medical Critical Care, Careggi University Hospital of Florence, Italy.
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257
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Cortey A, Berry M, Pernot F, Lattes F, Galiay JC, Chevalier M. Photothérapie : critères d’indication et choix des modalités. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)70950-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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258
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Abstract
UNLABELLED Jaundice is the most common reason for instituting treatment in otherwise healthy as well as sick newborn infants. Herein, we describe the process employed in Norway to forge agreement on a set of treatment guidelines that are now used across the country. The Norwegian Pediatric Association was a key resource in this process, which involved contacts with all paediatric departments in Norway. We have also performed an international survey regarding the use of such national guidelines, showing that the majority of those queried confirm having national guidelines. The evidence base for any neonatal jaundice guideline is weak; therefore, it is not surprising that the various guidelines differ both in format and in specifics. In the Norwegian guidelines, treatment indications are based on bilirubin concentrations and related to birth weight. Postnatal age is also factored in because jaundice develops gradually during the first 3-4 days before it levels off. CONCLUSION Following the introduction of these guidelines, fewer babies in Norway receive phototherapy, and no cases of chronic kernicterus have been reported during this period.
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Affiliation(s)
- D Bratlid
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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259
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de Carvalho M, Mochdece CC, Sá CAM, Moreira MEL. High-intensity phototherapy for the treatment of severe nonhaemolytic neonatal hyperbilirubinemia. Acta Paediatr 2011; 100:620-3. [PMID: 21251060 DOI: 10.1111/j.1651-2227.2011.02170.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To describe the clinical approach to term and near-term newborn infants with severe hyperbilirubinaemia and to analyse the effect of high-intensity phototherapy on total serum bilirubin (TSB) levels. METHODS We analysed a cohort of 116 newborn infants with severe nonhaemolytic hyperbilirubinaemia (TSB ≥20 mg/dL/342 μmol/L). All patients were treated with high-intensity phototherapy. The main outcomes were reduction in TSB levels in the first 24 h of phototherapy, incidence of exchange transfusion, pathological brainstem auditory evoked responses and pathological findings on neurological examination at discharge. RESULTS The mean birth weight and gestational age were 3161±466 g and 37.8±1.6 weeks. Mean initial TSB concentration was 22.4±2.4 mg/dL. Per cent decreases in TSB after 2, 4, 6, 12, 18 and 24 h of phototherapy were 9.4%, 16%, 23%, 40%, 44% and 50%, respectively. No infant was treated with exchange transfusion. Brainstem evoked response audiometry (BAER) was performed in 100% of the patients, and in three of them, this examination was altered. However, when repeated 3 months later, these BAER examinations were normal. Neurological examination was normal in all patients. CONCLUSIONS High-intensity phototherapy significantly reduces TSB in nonhaemolytic severe hyperbilirubinaemia and decreases the need for exchange transfusion.
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Affiliation(s)
- Manoel de Carvalho
- Department of Neonatology, Instituto Fernandes Figueira/Fiocruz, Flamengo, Rio de Janeiro, Brazil
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260
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Elalfy MS, Elbarbary NS, Abaza HW. Early intravenous immunoglobin (two-dose regimen) in the management of severe Rh hemolytic disease of newborn--a prospective randomized controlled trial. Eur J Pediatr 2011; 170:461-7. [PMID: 20924607 DOI: 10.1007/s00431-010-1310-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Accepted: 09/15/2010] [Indexed: 11/28/2022]
Abstract
Phototherapy is the standard treatment in moderately severe hemolytic disease of newborn (HDN), whereas exchange transfusion (ET) is the second line in progressive cases. Intravenous immunoglobin (IVIG) has been suggested to decrease the need for ET. We aimed at assessing the efficacy of early two-dose regimens of IVIG to avoid unnecessary ET in severe Rh HDN. The study included 90 full-term neonates with Rh incompatibility unmodified by antenatal treatment and not eligible for early ET and which were randomly assigned into one of three groups: group (I), treated by conventional method; groups IIa and IIb received IVIG once at 12 h postnatal age if PT was indicated, in a dose of 0.5 and 1 g/kg, respectively. Analysis revealed 11 neonates (22%) in the conventional group and 2 (5%) in the intervention group who administered low-dose IVIG at 12 h, while none in group IIb required exchange transfusion (p = 0.03). Mean bilirubin levels were significantly lower during the first 96 h in the intervention group compared to the conventional group (p < 0.0001). Shorter duration of phototherapy (52.8 ± 12.39 h) and hospital stay (3.25 ± 0.71 days) in the IVIG group compared to conventional group (84 ± 12.12 h and 4.72 ± 0.78 days, p < 0.0001, respectively) were observed. We conclude that IVIG administration at 12 h was effective in the treatment of severe Rh HDN; the low-dose IVIG (0.5 g/kg) was as effective as high dose (1 g/kg) in reducing the duration of phototherapy and hospital stay, but less effective in avoiding exchange transfusion.
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Affiliation(s)
- Mohsen Saleh Elalfy
- Department of Pediatric Hematology, Faculty of Medicine, Ain Shams University Cairo, Morbah, 1153, Egypt.
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261
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Muldoon TJ, Roblyer D, Williams MD, Stepanek VMT, Richards-Kortum R, Gillenwater AM. Noninvasive imaging of oral neoplasia with a high-resolution fiber-optic microendoscope. Head Neck 2011; 34:305-12. [PMID: 21413101 PMCID: PMC3078517 DOI: 10.1002/hed.21735] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2010] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the ability of high-resolution microendoscopy to image and quantify changes in cellular and architectural features seen in early oral neoplasia in vivo. METHODS A high-resolution microendoscope (HRME) was used to image intact, resected oral squamous carcinoma specimens. HRME images were reviewed and classified as non-neoplastic or neoplastic by expert clinicians. An algorithm based on quantitative morphologic features was also used to classify each image. Results were compared to the histopathologic diagnosis. RESULTS HRME images were obtained from 141 sites in resected specimens from 13 patients. Subjective image interpretation yielded sensitivity and specificity of 85% to 90% and 80% to 85%, respectively, whereas the objective classification algorithm achieved sensitivity and specificity of 81% and 77%, respectively. CONCLUSION High-resolution microendoscopy of intact oral mucosa can provide images with sufficient detail to classify oral lesions by both subjective image interpretation and objective image analysis.
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Affiliation(s)
- Timothy J Muldoon
- Rice University Department of Bioengineering, 6100 Main Street, Houston, Texas 77005, USA
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262
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[Neonatal ABO incompatibility underlies a potentially severe hemolytic disease of the newborn and requires adequate care]. Arch Pediatr 2011; 18:279-82. [PMID: 21255989 DOI: 10.1016/j.arcped.2010.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/08/2010] [Accepted: 12/19/2010] [Indexed: 11/20/2022]
Abstract
ABO allo-immunization is the most frequent hemolytic disease of the newborn and ABO incompatibility is present in 15-25 % of pregnancies. True ABO alloimmunization occurs in approximately one out of 150 births. Intensity is generally lower than in RhD allo-immunization. We report on three cases showing that ABO allo-immunization can lead to severe hemolytic disease of the newborn with potentially threatening hyperbilirubinemia and complications. Early diagnosis and adequate care are necessary to prevent complications in ABO incompatibility. A direct antiglobulin test is the cornerstone of diagnosis and should be performed at birth on cord blood sampling in all group infants born to O mothers, especially if of African origin. Risk factor analysis and attentive clinical monitoring during the first days of life are essential. Vigilance is even more important for infants discharged before the age of 72 h. Every newborn should be assessed for the risk of developing severe hyperbilirubinemia and should be examined by a qualified healthcare professional in the first days of life. Treatment depends on the total serum bilirubin level, which may increase very rapidly in the first 48 h of life in cases of hemolytic disease of the newborn. Phototherapy and, in severe cases, exchange transfusion are used to prevent hyperbilirubinemia encephalopathy. Intravenous immunoglobulins are used to reduce exchange transfusion. Treatments of severe hemolytic disease of the newborn should be provided and performed by trained personnel in neonatal intensive care units.
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263
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van Imhoff DE, Dijk PH, Weykamp CW, Cobbaert CM, Hulzebos CV. Measurements of neonatal bilirubin and albumin concentrations: a need for improvement and quality control. Eur J Pediatr 2011; 170:977-82. [PMID: 21213112 PMCID: PMC3139054 DOI: 10.1007/s00431-010-1383-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 12/14/2010] [Indexed: 11/17/2022]
Abstract
Accurate and precise bilirubin and albumin measurements are essential for proper management of jaundiced neonates. Data hereon are lacking for Dutch laboratories. We aimed to determine variability of measurements of bilirubin and albumin concentrations typical for (preterm) neonates. Aqueous, human serum albumin-based samples with different concentrations of bilirubin (100, 200, 300, 400, and 500 μmol/L) and albumin (0, 10, 15, 20, 25, and 30 g/L) were sent to laboratories of all Dutch neonatal intensive care units (n = 10). Bilirubin and albumin recoveries of the specimens were measured using locally available routine analytical methods. The mean, standard deviation, and coefficients of variations (CV) were calculated per sample. Bilirubin concentrations were underestimated in the absence of albumin (maximal CV 26.0%). When the albumin concentration was 10 or 20 g/L, the bilirubin concentrations of the samples were overestimated (maximal CV 14.1% and 9.2%, respectively). Variability increased with higher weighed-in bilirubin concentrations. Measured albumin levels were ~10% lower than albumin levels of manufactured samples. Bilirubin concentration did not influence albumin measurements. The maximal CV was 6.8%. In conclusion, interlaboratory variability of bilirubin and albumin measurements is high. Recalibration and introduction of a specific quality assessment scheme for neonatal samples is recommended to ensure exchangeability of bilirubin and albumin measurements among laboratories and to control the observed large variability.
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Affiliation(s)
- Deirdre E. van Imhoff
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Peter H. Dijk
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Cas W. Weykamp
- Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, The Netherlands
| | - Christa M. Cobbaert
- Department of Clinical Chemistry, University Medical Center Leiden, Leiden, The Netherlands
| | - Christian V. Hulzebos
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - On behalf of the BARTrial Study Group
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
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264
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Abstract
To reduce the incidence of severe neonatal hyperbilirubinemia affecting newborns with jaundice in the United States and to prevent kernicterus, there is a need to implement proven prevention strategies for severe neonatal hyperbilirubinemia as recommended in the 2004 American Academy of Pediatrics Guidelines for newborns >35 weeks gestational age. The purpose of universal predischarge bilirubin screening is to identify infants with bilirubin levels >75th percentile for age in hours and track those with rapid rates of bilirubin rise (>0.2 mg per 100 ml per h). Early identification has been reported to predict severe hyperbilirubinemia and allow for evidence-based targeted interventions. A systems approach is likely to reduce the preventable causes of acute bilirubin encephalopathy. To do so, highest priority should be given to (i) designating extreme hyperbilirubinemia (total serum bilirubin >427 μmol l(-1) or >25 mg per 100 ml) as a reportable condition by laboratories and health-care providers through public health mandates; (ii) implementation of Joint Commission's Sentinel Report for kernicterus; (iii) nursing outreach to communities for education of prospective parents; (iv) development of clinical pathways to monitor, evaluate and track infants with extreme hyperbilirubinemia; and (v) societal awareness. These efforts should be monitored by a state and national surveillance system in order to critically improve the timeliness and completeness of notifications and to allow evaluation and interventions at the policy and individual family level.
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266
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Oakes GH, Bend JR. Global changes in gene regulation demonstrate that unconjugated bilirubin is able to upregulate and activate select components of the endoplasmic reticulum stress response pathway. J Biochem Mol Toxicol 2010; 24:73-88. [PMID: 20196124 DOI: 10.1002/jbt.20313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Elevated concentrations of unconjugated bilirubin (UCB) are responsible for neonatal jaundice and can eventually lead to kernicterus or death. The molecular mechanism of UCB toxicity is incompletely elucidated. The purpose of this study was to analyze changes in gene regulation mediated by UCB to determine novel pathways that contribute to UCB-mediated toxicity. We employed microarray analysis to determine changes in gene regulation mediated by UCB at both pro- (50 microM) and antioxidant (70 nM) concentrations in Hepa 1c1c7 cells at 1 and 6 h. The changes observed in select genes were validated with qPCR. Using immunoblot analysis, we validated these changes at the protein level for select genes and documented the activation of two proteins involved in the endoplasmic reticulum (ER) stress pathway, eIF2 alpha and PERK. Following treatment with 50 microM UCB, microarray analysis revealed the upregulation of many genes involved in ER stress (ATF3, BiP, CHOP, Dnajb1, and Herp). We demonstrate that upregulation of the proapoptotic transcription factor CHOP results in increased intracellular protein content. It was determined that activation of proteins involved in ER stress was an early event in UCB toxicity as eIF2 alpha and PERK were both phosphorylated and activated by 1 h posttreatment. We also demonstrate that procaspase-12 content, a proposed initiator caspase in ER stress-mediated apoptosis, is decreased by 4 h posttreatment. In conclusion, this study demonstrates that elevated concentrations of UCB (50 microM) are able to activate select components of the ER stress pathway in Hepa 1c1c7 cells, which may contribute to UCB-mediated apoptosis.
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Affiliation(s)
- Garth H Oakes
- Department of Physiology & Pharmacology, Siebens-Drake Medical Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, 1400 Western Road, London, Ontario, Canada
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267
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A fiber-optic fluorescence microscope using a consumer-grade digital camera for in vivo cellular imaging. PLoS One 2010; 5:e11218. [PMID: 20585636 PMCID: PMC2890400 DOI: 10.1371/journal.pone.0011218] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 05/27/2010] [Indexed: 11/25/2022] Open
Abstract
Background Early detection is an essential component of cancer management. Unfortunately, visual examination can often be unreliable, and many settings lack the financial capital and infrastructure to operate PET, CT, and MRI systems. Moreover, the infrastructure and expense associated with surgical biopsy and microscopy are a challenge to establishing cancer screening/early detection programs in low-resource settings. Improvements in performance and declining costs have led to the availability of optoelectronic components, which can be used to develop low-cost diagnostic imaging devices for use at the point-of-care. Here, we demonstrate a fiber-optic fluorescence microscope using a consumer-grade camera for in vivo cellular imaging. Methods The fiber-optic fluorescence microscope includes an LED light, an objective lens, a fiber-optic bundle, and a consumer-grade digital camera. The system was used to image an oral cancer cell line labeled with 0.01% proflavine. A human tissue specimen was imaged following surgical resection, enabling dysplastic and cancerous regions to be evaluated. The oral mucosa of a healthy human subject was imaged in vivo, following topical application of 0.01% proflavine. Findings The fiber-optic microscope resolved individual nuclei in all specimens and tissues imaged. This capability allowed qualitative and quantitative differences between normal and precancerous or cancerous tissues to be identified. The optical efficiency of the system permitted imaging of the human oral mucosa in real time. Conclusion Our results indicate this device as a useful tool to assist in the identification of early neoplastic changes in epithelial tissues. This portable, inexpensive unit may be particularly appropriate for use at the point-of-care in low-resource settings.
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268
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Abstract
Phototherapy for jaundice is a common treatment in neonatal medicine and is used to prevent the neurotoxic effects of bilirubin. Studies have assessed the optimal wavelength of phototherapy light, the importance of irradiance and spectral power, and the types of light source, including the use of single versus multiple light sources. Outcome measures have been duration of need for phototherapy or rate of reduction of serum bilirubin over a given time. An apparent resurgence of kernicterus in recent years has forced us to focus on the emergency management of severely jaundiced infants. Several studies have shown that very rapid reductions of total serum bilirubin levels are possible. The speed with which photoisomers are formed appears to be important both from this perspective and theoretically may also be neuroprotective because of the more polar nature of the photoisomers. This work reviews the evidence concerning the speed of photoisomer formation, as well as the evidence regarding the relative neurotoxicity of bilirubin isomers.
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Affiliation(s)
- Thor Willy Ruud Hansen
- Neonatal Intensive Care Unit, Women's and Children's Clinic, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
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269
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Abstract
Despite a century of research, several clinically relevant areas of bilirubin biochemistry remain controversial, poorly understood, or unrecognized. These include: (i) The structure and molecularity of bilirubin under physiological environments such as membranes, brain tissue and when bound to proteins. Related to this is the large number of structurally different bilirubin species that may occur in blood under pathological conditions and their potential effects on measurements of bilirubin and free bilirubin. (ii) The mechanism of phototherapy, the neurotoxicity of the photoisomers produced and their influence on measurements of bilirubin and free bilirubin. (iii) The role of membrane transporters in the passage of unconjugated bilirubin across the placenta, intestine, vascular epithelium, blood-brain barrier, and into the liver. (iv) Biochemical mechanisms of bilirubin toxicity, pharmacologic prevention of kernicterus, the contribution of bilirubin to antioxidant defenses, and the practical value of free bilirubin measurements for identifying infants at most risk of kernicterus.
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Mreihil K, McDonagh AF, Nakstad B, Hansen TWR. Early isomerization of bilirubin in phototherapy of neonatal jaundice. Pediatr Res 2010; 67:656-9. [PMID: 20308939 DOI: 10.1203/pdr.0b013e3181dcedc0] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neonatal jaundice is usually treated with phototherapy that converts bilirubin to more polar stereoisomers. These should theoretically be less able to cross the blood-brain barrier. The rates of photoisomer formation and concentrations accumulating in the circulation may have a bearing on the risk of kernicterus. The purpose of this study was to determine the rate of appearance of the major 4Z, 15E photoisomer of bilirubin during the early stages of phototherapy. Twenty jaundiced neonates were treated with phototherapy, and blood samples were drawn before and at approximately 15, 30, 60, and 120 min (10 infants) or at approximately 15, 60, 120, and 240 min (10 infants) after beginning phototherapy. Blood samples were analyzed for total serum bilirubin (TSB) and the 4Z, 15E photoisomer of bilirubin. Significant (p<0.0001) formation of the 4Z, 15E photoisomer was detectable within 15 min. The change in TSB from time 0 was insignificant at 120 min but reached significance at 240 min (p<0.001). The 4Z, 15E bilirubin constituted up to 20-25% of TSB at 2 h and may not have peaked by 4 h. Further studies are needed to determine whether this early shift in balance between bilirubin isomers with different polarities may impact the risk of bilirubin encephalopathy even before TSB starts to fall.
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Affiliation(s)
- Khalaf Mreihil
- Neonatal Intensive Care Unit, Children's and Youth Clinic, Akershus University Hospital, N-1478 Nordbyhagen, Norway
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271
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Abstract
BACKGROUND It was long believed that newborns could not experience pain. As it is now documented that newborns have all the necessary systems to perceive pain, pain management can no longer be ignored. The objective of this study is to investigate which concentration of glucose is most effective in reducing pain for venipuncture in the newborn. METHODS This double-blind clinical trial of 304 newborns was conducted on a maternity and neonatal ward (neonatal medium intensive care unit). During at least 1 month, one of the four selected solutions (10, 20, 30% glucose, and placebo) was administered orally, 2 minutes before the venipuncture was performed. The pain from the skin puncture was scored using a validated pain scale (the "Leuven Pain Scale"). RESULTS This study showed a significantly lower average pain score in the 30 percent glucose group (3.99) when compared with the placebo group (8.43). The average pain scores in the 20 percent glucose group (5.26) and the 10 percent glucose group (5.92) were also significantly lower than those in the placebo group. CONCLUSION Oral administration of 2 mL of 30 percent glucose 2 minutes before the venipuncture provides the most effective pain reduction in newborns.
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Affiliation(s)
- Ben Dilen
- Neonatal Ward, Heilig Hart Hospital, Mol, Belgium
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272
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273
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Managing well-appearing neonates with hyperbilirubinemia in the emergency department observation unit. Pediatr Emerg Care 2010; 26:343-8. [PMID: 20404780 DOI: 10.1097/pec.0b013e3181db2058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In September 2005, Texas Children's Hospital initiated a protocol for all neonates presenting to the emergency department (ED) with hyperbilirubinemia based on the American Academy of Pediatrics guidelines. As part of the protocol, low-risk neonates with hyperbilirubinemia requiring phototherapy are treated in the ED observation unit (EDOU). OBJECTIVE The aim of the study was to compare time to phototherapy and duration of hospital stay in low-risk neonates with hyperbilirubinemia presenting to the Texas Children's Hospital ED before and after the initiation of a triage-based protocol. DESIGN/METHODS We performed a retrospective historical control study comparing neonates with hyperbilirubinemia treated in the EDOU between January 1 and December 31, 2006 (EDOU group), with neonates with hyperbilirubinemia admitted to the inpatient unit between January 1 and December 31, 2004 (inpatient group). RESULTS There were 167 neonates included in the study: 62 neonates were treated in the EDOU and 105 in the inpatient unit. Median time to phototherapy (inpatient: 6.7 hours, EDOU: 1.6 hours) and duration of hospital stay (inpatient: 41.8 hours, EDOU: 17.8 hours) were shorter for neonates treated in the EDOU compared with neonates treated in the inpatient unit. Of the neonates treated in the EDOU initially, 11 were admitted to the inpatient unit after 24 hours because their bilirubin level did not decline adequately. CONCLUSIONS Low-risk neonates with hyperbilirubinemia can be managed more efficiently in an EDOU than in an inpatient unit. Phototherapy is initiated more rapidly, and patients are discharged sooner in the EDOU than in the inpatient setting.
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274
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Tayman C, Tatli MM, Aydemir S, Karadag A. Overhead is superior to underneath light-emitting diode phototherapy in the treatment of neonatal jaundice: a comparative study. J Paediatr Child Health 2010; 46:234-7. [PMID: 20337873 DOI: 10.1111/j.1440-1754.2009.01676.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To compare the efficacy of overhead and underneath light-emitting diode (LED) devices in the treatment of neonatal jaundice. METHODS We compared two LED phototherapy devices: the neoBLUE device, which provides overhead illumination, and the neoBLUE cozy device, which provides illumination from underneath the infant. The models we used had similar LED sources and provided similar light intensities (30 microW/cm(2)/nm). Infants with hyperbilirubinemia were assigned to one of two groups according to the phototherapy device used (group 1, overhead illumination, 181 infants; group 2, underneath illumination, 61 infants). Recorded variables included birthweight, gender, family history, aetiology of jaundice, total duration of phototherapy and total serum bilirubin (TSB) concentration at the initiation of phototherapy, at 12-hour intervals and just before the cessation of phototherapy. The rates of decrease in TSB concentration were calculated. RESULTS There were significant differences in the mean duration of phototherapy and in the rate of decrease in TSB concentration between the two groups. The mean duration of phototherapy in group 2 was higher than in group 1 (P= 0.037). The rate of decrease in TSB in group 1 was higher than in group 2 (P= 0.01). CONCLUSION These results suggest that when phototherapy is used in the treatment of neonatal jaundice, the direction from which the light is applied should be considered in addition to light source intensity.
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Affiliation(s)
- Cuneyt Tayman
- Department of Neonatology, Fatih University School of Medicine, Y. Ayranci, Ankara, Turkey.
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275
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Vasconcelos CKBD, Ferreira GR, Bianchi RF. Desenvolvimento e caracterização de sensor de acúmulo de dose de radiação azul polimérico. POLIMEROS 2010. [DOI: 10.1590/s0104-14282010005000010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neste trabalho as propriedades ópticas do poli[2-metóxi,5-(2'etil-hexiloxi)-p-fenilenovinileno] - MEH-PPV foram estudadas sob efeito de luz azul proveniente de super LEDs utilizada no tratamento da hiperbilirrubinemia neonatal (ou icterícia). Os resultados mostraram que o MEH-PPV apresenta uma mudança de cor do vermelho-alaranjado para o incolor, passando por diversas tonalidades de amarelo, bem como uma diminuição da intensidade dos espectros de absorção e de fotoluminescência (PL) em função do tempo de exposição à radiação. Essas mudanças foram usadas para projetar um sensor de acúmulo de dose de radiação azul, tipo indicador de cores, para avaliar a dose de radiação recebida por recém-nascidos durante o tratamento da icterícia neonatal.
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276
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Paragh G, Ugocsai P, Vogt T, Schling P, Kel AE, Tarabin V, Liebisch G, Orsó E, Markó L, Balogh A, Köbling T, Remenyik É, Wikonkál NM, Mandl J, Farwick M, Schmitz G. Whole genome transcriptional profiling identifies novel differentiation regulated genes in keratinocytes. Exp Dermatol 2010; 19:297-301. [DOI: 10.1111/j.1600-0625.2009.00920.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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277
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Curry S. Lessons from the crystallographic analysis of small molecule binding to human serum albumin. Drug Metab Pharmacokinet 2010; 24:342-57. [PMID: 19745561 DOI: 10.2133/dmpk.24.342] [Citation(s) in RCA: 221] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
SUMMARY Human serum albumin (HSA) is an abundant and highly soluble plasma protein with the capacity to bind a remarkably diverse set of lipophilic anionic compounds so that it fulfils important roles in the transport of nutrients, hormones and toxins. The protein attracts great interest from the pharmaceutical industry since it can also bind a variety of drug molecules, impacting their delivery and efficacy. Our understanding of the binding and transport properties of albumin has been transformed by structural studies of the protein, in which crystallographic analysis has played a leading role. This review summarises the main insights to have accrued from this work, highlighting the significant advances that have been made but also pointing out some of the challenges ahead. Since further progress is likely to benefit from increased structural scrutiny of HSA, methodological developments instrumental to the success of crystallographic analysis of the protein are discussed in some detail.
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Affiliation(s)
- Stephen Curry
- Biophysics Section, Blackett Laboratory, Imperial College, United Kingdom.
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278
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Onyango AB, Suresh G, Were F. Intermittent phototherapy versus continuous phototherapy for neonatal jaundice. Hippokratia 2009. [DOI: 10.1002/14651858.cd008168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Awuonda B Onyango
- University of Nairobi-Kenya; Pediatrics; P.O. Box 11305-00100 Nairobi Kenya
| | - Gautham Suresh
- Dartmouth-Hitchcock Medical Center; Department of Pediatrics, Neonatal Division; One Medical Center Drive Lebanon NH USA 03576-001
| | - Fred Were
- University of Nairobi and Aga Khan University; Department of Paediatrics and Child Health; Nairobi Kenya
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279
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Hansen TWR, Nietsch L, Norman E, Bjerre JV, Hascoet JM, Mreihil K, Ebbesen F. Reversibility of acute intermediate phase bilirubin encephalopathy. Acta Paediatr 2009; 98:1689-94. [PMID: 19583707 DOI: 10.1111/j.1651-2227.2009.01409.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To show the potential for reversing acute intermediate to advanced phase bilirubin encephalopathy. METHODS Case studies. RESULTS Six extremely jaundiced infants had symptoms of intermediate to advanced phase acute bilirubin encephalopathy. The infants were treated aggressively. Two patients had brain magnetic resonance imaging showing increased signals in the globus pallidus. On follow-up, all infants are neurologically normal. CONCLUSIONS Intermediate-to-advanced stage acute bilirubin encephalopathy may occasionally be reversible. These cases provide a strong argument in favour of rapid and aggressive intervention in infants presenting with extreme jaundice and neurological symptoms.
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Affiliation(s)
- Thor Willy Ruud Hansen
- Neonatal Intensive Care Unit, Division of Paediatrics, Oslo University Hospital, Oslo, Norway.
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280
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Immunoglobulines polyvalentes intraveineuses et ictère néonatal par allo-immunisation érythrocytaire. Arch Pediatr 2009; 16:1289-94. [DOI: 10.1016/j.arcped.2009.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 04/22/2009] [Accepted: 05/31/2009] [Indexed: 11/15/2022]
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281
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Abstract
Screening for severe neonatal hyperbilirubinemia is integral to newborn care. Predischarge risk assessment relies on documentation of visual jaundice: age at onset and progression; identification of clinical risk such as late prematurity and bruising; with determination of total bilirubin (blood or transcutaneous assay) adjusted for age in hours. Along with promotion of breastfeeding, coordination between birthing hospital and medically supervised outpatient follow-up, a systems approach allows for a safer and effective means to prevent adverse effects of extreme hyperbilirubinemia.
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Affiliation(s)
- Vinod K Bhutani
- Professor of Pediatrics-Neonatology Stanford University School of Medicine, Lucile Packard Children’s Hospital, 750 Welch Rd, #315, Stanford, CA 94305, USA
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282
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Navarro M, Negre S, Matoses ML, Golombek SG, Vento M. Necrotizing enterocolitis following the use of intravenous immunoglobulin for haemolytic disease of the newborn. Acta Paediatr 2009; 98:1214-7. [PMID: 19397554 DOI: 10.1111/j.1651-2227.2009.01279.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To describe a series of patients who received intravenous immunoglobulin (IVIg) for the treatment of neonatal hyperbilirubinaemia and developed necrotizing enterocolitis (NEC) shortly thereafter. POPULATION AND RESULTS We describe three healthy breastfed newly born infants with isoimmunization-derived hyperbilirubinaemia refractory to phototherapy who were treated with IVIg. Shortly after the perfusion finished they developed clinical and radiological signs compatible with NEC and needed antibiotic therapy, prolonged parenteral nutrition and even surgery in one case. Other conditions such as septicaemia or coagulopathy were ruled out. Microscopic examination of the resected intestine revealed the presence of disseminated thrombi obstructing multiple minor vessels of the mesenteric circulation. CONCLUSION IVIg in the newborn period should be cautiously employed and always administered under strict medical control.
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Affiliation(s)
- Mariel Navarro
- Division of Neonatology, University Hospital La Fe, Valencia, Spain
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283
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Watchko JF. Identification of neonates at risk for hazardous hyperbilirubinemia: emerging clinical insights. Pediatr Clin North Am 2009; 56:671-87, Table of Contents. [PMID: 19501698 DOI: 10.1016/j.pcl.2009.04.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hyperbilirubinemia is the most common condition requiring evaluation and treatment in neonates. Identifying among all newborns those few at risk to develop marked hyperbilirubinemia is a clinical challenge. Clinical, epidemiologic, and genetic risk factors associated with severe hyperbilirubinemia include late preterm gestational age, exclusive breastfeeding, glucose-6-phosphate dehydrogenase deficiency, ABO hemolytic disease, East Asian ethnicity, jaundice observed in the first 24 hours of life, cephalohematoma or significant bruising, and history of a previous sibling treated with phototherapy. It is increasingly apparent that the etiopathogenesis of severe hyperbilirubinemia is often multifactorial, and emerging evidence suggests that combining risk factor assessment with measurement of predischarge total serum or transcutaneous bilirubin levels will improve hyperbilirubinemia risk prediction.
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Affiliation(s)
- Jon F Watchko
- Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, Magee-Womens Research Institute, Magee-Womens Hospital, Pittsburgh, PA 15213, USA.
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284
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Karadag A, Yesilyurt A, Unal S, Keskin I, Demirin H, Uras N, Dilmen U, Tatli MM. A chromosomal-effect study of intensive phototherapy versus conventional phototherapy in newborns with jaundice. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2009; 676:17-20. [DOI: 10.1016/j.mrgentox.2009.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 02/18/2009] [Accepted: 03/05/2009] [Indexed: 01/12/2023]
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285
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Mahé E, Beauchet A, Aegerter P, Saiag P. Neonatal blue-light phototherapy does not increase nevus count in 9-year-old children. Pediatrics 2009; 123:e896-900. [PMID: 19403483 DOI: 10.1542/peds.2008-2986] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE One of the most important risk factors for melanoma is the number of acquired common and atypical nevi in childhood. The role played by neonatal blue-light phototherapy in the increasing incidence of common and atypical melanocytic nevi in childhood or adolescence has been discussed recently with discordant results. PATIENTS AND METHODS We designed a multicenter study to assess the effects of neonatal blue-light phototherapy on nevus count in a cohort of 9-year-old children. We counted back and arm nevi as a function of size in 828 children included in a French photoprotection educational campaign. History of neonatal phototherapy, phototype, skin, hair and eye color, and sunburn were assessed through questionnaires to which both parents and children responded, and a nevus count was performed by trained nurses blinded to phototherapy history. RESULTS Mean nevus count was 16.7 per child. Twenty-two percent of the children had received neonatal blue-light phototherapy. Neonatal phototherapy had no effect on the nevus count irrespective of nevi location, nevi size, or phototype of the children. A light phototype, skin, and hair color; blue/green eyes; and history of sunburn were closely correlated with an increase in nevus count. CONCLUSIONS This study found no evidence for a major role of blue-light phototherapy on nevus count in 9-year-old children. It underlines the dominant effect of phototype characteristics and history of sunburn in childhood on the early development of melanocytic nevi.
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Affiliation(s)
- Emmanuel Mahé
- Service de Dermatologie, Centre Hospitalier Universitaire Ambroise Paré, 9 Ave Charles de Gaulle, 92100 Boulogne-Billancourt, France.
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286
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Ferreira GR, de Vasconcelos CKB, Bianchi RF. Design and characterization of a novel indicator dosimeter for blue-light radiation. Med Phys 2009; 36:642-4. [PMID: 19292005 DOI: 10.1118/1.3039788] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Optical absorption and fluorescence measurements have been done on poly[2-methoxy-5-(2'-ethyl-hexyloxy)-1,4-phenylene vinylene]/[aluminum-tris(8-hydroxyquinoline)] solutions. The authors show that there is a visible response that covers the electronic absorption of bilirubin (350-500 nm), and hence, this material is applicable for managing the radiation doses planning before treatment of jaundice of neonates, which is one of the most common reasons of hospital readmission of newborns infants. The results show that the material presents a gradation of color from orange to yellow clearly, while its peak position emission shifts from orange-red (lambda(max) = 571 nm) to green (lambda(max) = 540 nm) with the radiation exposure time. The rate of these changes can be altered by manipulations of organic solution concentration and they are usually slow (from 2 to 8 h), suggesting these color and emission changes can be used to design an easy to make, easy to read, easy to operate, low cost (< US $0.50) and accuracy for individual monitoring indicator dosimeter in order to represent easily the radiation exposure time usually used in management of neonatal jaundice.
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Affiliation(s)
- G R Ferreira
- Departamento de Física da Universidade Federal de Ouro Preto-UFOP, Laborarório de Polímeros e Propriedades Eletrônicas de Materials-LAPPEM, Campus Morro do Cruzeiro, CEP 35400-000, Ouro Preto-MG, Brazil
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287
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288
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Owa JA, Ogunlesi TA, Ogunlesi TA. Why we are still doing so many exchange blood transfusion for neonatal jaundice in Nigeria. World J Pediatr 2009; 5:51-5. [PMID: 19172333 DOI: 10.1007/s12519-009-0009-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 07/19/2008] [Indexed: 01/08/2023]
Abstract
BACKGROUND Since exchange blood transfusion (EBT) is associated with serious complications, phototherapy has been made more powerful to reduce the need for EBT in the developed world. This study was undertaken to determine the indications for EBT in neonatal jaundice (NNJ) at our unit and what proportion of EBTs was possibly avoidable. METHODS All the babies who had EBT for hyperbilirubinemia over a three-year period were included. Age, sex, weight, place of delivery, blood group of baby and mother, other investigations, management, and the outcome of the babies were recorded. RESULTS Of the 1686 babies admitted to the neonatal unit, 90 (5.3%) had EBT. Fourteen (15.6%) were inborn while 76 (84.4%) were out-born babies. Fifty-six (62.2%) babies were admitted primarily for NNJ while 34 (37.8%) developed NNJ during admission. Thirty-six (40.0%) of the babies had phototherapy for more than 24 hours prior to EBT either because they were of very low birthweight or NNJ was detected very early and therapy was so commenced. Sixty-eight (75.6%) babies had single EBT while the remaining 22 (24.4%) had two sessions of EBT. Factors associated with severe NNJ in babies requiring EBT included low birthweight (<2500 g, 44.4%), ABO incompatibility (30.0%), glucose-6-phosphate dehydrogenase deficiency (34.4%) and septicemia (26.1%). Twenty-seven (30.0%) of the neonates developed features of kernicterus: 26 before admission while 1 during admission; all except one were delivered outside the hospital. CONCLUSIONS The EBT rate in our center was high. With more effective phototherapy, EBT could be avoided in most of the babies who initially had phototherapy for more than 24 hours before EBT and repeated EBT sessions. Health education of the population at risk, especially pregnant women, and early referral at the primary health care level will reduce the burden of severe NNJ.
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Affiliation(s)
- Joshua Aderinsola Owa
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
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289
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Fitzpatrick E, Mtegha M, Dhawan A. Crigler-Najjar syndrome: therapeutic options and consequences of mutations in the UGT1A1 complex. Expert Rev Endocrinol Metab 2008; 3:725-737. [PMID: 30764062 DOI: 10.1586/17446651.3.6.725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Crigler-Najjar syndrome (CN), a rare inherited disorder characterized by failure of bilirubin glucuronidation, can lead to severe disability and death from kernicterus. Gilbert syndrome is a more common, benign familial unconjugated hyperbilirubinemia. The underlying problem in both conditions is impaired bilirubin conjugation and elimination due to a mutation in uridine 5'-diphosphate glucuronyltransferase. The mainstay of current management of CN is phototherapy, followed by liver transplantation. Here, we review other therapies, including hepatocyte transplantation, that have been successfully used to lessen the phenotype, although long-term engraftment of cells remains elusive. Gene therapy holds hope for the future whereby the patient's hepatocytes are transduced with the wild-type gene. Outstanding issues include safety of the gene vector and establishing immunotolerance to both vector and the new protein. The significant advances in understanding the relevance of mutations in UGT not only in glucuronidation of bilirubin, but other drugs and substances, are also reviewed.
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Affiliation(s)
- Emer Fitzpatrick
- a Paediatric Liver Centre, King's College London School of Medicine at King's College Hospital, Denmark Hill, London SE5 9PJ, UK
| | - Marumbo Mtegha
- a Paediatric Liver Centre, King's College London School of Medicine at King's College Hospital, Denmark Hill, London SE5 9PJ, UK
| | - Anil Dhawan
- b Paediatric Liver Centre, King's College London School of Medicine at King's College Hospital, Denmark Hill, London SE5 9PJ, UK.
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290
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Carceller-Blanchard A, Cousineau J, Delvin EE. Point of care testing: transcutaneous bilirubinometry in neonates. Clin Biochem 2008; 42:143-9. [PMID: 18929553 DOI: 10.1016/j.clinbiochem.2008.09.106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 09/19/2008] [Accepted: 09/19/2008] [Indexed: 10/21/2022]
Abstract
Physicians taking care of infants in the first days of life are often faced with neonatal jaundice, especially in an era where post-partum discharge occurs earlier and assessment of newborn bilirubinemia status is required prior to discharge. The Canadian Pediatric Society and the American Academy of Pediatrics have developed and published guidelines for the diagnosis and management of hyperbilirubinemia in newborns. Point of care testing refers to any test performed outside of laboratory by clinical personnel and close to the site of patient care. Based on a summary of multiple reports during the last twenty years, we realize that devices which provide a non-invasive transcutaneous bilirubin (TcB) measurement have proven to be very useful as screening tools and provide a valid estimate of the total serum bilirubin level (TSB). Published data suggest that these devices provide measurements within 30-50 micromol/L of the TSB levels and can replace laboratory measurement particularly when TSB levels are less than 260 micromol/L. At the present time, in the literature, evidence is insufficient to abandon neonatal serum bilirubin testing and replace it with TcB. Any measurement, TSB or TcB, has potential for error. However, we have evidence that TcB, can help avoiding potential errors associated with even visual assessment of jaundice and may be useful as screening device to detect significant jaundice and decrease a large number of unnecessary skin punctures. The current manuscript is based on a careful comprehensive literature review concerning neonatal hyperbilirubinemia. We consider that this manuscript will help clinicians and laboratory professionals in the management of neonatal jaundice.
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Affiliation(s)
- A Carceller-Blanchard
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
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291
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Bhutani VK, Johnson L. The Jaundiced Newborn in the Emergency Department: Prevention of Kernicterus. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2008. [DOI: 10.1016/j.cpem.2008.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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292
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Photolysis and photoisomerization of bilirubin in serum specimens exposed to room lighting. Clin Chim Acta 2008; 393:130; author reply 131. [DOI: 10.1016/j.cca.2008.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Accepted: 03/06/2008] [Indexed: 11/21/2022]
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293
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Rehak NN, Cecco SA, Hortin GL. Photolysis of bilirubin in serum specimens exposed to room lighting. Clin Chim Acta 2008. [DOI: 10.1016/j.cca.2008.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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294
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Zunszain PA, Ghuman J, McDonagh AF, Curry S. Crystallographic analysis of human serum albumin complexed with 4Z,15E-bilirubin-IXalpha. J Mol Biol 2008; 381:394-406. [PMID: 18602119 PMCID: PMC2568863 DOI: 10.1016/j.jmb.2008.06.016] [Citation(s) in RCA: 201] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 05/28/2008] [Accepted: 06/03/2008] [Indexed: 11/30/2022]
Abstract
Bilirubin, an insoluble yellow-orange pigment derived from heme catabolism, accumulates to toxic levels in individuals with impaired or immature liver function. The resulting jaundice may be managed with phototherapy to isomerize the biosynthetic 4Z,15Z-bilirubin-IXalpha to more soluble and excretable isomers, such as 4Z,15E-bilirubin. Bilirubin and its configurational isomers are transported to the liver by human serum albumin (HSA) but their precise binding location(s) on the protein have yet to be determined. To investigate the molecular details of their interaction, we co-crystallised bilirubin with HSA. Strikingly, the crystal structure--determined to 2.42 A resolution--revealed the 4Z,15E-bilirubin-IXalpha isomer bound to an L-shaped pocket in sub-domain IB. We also determined the co-crystal structure of HSA complexed with fusidic acid, an antibiotic that competitively displaces bilirubin from the protein, and showed that it binds to the same pocket. These results provide the first crystal structure of a natural bilirubin pigment bound to serum albumin, challenge some of the present conceptions about HSA-bilirubin interactions, and provide a sound structural framework for finally resolving the long-standing question of where 4Z,15Z-bilirubin-IXalpha binds to the protein.
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Affiliation(s)
- Patricia A Zunszain
- Biophysics Section, Blackett Laboratory, Imperial College, South Kensington Campus, Exhibition Road, London SW7 2AZ, UK
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McDonagh AF, Boiadjiev SE, Lightner DA. Slipping Past UGT1A1 and Multidrug Resistance-Associated Protein 2 in the Liver: Effects of Steric Compression and Hydrogen Bonding on the Hepatobiliary Elimination of Synthetic Bilirubins. Drug Metab Dispos 2008; 36:930-6. [DOI: 10.1124/dmd.107.019778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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