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Dam-Vervloet AJ, Bosschaart N, van Straaten HLM, Poot L, Hulzebos CV. Irradiance footprint of phototherapy devices: a comparative study. Pediatr Res 2022; 92:453-458. [PMID: 34728809 PMCID: PMC9522581 DOI: 10.1038/s41390-021-01795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/13/2021] [Accepted: 10/04/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Phototherapy (PT) is the standard treatment of neonatal unconjugated hyperbilirubinemia. The irradiance footprint, i.e., the illuminated area by the PT device with sufficient spectral irradiance, is essential for PT to be effective. Irradiance footprint measurements are not performed in current clinical practice. We describe a user-friendly method to systematically evaluate the high spectral irradiance (HSI) footprint (illuminated area with spectral irradiance of ≥30 μW cm-2 nm-1) of PT devices in clinical practice. MATERIALS AND METHODS Six commercially available LED-based overhead PT devices were evaluated in overhead configuration with an incubator. Spectral irradiance (µW cm-2 nm-1) and HSI footprint were measured with a radiospectrometer (BiliBlanket Meter II). RESULTS The average measured spectral irradiance ranged between 27 and 52 μW cm-2 nm-1 and HSI footprint ranged between 67 and 1465 cm2, respectively. Three, two, and one PT devices out of six covered the average BSA of an infant born at 22, 26-32, and 40 weeks of gestation, respectively. CONCLUSION Spectral irradiance of LED-based overhead PT devices is often lower than manufacturer's specifications, and HSI footprints not always cover the average BSA of a newborn infant. The proposed measurement method will contribute to awareness of the importance of irradiance level as well as footprint measurements in the management of neonatal jaundice. IMPACT While a sufficient spectral irradiance footprint is essential for PT to be effective, some PT devices have spectral irradiance footprints that are too small to cover the entire body surface area (BSA) of a newborn infant. This study introduces a user-friendly, accessible method to systematically evaluate the spectral irradiance level and footprint of PT devices. This study supports awareness on the role of the spectral irradiance footprint in the efficacy of PT devices. Irradiance footprint can be easily measured during phototherapy with the proposed method.
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Affiliation(s)
- Alida J. Dam-Vervloet
- grid.452600.50000 0001 0547 5927Medical Physics Department, Isala Hospital, Zwolle, The Netherlands
| | - Nienke Bosschaart
- grid.6214.10000 0004 0399 8953Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - Lieke Poot
- grid.452600.50000 0001 0547 5927Medical Physics Department, Isala Hospital, Zwolle, The Netherlands
| | - Christian V. Hulzebos
- grid.4494.d0000 0000 9558 4598Neonatology Department, UMCG, Groningen, The Netherlands
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252
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Stannsoporfin with phototherapy to treat hyperbilirubinemia in newborn hemolytic disease. J Perinatol 2022; 42:110-115. [PMID: 34635771 DOI: 10.1038/s41372-021-01223-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/09/2021] [Accepted: 09/23/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of tin mesoporphyrin (SnMP) in neonates with hyperbilirubinemia (HB) due to hemolysis. STUDY DESIGN This multicenter, placebo-controlled phase 2b study (NCT01887327) randomized newborns (35-42 weeks) with hemolysis started on phototherapy (PT) to placebo (Ctrl), SnMP 3.0 mg/kg, or SnMP 4.5 mg/kg given once IM within 30 min of initiation of PT. RESULTS In all, 91 patients were randomized (Ctrl: n = 30; 3 mg/kg SnMP: n = 30; 4.5 mg/kg SnMP: n = 31). At 48 h TSB significantly increased in Ctrl by 17.5% (95% CI 5.6-30.7; p = 0.004) and significantly decreased by -13% (95% CI -21.7 to -3.2; p = 0.013) in the 3.0 mg/kg and by -10.5% (95% CI -19.4 to -0.6; p = 0.041) in the 4.5 mg/kg group. Decreases in SnMP groups were significant (p < 0.0001) vs Ctrl. CONCLUSION SnMP with PT significantly reduced TSB by 48 h. SnMP may be useful as a treatment for HB in neonates with hemolysis.
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253
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Meek JY, Carmona CA, Mancini EM. Problems of the Newborn and Infant. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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254
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Hanin EA, Rayan H, Hani T, Taleb J, Dany AH, Lama C. Breastfeeding and Readmission for Hyperbilirubinemia in Late Preterm and Term Infants in Beirut, Lebanon. Indian Pediatr 2021. [DOI: 10.1007/s13312-022-2472-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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255
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Deng H, Zhou Y, Wang L, Zhang C. Ensemble learning for the early prediction of neonatal jaundice with genetic features. BMC Med Inform Decis Mak 2021; 21:338. [PMID: 34852805 PMCID: PMC8638201 DOI: 10.1186/s12911-021-01701-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal jaundice may cause severe neurological damage if poorly evaluated and diagnosed when high bilirubin occurs. The study explored how to effectively integrate high-dimensional genetic features into predicting neonatal jaundice. METHODS This study recruited 984 neonates from the Suzhou Municipal Central Hospital in China, and applied an ensemble learning approach to enhance the prediction of high-dimensional genetic features and clinical risk factors (CRF) for physiological neonatal jaundice of full-term newborns within 1-week after birth. Further, sigmoid recalibration was applied for validating the reliability of our methods. RESULTS The maximum accuracy of prediction reached 79.5% Area Under Curve (AUC) by CRF and could be marginally improved by 3.5% by including genetic variant (GV). Feature importance illustrated that 36 GVs contributed 55.5% in predicting neonatal jaundice in terms of gain from splits. Further analysis revealed that the main contribution of GV was to reduce the false-positive rate, i.e., to increase the specificity in the prediction. CONCLUSIONS Our study shed light on the theoretical and practical value of GV in the prediction of neonatal jaundice.
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Affiliation(s)
- Haowen Deng
- School of Management, Fudan University, Shanghai, China
| | - Youyou Zhou
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Lin Wang
- Shanghai University of Finance and Economics, Shanghai, China
| | - Cheng Zhang
- School of Management, Fudan University, Shanghai, China.
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256
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Lahmann JM, Faase RA, Leu HY, Jacques SL, Scottoline B, Schilke KF, Baio JE, Higgins AZ. Microfluidic photoreactor to treat neonatal jaundice. BIOMICROFLUIDICS 2021; 15:064104. [PMID: 34853627 PMCID: PMC8616629 DOI: 10.1063/5.0066073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
While in most cases, jaundice can be effectively treated using phototherapy, severe cases require exchange transfusion, a relatively risky procedure in which the neonate's bilirubin-rich blood is replaced with donor blood. Here, we examine extracorporeal blood treatment in a microfluidic photoreactor as an alternative to exchange transfusion. This new treatment approach relies on the same principle as phototherapy but leverages microfluidics to speed up bilirubin removal. Our results demonstrate that high-intensity light at 470 nm can be used to rapidly reduce bilirubin levels without causing appreciable damage to DNA in blood cells. Light at 470 nm was more effective than light at 505 nm. Studies in Gunn rats show that photoreactor treatment for 4 h significantly reduces bilirubin levels, similar to the bilirubin reduction observed for exchange transfusion and on a similar time scale. Predictions for human neonates demonstrate that this new treatment approach is expected to exceed the performance of exchange transfusion using a low blood flow rate and priming volume, which will facilitate vascular access and improve safety.
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Affiliation(s)
- John M. Lahmann
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Ryan A. Faase
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Hsuan Yu Leu
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Steven L. Jacques
- Department of Bioengineering, University of Washington, Seattle, Washington 98105, USA
| | - Brian Scottoline
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - Kate F. Schilke
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Joe E. Baio
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Adam Z. Higgins
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
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Rabbani T, Guthery SL, Himes R, Shneider BL, Harpavat S. Newborn Screening for Biliary Atresia: a Review of Current Methods. Curr Gastroenterol Rep 2021; 23:28. [PMID: 34817690 DOI: 10.1007/s11894-021-00825-2] [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] [Accepted: 09/24/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Biliary atresia is a serious neonatal liver disease due to obstructed bile ducts that has better outcomes when detected and treated in the first 30-45 days of life. This review examines different methods to screen newborns for biliary atresia as well as discusses observations from ongoing screening programs implemented in parts of the United States. RECENT FINDINGS Screening strategies for biliary atresia include detecting persistent jaundice, examining stool color, testing fractionated bilirubin levels, or measuring bile acid levels from dried blood spot cards. The stool color card program is the most widely used screening strategy worldwide. An alternative approach under investigation in the United States measures fractionated bilirubin levels, which are abnormal in newborns with biliary atresia. Fractionated bilirubin screening programs require laboratories to derive reference ranges, nurseries to implement universal testing, and healthcare systems to develop infrastructure that identifies and acts upon abnormal results. Biliary atresia meets the disease-specific criteria for newborn screening. Current studies focus on developing a strategy which also meets all test-specific criteria. Such a strategy, if implemented uniformly, has the potential to accelerate treatment and reduce biliary atresia's large liver transplant burden.
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Affiliation(s)
- Tebyan Rabbani
- Department of Pediatrics, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Stephen L Guthery
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Utah and Intermountain Primary Children's Hospital, Salt Lake City, UT, USA
| | - Ryan Himes
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Ochsner Health, New Orleans, LA, USA
| | - Benjamin L Shneider
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin Street, CCC 1010, Houston, TX, 77030, USA
| | - Sanjiv Harpavat
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin Street, CCC 1010, Houston, TX, 77030, USA.
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259
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Bahr TM, Agarwal AM, Meznarich JA, Prince WL, Wait TWP, Prchal JT, Christensen RD. Thirty-five males with severe (Class 1) G6PD deficiency (c.637G>T) in a North American family of European ancestry. Blood Cells Mol Dis 2021; 92:102625. [PMID: 34773909 DOI: 10.1016/j.bcmd.2021.102625] [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] [Received: 06/22/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022]
Abstract
In North America, jaundiced neonates are not usually tested for G6PD deficiency if the family is of European ancestry. However, we describe such a family where ≥35 males have had severe (Class I) G6PD deficiency. Many of the jaundiced neonates did not have this diagnosis considered, at least three of whom developed bilirubin neurotoxicity. Over seven generations 35 affected males were identified. Three developed signs of kernicterus spectrum disorder; three had exchange transfusions for hyperbilirubinemia; and nine received one or more blood transfusions during childhood.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA; Neonatology, Intermountain Healthcare, Murray, UT, USA.
| | - Archana M Agarwal
- Division of Hematopathology, Department of Pathology, University of Utah Health, Salt Lake City, UT, USA; ARUP Laboratories, Salt Lake City, UT, USA
| | - Jessica A Meznarich
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
| | | | - Tirzah W P Wait
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Josef T Prchal
- Division of Hematology, Department of Internal Medicine, University of Utah Health, the Huntsman Cancer Institute, and the George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Robert D Christensen
- Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA; Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA; Neonatology, Intermountain Healthcare, Murray, UT, USA
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260
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Franchinard L, Maisonneuve E, Friszer S, Toly Ndour C, Huguet-Jacquot S, Maurice P, Mailloux A, Cortey A, Jouannic JM. Perinatal risk factors associated with severity of haemolytic disease of the foetus and newborn due to Rhc maternal-foetal incompatibility: A retrospective cohort study. Vox Sang 2021; 117:570-579. [PMID: 34743337 DOI: 10.1111/vox.13215] [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: 07/27/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Anti-c is the third red blood cell antibody responsible for haemolytic disease of the foetus and newborn (HDFN) requiring intrauterine transfusion. We aimed to identify risk factors associated with HDFN and severe HDFN due to Rhc maternal-foetal incompatibility. MATERIALS AND METHODS A retrospective cohort study was conducted in Paris and the surrounding area (France), between 2013 and 2015. We included mothers and their children managed by the National Reference Centre in Perinatal Hemobiology for alloimmunization and maternal-foetal incompatibility for the Rhc antigen (N = 121). We conducted bivariate analyses to assess a relationship between perinatal factors (e.g., titre and concentration of anti-c antibodies, direct antiglobulin test) and HDFN, its severity and duration. RESULTS The incidence of HDFN was 30% (n = 36), including 11% of severe HDFN (n = 13). Seven percent (n = 9) of neonates received at least one transfusion during the first week and 21% (n = 26) after this period until 3 weeks of life. During pregnancy, a concentration ≥7.5 IU/ml and a titre ≥4 and above were associated with HDFN and severe HDFN (p < 0.05). At birth, the high intensity of the quantitative direct antiglobulin test was associated with HDFN and severe HDFN (p < 0.05). A concentration ≥15 IU/ml is the best factor (area under curve [AUC] = 0.78) in predicting HDFN, followed by a titre ≥8 (AUC = 0.76). CONCLUSION Anti-c alloimmunization causes neonatal anaemia, which is often belated. Paediatricians have to be aware of these risk factors and organize prolonged monitoring of neonates.
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Affiliation(s)
- Loriane Franchinard
- Department of Fetal Medicine, Sorbonne University, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Unité Fonctionnelle Clinique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Armand Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Emeline Maisonneuve
- Department of Fetal Medicine, Sorbonne University, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Unité Fonctionnelle Clinique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Armand Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Stéphanie Friszer
- Department of Fetal Medicine, Sorbonne University, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Toly Ndour
- Unité Fonctionnelle Biologique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Stéphanie Huguet-Jacquot
- Unité Fonctionnelle Biologique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Paul Maurice
- Department of Fetal Medicine, Sorbonne University, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Unité Fonctionnelle Clinique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Armand Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Agnès Mailloux
- Unité Fonctionnelle Biologique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Anne Cortey
- Unité Fonctionnelle Clinique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Armand Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jean-Marie Jouannic
- Department of Fetal Medicine, Sorbonne University, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Unité Fonctionnelle Clinique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Armand Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
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261
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Pan SN, Lu WN. Reply - Fully automated simultaneous peripheral arteriovenous exchange transfusion not seen to aggravate brain function and the disorder of the internal environment in neonates with severe hyperbilirubinemia. Pediatr Neonatol 2021; 62:689-690. [PMID: 34389263 DOI: 10.1016/j.pedneo.2021.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/12/2021] [Accepted: 05/20/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Si-Nian Pan
- Pediatric Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Wei-Neng Lu
- Neonatology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China; Neonatology Department, Guangzhou Women and Children's Medical Center, Guangzhou, China
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262
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Digitale JC, Chang PW, Li SX, Kuzniewicz MW, Newman TB. The effect of hospital phototherapy on early breastmilk feeding. Paediatr Perinat Epidemiol 2021; 35:717-725. [PMID: 34184759 DOI: 10.1111/ppe.12794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/20/2021] [Accepted: 05/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The effect of phototherapy on breastmilk feeding is unclear. OBJECTIVE To estimate the effect of inpatient phototherapy on breastmilk feeding at 2-month well-child visits. METHODS We performed a retrospective cohort study using electronic health record data. From births at 16 Kaiser Permanente Northern California hospitals (2013-2017), we identified a cohort of infants ≥ 35 weeks' gestation with total serum bilirubin levels close to the American Academy of Pediatrics 2004 phototherapy threshold during their birth hospitalisation. We compared self-reported breastmilk feeding at 2-month well-child visits among those who had and had not received birth hospitalisation phototherapy, adjusting for bilirubin levels and other confounding variables. We used multiple imputation (K = 200) to address missing data. RESULTS Approximately a quarter of infants in the cohort (24.5%) received phototherapy during their birth hospitalisation. At the 2-month visit, exclusive breastmilk feeding was less common (RR 0.91, 95% interval [CI] 0.88, 0.95) among those who received phototherapy (41.3%) than those who did not (45.2%). However, no association remained after adjusting for potential confounders (RR 0.99, 95% CI 0.95, 1.04; average treatment effect on the treated [ATET] -0.2%, 95% CI -2.0%, 1.5%). In contrast, any breastmilk feeding was similar between infants who did (76.8%) and did not get phototherapy (77.9%). After adjusting for confounders, phototherapy had a slightly positive association with any breastmilk feeding at 2 months (RR 1.02, 95% CI 1.00, 1.04). Among infants who received phototherapy, the proportion being fed any breastmilk at the 2-month visit was an estimated 1.6 percentage points higher than it would have been if they had not received phototherapy (ATET 1.6%, 95% CI 0.1%, 3.1%). Multiple imputation results were similar. CONCLUSIONS Birth hospitalisation phototherapy can be delivered in a way that does not adversely affect breastmilk feeding at 2 months.
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Affiliation(s)
- Jean C Digitale
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Pearl W Chang
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Sherian X Li
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Michael W Kuzniewicz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Thomas B Newman
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco, CA, USA
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263
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Kujabi ML, Petersen JP, Pedersen MV, Parner ET, Henriksen TB. Neonatal jaundice and autism spectrum disorder: a systematic review and meta-analysis. Pediatr Res 2021; 90:934-949. [PMID: 33526883 DOI: 10.1038/s41390-020-01272-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: 05/13/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Two meta-analyses concluded that jaundice was associated with an increased risk of autism. We hypothesize that these findings were due to methodological limitations of the studies included. Neonatal jaundice affects many infants and risks of later morbidity may prompt physicians towards more aggressive treatment. METHODS To conduct a systematic literature review and a meta-analysis of the association between neonatal jaundice and autism with particular attention given to low risk of bias studies. Pubmed, Scopus, Embase, Cochrane, and Google Scholar were searched for publications until February 2019. Data was extracted by use of pre-piloted structured sheets. Low risk of bias studies were identified through predefined criteria. RESULTS A total of 32 studies met the inclusion criteria. The meta-analysis of six low risk of bias studies showed no association between neonatal jaundice and autism; cohort studies risk ratio 1.09, 95% CI, 0.99-1.20, case-control studies odds ratio 1.29 95% CI 0.95, 1.76. Funnel plot of all studies suggested a high risk of publication bias. CONCLUSIONS We found a high risk of publication bias, selection bias, and potential confounding in all studies. Based on the low risk of bias studies there was no convincing evidence to support an association between neonatal jaundice and autism. IMPACT Meta-analysis of data from six low risk of bias studies indicated no association between neonatal jaundice and autism spectrum disorder. Previous studies show inconsistent results, which may be explained by unadjusted confounding and selection bias. Funnel plot suggested high risk of publication bias when including all studies. There is no evidence to suggest jaundice should be treated more aggressively to prevent autism.
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Affiliation(s)
- Monica L Kujabi
- Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
| | - Jesper P Petersen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Mette V Pedersen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Erik T Parner
- Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
| | - Tine B Henriksen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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264
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Deng L, Ouyang W, Liu R, Deng M, Qiu J, Yaqub M, Raza M, Lin W, Guo L, Li H, Chen F, Ouyang Y, Huang Y, Huang Y, Long X, Huang X, Li S, Song Y. Clinical characterization of NTCP deficiency in paediatric patients : A case-control study based on SLC10A1 genotyping analysis. Liver Int 2021; 41:2720-2728. [PMID: 34369070 PMCID: PMC9291912 DOI: 10.1111/liv.15031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023]
Abstract
Na+ -taurocholate cotransporting polypeptide deficiency (NTCPD) is a newly described disorder arising from biallelic mutations of the SLC10A1 gene. As a result of a lack of compelling evidence from case-control studies, its genotypic and phenotypic features remain open for in-depth investigation. This study aimed to explore the genotypic and clinical phenotypic characteristics of paediatric patients with NTCPD. The SLC10A1 genotypes of all NTCPD patients were confirmed by screening for the prevalent variant c.800C>T and Sanger sequencing when necessary. The clinical presentations and laboratory changes were collected, reviewed and analysed, and then qualitatively and quantitatively compared with the relevant controls. A total of 113 paediatric NTCPD patients were diagnosed while c.374dupG and c.682_683delCT were detected as two novel pathogenic mutations. Hypercholanemia was observed in 99.12% of the patients. Indirect hyperbilirubinemia in affected neonates exhibited higher positive rates in comparison to controls. Moreover, transient cholestatic jaundice, elevated liver enzymes and 25-hydroxyvitamin D (Vit D) deficiency during early infancy were more commonly observed in patients than in controls. All NTCPD patients exhibited favourable clinical outcomes as a result of symptomatic and supportive treatment. The findings enriched the SLC10A1 mutation spectrum and provided comprehensive insights into the phenotypic characteristics of NTCPD. NTCPD should be considered and SLC10A1 gene should be analysed in patients with above age-dependent clinical features. Furthermore, over investigation and intervention should be avoided in the management of NTCPD patients.
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Affiliation(s)
- Li‐Jing Deng
- Department of PaediatricsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Wen‐Xian Ouyang
- Department of HepatopathyHunan Children’s HospitalChangshaChina
| | - Rui Liu
- Department of PaediatricsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Mei Deng
- Department of PaediatricsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Jian‐Wu Qiu
- Department of PaediatricsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Muhammad‐Rauf Yaqub
- Department of PaediatricsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Muhammad‐Atif Raza
- Department of PaediatricsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Wei‐Xia Lin
- Department of PaediatricsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Li Guo
- Department of PaediatricsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Hua Li
- Department of PaediatricsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Feng‐Ping Chen
- Department of Laboratory ScienceThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Ying Ouyang
- Department of PaediatricsSun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Yu‐Ge Huang
- Department of PaediatricsThe Affiliated Hospital of Guangdong Medical UniversityZhanjiangChina
| | - Yue‐Jun Huang
- Department of PaediatricsThe Second Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Xiao‐Ling Long
- Department of PaediatricsBo‐Ai Hospital of ZhongshanZhongshanChina
| | - Xiao‐Ling Huang
- Dongguan Maternal and Child Health Care HospitalDongguanChina
| | - Shuang‐Jie Li
- Department of HepatopathyHunan Children’s HospitalChangshaChina
| | - Yuan‐Zong Song
- Department of PaediatricsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
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265
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Digitale JC, Kim MO, Kuzniewicz MW, Newman TB. Update on Phototherapy and Childhood Cancer in a Northern California Cohort. Pediatrics 2021; 148:peds.2021-051033. [PMID: 34716218 DOI: 10.1542/peds.2021-051033] [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] [Accepted: 08/10/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We aimed to reassess the relationship between phototherapy and cancer in an extended version of a previous cohort and to replicate a report from Quebec of increased cancer risk after phototherapy beginning at age 4 years. METHODS This cohort study included 139 100 children born at ≥35 weeks' gestation from 1995 to 2017, followed through March 16, 2019, in Kaiser Permanente Northern California hospitals who had a qualifying bilirubin level from -3 mg/dL to +4.9 mg/dL from the American Academy of Pediatrics phototherapy threshold; an additional 40 780 children and 5 years of follow-up from our previous report. The exposure was inpatient phototherapy (yes or no), and the outcomes were various types of childhood cancer. We used Cox proportional hazard models, controlling for propensity-score quintiles, and allowed for time-dependent exposure effects to assess for the risk of cancer after a latent period. RESULTS Over a mean (SD) follow-up of 8.2 (5.7) years, the crude incidence of cancer per 100 000 person-years was 25.1 among those exposed to phototherapy and 19.2 among those not exposed (233 cases of cancer). After propensity adjustment, phototherapy was not associated with any cancer (hazard ratio [HR]: 1.13, 95% confidence interval [CI]: 0.83-1.54), hematopoietic cancer (HR: 1.17, 95% CI: 0.74-1.83), or solid tumors (HR: 1.01, 95% CI: 0.65-1.58). We also found no association with cancer diagnoses at age ≥4 years. CONCLUSIONS We did not confirm previous, concerning associations between phototherapy and adjusted risk of any cancer, nonlymphocytic leukemia, or brain and/or central nervous systems tumors in later childhood.
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Affiliation(s)
| | - Mi-Ok Kim
- Department of Epidemiology and Biostatistics.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Michael W Kuzniewicz
- Pediatrics.,Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Thomas B Newman
- Department of Epidemiology and Biostatistics.,Pediatrics.,Division of Research, Kaiser Permanente Northern California, Oakland, California
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266
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Bahr TM, Shakib JH, Stipelman CH, Kawamoto K, Lauer S, Christensen RD. Improvement Initiative: End-Tidal Carbon Monoxide Measurement in Newborns Receiving Phototherapy. J Pediatr 2021; 238:168-173.e2. [PMID: 34260896 DOI: 10.1016/j.jpeds.2021.07.008] [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: 04/28/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine, as part of our Utah Newborn Nursery Bilirubin Management Program, whether end-tidal carbon monoxide concentration (ETCOc) measurements in all newborns in our nursery receiving phototherapy were associated with outcomes related to the management of hyperbilirubinemia, including time (hours after birth) when phototherapy was initiated, total duration of phototherapy during the nursery stay, repeat phototherapy treatments, and hospital readmission for phototherapy. STUDY DESIGN We performed a planned interim analysis of a component of our program in which we measured ETCOc noninvasively using CoSense on each newborn in our nursery receiving phototherapy and recorded specific outcomes related to phototherapy management. RESULTS Of 1856 newborns admitted to our nursery in a 6-month period in 2020, 170 (9.8%) were treated with phototherapy. An ETCOc reading was successfully obtained in 145 of 151 attempts (96%). Higher ETCOc values were associated with earlier institution of phototherapy and longer duration of phototherapy. For every 1-ppm increase in ETCOc, phototherapy was started 9 hours earlier (95% CI, 3.3-14.8; P = .002) and was administered for an additional 9.3 hours (95% CI, 4.1-14.6; P < .001). Three newborns were readmitted to the hospital for intensive phototherapy; while in the nursery, all 3 had an elevated ETCOc (2.2, 2.6, and 2.9 ppm). CONCLUSIONS Our findings provide answers to questions raised in the 2004 American Academy of Pediatrics bilirubin guidelines. In our neonatal nursery, measuring ETCOc in all phototherapy recipients was feasible and safe, and the results were associated with multiple aspects of phototherapy management. Higher ETCOc values predicted earlier and longer phototherapy courses.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT.
| | - Julie H Shakib
- Division of General Pediatrics, Department of Pediatrics, University of Utah Health, Salt Lake City, UT
| | - Carole H Stipelman
- Division of General Pediatrics, Department of Pediatrics, University of Utah Health, Salt Lake City, UT
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah Health, Salt Lake City, UT
| | - Sarah Lauer
- Department of System Quality, University of Utah Health, Salt Lake City, UT
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT; Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT
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267
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Kaufman JS, Merckx J, Cooper RS. Use of Racial and Ethnic Categories in Medical Testing and Diagnosis: Primum Non Nocere. Clin Chem 2021; 67:1456-1465. [PMID: 34557889 DOI: 10.1093/clinchem/hvab164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Use of race and ethnicity is common in medical tests and procedures, even though these categories are defined by sociological, historical, and political processes, and vary considerably in their definitions over time and place. Because all societies organize themselves around these constructs in some way, they are undeniable facets of the human experience, with myriad health consequences. In the biomedical literature, they are also commonly interpreted as representing biological heterogeneity that is relevant for health and disease. CONTENT We review the use of race and ethnicity in medical practice, especially in the USA, and provide 2 specific examples to represent a large number of similar instances. We then critique these uses along a number of different dimensions, including limitations in measurement, within- versus between-group variance, and implications for informativeness of risk markers for individuals, generalization from arbitrary or nonrepresentative samples, perpetuation of myths and stereotypes, instability in time and place, crowding out of more relevant risk markers, stigmatization, and the tainting of medicine with the history of oppression. We conclude with recommendations to improve practice that are technical, ethical, and pragmatic. SUMMARY Medicine has evolved from a mystical healing art to a mature science of human health through a rigorous process of quantification, experimentation, and evaluation. Folkloric traditions, such as race- and ethnic-specific medicine will fade from use as we become increasingly critical of outdated and irrational clinical practices and replace these with personalized, evidenced-based tests, algorithms, and procedures that privilege patients' individual humanity over obsolete and misleading labels.
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268
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Shehab N, Isalmovic F, Williams P, Naymick SA, Alissa R. Copious amount of bloody stool in a newborn shortly after birth. SAGE Open Med Case Rep 2021; 9:2050313X211054260. [PMID: 34707868 PMCID: PMC8543549 DOI: 10.1177/2050313x211054260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
Melena neonatorum is not uncommon; it presents as bloody stool in newborns and is caused by ingestion of maternal blood. This case presents an infant who had multiple episodes of copious amount of blood in his stool starting at 10 min of life, which raised multiple concerns requiring further investigation. The alkali denaturation test confirmed that the blood was maternal; however, due to the amount of bloody stool and the time required for the alkali denaturation test to result, further workups such as abdominal radiograph and hemoglobin/hematocrit were completed to ensure nothing was overlooked. Our infant remained clinically stable under the newborn nursery care, and did not require a higher level of care. He was discharged with his mother at 52 Hours of Life with a follow-up appointment the next day with the Primary Care Physician.
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Affiliation(s)
- Norane Shehab
- Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Florinda Isalmovic
- Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Patty Williams
- Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - S Andrew Naymick
- Department of Family Medicine, Naval Hospital Jacksonville, Jacksonville, FL, USA
| | - Rana Alissa
- Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
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269
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Neonatal Jaundice Diagnosis Using a Smartphone Camera Based on Eye, Skin, and Fused Features with Transfer Learning. SENSORS 2021; 21:s21217038. [PMID: 34770345 PMCID: PMC8588081 DOI: 10.3390/s21217038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/17/2021] [Accepted: 10/21/2021] [Indexed: 11/17/2022]
Abstract
Neonatal jaundice is a common condition worldwide. Failure of timely diagnosis and treatment can lead to death or brain injury. Current diagnostic approaches include a painful and time-consuming invasive blood test and non-invasive tests using costly transcutaneous bilirubinometers. Since periodic monitoring is crucial, multiple efforts have been made to develop non-invasive diagnostic tools using a smartphone camera. However, existing works rely either on skin or eye images using statistical or traditional machine learning methods. In this paper, we adopt a deep transfer learning approach based on eye, skin, and fused images. We also trained well-known traditional machine learning models, including multi-layer perceptron (MLP), support vector machine (SVM), decision tree (DT), and random forest (RF), and compared their performance with that of the transfer learning model. We collected our dataset using a smartphone camera. Moreover, unlike most of the existing contributions, we report accuracy, precision, recall, f-score, and area under the curve (AUC) for all the experiments and analyzed their significance statistically. Our results indicate that the transfer learning model performed the best with skin images, while traditional models achieved the best performance with eyes and fused features. Further, we found that the transfer learning model with skin features performed comparably to the MLP model with eye features.
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270
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Hasosah M. Knowledge and Practice of Pediatric Providers Regarding Neonatal Cholestasis in the Western Region of Saudi Arabia. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2021; 9:248-253. [PMID: 34667472 PMCID: PMC8474005 DOI: 10.4103/sjmms.sjmms_462_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/22/2020] [Accepted: 04/20/2021] [Indexed: 11/05/2022]
Abstract
Background: Early detection of neonatal cholestasis (NC) is important for better clinical outcomes but can be challenging. Objective: The objective of this study was to evaluate the knowledge and practice styles of pediatric providers (PPs) regarding NC in the western region of Saudi Arabia. Methods: This cross-sectional, questionnaire study was conducted between November 2019 and February 2020 in three major cities of the western region of Saudi Arabia (namely, Taif, Makkah and Jeddah). PPs included pediatric residents, pediatric specialists, pediatric consultants and family physicians. The questionnaire included 15 items in five subscales (definition, causes, diagnosis and management of NC and knowledge of guidelines). Results: A total of 488 participants completed the questionnaire. Only 30.2% were aware of the correct definition of NC (P < 0.001). Two-thirds of the respondents did not consider a history of pale stool being important for evaluating NC. The importance of biliary atresia as a serious cause of NC was found to be significantly different between pediatric consultants and other pediatricians (P < 0.001). In cases of prolonged NC, 32.4% of the PPs refer to pediatric gastroenterologist. Only 18.9% of the respondents were aware of liver biopsy being the gold standard investigation of NC. The majority of the respondents (41.8%) used ursodeoxycholic acid as a supportive therapy of NC. Conclusions: This study found a significant deficit in the knowledge and practice styles of PPs in the western region of Saudi Arabia. These findings highlight the need for policymakers to develop educational materials for PPs to increase their knowledge of NC.
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Affiliation(s)
- Mohammed Hasosah
- Department of Pediatric Gastroenterology, King Abdullah International Medical Research Center, National Guard Hospital, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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271
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Tchou MJ, Schondelmeyer AC, Alvarez F, Holmes AV, Lee V, Lossius MN, O'Callaghan J, Rajbhandari P, Soung PJ, Quinonez R. Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value. Hosp Pediatr 2021; 11:1179-1190. [PMID: 34667087 DOI: 10.1542/hpeds.2021-006037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The health care system faces ongoing challenges due to low-value care. Building on the first pediatric hospital medicine contribution to the American Board of Internal Medicine Foundation Choosing Wisely Campaign, a working group was convened to identify additional priorities for improving health care value for hospitalized children. METHODS A study team composed of nominees from national pediatric medical professional societies was convened, including pediatric hospitalists with expertise in clinical care, hospital leadership, and research. The study team surveyed national pediatric hospitalist LISTSERVs for suggestions, condensed similar responses, and performed a literature search of articles published in the previous 10 years. Using a modified Delphi process, the team completed a series of structured ratings of feasibility and validity and facilitated group discussion. The sum of final mean validity and feasibility scores was used to identify the 5 highest priority recommendations. RESULTS Two hundred seven respondents suggested 397 preliminary recommendations, yielding 74 unique recommendations that underwent evidence review and rating. The 5 highest-scoring recommendations had a focus on the following aspects of hospital care: (1) length of intravenous antibiotic therapy before transition to oral antibiotics, (2) length of stay for febrile infants evaluated for serious bacterial infection, (3) phototherapy for neonatal hyperbilirubinemia, (4) antibiotic therapy for community-acquired pneumonia, and (5) initiation of intravenous antibiotics in infants with maternal risk factors for sepsis. CONCLUSIONS We propose that pediatric hospitalists can use this list to prioritize quality improvement and scholarly work focused on improving the value and quality of patient care for hospitalized children.
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Affiliation(s)
- Michael J Tchou
- Section of Hospital Medicine, Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Francisco Alvarez
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Alison V Holmes
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Vivian Lee
- Division of Hospital Medicine, Children's Hospital Los Angeles and Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michele N Lossius
- Pediatric Hospital Medicine, Department of Pediatrics, University of Florida Shands Children's Hospital, Gainesville, Florida
| | - James O'Callaghan
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Prabi Rajbhandari
- Division of Hospital Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - Paula J Soung
- Section of Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ricardo Quinonez
- Section of Pediatric Hospital Medicine, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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272
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Makkong P, Choosongsang P, Choosongsang P, Trongnit S, Sriwimol W. The Direct Spectrophotometric Method Is Reliable for Initial Assessment of Total Bilirubin in Neonatal Venous Plasma. Lab Med 2021; 53:199-205. [PMID: 34661656 DOI: 10.1093/labmed/lmab086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the consistency of bilirubin values between the direct spectrophotometric (DS) and colorimetric diazo (diazo) methods in neonatal venous plasma specimens. METHODS We measured the total bilirubin via the DS and diazo methods in 255 neonatal venous plasma specimens and compared the overall and subgroup results. RESULTS Slight underestimation of total bilirubin values in most specimens using the DS method was observed, with higher mean biases found in higher concentrations. Significantly high positive correlations were found in all groups in which most of the different values were within the limits of agreement. DS cutoff of > 12 mg/dL showed 100% for all predictive indices in comparison with the diazo cutoff > 15 mg/dL. CONCLUSIONS Measurement of total bilirubin in neonatal venous plasma using the DS method had favorable agreement and high correlation with the diazo method. Therefore, the direct spectrophotometric method can be used as a reliable screening method.
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Affiliation(s)
| | | | | | - Sasipong Trongnit
- Division of Human Genetics, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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273
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Thielemans L, Peerawaranun P, Mukaka M, Paw MK, Wiladphaingern J, Landier J, Bancone G, Proux S, Elsinga H, Trip-Hoving M, Hanboonkunupakarn B, Htoo TL, Wah TS, Beau C, Nosten F, McGready R, Carrara VI. High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border. PLoS One 2021; 16:e0258127. [PMID: 34618852 PMCID: PMC8496801 DOI: 10.1371/journal.pone.0258127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
Population risks for neonatal hyperbilirubinaemia (NH) vary. Knowledge of local risks permits interventions that may reduce the proportion becoming severe. Between January 2015 and May 2016, in a resource-limited setting on the Thailand-Myanmar border, neonates from 28 weeks' gestation were enrolled into a prospective birth cohort. Each neonate had total serum bilirubin measurements: scheduled (24, 48, 72 and 144 hours of life) and clinically indicated; and weekly follow up until 1 month of age. Risk factors for developing NH were evaluated using Cox proportional hazard mixed model. Of 1710 neonates, 22% (376) developed NH (83% preterm, 19% term). All neonates born <35 weeks, four in five born 35-37 weeks, and three in twenty born ≥38 weeks had NH, giving an overall incidence of 249 per 1000 livebirths [95%CI 225, 403]. Mortality from acute bilirubin encephalopathy was 10% (2/20) amongst the 5.3% (20/376) who reached the severe NH threshold. One-quarter (26.3%) of NH occurred within 24 hours. NH onset varied with gestational age: at a median [IQR] 24 hours [24, 30] for neonates born 37 weeks or prematurely vs 59 hours [48, 84] for neonates born ≥38 weeks. Risk factors for NH in the first week of life independent of gestational age were: neonatal G6PD deficiency, birth bruising, Sgaw Karen ethnicity, primigravidae, pre-eclampsia, and prolonged rupture of membranes. The genetic impact of G6PD deficiency on NH was partially interpreted by using the florescent spot test and further genotyping work is in progress. The risk of NH in Sgaw Karen refugees may be overlooked internationally as they are most likely regarded as Burmese in countries of resettlement. Given high levels of pathological jaundice in the first 24 hours and overall high NH burden, guidelines changes were implemented including preventive PT for all neonates <35 weeks and for those 35-37 weeks with risk factors.
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Affiliation(s)
- Laurence Thielemans
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Neonatology-Pediatrics, Université Libre de Bruxelles, Brussels, Belgium
| | - Pimnara Peerawaranun
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mavuto Mukaka
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- IRD, INSERM, SESSTIM, Aix Marseille University, Marseille, France
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stephane Proux
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Henrike Elsinga
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Margreet Trip-Hoving
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tha Ler Htoo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Thaw Shee Wah
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Candy Beau
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Verena I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
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274
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Ye L, Ji Y, Zhou C, Luo J, Zhang L, Jing L, Zhao X, Guo J, Gao Q, Peng G, Li Y, Li Y, Li J, Fan H, Yang W, Yang Y, Ma Y, Zhang F. Comparison of Levitt's CO breath test and the 15 N-glycine labeling technique for measuring the lifespan of human red blood cells. Am J Hematol 2021; 96:1232-1240. [PMID: 34265098 DOI: 10.1002/ajh.26290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/22/2021] [Accepted: 07/10/2021] [Indexed: 02/04/2023]
Abstract
The red blood cell (RBC) lifespan is an important physiological indicator of clear significance in clinical research, used for the differential diagnosis of various diseases such as anemia, compensatory phase hemolysis, and polycythemia. The 15 N-glycine labeling technique is the gold standard method for determining RBC lifespans. However, the usefulness of this technique in clinical settings is seriously hindered by the several weeks required to complete the analyses. Levitt's CO breath test is another reliable technique for determining RBC lifespans, with a simpler protocol giving much faster results, making it more useful in clinical applications. We compared the CO breath test and 15 N-glycine labeling technique for measuring the human RBC lifespan. We investigated human RBC lifespans where each subject undertook both the 15 N-glycine labeling technique and the CO breath test. The correlation between the results from these two methods was analyzed. Eight of the ten subjects successfully completed the study. The RBC lifespan values obtained by Levitt's CO breath test were lower than those obtained by the 15 N-glycine labeling technique. The RBC lifespan values determined from the 15 N-glycine labeling technique and the CO breath test were significantly correlated, with a Pearson correlation coefficient of R = 0.98 (p < 0.05), while the R2 of the linear regression equation was 0.96. The CO breath test exhibits as good performance as the 15 N-glycine labelling technique in distinguishing healthy subjects from subjects with hemolysis. The result suggests that the CO breath test is a reliable method for quickly determining human RBC lifespans in clinical applications.
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Affiliation(s)
- Lei Ye
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Yongqiang Ji
- Guangdong Breath Test Engineering and Technology Research Center Shenzhen University Shenzhen China
| | - Cong Zhou
- Guangdong Breath Test Engineering and Technology Research Center Shenzhen University Shenzhen China
| | - Junfeng Luo
- School of Medicine Sun Yat‐Sen University Guangzhou China
| | - Li Zhang
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Liping Jing
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Xin Zhao
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Jie Guo
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Qingyan Gao
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Guangxin Peng
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Yang Li
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Yuan Li
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Jianping Li
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Huihui Fan
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Wenrui Yang
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Yang Yang
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Yongjian Ma
- Guangdong Breath Test Engineering and Technology Research Center Shenzhen University Shenzhen China
| | - Fengkui Zhang
- Anemia Therapeutic Centre, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
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275
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Iskander I, Abdelmonem S, El Houchi S, Mandour I, Aly H. Intensive phototherapy and oxidant-antioxidant status in infants with jaundice. Early Hum Dev 2021; 161:105465. [PMID: 34517206 DOI: 10.1016/j.earlhumdev.2021.105465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Conventional phototherapy converts unconjugated bilirubin to its oxidation products and consequently causes oxidative stress with lipid peroxidation products. New devices that deliver intensive phototherapy are efficacious in treating severe hyperbilirubinemia and minimizing the need for exchange transfusions. However, the oxidative stress status when using these devices has not been explored. Therefore, we aimed to study the impact of using intensive phototherapy on the oxidant-antioxidant status in severely jaundiced neonates. STUDY DESIGN This prospective case-control study included term newborns admitted with severe hyperbilirubinemia managed with intensive phototherapy. Baseline oxidant-antioxidant concentrations were compared to healthy controls and re-measured after 8 h of intensive phototherapy exposure. RESULTS The study included 40 cases with severe jaundice and 40 non-jaundiced apparently normal controls. Total serum bilirubin at enrollment was 23.4 ± 4.2 mg/dl that significantly decreased after 8 h of therapy to 15.4 ± 3.4 mg/dl (p < 0.001). The decline of total serum bilirubin was 1 mg/dl/h. Bilirubin: albumin ratio decreased from 3.45 ± 0.28 to 2.7 ± 0.21 (p < 0.001). Total antioxidant capacity (TAC), superoxide dismutase (SOD), malondialdehyde (MDA), and total oxidative stress (TOS) concentrations were lower in cases (p < 0.001, p < 0.001, p = 0.049, and p < 0.001 respectively) compared to controls. Following 8 h of intensive phototherapy, further decline of TAC (p = 0.016) with increased concentrations of TOS (p = 0.005) were noted. SOD and MDA did not change. CONCLUSIONS Although efficacious, intensive phototherapy was associated with increased oxidative stress. The clinical correlates for harms related to such oxidative stress need further studying.
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Affiliation(s)
- Iman Iskander
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt
| | - Samira Abdelmonem
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt
| | - Salma El Houchi
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt
| | - Iman Mandour
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, United States of America.
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276
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Amiri FB, Tavasoli S, Borumandnia N, Taheri M. Factors Affecting Prevalence of Urinary Tract Infection in Neonates with Unexplained Hyperbilirubinemia: A Systematic Review and Meta-Analysis Study in Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:1311-1323. [PMID: 34568169 PMCID: PMC8426769 DOI: 10.18502/ijph.v50i7.6617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/14/2021] [Indexed: 11/24/2022]
Abstract
Background: The prevalence and risk factors of urinary tract infection (UTI) in neonates with unexplained hyperbilirubinemia are not studied thoroughly. Since the prevalence of UTI is highly variable in different areas and countries, this study aimed to review the existing data of Iranian neonates with UTI presented with unexplained hyperbilirubinemia. Methods: This study is a meta-analysis of Iranian newborns with unexplained hyperbilirubinemia. We identified all studies indexed in international (Web of Science, PubMed, Scopus, Google Scholar) and national (Science Information Database, Magiran) databases from 2000–2018. Search terms included: Urinary Tract Infections OR UTI AND urine OR culture OR microbio, jaundice OR icter OR hyperbili, AND Iran. Results: Overall, 4210 neonates from 17 studies were included. The pooled prevalence of UTI in neonates with unexplained hyperbilirubinemia was 6.81% (95% CI: 4.86–8.77). Considering the subgroups analyses; the prevalence of UTI was higher in the prolonged vs. not-prolonged state (8.34% vs. 4.00%), low birth weight vs. normal birth weight (7.81% vs. 4.51%), and exclusive vs. non-exclusive breastfeeding (8.84% vs. 4.72%). Male gender and low birth weight increased the risk of UTI about two times compared to the female gender and normal birth weight, respectively. The results of the analyses in neonates with unconjugated hyperbilirubinemia also showed the above-mentioned subgroup differences. Conclusion: Due to considerable prevalence of UTI in neonates with unexplained hyperbilirubinemia and risk factors in this age group, investigation for UTI is essential for the workup in this situation.
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Affiliation(s)
- Fahimeh Bagheri Amiri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sanaz Tavasoli
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Taheri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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277
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So V, Khurshid F. Treatment practices and implementation of guidelines for hyperbilirubinemia and rebound hyperbilirubinemia. J Neonatal Perinatal Med 2021; 15:335-343. [PMID: 34542033 DOI: 10.3233/npm-210781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hyperbilirubinemia (HB), defined as elevated total serum bilirubin (TSB) levels, commonly affects neonates and requires prompt treatment to prevent neurological complications. Up to 10%of neonates experience rebound hyperbilirubinemia (RHB), requiring re-initiation of treatment. Unfortunately, treatment guidelines lack practical recommendations surrounding subthreshold phototherapy, treatment termination, and RHB investigations. We examined local management practices for HB and RHB treatment in a well newborn nursery. As a secondary aim, we investigated the association between treatment practices and RHB rates. METHODS Retrospective chart review identified neonates treated for hyperbilirubinemia between January 2015 and December 2019 during their birth hospitalization at a tertiary care centre. Standardized data collection sheets were used to record treatment parameters. RESULTS Over the 5-year period, there were 9683 births and 305 (3.15%) neonates received phototherapy. Of the treated cases, 20-25%were subthreshold to practice guideline values. Upon treatment termination 25-55%of cases had TSB levels within 3 mg/dL, which may increase the risk of RHB. In our cohort, 20.3%of treated cases experienced one episode of RHB and 3.9%experienced two episodes of RHB. Although clinicians evaluated neonates for RHB 0-12 hours following treatment termination prior to discharge, many cases were identified in outpatient settings and required re-admission for phototherapy. CONCLUSION When managing HB and RHB, treatment practices such as when to terminate treatment in relation to threshold values, and timing of RHB investigations, are largely inconsistent amongst clinicians. Future studies are required to better understand the landscape of hyperbilirubinemia treatment beyond initiation of phototherapy.
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Affiliation(s)
- V So
- Department of Pediatrics, School of Medicine, Queen's University, Kingston, Ontario, Canada.,Queen's School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - F Khurshid
- Department of Pediatrics, School of Medicine, Queen's University, Kingston, Ontario, Canada
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278
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Ding Y, Wang S, Guo R, Zhang A, Zhu Y. High levels of unbound bilirubin are associated with acute bilirubin encephalopathy in post-exchange transfusion neonates. Ital J Pediatr 2021; 47:187. [PMID: 34526082 PMCID: PMC8444375 DOI: 10.1186/s13052-021-01143-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/30/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although it is known that unbound bilirubin can enter the brain, there is little evidence of its association with the development of acute bilirubin encephalopathy. Here, we investigated this potential relationship in neonates who had undergone exchange transfusion. METHODS Data from 46 newborns who underwent exchange transfusion between 2016 and 1-1 to 2018-12-31 at the First People's Hospital of Changde City in China were analyzed. The unbound bilirubin level was taken as the independent variable and the development of the acute bilirubin encephalopathy as the dependent variable. The covariates were age, birth weight, sex, red blood cell count, blood glucose, hemolytic disease, and whether the infant had received phototherapy. RESULTS The mean age and gestational age of the neonates were 146.5 ± 86.9 h and 38.6 ± 1.3 weeks [38.7(34.6-41.1) weeks] old, respectively; 52.17% were male. Binary logistic regression analysis after adjustment for covariates showed a positive association between the levels of unbound bilirubin and the development of acute bilirubin encephalopathy (odds ratio = 1.41, 95% confidence intervals 1.05-1.91, P = < 0.05). CONCLUSION There is a significant association between unbound bilirubin levels and the development of acute bilirubin encephalopathy in neonates. Further investigations are required to explore the mechanisms.
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Affiliation(s)
- Yiyi Ding
- grid.459514.80000 0004 1757 2179Department of Pediatrics, The First People’s Hospital of Changde, Changde, 415003 China
| | - Shuo Wang
- grid.411912.e0000 0000 9232 802XJishou University School of Medicine, Jishou, 416007 China
| | - Rui Guo
- grid.459514.80000 0004 1757 2179Department of Pediatrics, The First People’s Hospital of Changde, Changde, 415003 China
| | - Aizhen Zhang
- grid.459514.80000 0004 1757 2179Department of Pediatrics, The First People’s Hospital of Changde, Changde, 415003 China
| | - Yufang Zhu
- Department of Pediatrics, The First People's Hospital of Changde, Changde, 415003, China.
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279
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Clarkson DM, Tshangini M, Satodia P. Preliminary observations of a system for determination of phototherapy exposure over a neonate body shape. Med Eng Phys 2021; 95:1-8. [PMID: 34479685 DOI: 10.1016/j.medengphy.2021.07.001] [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: 09/11/2019] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
While it is possible to determine the irradiance and spectral content for a given neonatal phototherapy device at various locations over a neonate's surface, this does not allow estimation of the total rate of energy delivery within a specific spectral range over the neonate's exposed body surface. A series of 192 blue wavelength enhanced silicon photodiodes was distributed over the surface of a commercially available newborn body shape and connected to a specially designed interface circuit. Placement of photosensors over the surface of the baby shape was determined with consideration of the surface area of twelve specific anatomical areas where each was allocated 16 individual photodiodes. Calibration of detection channels for specific wavelength intervals was undertaken using a Bentham dmc150 spectroradiometer system and also a separate hand held spectroradiometer. This made it possible to estimate the effective integrated dose rate in Watts for specific wavelength intervals such as 460 nm to 490 nm as identified by the American Academy of Pediatrics for phototherapy lamp devices. This allowed identification of dose rate contributions from specific anatomical areas. Initial observations are reported for a range of phototherapy lamp systems and the findings are discussed in terms of their predicted relative clinical effectiveness. Options are also discussed in relation to the future development of the reported measurement system.
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Affiliation(s)
- Douglas M Clarkson
- Department of Clinical Physics and Bioengineering FM Building, University Hospital Coventry, CV2 2DX, United Kingdom.
| | - Mati Tshangini
- Department of Clinical Physics and Bioengineering FM Building, University Hospital Coventry, CV2 2DX, United Kingdom
| | - Prakash Satodia
- Department of Clinical Physics and Bioengineering FM Building, University Hospital Coventry, CV2 2DX, United Kingdom
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280
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Weiss NM, Kuzniewicz MW, Shimano KA, Walsh EM, Newman TB. Use of Complete Blood Cell Count Components to Screen for Hereditary Spherocytosis in Neonates. Pediatrics 2021; 148:peds.2020-021642. [PMID: 34376530 DOI: 10.1542/peds.2020-021642] [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] [Accepted: 06/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The neonatal hereditary spherocytosis (HS) index, defined as the mean corpuscular hemoglobin concentration divided by the mean corpuscular volume, has been proposed as a screening tool for HS in neonates. In a population of mostly white infants, an HS Index >0.36 was 97% sensitive and >99% specific. We evaluated the utility of the HS Index among a more racially and ethnically diverse population and determined if its discrimination varies with total serum bilirubin (TSB) levels. METHODS Infants born at ≥35 weeks' gestation at 15 Kaiser Permanente Northern California hospitals from 1995 to 2015 were eligible (N = 670 272). Erythrocyte indices from the first complete blood count drawn at ≤7 days and TSB levels drawn at ≤30 days were obtained. Diagnoses of HS were confirmed via chart review. RESULTS HS was confirmed in 79 infants, 1.2 per 10 000. HS was more common among infants of white and "other" race or ethnicity and among those with higher peak TSB levels. The area under the receiver operating characteristic curve for the HS Index was 0.84 (95% confidence interval 0.78-0.90). Likelihood ratios ranged from 10.1 for an HS Index ≥0.380 to 0.1 for an HS Index <0.310. Dichotomized at 0.36, the HS Index was 56% sensitive and 93% specific. Discrimination of the HS Index appeared best among infants with TSB levels <10 mg/dL. CONCLUSIONS The HS Index, when obtained from a CBC drawn within the first week after birth, had only modest ability to alter the probability of HS.
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Affiliation(s)
- Nicole M Weiss
- Departments of Pediatrics .,Department of Pediatrics, Kaiser Permanente Santa Clara, Santa Clara, California
| | - Michael W Kuzniewicz
- Departments of Pediatrics.,Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Eileen M Walsh
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Thomas B Newman
- Departments of Pediatrics.,Division of Research, Kaiser Permanente Northern California, Oakland, California.,Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
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281
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Vidavalur R, Devapatla S. Trends in hospitalizations of newborns with hyperbilirubinemia and kernicterus in United States: an epidemiological study. J Matern Fetal Neonatal Med 2021; 35:7701-7706. [PMID: 34470114 DOI: 10.1080/14767058.2021.1960970] [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: 10/20/2022]
Abstract
BACKGROUND Hyperbilirubinemia is one of the most common diagnosis in newborn nurseries in United States. Universal pre-discharge bilirubin screening decreased the incidence of extreme hyperbilirubinemia and risk of kernicterus. OBJECTIVES We sought to assess temporal population trends of hyperbilirubinemia, kernicterus and usage of phototherapy, intravenous immunoglobulin (IVIG), and exchange transfusion. DESIGN/METHODS Data from Healthcare Cost and Utilization Project (HCUP)-the Kids' Inpatient Database (KID) obtained for years 1997-2012. All neonatal discharges with ICD-9 codes for neonatal jaundice (774.2, 774.6), kernicterus (773.4, 774.7) and procedure codes for phototherapy (99.83), IVIG infusion (99.14), exchange transfusion (99.01) were extracted. We compared the trends of diagnosis of hyperbilirubinemia, kernicterus, use of phototherapy, IVIG, and exchange transfusion. RESULTS During the study period, the proportion of infants diagnosed with hyperbilirubinemia increased by 65% (9.4% vs. 15.5%; p<.001) in term infants and 34.5% (33.5% vs. 45%; p<.001) in preterm infants, respectively. Rate of kernicterus discharges significantly reduced from 7 to 1.9 per 100,000 newborns. Overall, the number of exchange transfusions has decreased by 67% during study period while phototherapy and IVIG use increased by 83% and 170%, respectively. CONCLUSIONS In last two decades, there was a significant decrease in neonatal discharges with a history of exchange transfusion or with a diagnosis of kernicterus. However, there was a significant increase in number of neonates discharged home with a history of phototherapy during birth hospitalization and decreased number of exchange transfusions were observed during the study period. Incremental implementation of universal predischarge bilirubin screening and treatments based on 2004 AAP recommended risk-based strategies might have contributed to timely interventions in infants with significant hyperbilirubinemia.
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282
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Bahr TM, Henry E, Christensen RD, Minton SD, Bhutani VK. A New Hour-Specific Serum Bilirubin Nomogram for Neonates ≥35 Weeks of Gestation. J Pediatr 2021; 236:28-33.e1. [PMID: 34023346 DOI: 10.1016/j.jpeds.2021.05.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To develop a statistically rigorous, hour-specific bilirubin nomogram for newborns based on a very large data set; and use it prospectively as a replacement for the 1999 Bhutani nomogram. STUDY DESIGN This was a retrospective analysis of first total serum bilirubin (TSB) measurements from 15 years of universal bilirubin screening during birth hospitalizations at 20 Intermountain Healthcare hospitals. Hour-specific TSB values were assembled into a nomogram by percentile, and subgroups were compared. RESULTS The information obtained included robust data in the first 12 hours after birth (which was not included in the 1999 nomogram), general agreement with the 1999 nomogram for values in the first 60 hours, but higher 75th and 95th percentile TSB values thereafter in the new version, no difference in TSB between male and female infants, higher TSB values among earlier gestation neonates (350/7-366/7 weeks vs ≥37 weeks, P < .0001), and lower TSB values in neonates of Black race (P < .0001) and higher values in neonates of Asian race (P < .001). CONCLUSIONS An updated and more informative Bhutani neonatal bilirubin nomogram, based on 140 times the number of subjects included the 1999 version, is now in place in our health care system.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT.
| | - Erick Henry
- Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake Cit, UT
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT; Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake Cit, UT; Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT
| | - Stephen D Minton
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT; Division of Neonatology, Department of Pediatrics, Utah Valley Regional Medical Center, Provo, UT
| | - Vinod K Bhutani
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford Medicine, and Lucile Packard Children's Hospital, Stanford, CA
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283
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Neonatal outcomes of pregnant women with COVID-19 in a developing country setup. Pediatr Neonatol 2021; 62:499-505. [PMID: 34147430 PMCID: PMC8129779 DOI: 10.1016/j.pedneo.2021.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/08/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Current evidence on vertical transmission of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and neonatal outcome among exposed newborns is emerging and posing a challenge for preventive interventions. Perinatal transmission to the neonates especially during breastfeeding and rooming in is also relatively unknown. METHODS This prospective observational study was conducted in Kalinga Institute of Medical Science (KIMS), Odisha state from 1st May to 20th October 2020. A total of 165 neonates born to SARS-CoV-2 infected mothers were enrolled. Real time polymerase chain reaction (RT PCR) testing was done in first 32 neonates in initial 24 h of life. RESULTS The clinical characteristics of 162 mothers & 165 neonates were analyzed. Mode of delivery was by caesarian section in most (n = 103, 60%) cases. Three (3/32, 9.4%) inborn and 6 outborn neonates were SARS-CoV-2 positive. Thirty-eight (23%) babies needed neonatal intensive care. Clinical characteristics of neonates were meconium-stained amniotic fluid (MSAF [23.63%]), prematurity (16.9%), respiratory distress (10.5%), moderate to severe hypoxic ischemic encephalopathy (3.6%), sepsis (7%) and hyperbilirubinemia (8.7%). Out of 138 stable babies kept on mother side and initiated breast feeding, none of them developed any signs and symptoms attributable to SARS-CoV-2. Five (3%) neonates died in COVID hospital of which one baby was SARS-CoV-2 positive. CONCLUSION There was an increased rate of incidences of hypoxic ischemic encephalopathy, meconium stained liquor and cesarean section delivery in COVID hospital. We found a possible vertical transmission in 9.4% cases. None of the neonates developed sign and symptoms of SARS-CoV-2 infection during rooming in and breast feeding.
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284
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Cortesi V, Manzoni F, Raffaeli G, Cavallaro G, Fattizzo B, Amelio GS, Gulden S, Amodeo I, Giannotta JA, Mosca F, Ghirardello S. Severe Presentation of Congenital Hemolytic Anemias in the Neonatal Age: Diagnostic and Therapeutic Issues. Diagnostics (Basel) 2021; 11:diagnostics11091549. [PMID: 34573891 PMCID: PMC8467765 DOI: 10.3390/diagnostics11091549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 01/22/2023] Open
Abstract
Congenital hemolytic anemias (CHAs) are a group of diseases characterized by premature destruction of erythrocytes as a consequence of intrinsic red blood cells abnormalities. Suggestive features of CHAs are anemia and hemolysis, with high reticulocyte count, unconjugated hyperbilirubinemia, increased lactate dehydrogenase (LDH), and reduced haptoglobin. The peripheral blood smear can help the differential diagnosis. In this review, we discuss the clinical management of severe CHAs presenting early on in the neonatal period. Appropriate knowledge and a high index of suspicion are crucial for a timely differential diagnosis and management. Here, we provide an overview of the most common conditions, such as glucose-6-phosphate dehydrogenase deficiency, pyruvate kinase deficiency, and hereditary spherocytosis. Although rare, congenital dyserythropoietic anemias are included as they may be suspected in early life, while hemoglobinopathies will not be discussed, as they usually manifest at a later age, when fetal hemoglobin (HbF) is replaced by the adult form (HbA).
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Affiliation(s)
- Valeria Cortesi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Francesca Manzoni
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Genny Raffaeli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
- Correspondence: ; Tel.: +39-(25)-5032234; Fax: +39-(25)-503221
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Bruno Fattizzo
- UO Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.F.); (J.A.G.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giacomo Simeone Amelio
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Silvia Gulden
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Ilaria Amodeo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Juri Alessandro Giannotta
- UO Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.F.); (J.A.G.)
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
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Abolurin OO, Adekoya AO, Ogunlesi TA, Ajibola ED, Adekanye TE, Adeniran EM. Pattern of serum bilirubin changes following double volume exchange blood transfusion in neonates at a tertiary health facility in Nigeria. Pan Afr Med J 2021; 39:60. [PMID: 34422183 PMCID: PMC8363959 DOI: 10.11604/pamj.2021.39.60.26408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/12/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction exchange blood transfusion (EBT) is a form of massive transfusion useful in rapidly reducing serum bilirubin levels, but serum bilirubin levels frequently rebound within hours of completing the procedure, due to equilibration of extravascular bilirubin as well as on-going hemolysis. The study was carried out to determine the pattern of reduction in serum bilirubin levels following EBT among neonates with severe hyperbilirubinemia, as well as the factors contributing to this pattern, so as to establish evidence-based expectations following EBT. Methods a retrospective descriptive study covering a two-year period in a Nigerian tertiary hospital. Details of the EBT procedures, including serial serum bilirubin levels, were obtained from the hospital records of all newborn babies who had double volume EBT done for severe hyperbilirubinaemia during the study period. Data was analyzed using the statistical software SPSS version 21.0. Results the mean total serum bilirubin (TSB) before EBT in the 36 babies was 17.9 ± 6.3 mg/dl. The mean percentage decrease in TSB immediately following EBT was 44.3 ± 10.2%. Six hours after EBT, TSB levels had increased from the immediate post-EBT values by an average of 57.5 ± 32.2%. Twenty-four hours after the procedure, TSB values in most (87.1%) cases were still higher than the immediate post-EBT values, but lower than the pre-EBT values. Post-EBT anemia was recorded among 33.3% of the babies. Conclusion EBT is effective in rapidly reducing serum bilirubin levels and preventing acute bilirubin encephalopathy in neonates with severe hyperbilirubinemia, despite the rebound increase that occurs in TSB values after the procedure.
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Affiliation(s)
| | | | - Tinuade Adetutu Ogunlesi
- Department of Paediatrics, Babcock University Teaching Hospital, Ilishan, Ogun State, Nigeria.,Department of Paediatrics, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria
| | | | | | - Eniola Mary Adeniran
- Nursing Services Unit, Department of Paediatrics, Babcock University Teaching Hospital, Ilishan, Ogun State, Nigeria
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286
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Gottimukkala SB, Sethuraman G, Kitchanan S, Pathak S. Comparison of efficacy, safety & satisfaction of intermittent versus continuous phototherapy in hyperbilirubinaemic newborns ≥35 week gestation: A randomized controlled trial. Indian J Med Res 2021; 153:446-452. [PMID: 34380790 PMCID: PMC8354053 DOI: 10.4103/ijmr.ijmr_2156_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives Phototherapy (PT) has become the standard of care for treating neonatal jaundice. This study was aimed to find out if intermittent PT (IPT) results in comparable rate of fall of bilirubin level to continuous PT (CPT) and results in lesser side effects and better acceptance. Methods In this non-inferiority trial, 174 neonates ≥35 wk gestation and >2000 g with jaundice requiring PT were randomized to receive either IPT (one hour on and two hours off) or CPT (with minimum interruptions for feeding) after device stratification [light-emitting diode (LED) or compact fluorescent light (CFL)]. Bilirubin was checked 12th hourly, and calcium, vitamin D and nitric oxide (NO) levels were analyzed along with the clinical side effects and nursing and maternal satisfaction scores (CTRI Registration No. CTRI/2018/01/011072). Results The rate of fall of bilirubin was similar in both the CPT and IPT groups [0.16 (0.10, 0.22) vs. 0.13 (0.09, 0.20) mg/dl/h, P=0.22]. The median difference with 95 per cent confidence interval of 0.03 (0.03, 0.03) mg/dl was also within the pre-defined inferiority limits. There was no significant change in the duration of PT and side effects such as fall in calcium levels, rise in vitamin D and NO levels or the clinical side effects. Maternal satisfaction favoured the IPT group, but the nurses opined that IPT was difficult to implement. Subgroup analysis for PT devices used showed that efficacy of both CFL and LED devices was equivalent. Interpretation & conclusions IPT was non-inferior to CPT in reducing bilirubin levels in ≥35 wk neonates, irrespective of device used, and also mothers reported better satisfaction with IPT. Although IPT appears promising, CPT does not increase clinical and biochemical side effects compared to IPT.
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Affiliation(s)
| | - Giridhar Sethuraman
- Department of Neonatology, Chettinad Hospital & Research Institute, Chennai, Tamil Nadu, India
| | - Srinivasan Kitchanan
- Department of Neonatology, Chettinad Hospital & Research Institute, Chennai, Tamil Nadu, India
| | - Surajit Pathak
- Department of Allied Health Sciences, Chettinad Hospital & Research Institute, Chennai, Tamil Nadu, India
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287
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DelFavero JJ, Jnah AJ, Newberry D. Glucose-6-Phosphate Dehydrogenase Deficiency and the Benefits of Early Screening. Neonatal Netw 2021; 39:270-282. [PMID: 32879043 DOI: 10.1891/0730-0832.39.5.270] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 11/25/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common enzymopathy worldwide, is an insufficient amount of the G6PD enzyme, which is vital to the protection of the erythrocyte. Deficient enzyme levels lead to oxidative damage, hemolysis, and resultant severe hyperbilirubinemia. If not promptly recognized and treated, G6PD deficiency can potentially lead to bilirubin-induced neurologic dysfunction, acute bilirubin encephalopathy, and kernicterus. Glucose-6-phosphate dehydrogenase deficiency is one of the three most common causes for pathologic hyperbilirubinemia. A change in migration patterns and intercultural marriages have created an increased incidence of G6PD deficiency in the United States. Currently, there is no universally mandated metabolic screening or clinical risk assessment tool for G6PD deficiency in the United States. Mandatory universal screening for G6PD deficiency, which includes surveillance and hospital-based risk assessment tools, can identify the at-risk infant and foster early identification, diagnosis, and treatment to eliminate neurotoxicity.
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288
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Aydın B, Yılmaz HÇ, Botan E, Aktepe AÖ, Dilli D. Is it necessary to give calcium infusion during the exchange transfusion in newborns? Transfus Apher Sci 2021; 60:103236. [PMID: 34389203 DOI: 10.1016/j.transci.2021.103236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We aimed to evaluate total serum calcium (TSC) and ionized serum calcium (ISC) levels and their effects on clinical outcomes in neonates underwent exchange transfusion (ET). METHOD In this study, the data of newborn infants who underwent ET due to hyperbilirubinemia in a third level neonatal intensive care unit (NICU) were retrospectively analyzed. The patients were monitored by electrocardiogram during ET. Cardiac and respiratory rates, peripheral oxygen saturation, blood pressure values and clinical findings as convulsion, tremor, hypertonia, laryngospasm, cyanosis and apnea were recorded in ET observation forms. The infants with no symptoms of hypocalcemia during the procedure were not routinely given IV calcium gluconate. TSC and ISC measured at the beginning, at the end and 24 h after the end of ET were evaluated retrospectively. RESULTS Data of 36 newborn patients were evaluated. Median gestational age was 39 (35-40) weeks, mean birthweight was 2840 ± 841 (mean ± SD) grams. During the ET, desaturation was observed in five patients(13.9 %), sinus bradycardia in six(16.7 %), tachypnea in two(5.5 %), sinus tachycardia in one(2.8 %), and rare ventricular extrasystoles in one(2.8 %). Hypocalcaemia was not detected in any of the patients at the beginning of ET. Hypocalcemia was observed in two cases (5.5 %) at the end of ET. There was no statistically significant difference between the TSC and ISC levels at the beginning of ET, at the end and at the end of 24 h. CONCLUSION As a result, routine intravenous (IV) calcium administration seems to be unnecessary provided that vital signs and neurological status are closely monitored during ET.
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Affiliation(s)
- Banu Aydın
- Lokman Hekim University, Faculty of Medicine Department of Pediatrics, Neonatology Unit, Ankara, Turkey.
| | - Havva Çınar Yılmaz
- Malatya Training and Research Hospital, Laboratuary of Hematology, Malatya, Turkey
| | - Edin Botan
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Özcan Aktepe
- Health Sciences University, Van Training and Research Hospital, Van, Turkey
| | - Dilek Dilli
- Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Neonatology Unit, Ankara, Turkey
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289
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Abstract
This article attempts to highlight contemporary issues relating to term neonatal hyperbilirubinemia and to focus attention on controversial issues and concepts with the potential to effect change in clinical approach. On the one hand, the focus is bilirubin neurotoxicity, which is now known to encompass a wide, diverse spectrum of features. The various aspects of this spectrum are outlined and defined. On the other hand, bilirubin also possesses antioxidant properties. As such, mild hyperbilirubinemia is suggested as actually offering the neonate some protective advantage.
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290
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Abstract
Keeping the umbilical cord intact after delivery facilitates transition from fetal to neonatal circulation and allows a placental transfusion of a considerable amount of blood. A delay of at least 3 minutes improves neurodevelopmental outcomes in term infants. Although regarded as common sense and practiced by many midwives, implementation of delayed cord clamping into practice has been unduly slow, partly because of beliefs regarding theoretic risks of jaundice and lack of understanding regarding the long-term benefits. This article provides arguments for delaying cord clamping for a minimum of 3 minutes.
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Affiliation(s)
- Ola Andersson
- Department of Clinical Sciences, Lund, Pediatrics, Lund University, SE-221 85 Lund, Sweden; Department of Neonatology, Skåne University Hospital, Jan Waldenströms gata 47, Malmö SE-214 28, Sweden.
| | - Judith S Mercer
- Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA; University of Rhode Island, Kingston, RI, USA
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291
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Chiruvolu A, Medders A, Daoud Y. Effects of Umbilical Cord Milking on Term Infants Delivered by Cesarean Section. Am J Perinatol 2021; 38:1042-1047. [PMID: 32069483 DOI: 10.1055/s-0040-1701617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Umbilical cord milking (UCM) is an efficient way to achieve optimal placental transfusion in term infants born by cesarean section (CS). However, it is not frequently performed due to concern for short-term adverse effects of increased blood volume, such as polycythemia and hyperbilirubinemia. The aim of this study is to evaluate the short-term effects of UCM on term infants delivered by CS. STUDY DESIGN We conducted a pre- and postimplementation cohort study comparing term infants delivered by CS who received UCM five times (141 infants, UCM group) during a 6-month period (August 1, 2017 to January 31, 2018) to those who received immediate cord clamping (ICC) during the same time period (105 infants, postimplementation ICC) and during a 3-month period (October1, 2016 to December 31, 2016) prior to the implementation of UCM (141 infants, preimplementation ICC). RESULTS Mothers were older in UCM group compared with both ICC groups. There were no significant differences in other maternal or neonatal characteristics. Although this study was not powered to detect differences in outcomes, the occurrence of hyperbilirubinemia needing phototherapy, symptomatic polycythemia, NICU admissions, or readmissions for phototherapy was similar between the groups. CONCLUSION UCM intervention was not associated with increased incidence of phototherapy or symptomatic polycythemia in term infants delivered by CS.
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Affiliation(s)
- Arpitha Chiruvolu
- Department of Women and Infants, Baylor Scott and White Medical Center McKinney, Pediatrix Medical Group of Dallas, Dallas, Texas
| | - Alexis Medders
- Department of Medical Education, College of Medicine, Texas A&M University, Bryan, Texas
| | - Yahya Daoud
- Department of Quantitative Sciences, Center for Clinical Effectiveness, Baylor Scott & White Health Care System, Dallas, Texas
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292
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Screening methods for neonatal hyperbilirubinemia: benefits, limitations, requirements, and novel developments. Pediatr Res 2021; 90:272-276. [PMID: 33941863 DOI: 10.1038/s41390-021-01543-1] [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] [Received: 08/06/2020] [Revised: 02/12/2021] [Accepted: 03/19/2021] [Indexed: 12/20/2022]
Abstract
Severe neonatal hyperbilirubinemia (SNH) is a serious condition that occurs worldwide. Timely recognition with bilirubin determination is key in the management of SNH. Visual assessment of jaundice is unreliable. Fortunately, transcutaneous bilirubin measurement for screening newborn infants is routinely available in many hospitals and outpatient settings. Despite a few limitations, the use of transcutaneous devices facilitates early recognition and appropriate management of neonatal jaundice. Unfortunately, however, advanced and often costly screening modalities are not accessible to everyone, while there is an urgent need for inexpensive yet accurate instruments to assess total serum bilirubin (TSB). In the near future, novel icterometers, and in particular optical bilirubin estimates obtained with a smartphone camera and processed with a smartphone application (app), seem promising methods for screening for SNH. If proven reliable, these methods may empower outpatient health workers as well as parents at home to detect jaundice using a simple portable device. Successful implementation of ubiquitous bilirubin screening may contribute substantially to the reduction of the worldwide burden of SNH. The benefits of non-invasive bilirubin screening notwithstanding, any bilirubin determination obtained through non-invasive screening must be confirmed by a diagnostic method before treatment. IMPACT: Key message: Screening methods for neonatal hyperbilirubinemia facilitate early recognition and timely treatment of severe neonatal hyperbilirubinemia (SNH). Any bilirubin screening result obtained must be confirmed by a diagnostic method. What does this article add to the existing literature? Data on optical bilirubin estimation are summarized. Niche research strategies for prevention of SNH are presented. Impact: Transcutaneous screening for neonatal hyperbilirubinemia contributes to the prevention of SNH. A smartphone application with optical bilirubin estimation seems a promising low-cost screening method, especially in low-resource settings or at home.
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293
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Vigneshwar NKV, Basu S, Naithani M, Vivekanand N, Chacham S, Singh P. Serum Calcium and Melatonin Levels in Neonates Undergoing Phototherapy. Indian J Pediatr 2021; 88:805-808. [PMID: 33570703 DOI: 10.1007/s12098-020-03655-8] [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: 08/20/2020] [Accepted: 12/31/2020] [Indexed: 12/01/2022]
Abstract
Phototherapy-induced hypocalcemia has been postulated to result from a decline in serum melatonin levels. The present observational study evaluated the effects of phototherapy on serum calcium and melatonin levels, and assessed their correlation, if any. Eighty-nine neonates with a total serum bilirubin levels of 14.1 ± 2.8 mg/dL were recruited at the mean age of 51.9 ± 21.7 h. After a median interquartile range (IQR) duration of phototherapy for 24.0 (24-25.5) h, serum calcium levels decreased significantly, from 9.6 ± 0.8 to 9.4 ± 0.6 mg/dL; p = 0.02, leading to asymptomatic hypocalcemia in 2.2% of the neonates. Median (IQR) serum melatonin levels also decreased from 187.8 (133.5-227.6) to 176.3 (145.6-202.5) pg/mL after phototherapy, the difference being statistically insignificant. No significant correlation was documented between the duration of phototherapy with calcium and melatonin levels. The authors conclude that phototherapy resulted in a small but significant reduction of serum calcium levels without any significant correlation with serum melatonin.
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Affiliation(s)
- N K V Vigneshwar
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Manisha Naithani
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - N Vivekanand
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Swathi Chacham
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
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294
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Sabry AM, El-Shabrawi MHF, Abdelrazek AA, Ali MF. Efficacy of single phototherapy with low-cost reflective sheets versus single phototherapy alone in mild-to-moderate unconjugated hyperbilirubinaemia in full-term neonates. Paediatr Int Child Health 2021; 41:206-210. [PMID: 34472420 DOI: 10.1080/20469047.2021.1958603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND An economical alternative method of increasing the light intensity of phototherapy for neonatal jaundice is the use of reflective sheets placed on the sides of the incubator. AIM To determine whether reflective sheets in addition to phototherapy increase the reduction of bilirubin levels and the duration of hospital stay. METHODS The study was undertaken in the neonatal intensive care unit of Cairo University Children's Hospital. There were two groups: a study group of 90 full-term neonates with neonatal jaundice who received single phototherapy in incubators covered with white plastic reflective sheets and a control group of 90 full-term neonates with neonatal jaundice who received single phototherapy without the reflective sheets. RESULTS The mean (SD) rate of bilirubin decline in the first 24 hours of phototherapy was greater in the study group [3.7 (0.86) µmol/L/hr] than in the control group [2.2 (0.14) µmol/L/hr] (p<0.001). CONCLUSION Use of reflective sheets decreases the total duration of phototherapy and the cost and duration of hospitalisation without any added complications.Abbreviations: AAP: American Academy of Pediatrics; HIDS: high-intensity double-surface; LMIC: low- and middle-income countries; MCTP: mirror-covered tunnel phototherapy; NICU: neonatal intensive care unit; TSB: total serum bilirubin.
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Affiliation(s)
- Amira M Sabry
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Mahmoud F Ali
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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295
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Kawamoto K, Kukhareva PV, Weir C, Flynn MC, Nanjo CJ, Martin DK, Warner PB, Shields DE, Rodriguez-Loya S, Bradshaw RL, Cornia RC, Reese TJ, Kramer HS, Taft T, Curran RL, Morgan KL, Borbolla D, Hightower M, Turnbull WJ, Strong MB, Chapman WW, Gregory T, Stipelman CH, Shakib JH, Hess R, Boltax JP, Habboushe JP, Sakaguchi F, Turner KM, Narus SP, Tarumi S, Takeuchi W, Ban H, Wetter DW, Lam C, Caverly TJ, Fagerlin A, Norlin C, Malone DC, Kaphingst KA, Kohlmann WK, Brooke BS, Del Fiol G. Establishing a multidisciplinary initiative for interoperable electronic health record innovations at an academic medical center. JAMIA Open 2021; 4:ooab041. [PMID: 34345802 PMCID: PMC8325485 DOI: 10.1093/jamiaopen/ooab041] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/18/2021] [Accepted: 05/04/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To establish an enterprise initiative for improving health and health care through interoperable electronic health record (EHR) innovations. Materials and Methods We developed a unifying mission and vision, established multidisciplinary governance, and formulated a strategic plan. Key elements of our strategy include establishing a world-class team; creating shared infrastructure to support individual innovations; developing and implementing innovations with high anticipated impact and a clear path to adoption; incorporating best practices such as the use of Fast Healthcare Interoperability Resources (FHIR) and related interoperability standards; and maximizing synergies across research and operations and with partner organizations. Results University of Utah Health launched the ReImagine EHR initiative in 2016. Supportive infrastructure developed by the initiative include various FHIR-related tooling and a systematic evaluation framework. More than 10 EHR-integrated digital innovations have been implemented to support preventive care, shared decision-making, chronic disease management, and acute clinical care. Initial evaluations of these innovations have demonstrated positive impact on user satisfaction, provider efficiency, and compliance with evidence-based guidelines. Return on investment has included improvements in care; over $35 million in external grant funding; commercial opportunities; and increased ability to adapt to a changing healthcare landscape. Discussion Key lessons learned include the value of investing in digital innovation initiatives leveraging FHIR; the importance of supportive infrastructure for accelerating innovation; and the critical role of user-centered design, implementation science, and evaluation. Conclusion EHR-integrated digital innovation initiatives can be key assets for enhancing the EHR user experience, improving patient care, and reducing provider burnout.
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Affiliation(s)
- Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Polina V Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Michael C Flynn
- University of Utah Health, Salt Lake City, Utah, USA.,Community Physicians Group, University of Utah, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Claude J Nanjo
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Douglas K Martin
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Phillip B Warner
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - David E Shields
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Salvador Rodriguez-Loya
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Richard L Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Ryan C Cornia
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Thomas J Reese
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Heidi S Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Rebecca L Curran
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Keaton L Morgan
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA.,Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Maia Hightower
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Michael B Strong
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Wendy W Chapman
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | | | - Carole H Stipelman
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Julie H Shakib
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Hess
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Jonathan P Boltax
- Division of Pulmonary Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Joseph P Habboushe
- MD Aware, LLC, New York, New York, USA.,Department of Emergency Medicine, New York University, New York, New York, USA
| | - Farrant Sakaguchi
- University of Utah Health, Salt Lake City, Utah, USA.,Community Physicians Group, University of Utah, Salt Lake City, Utah, USA.,Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kyle M Turner
- University of Utah Health, Salt Lake City, Utah, USA.,Community Physicians Group, University of Utah, Salt Lake City, Utah, USA.,Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Scott P Narus
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,Intermountain Healthcare, Murray, Utah, USA
| | - Shinji Tarumi
- Research & Development Group, Hitachi, Ltd, Tokyo, Japan
| | | | - Hideyuki Ban
- Research & Development Group, Hitachi, Ltd, Tokyo, Japan
| | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Cho Lam
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Tanner J Caverly
- VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Departments of Learning Health Sciences and Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.,VA Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, Utah, USA
| | - Chuck Norlin
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Daniel C Malone
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Communication, University of Utah, Salt Lake City, Utah, USA
| | - Wendy K Kohlmann
- University of Utah Health, Salt Lake City, Utah, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Benjamin S Brooke
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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296
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Zgutka K, Prasanth K, Pinero-Bernardo S, Lew LQ, Cervellione K, Rhythm R, Rahman L, Dolmaian G, Cohen L. Infant outcomes and maternal COVID-19 status at delivery. J Perinat Med 2021; 49:691-696. [PMID: 33713593 DOI: 10.1515/jpm-2020-0481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/24/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare clinical characteristics and outcomes of infants born to COVID-19 to non COVID-19 mothers at delivery in a community hospital in Queens, New York. METHODS Case-control study conducted March 15 to June 15, 2020. Cases were infants born to mothers with laboratory-confirmed COVID-19 infection at delivery. The infant of non COVID-19 mother born before and after each case were selected as controls. RESULTS Of 695 deliveries, 62 (8.9%) infants were born to COVID-19 mothers; 124 controls were selected. Among cases, 18.3% were preterm compared to 8.1% in controls (p=0.04). In preterm cases, birth weight was not significantly different between groups. However, there was a significantly higher proportion of neonatal intensive care unit (NICU) admissions, need for respiratory support, suspected sepsis, hyperbilirubinemia, feeding intolerance and longer length of stay (LOS) in preterm cases. Among term cases, birth weight and adverse outcomes were not significantly different between cases and controls except for more feeding intolerance in cases. All infants born to COVID-19 mothers were COVID-19 negative at 24 and 48 h of life. No infants expired during birth hospitalization. CONCLUSIONS Significantly, more infants of COVID-19 mothers were premature compared to controls. Preterm cases were more likely to have adverse outcomes despite having similar birth weight and gestational age. These differences were not seen among full term infants. Health care providers should anticipate the need for NICU care when a COVID-19 mother presents in labor.
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Affiliation(s)
- Kinga Zgutka
- Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
| | - Kaninghat Prasanth
- Division of Neonatology, Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
| | | | - Lily Q Lew
- Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
| | - Kelly Cervellione
- Department of Clinical Research, Medisys Health Network, Flushing, NY, USA
| | - Rhythm Rhythm
- Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
| | - Lubna Rahman
- Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
| | - Gigliola Dolmaian
- Division of Neonatology, Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
| | - Lourdes Cohen
- Division of Neonatology, Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
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297
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Fu SC, Wang CY, Lin CK. Do postpartum nonsteroidal antiinflammatory drugs (NSAIDs) affect neonatal hyperbilirubinaemia? Taiwan J Obstet Gynecol 2021; 59:891-894. [PMID: 33218407 DOI: 10.1016/j.tjog.2020.09.015] [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] [Accepted: 08/10/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE There has been no previous study on the interaction between neonatal hyperbilirubinemia and NSAID use in breastfeeding mothers. This study aimed to investigate whether postpartum analgesics (with NSAIDs) can affect neonatal hyperbilirubinaemia. MATERIALS AND METHODS Mothers who gave birth between January 2017 and December 2017 were included. Those who were not exclusively breastfeeding, gave premature birth, who underwent caesarean section, or whose infants had abnormalities such as an imperforated anus, diaphragmatic hernia, or ovarian tumour were excluded. Mothers were divided into 2 groups based on the analgesics received postpartum: acetaminophen and NSAID (non-steroidal anti-inflammatory drug; flurbiprofen) users. Multivariable logistic regression was adopted to estimate the risk of hyperbilirubinaemia with the use of different kinds of painkillers. RESULTS In total, 1153 mothers were reviewed. After applying the exclusion criteria, 480 mothers were finally included in the analyses. Among them, 348 (72.67%) and 132 (27.33%) mothers received acetaminophen and flurbiprofen, respectively. Seven (2.01%) and 1 (0.76%) newborn had hyperbilirubinaemia among the acetaminophen and flurbiprofen users, respectively. Hyperbilirubinaemia risk of infants whose mothers were flurbiprofen users was not significantly different from that of infants whose mothers were acetaminophen users (adjusted odd ratio = 0.50, 95% confidence interval = 0.06-4.50, p-value = 0.4552). CONCLUSIONS Breastfeeding mothers receiving flurbiprofen do not have increased risk of neonatal hyperbilirubinaemia.
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Affiliation(s)
- Shao-Chi Fu
- Department of Obstetrics and Gynecology, Taichung Armed Forces General Hospital, No. 348, Sec. 2, Zhongshan Rd., Taiping Dist., Taichung City, 411, Taiwan, ROC; Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 114, Taiwan, ROC
| | - Chen-Yu Wang
- School of Pharmacy, College of Medicine, National Taiwan University, No. 33, Linsen S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan, ROC
| | - Chi-Kang Lin
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 114, Taiwan, ROC.
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298
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Serra de Almeida N, Pinho C, Faim D, Henriques R. Haemolytic disease of the fetus and newborn: do not miss a positive maternal antierythrocyte antibody screen. BMJ Case Rep 2021; 14:14/7/e242731. [PMID: 34253518 DOI: 10.1136/bcr-2021-242731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Jaundice is one of the most common situations during the neonatal period. Alloimmune haemolytic disease of the fetus and newborn (AHDFN) is a major cause of pathological jaundice during the neonatal period. Since the establishment of anti-D prophylaxis, other antigens have gained greater clinical importance. The maternal antierythrocyte antibody screen is of great importance in monitoring pregnancy and in predicting the risk of AHDFN. A positive result should alert to the possibility of AHDFN and promote close surveillance of fetal anaemia, as well as neonatal anaemia and hyperbilirubinaemia. We describe a case of AHDFN due to incompatibility of the Rhesus c (Rhc) subgroup, diagnosed in pregnancy, but without effective transmission of information in the perinatal period, so a positive maternal antierythrocyte antibody screen was missed. This case highlights the importance of non-RhD antigens in this disease, but also the importance of a successful handoff of information in the delivery room.
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Affiliation(s)
| | - Crisbety Pinho
- Pediatric Department, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Diogo Faim
- Pediatric Department, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Raquel Henriques
- Department of Neonatology, Maternidade Doutor Daniel de Matos, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
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299
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Horn D, Ehret D, Gautham KS, Soll R. Sunlight for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates. Cochrane Database Syst Rev 2021; 7:CD013277. [PMID: 34228352 PMCID: PMC8259558 DOI: 10.1002/14651858.cd013277.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute bilirubin encephalopathy (ABE) and the other serious complications of severe hyperbilirubinemia in the neonate occur far more frequently in low- and middle-income countries (LMIC). This is due to several factors that place babies in LMIC at greater risk for hyperbilirubinemia, including increased prevalence of hematologic disorders leading to hemolysis, increased sepsis, less prenatal or postnatal care, and a lack of resources to treat jaundiced babies. Hospitals and clinics face frequent shortages of functioning phototherapy machines and inconsistent access to electricity to run the machines. Sunlight has the potential to treat hyperbilirubinemia: it contains the wavelengths of light that are produced by phototherapy machines. However, it contains harmful ultraviolet light and infrared radiation, and prolonged exposure has the potential to lead to sunburn, skin damage, and hyperthermia or hypothermia. OBJECTIVES To evaluate the efficacy of sunlight administered alone or with filtering or amplifying devices for the prevention and treatment of clinical jaundice or laboratory-diagnosed hyperbilirubinemia in term and late preterm neonates. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 5), MEDLINE, Embase, and CINAHL on 2 May 2019. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials (RCTs), quasi-RCTs, and cluster RCTs. We updated the searches on 1 June 2020. SELECTION CRITERIA We included RCTs, quasi-RCTs, and cluster RCTs. We excluded crossover RCTs. Included studies must have evaluated sunlight (with or without filters or amplification) for the prevention and treatment of hyperbilirubinemia or jaundice in term or late preterm neonates. Neonates must have been enrolled in the study by one-week postnatal age. DATA COLLECTION AND ANALYSIS We used standard methodologic procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Our primary outcomes were: use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, chronic bilirubin encephalopathy, and death. MAIN RESULTS We included three RCTs (1103 infants). All three studies had small sample sizes, were unblinded, and were at high risk of bias. We planned to undertake four comparisons, but only found studies reporting on two. Sunlight with or without filters or amplification compared to no treatment for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates One study of twice-daily sunlight exposure (30 to 60 minutes) compared to no treatment reported the incidence of jaundice may be reduced (risk ratio [RR] 0.61, 95% confidence interval [CI] 0.45 to 0.82; risk difference [RD] -0.14, 95% CI -0.22 to -0.06; number needed to treat for an additional beneficial outcome [NNTB] 7, 95% CI 5 to 17; 1 study, 482 infants; very low-certainty evidence) and the number of days that an infant was jaundiced may be reduced (mean difference [MD] -2.20 days, 95% CI -2.60 to -1.80; 1 study, 482 infants; very low-certainty evidence). There were no data on safety or potential harmful effects of the intervention. The study did not assess use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, and long-term consequences of hyperbilirubinemia. The study showed that sunlight therapy may reduce rehospitalization rates within seven days of discharge for treatment for hyperbilirubinemia, but the evidence was very uncertain (RR 0.55, 95% CI 0.27 to 1.11; RD -0.04, -0.08 to 0.01; 1 study, 482 infants; very low-certainty evidence). Sunlight with or without filters or amplification compared to other sources of phototherapy for the treatment of hyperbilirubinemia in infants with confirmed hyperbilirubinemia Two studies (621 infants) compared the effect of filtered-sunlight exposure to other sources of phototherapy in infants with confirmed hyperbilirubinemia. Filtered-sunlight phototherapy (FSPT) and conventional or intensive electric phototherapy led to a similar number of days of effective treatment (broadly defined as a minimal increase of total serum bilirubin in infants less than 72 hours old and a decrease in total serum bilirubin in infants more than 72 hours old on any day that at least four to five hours of sunlight therapy was available). There may be little or no difference in treatment failure requiring exchange transfusion (typical RR 1.00, 95% CI 0.06 to 15.73; typical RD 0.00, 95% CI -0.01 to 0.01; 2 studies, 621 infants; low-certainty evidence). One study reported ABE, and no infants developed this outcome (RR not estimable; RD 0.00, 95% CI -0.02 to 0.02; 1 study, 174 infants; low-certainty evidence). One study reported death as a reason for study withdrawal; no infants were withdrawn due to death (RR not estimable; typical RD 0.00, 95% CI -0.01 to 0.01; 1 study, 447 infants; low-certainty evidence). Neither study assessed long-term outcomes. Possible harms: both studies showed a probable increased risk for hyperthermia (body temperature greater than 37.5 °C) with FSPT (typical RR 4.39, 95% CI 2.98 to 6.47; typical RD 0.30, 95% CI 0.23 to 0.36; number needed to treat for an additional harmful outcome [NNTH] 3, 95% CI 2 to 4; 2 studies, 621 infants; moderate-certainty evidence). There was probably no difference in hypothermia (body temperature less than 35.5 °C) (typical RR 1.06, 95% CI 0.55 to 2.03; typical RD 0.00, 95% CI -0.03 to 0.04; 2 studies, 621 infants; moderate-certainty evidence). AUTHORS' CONCLUSIONS Sunlight may be an effective adjunct to conventional phototherapy in LMIC settings, may allow for rotational use of limited phototherapy machines, and may be preferable to families as it can allow for increased bonding. Filtration of sunlight to block harmful ultraviolet light and frequent temperature checks for babies under sunlight may be warranted for safety. Sunlight may be effective in preventing hyperbilirubinemia in some cases, but these studies have not demonstrated that sunlight alone is effective for the treatment of hyperbilirubinemia given its sporadic availability and the low or very low certainty of the evidence in these studies.
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Affiliation(s)
- Delia Horn
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Danielle Ehret
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Kanekal S Gautham
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Roger Soll
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
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Evaluation of the Relationship Between Transcutaneous Bilirubin Measurement and Total Serum Bilirubin in Neonatal Patients Followed for Jaundice. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:262-267. [PMID: 34349605 PMCID: PMC8298076 DOI: 10.14744/semb.2020.79837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
Abstract
Objectives: Jaundice is a physiological condition caused by hyperbilirubinemia, which is common in neonatal period. However, severe hyperbilirubinemia can cause kernicterus, which is a serious condition that leads to neurological problems. In this study, we aimed to investigate whether it is safe to use transcutaneous bilirubin (TcB) instead of blood for the evaluation of jaundice by comparing TcB measurement with standard total serum bilirubin (TSB) measurement values. Methods: A total of 105 term and early term infants with gestational ages between 37 and 42 weeks were included in the study. MBJ20 TcB measuring device was used for TcB measurement. TcB was measured from the forehead and sternum. To evaluate the relationship between TcB measurements and TSB measurements, we performed Pearson correlation, Spearman correlation, linear regression analysis, and Bland-Altman analysis in which we evaluated the scatter plot of the differences between the average values of the measurements. Results: There was a positive and statistically significant correlation between TcB forehead and TSB measurements and TcB sternum and TSB measurements (p<0.001). Linear regression analysis showed a positive directional correlation between TcB forehead and TSB measurements (R²=0.85) and TcB sternum and TSB measurements (R²=0.87). Bland-Altman analysis showed a good consistency between TSB and TcB forehead measurement methods (mean difference: 0.39±1.46, 95% CI: [−2.47]–[3.26]), and between TSB and TcB sternum measurement methods (mean difference: 0.49±1.32 95% CI: [−2.1]–[3.07]). Conclusion: As a result of our study, we found that TcB measurement can be reliable instead of taking blood for jaundice evaluation.
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