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Hulzebos CV, Camara JE, van Berkel M, Delatour V, Lo SF, Mailloux A, Schmidt MC, Thomas M, Mackay LG, Greaves RF. Bilirubin measurements in neonates: uniform neonatal treatment can only be achieved by improved standardization. Clin Chem Lab Med 2024; 0:cclm-2024-0620. [PMID: 39066506 DOI: 10.1515/cclm-2024-0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024]
Abstract
Measurement of total bilirubin (TBil) concentration in serum is the gold standard approach for diagnosing neonatal unconjugated hyperbilirubinemia. It is of utmost importance that the measured TBil concentration is sufficiently accurate to prevent under treatment, unnecessary escalation of care, or overtreatment. However, it is widely recognized that TBil measurements urgently require improvement in neonatal clinical chemistry. External quality assessment (EQA) programs for TBil assess for differences between laboratories and provide supporting evidence of significant differences between various methods, manufacturers and measurement platforms. At the same time, many countries have adopted or only slightly adapted the neonatal hyperbilirubinemia management guidelines from the USA or UK, often without addressing differences in the methodology of TBil measurements. In this report, we provide an overview of the components of bilirubin that are measured by laboratory platforms, the availability of current reference measurement procedures and reference materials, and the role of EQA surveys in this context. Furthermore, the current status of agreement in neonatal bilirubin against clinical decision thresholds is reviewed. We advocate for enhancements in accuracy and comparability of neonatal TBil measurements, propose a path forward to accomplish this, and reflect on the position of the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Working Group Neonatal Bilirubin (WG-NB) in this matter.
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Affiliation(s)
- Christian V Hulzebos
- Department of Paediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna E Camara
- Chemical Sciences Division, National Institute of Standards and Technology (NIST), Gaithersburg, MD, USA
| | - Miranda van Berkel
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Vincent Delatour
- Laboratoire National de Métrologie et d'Essais (LNE), Paris, France
| | - Stanley F Lo
- Department of Pathology and Laboratory Medicine, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Agnès Mailloux
- Centre National de Référence en Hémobiologie Périnatale, Unit of Biologie, Pole Biology, Hopital Saint Antoine (Public Assistance Hospitals of Paris (AP-HP)), Paris, France
| | | | - Mercy Thomas
- The Royal Children's Hospital, Parkville, VIC, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | | | - Ronda F Greaves
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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Tan TJ, Chen WJ, Lin WC, Yang MC, Tsai CC, Yang YN, Yang SN, Liu HK. Early-Term Neonates Demonstrate a Higher Likelihood of Requiring Phototherapy Compared to Those Born Full-Term. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1819. [PMID: 38002910 PMCID: PMC10670379 DOI: 10.3390/children10111819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
Early-term neonates (with a gestational age (GA) of 37 and 0/7 weeks to 38 and 6/7 weeks) face higher morbidities, including respiratory and neurodevelopmental issues, than full-term (39 and 0/7 weeks to 40 and 6/7 weeks) infants. This study explores whether hyperbilirubinemia necessitating phototherapy also differs between these groups. A retrospective study was conducted on neonates born from January 2021-June 2022, excluding those with specific conditions. Evaluated factors included GA, birth weight, bilirubin levels, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and feeding type, with phototherapy given as per AAP guidelines. Of 1085 neonates, 356 met the criteria. When stratifying the neonates based on the need for phototherapy, a higher proportion of early-term neonates required phototherapy compared to full-term (p < 0.05). After factoring in various risks (GA; birth weight; gender; feeding type; G6PD deficiency; transcutaneous bilirubin levels at 24 h and 24-48 h postpartum; maternal diabetes; and the presence of caput succedaneum or cephalohematoma), early-term neonates were more likely to need phototherapy than full-term babies (OR: 2.15, 95% CI: 1.21 to 3.80). The optimal cut-off for transcutaneous bilirubin levels 24-48 h postpartum that were used to predict phototherapy need was 9.85 mg/dl. In conclusion, early-term neonates are at a greater risk for developing jaundice and requiring phototherapy than full-term neonates. Monitoring bilirubin 24-48 h postpartum enhances early prediction and intervention.
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Affiliation(s)
- Teck-Jin Tan
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (T.-J.T.); (M.-C.Y.); (C.-C.T.); (Y.-N.Y.); (S.-N.Y.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Wan-Ju Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
- Department of Pediatrics, E-Da Dachang Hospital, I-Shou University, Kaohsiung 80794, Taiwan
| | - Wan-Chun Lin
- Department of Nurse Practitioners, Yuan’s General Hospital, Kaohsiung 80249, Taiwan;
| | - Ming-Chun Yang
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (T.-J.T.); (M.-C.Y.); (C.-C.T.); (Y.-N.Y.); (S.-N.Y.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Ching-Chung Tsai
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (T.-J.T.); (M.-C.Y.); (C.-C.T.); (Y.-N.Y.); (S.-N.Y.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Yung-Ning Yang
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (T.-J.T.); (M.-C.Y.); (C.-C.T.); (Y.-N.Y.); (S.-N.Y.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - San-Nan Yang
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (T.-J.T.); (M.-C.Y.); (C.-C.T.); (Y.-N.Y.); (S.-N.Y.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Hsien-Kuan Liu
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (T.-J.T.); (M.-C.Y.); (C.-C.T.); (Y.-N.Y.); (S.-N.Y.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
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Huang MJ, Chen PL, Huang CS. Bilirubin metabolism and UDP-glucuronosyltransferase 1A1 variants in Asians: Pathogenic implications and therapeutic response. Kaohsiung J Med Sci 2022; 38:729-738. [PMID: 35942604 DOI: 10.1002/kjm2.12579] [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: 03/10/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022] Open
Abstract
In the Asian general population, at least six single-nucleotide variants (SNVs) in the UDP-glucuronosyltransferase (UGT) 1A1 gene have been identified: -3279T>G, -53A(TA)6 TAA>A(TA)7 TAA, 211G>A, 686C>A, 1091C>T, and 1456T>G. Each of these six SNVs was observed in at least four ethnic groups of the 12 Asian populations studied. In East Asian populations, the descending frequency of these six SNVs was as follows: -3279G>[-53A(TA)7 TAA, 211A]>(686A, 1091T)>1456G. Because of the presence of linkage disequilibrium and the expulsion phenomenon, when the SNVs -3279G, -53A(TA)7 TAA, 211A, and 686A were simultaneously involved, 15 instead of the estimated 81 genotypes were observed. Those carrying 686AA or 1456GG developed Gilbert's syndrome or Crigler-Najjar syndrome type 2. Both -53A(TA)7 TAA/A(TA)7 TAA and 211AA are the main causes of Gilbert's syndrome in East Asian populations. In East Asian populations, the 211AA genotype is the main cause of neonatal hyperbilirubinemia, whereas -53A(TA)7 TAA/A(TA)7 TAA exerts a protective effect on hyperbilirubinemia development in neonates fed with breast milk. Both 211A and -53A(TA)7 TAA are significantly associated with adverse drug reactions induced by irinotecan (one of the most widely used anticancer agents) in Asians. However, at least three common SNVs (-3279G, -53A(TA)7 TAA, and 211A) should be comprehensively analyzed. This study investigated the clinical significance of these six SNVs and demonstrated that examining UGT1A1 variants in Asian populations is considerably challenging.
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Affiliation(s)
- May-Jen Huang
- Department of Clinical Pathology, Cathay General Hospital, Taipei, Taiwan
| | - Pei-Lain Chen
- Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Ching-Shan Huang
- Department of Clinical Pathology, Cathay General Hospital, Taipei, Taiwan
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Lecomte F, Thecua E, Ziane L, Deleporte P, Duhamel A, Vamour C, Mordon S, Rakza T. Phototherapy Using a Light-Emitting Fabric (BUBOLight) Device in the Treatment of Newborn Jaundice: Protocol for an Interventional Feasibility and Safety Study. JMIR Res Protoc 2021; 10:e24808. [PMID: 34032584 PMCID: PMC8188309 DOI: 10.2196/24808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Neonatal jaundice is a common condition occurring in 60%-80% of all healthy-term and late-preterm neonates. In the majority of cases, neonatal jaundice resolves spontaneously and causes no harm; however, in some neonates, significant hyperbilirubinemia can develop and lead to kernicterus jaundice, a serious neurological disease. Phototherapy (PT) is the preferred treatment for jaundice; however, to be effective, PT devices need to have a broad light emission surface to generate no or little heat and to provide an optimal wavelength and light intensity (420-490 nm and ≥30 µW/cm²/nm, respectively). Objective This study aimed to investigate the feasibility, safety, and level of satisfaction of parents and health care teams with the BUBOlight device, an innovative alternative to conventional hospital PT, in which luminous textiles have been incorporated in a sleeping bag. Methods This interventional, exploratory, simple group, nonrandomized, single-center trial will be conducted at Lille Hospital. In total, 10-15 neonates and their parents will be included to obtain evaluable data from 10 parent-neonate pairs. Neonates weighing more than 2500 g at birth and born with ≥37 weeks of amenorrhea that required PT in accordance with the guidelines of the National Institute For Health and Clinical Excellence will receive one 4-hour session of illumination. Total serum bilirubin and transcutaneous bilirubin levels were obtained at the start and 2 hours after the end of PT. Cutaneous and rectal temperatures, heart rate, and oxygen saturation will be measured at the beginning and during PT. The number of subjects is therefore not calculated on the basis of statistical assumptions. We aim to obtain a minimum proportion of 90% (ie, 9 of 10) of the neonates included, who have been able to undergo 4-hour PT without unacceptable and unexpected toxicities. We will calculate the mean, median, quartiles, minimum and maximum values of the quantitative parameters, and the frequency of the qualitative parameters. The rate of patients with no unacceptable and unexpected toxicities (ie, the primary endpoint) will be calculated. Results The first patient is expected to be enrolled at the end of 2020, and clinical investigations are intended for up to June 2021. The final results of this study are expected to be available at the end of 2021. Conclusions Our findings will provide insights into the safety and feasibility of a new PT device based on light-emitting fabrics for the treatment of newborn jaundice. This new system, if proven effective, will improve the humanization of neonatal care and help avoid mother-child separation. Trial Registration ClinicalTrials.gov NCT04365998; https://clinicaltrials.gov/ct2/show/NCT04365998 International Registered Report Identifier (IRRID) PRR1-10.2196/24808
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Affiliation(s)
- Fabienne Lecomte
- U1189 - Assisted Laser Therapy and Immunotherapy for Oncology, Univ- Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Elise Thecua
- U1189 - Assisted Laser Therapy and Immunotherapy for Oncology, Univ- Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Laurine Ziane
- U1189 - Assisted Laser Therapy and Immunotherapy for Oncology, Univ- Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Pascal Deleporte
- U1189 - Assisted Laser Therapy and Immunotherapy for Oncology, Univ- Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Alain Duhamel
- EA 2694 - Santé publique: épidémiologie et qualité des soins, Univ- Lille, CHU Lille, F-59000 Lille, France
| | - Clémence Vamour
- Jeanne de Flandre Hospital, Department of Obstetrics, CHU Lille, F-59000 Lille, France
| | - Serge Mordon
- U1189 - Assisted Laser Therapy and Immunotherapy for Oncology, Univ- Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Thameur Rakza
- EA4489, Perinatal Growth and Health, Jeanne de Flandre Hospital, Department of Obstetrics, Univ- Lille, CHU Lille, F-59000 Lille, France
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Chu L, Xue X, Qiao J. Efficacy of Intermittent Phototherapy versus Continuous Phototherapy for Treatment of Neonatal Hyperbilirubinaemia: A Systematic Review and Meta-analysis. J Adv Nurs 2020; 77:12-22. [PMID: 33150664 DOI: 10.1111/jan.14535] [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: 12/17/2019] [Revised: 06/25/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Abstract
AIMS We review the current literatures to determine whether intermittent phototherapy is more effective than continuous phototherapy in treating neonatal hyperbilirubinaemia. DESIGN The systematic review is a systematic review and meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for reporting methods and results of synthesis with meta-analysis. Synthesis Without Meta-analysis (SWIM) guidelines were used for reporting methods and results of synthesis without meta-analysis. DATA SOURCE Pubmed, Embase, Cochrane library, China National Knowledge Infrastructure, China Biology Medicine, VIP Database, and Wanfang Database. REVIEW METHODS PICOS eligibility criteria were used to select original studies published from 1984 through 2019. Data were statistically extracted and evaluated using RevMan 5.3 software. RESULTS A total of 416 records were identified through database searching. Four studies (three randomized studies and one retrospective study) meet the final inclusion criteria. Seven hundred and sixteen neonates were included in the meta-analysis. There was no difference in the treatment efficacy and total serum bilirubin (TSB), while there was a significant difference in phototherapy duration and side effects after treatment of intermittent phototherapy and continuous phototherapy for neonatal hyperbilirubinaemia. CONCLUSION Intermittent phototherapy appeared to be as effective as continuous phototherapy for the treatment of neonatal hyperbilirubinaemia and is safer than continuous phototherapy. Healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinaemia. IMPACT Intermittent phototherapy is an effective, feasible, and safer treatment method for the infants with hyperbilirubinaemia in paediatric department. Healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinaemia.
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Affiliation(s)
- Liangliang Chu
- Nursing, Shandong University, Qianfoshan Hospital, Jinan, China
| | - Xiujuan Xue
- Nursing, Shandong University, Qianfoshan Hospital, Jinan, China
| | - Jianhong Qiao
- Nursing, Shandong University, Qianfoshan Hospital, Jinan, China
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Hansen TWR, Wong RJ, Stevenson DK. Molecular Physiology and Pathophysiology of Bilirubin Handling by the Blood, Liver, Intestine, and Brain in the Newborn. Physiol Rev 2020; 100:1291-1346. [PMID: 32401177 DOI: 10.1152/physrev.00004.2019] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Bilirubin is the end product of heme catabolism formed during a process that involves oxidation-reduction reactions and conserves iron body stores. Unconjugated hyperbilirubinemia is common in newborn infants, but rare later in life. The basic physiology of bilirubin metabolism, such as production, transport, and excretion, has been well described. However, in the neonate, numerous variables related to nutrition, ethnicity, and genetic variants at several metabolic steps may be superimposed on the normal physiological hyperbilirubinemia that occurs in the first week of life and results in bilirubin levels that may be toxic to the brain. Bilirubin exists in several isomeric forms that differ in their polarities and is considered a physiologically important antioxidant. Here we review the chemistry of the bilirubin molecule and its metabolism in the body with a particular focus on the processes that impact the newborn infant, and how differences relative to older children and adults contribute to the risk of developing both acute and long-term neurological sequelae in the newborn infant. The final section deals with the interplay between the brain and bilirubin and its entry, clearance, and accumulation. We conclude with a discussion of the current state of knowledge regarding the mechanism(s) of bilirubin neurotoxicity.
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Affiliation(s)
- Thor W R Hansen
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ronald J Wong
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David K Stevenson
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Zhou S, Wu X, Ma A, Zhang M, Liu Y. Analysis of therapeutic effect of intermittent and continuous phototherapy on neonatal hemolytic jaundice. Exp Ther Med 2019; 17:4007-4012. [PMID: 30988782 PMCID: PMC6447920 DOI: 10.3892/etm.2019.7432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/14/2019] [Indexed: 12/04/2022] Open
Abstract
Clinical efficacy and adverse reaction rates of ABO hemolytic jaundice in patients with continuous and intermittent blue light irradiation were compared, to provide reference for clinical treatment of neonatal ABO hemolytic jaundice. A retrospective analysis of 307 patients with neonatal hemolytic jaundice admitted to Qilu Hospital of Shandong University (Qingdao) from January 2010 to December 2017 was undertaken. A total of 165 cases of children with continuous blue light irradiation and 142 cases of intermittent blue light irradiation were analyzed. Also the serum bilirubin levels, phototherapy time and frequency, treatment efficiency and adverse reaction rates were compared between the groups. The phototherapy time of children in the continuous phototherapy group was significantly higher from the intermittent phototherapy group, and the difference was statistically significant (t=26.800, P<0.001). Before treatment, there was no significant difference in serum bilirubin levels between continuous and intermittent phototherapy groups (P>0.050). Serum bilirubin levels of patients in continuous and intermittent phototherapy groups were lower than both previous and before treatment period, and differences were statistically significant (P<0.001). The overall effective rate of the continuous phototherapy group was higher than that of the intermittent phototherapy group (P>0.050). The adverse reaction rates after treatment in the continuous phototherapy group was significantly higher than the intermittent phototherapy group (P<0.050). After the symptomatic treatment in children, the adverse reactions ceased. The therapeutic effect of intermittent blue light irradiation on neonatal ABO hemolytic jaundice was consistent with the continuous blue light irradiation treatment, and the intermittent blue light irradiation treatment has a low adverse reaction rate, and is worth promotion in clinical practice.
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Affiliation(s)
- Shiying Zhou
- Department of Pediatric Internal Medicine, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266000, P.R. China
| | - Xiaoyan Wu
- Department of Pediatrics, People's Hospital of Chiping, Liaocheng, Shandong 252000, P.R. China
| | - Aihua Ma
- PIVAS, The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Min Zhang
- Department of Stomatology, The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Yanli Liu
- Department of Pediatric Internal Medicine, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266000, P.R. China
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Identification of Genetic Risk Factors for Neonatal Hyperbilirubinemia in Fujian Province, Southeastern China: A Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7803175. [PMID: 30298137 PMCID: PMC6157199 DOI: 10.1155/2018/7803175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 08/09/2018] [Indexed: 12/18/2022]
Abstract
To date, the genetic risk factors for neonatal hyperbilirubinemia remain unknown in Southeastern China. This case-control study aimed to identify the genetic risk factors for neonatal hyperbilirubinemia in Fujian, Southeastern China. A total of 286 hyperbilirubinemic newborns were enrolled as a case group, and 250 randomly selected newborns without jaundice or with a bilirubin level that was lower than the threshold required for phototherapy served as controls. The serum levels of total bilirubin, unconjugated bilirubin, and direct bilirubin were measured, and the common genetic loci in UGT1A1, OATP1B1, and HO-1 genes were genotyped. Higher incidence of ABO incompatibility and G6PD deficiency was detected in the case group compared to the control group (P < 0.01). There were significant differences in the frequencies of rs4148323 and rs1805173 genotypes between the case and control groups (P < 0.05). At the rs4148323 locus, the frequencies of GA heterozygotes and AA mutant homozygotes were higher in the case group than in the control group (P < 0.05), and at the rs1805173 locus, the frequencies of LS, MS, and SS genotypes were higher in the case group than in the control group (P < 0.05). A higher frequency of rs4148323 A allele and rs1805173 S allele was detected in the case group compared to the control group (P = 0). Additionally, multivariate logistic regression analysis identified that the mutant genotype of rs4148323 in the UGT1A1 gene, ABO incompatibility, G6PD deficiency, and SS genotype at rs1805173 locus of the HO-1 gene were genetic risk factors of neonatal hyperbilirubinemia. Our data demonstrate that G211 mutation in the UGT1A1 gene, ABO incompatibility, G6PD deficiency, and the SS genotype of the repeats in the promoter region of the HO-1 gene are risk factors for neonatal hyperbilirubinemia in Fujian, Southeastern China.
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Hyperthyroxinemia at birth: a cause of idiopathic neonatal hyperbilirubinemia? World J Pediatr 2018; 14:247-253. [PMID: 29721843 DOI: 10.1007/s12519-017-0113-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/16/2016] [Indexed: 10/17/2022]
Abstract
BACKGROUND Some neonates develop idiopathic hyperbilirubinemia (INHB) requiring phototherapy, yet with no identifiable causes. We searched for an association between abnormal thyroid levels after birth and INHB. METHODS Of 5188 neonates, 1681 (32.4%) were excluded due to one or more risk factors for hyperbilirubinemia. Total thyroxine (TT4) and thyroid stimulating hormone values were sampled routinely at 40-48 hours of age and measured in the National Newborn Screening Program. RESULTS Of the 3507 neonates without known causes for hyperbilirubinemia, 61 (1.7%) developed INHB and received phototherapy. Univariate analyses found no significant association between mode of delivery and INHB (vacuum-delivered neonates were a priori excluded). Nonetheless, in cesarean-delivered (CD) neonates, two variables had significant association with INHB: TT4 ≥ 13 µg/dL and birth at 38-38.6 weeks. In vaginally delivered (VD) born neonates, INHB was associated with weight loss > 7.5% up to 48 hours of age. Multivariate logistic regression analysis showed a strong effect of mode of delivery on possible significant association with INHB. In CD neonates, such variables included: TT4 ≥ 13 µg/dL [P = 0.025, odds ratio (OR) 5.49, 95% confidence interval (CI) 1.23-24.4] and birth at 38-38.6 weeks (P = 0.023, OR 3.44, 95% CI 1.19-9.97). In VD neonates, weight loss > 7.5% (P = 0.019, OR 2.1, 95% CI 1.13-3.83) and 1-min Apgar score < 9 (P < 0.001, OR 3.8, 95% CI 1.83-7.9), but not TT4, showed such an association. CONCLUSIONS INHB was significantly associated with birth on 38-38.6 week and TT4 (≥ 13 µg/dL) in CD neonates, and with a weight loss > 7.5% in VD neonates. We herein highlight some acknowledged risk factors for neonatal hyperbilirubinemia, and thus minimize the rate of INHB.
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Weng YH, Chiu YW, Cheng SW, Yang CY. Risk assessment of gene variants for neonatal hyperbilirubinemia in Taiwan. BMC Pediatr 2016; 16:144. [PMID: 27557546 PMCID: PMC4997681 DOI: 10.1186/s12887-016-0685-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/23/2016] [Indexed: 12/20/2022] Open
Abstract
Background Hyperbilirubinemia is a common disorder during neonatal period in Taiwan. Gene variants may play an important role in the development of neonatal hyperbilirubinemia. The current study investigated the association between neonatal hyperbilirubinemia and common gene variants involving the production and metabolism of bilirubin. Methods This prospective study enrolled 444 healthy infants born in the Chang Gung Memorial Hospital at Taipei from 2013–2015. Hyperbilirubinemia was defined as a total bilirubin ≥ 15 mg/dL. A log-binomial model was used to assess the risk of gene variants. Results The most common genetic variant was short heme oxygenase (HO)-1 promoter GT-allele (<24 repeats) (39.4 %), followed by GA at nt388 in hepatic solute carrier organic anion transporter 1B1 (SLCO1B1) (31.1 %), GA at nt211 in UDP-glucuronosyltransferase 1A1 (UGT1A1) (29.3 %), ABO incompatibility (16.2 %), alpha thalassemia (5.0 %), and G6PD deficiency (3.2 %). The log-binomial analysis demonstrated greater risks of hyperbilirubinemia in infants with GA at nt211 in UGT1A1 (RR = 1.548; 95 % CI = 1.096–2.187), short HO-1 promoter GT-repeat (RR = 2.185; 95 % CI = 1.527–3.125), and G6PD deficiency (RR = 1.985; 95 % CI = 1.010–3.901). The other gene variants – including blood type, alpha thalassemia, and SLCO1B1 – carried no significant risk. Conclusions G6PD deficiency, short HO-1 promoter GT-repeat and GA at nt211 in UGT1A1 are risk factors of neonatal hyperbilirubinemia. The data provide clinical evidence to explain the high incidence of neonatal hyperbilirubinemia in Taiwan.
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Affiliation(s)
- Yi-Hao Weng
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199 Dunhua North Road, Taipei, 105, Taiwan.
| | - Ya-Wen Chiu
- Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Shao-Wen Cheng
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199 Dunhua North Road, Taipei, 105, Taiwan
| | - Chun-Yuh Yang
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
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Memon N, Weinberger BI, Hegyi T, Aleksunes LM. Inherited disorders of bilirubin clearance. Pediatr Res 2016; 79:378-86. [PMID: 26595536 PMCID: PMC4821713 DOI: 10.1038/pr.2015.247] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/31/2015] [Indexed: 01/01/2023]
Abstract
Inherited disorders of hyperbilirubinemia may be caused by increased bilirubin production or decreased bilirubin clearance. Reduced hepatic bilirubin clearance can be due to defective (i) unconjugated bilirubin uptake and intrahepatic storage, (ii) conjugation of glucuronic acid to bilirubin (e.g., Gilbert syndrome, Crigler-Najjar syndrome, Lucey-Driscoll syndrome, breast milk jaundice), (iii) bilirubin excretion into bile (Dubin-Johnson syndrome), or (iv) conjugated bilirubin re-uptake (Rotor syndrome). In this review, the molecular mechanisms and clinical manifestations of these conditions are described, as well as current approaches to diagnosis and therapy.
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Affiliation(s)
- Naureen Memon
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Corresponding author: Naureen Memon, M.D., Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB 396, New Brunswick, NJ, 08901 USA, Phone: (732) 235-5599, Fax: (732) 235-5668,
| | - Barry I Weinberger
- Department of Pediatrics, Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA
| | - Thomas Hegyi
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Lauren M Aleksunes
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, NJ, USA
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Role of extrahepatic UDP-glucuronosyltransferase 1A1: Advances in understanding breast milk-induced neonatal hyperbilirubinemia. Toxicol Appl Pharmacol 2015; 289:124-32. [PMID: 26342858 DOI: 10.1016/j.taap.2015.08.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/25/2015] [Accepted: 08/26/2015] [Indexed: 01/29/2023]
Abstract
Newborns commonly develop physiological hyperbilirubinemia (also known as jaundice). With increased bilirubin levels being observed in breast-fed infants, breast-feeding has been recognized as a contributing factor for the development of neonatal hyperbilirubinemia. Bilirubin undergoes selective metabolism by UDP-glucuronosyltransferase (UGT) 1A1 and becomes a water soluble glucuronide. Although several factors such as gestational age, dehydration and weight loss, and increased enterohepatic circulation have been associated with breast milk-induced jaundice (BMJ), deficiency in UGT1A1 expression is a known cause of BMJ. It is currently believed that unconjugated bilirubin is metabolized mainly in the liver. However, recent findings support the concept that extrahepatic tissues, such as small intestine and skin, contribute to bilirubin glucuronidation during the neonatal period. We will review the recent advances made towards understanding biological and molecular events impacting BMJ, especially regarding the role of extrahepatic UGT1A1 expression.
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