Phototherapy for neonatal hyperbilirubinemia and childhood eczema, rhinitis and wheeze

Hematological abnormality and associated factors in newborns with hyperbilirubinemia before and after phototherapy at University of Gondar Comprehensive Specialized Hospital

This study aimed to assess the magnitude of hematological toxicity and associated factors in newborns with hyperbilirubinemia. A cross-sectional study was conducted from April to December 2023. A total of 247 newborns were included. The data were collected using questionnaires and a data extraction sheet. Four 4 ml of blood was collected. A Sysmex KX-21 analyzer was used for blood analysis, and a Mindray BS-240 analyzer was used for bilirubin measurement. The data were entered into Epi-data and analyzed by SPSS. The logistic regression was used. The P value was set at 0.05. Before phototherapy, the hematological toxicities, such as anemia, leucopenia, and thrombocytopenia, were 45.7%, 22.2%, and 6.1%, respectively, whereas after phototherapy, anemia and thrombocytopenia, significantly increased, but the leucopenia, significantly decreased. The risk of developing anemia increased, 3.5, 2.7, and 2.1-fold among newborns with bilirubin > 18 mg/dl, with Rh blood group incompatibility, and treated with intensive phototherapy, respectively. Both low birth weight and intensive phototherapy increased the incidence of thrombocytopenia by 2 and 3.4-fold, respectively. Hematological toxicity was found to be a severe public health issue in newborns. Thus, strict follow-up and early detection of toxicity by considering aggravation factors are necessary.

Probiotics' effects on gut microbiota in jaundiced neonates: a randomized controlled trial protocol

Introduction

Recent evidence suggests that blue-light phototherapy impacts gut microbiota composition in jaundiced newborns, leading to disturbances closely related to the therapy's side effects. As a result, gut microbiota may serve as a potential intervention target to mitigate these side effects. In this study, we aim to examine the effects of AB-GG (Lactobacillus rhamnosus LGG), Bb-12 (Bifidobacterium animalis Bb-12) and M-16V (Bifidobacterium breve M-16V) and their combination on the intestinal microbiota, metabolomics and phototherapy-related side effects in neonates with jaundice.

Methods and analysis

A total of 100 jaundiced newborns aged two weeks or younger will be included in this randomized, single-blind (the parents knew, but the neonatologists did not know), single-center controlled trial to receive either 109 colony-forming units of AB-GG, Bb-12, M-16V, a combination of the three probiotics with blue-light phototherapy, or blue-light phototherapy alone. The experimental group will be treated with oral probiotics once daily for 30 days, while the control group will receive only blue-light phototherapy. The follow-up duration will last 30 days. The primary outcomes include changes in gut microbiota, metabolomics, and the incidence of phototherapy side effects, assessed after each phototherapy session, as well as on days 10, 20, and 30.

Ethics and dissemination

The study protocol has been approved by the Ethics Committee of our institution. The findings of this trial will be submitted to a peer-reviewed pediatric journal. Its abstracts will be submitted to relevant national and international conferences.

Clinical Trial Registration

http://www.chictr.org.cn/index.aspx, identifer (ChiCTR2000036013).

Growing Up in Singapore with allergies - Lessons learnt from the GUSTO & S-PRESTO cohorts

Healthcare systems across the world face major challenges due to allergic diseases, known to affect people of all ages. In Singapore, two prominent cohort studies, Growing Up in Singapore Towards healthy Outcomes (GUSTO) and the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO), have made notable advancements to our knowledge and understanding of allergic diseases. These cohorts, which comprised of healthy mother-infant dyads recruited from the healthy Singapore population, have shed light on the complex connections between factors influencing health in early life, preconception and pregnancy, on the pathogenesis of allergic disorders in offspring. GUSTO highlighted significant risk factors in antenatal and early life, such as maternal diet, health and lifestyle choices, as well as infant environmental influences, that contributed to the risk of allergic diseases in the Asian Singaporean population. It also identified differential patterns of allergic disease in comparison to other populations, particularly the role of the microbiome in predicting atopic outcomes. Meanwhile, S-PRESTO further explores the long-term maternal and child outcomes associated with preconception health. Findings seem to suggest that prevention of offspring allergic conditions can be achieved through optimizing maternal health and lifestyle choices before conception. Both studies underscore the significance of early life interventions, preconception health, and personalized approaches to effectively manage and prevent allergies. By leveraging the insights and promising findings from GUSTO and S-PRESTO, future work can drive development of preventative strategies and personalized interventions to reduce burden of allergic diseases in the Singapore population.

Is neonatal phototherapy associated with a greater risk of childhood cancers?

Background

Neonatal phototherapy (NNPT) has long been used as an effective and relatively safe method of treating neonatal hyperbilirubinemia. Considering the subsequent evidence of long-term impacts of NNPT such as malignancies, this study was conducted to evaluate the relationship between NNPT and childhood cancers.

Methods

This case-control study assessed 116 children up to 4 years old with every kind of cancer referred to the Oncology department of Afzalipour hospital, Kerman, Iran, from 2011 to 18. Moreover, 116 pediatric patients without cancer hospitalized at the same Center were included after sex and age matching as the control group. The history of phototherapy and its duration were evaluated in these two groups.

Results

We found no association between the NNPT and malignancies in children. However, high intensive phototherapy was higher historically among affected cancerous patients than in non-cancerous cases without any statistically significant difference (25% vs 19%; P = 0.26). Maternal educational level and history of maternal infection during pregnancy, which initially appeared to be two factors associated with malignancy in single variable regression analyses, were not significant based on the adjusted models.

Conclusions

The results did not show a positive correlation between NNPT and childhood cancers, which may partly be due to the relatively small sample size of the study. However, some other evidence is worrisome enough that NNPT should not be considered risk-free. Additional multi-centric studies should be undertaken to specify that phototherapy is really safe.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03412-0.

Neonatal jaundice, phototherapy and childhood allergic diseases: An updated systematic review and meta-analysis

BACKGROUND

Neonatal jaundice and phototherapy have been associated with the development of allergic diseases. It has been suggested, however, that effect estimates of the associations might be smaller than expected. We sought to update the evidence of their associations including recently published large longitudinal studies.

METHODS

We sought published and unpublished observational studies through the major databases. We used a random-effect meta-analysis model weighted by the inverse variance estimate, the Quality in Prognosis Studies tool to assess the methodological quality for each study, and the Grading of Recommendations, Assessment, Development, and Evaluation approach to assess the certainty of evidence (COE).

RESULTS

Nineteen studies were enrolled in the qualitative syntheses, and fourteen studies were synthesized in the meta-analyses. Neonatal jaundice was associated with a higher risk of childhood-onset asthma (odds ratio [OR], 1.46; 95% confidence interval [95% CI], 1.39-1.53; COE, moderate), atopic dermatitis (AD; OR, 1.30; 95% CI, 1.07-1.57; COE, moderate), and allergic rhinitis (AR; OR, 3.01; 95% CI, 0.8810.30; COE, low). Neonatal phototherapy was also associated with a higher risk of childhood-onset asthma (OR, 1.24; 95% CI, 1.11-1.38; COE, moderate), AD (OR, 1.31; 95% CI, 1.24-1.39; COE, moderate), and AR (OR, 1.38; 95% CI, 0.93-2.04; COE, very low). There were no studies that reported effect estimates of the associations between childhood-onset food allergies and neonatal jaundice and phototherapy.

CONCLUSION

Neonatal jaundice and phototherapy were probably a prognostic factor of childhood-onset allergic diseases; however, the associations were likely to be smaller than previously estimated.

Challenges of phototherapy for neonatal hyperbilirubinemia (Review)

Phototherapy is universally recognized as the first option for treating neonatal jaundice due to its unparalleled efficiency and safety in reducing the high serum free bilirubin levels and limiting its neurotoxic effects. However, several studies have suggested that phototherapy may elicit a series of short- and long-term adverse reactions associated with pediatric diseases, including hemolysis, allergic diseases, DNA damage or even cancer. The aim of the present review was to summarize the etiology, mechanism, associated risks and therapeutic strategies for reducing high neonatal serum bilirubin levels. In order to shed light on the negative effects of phototherapy and to encourage implementation of a reasonable and standardized phototherapy scheme in the clinic, the present review sought to highlight the current understanding of the adverse reactions of phototherapy, as it is necessary to further study the mechanism underlying the development of the adverse effects of phototherapy in infants in order to explore novel therapeutic alternatives.

Regional variation in the development of neonatal hyperbilirubinemia and relation with sunshine duration in Japan: an ecological study

BACKGROUND

Few studies have investigated the regional variations in the development of neonatal hyperbilirubinemia. This study aimed to investigate regional variations in medical costs for neonatal hyperbilirubinemia and the correlations between sunshine duration and medical care costs for neonatal hyperbilirubinemia in an ecological study, using the National Database of Japan.

METHODS

We obtained data on the annual medical costs for neonatal hyperbilirubinemia, annual live births, and annual sunshine duration in each prefecture from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data, Vital Statistics in Japan, and System of Social and Demographic Statistics Prefectural Data Basic Data from 2014 to 2017. We created choropleth maps showing the regional variations (quartiles) in the annual medical costs for neonatal hyperbilirubinemia per 10 live births and the annual sunshine duration in each prefecture. We used Pearson's correlation coefficients to evaluate the associations between the annual sunshine duration and annual medical care costs for neonatal hyperbilirubinemia per 10 live births in each prefecture.

RESULTS

The Tohoku region (on the Sea of Japan side) and the Hokuriku region were likely to have higher medical care costs for neonatal hyperbilirubinemia and shorter sunshine duration than the rest of the country. There were weak and negative correlations between the annual sunshine duration and the annual medical care costs for neonatal hyperbilirubinemia. The correlation coefficients ranged from -0.086 to -0.33.

CONCLUSION

There could be regional variations in the medical care costs for neonatal hyperbilirubinemia in Japan. Short sunshine duration could be a prognostic factor for the development of neonatal hyperbilirubinemia.

A systematic review and meta-analysis of risk factors associated with atopic dermatitis in Asia

Background

Atopic dermatitis (AD) is a chronic, inflammatory skin disorder characterised by intense itch and eczematous lesions. Rising prevalence of AD has been observed worldwide including in Asia. Understanding the risk factors associated with AD may explain its pathogenicity and identify new preventive strategies and treatments. However, AD-associated risk factors and comorbidities specific to Asia have not been systematically reviewed.

Methods

We performed a systematic review in accordance with the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines and summarised epidemiological studies investigating personal, family, and environmental factors and comorbidities associated with AD in Asia. Significant factors were assessed if they can be altered through lifestyle practices and further classified into non-modifiable and modifiable factors. Meta-analysis using the random-effect model was also conducted to provide an overall estimate for several significant factors.

Results

We identified a total of 162 epidemiological studies conducted in Asia. Among non-modifiable factors, a family history of atopic diseases was the most reported, suggesting the involvement of genetics in AD pathogenesis. Among modifiable factors, the results of meta-analyses revealed maternal smoking as the strongest risk factor with a pooled odds ratio (OR) of 2.95 (95% CI, 2.43-3.60), followed by active smoking (pooled OR, 1.91, 95% CI, 1.41-2.59).

Conclusion

While a family history may aid clinicians in identifying high-risk individuals, literature has long suggested the importance of gene-environment interaction. This review identified several modifiable factors including medical treatments, indoor and outdoor environmental exposure, and personal and family lifestyle specific to Asia. Based on the meta-analyses performed, prevention strategies against AD may start from changing personal and family lifestyle choices, especially smoking habits.

Home-Based Phototherapy Versus Hospital-Based Phototherapy for Treatment of Neonatal Hyperbilirubinemia: A Systematic Review and Meta-Analysis

Objective. Phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. We reviewed the current literature to determine whether home-based phototherapy is more effective than hospital-based phototherapy for the treatment of neonatal hyperbilirubinemia. Method. PubMed, Scopus, Embase, Cochrane library, CBM, CNKI, and Wanfang Data were searched to collect the comparative study of home-based phototherapy versus hospital-based phototherapy for the treatment of neonatal hyperbilirubinemia. All studies were found to be of low risk based on Cochrane Collaborative Risk of Bias Tool. Data were statistically extracted and evaluated by RevMan 5.3 software. Result. A total of 259 neonates were included in the meta-analysis. Compared with hospital-based phototherapy, home-based phototherapy appeared more effective for the treatment of neonatal hyperbilirubinemia in reducing the rate of total serum bilirubin (standard mean difference = 0.32, 95% confidence interval = -0.22 to 0.86, P = .04); however, there was no significant difference in duration of phototherapy (standard mean difference = 0.59, 95% confidence interval = 0.28 to 0.90, P = .06) in the 2 groups. Conclusion. Home-based phototherapy was more effective than hospital-based phototherapy in treatment for neonatal hyperbilirubinemia; home-based phototherapy is an effective, feasible, safe, and alternative to hospital-based phototherapy for neonatal hyperbilirubinemia.