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Rallabandi S, Amin SB. Bilirubinemia and retinopathy of prematurity in infants ≤ 29 weeks' gestational age. Pediatr Res 2024:10.1038/s41390-024-03479-8. [PMID: 39191947 DOI: 10.1038/s41390-024-03479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 07/16/2024] [Accepted: 07/25/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Bilirubin is a known antioxidant. We hypothesized that the degree of bilirubinemia is inversely associated with oxidative stress-mediated retinopathy of prematurity (ROP). METHODS A prospective study was performed to determine if bilirubinemia is associated with ROP in infants ≤ 29 wks' gestational age and birth weights ≤ 1000 g. Total serum bilirubin (TSB) levels were measured at least twice daily during the first week and at least daily during the second week to determine peak and mean TSB levels. The outcomes were the incidence and severity of ROP. RESULTS Of 193 infants studied, 110 developed ROP: 53 had mild (stage 1 in zone 2 or 3); 31 had moderate (stage 2 in zone 2 or 3); and 26 had severe ROP ( ≥ stage 3 in any zone or any stage in zone 1). Mean TSB levels were associated with the severity (adjusted odds ratio [AOR] 0.68, 95% confidence interval [CI]:0.47-0.98, p = 0.04), but not with the incidence of ROP (AOR 0.81, 95% CI:0.52-1.27, p = 0.3). Peak TSB levels were also associated with the severity (AOR 0.71, 95% CI:0.52-0.96, p = 0.02), but not with the incidence of ROP (AOR 0.71, 95% CI:0.48-1.01, p = 0.07). CONCLUSIONS Bilirubinemia may be protective against severity of ROP. IMPACT Retinopathy of prematurity (ROP) is a disease mediated by oxidative stress. Increasing antioxidant status may decrease the incidence and severity of ROP. Bilirubin is a known antioxidant; however, findings from observational studies evaluating the role of bilirubinemia against the incidence and/or severity of ROP in premature infants are conflicting. Our findings from this prospective study suggests that bilirubinemia may be protective against the severity of ROP.
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Affiliation(s)
- Srujana Rallabandi
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Sanjiv B Amin
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
- Department of Pediatrics, Wayne State University, Detroit, MI, USA.
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Tapak L, Farahani LN, Taleghani NT, Ebrahimiadib N, Pour EK, Farahani AD, Hamidi O. Risk factors for the time to development of retinopathy of prematurity in premature infants in Iran: a machine learning approach. BMC Ophthalmol 2024; 24:364. [PMID: 39180010 PMCID: PMC11342517 DOI: 10.1186/s12886-024-03637-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 08/14/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP), is a preventable leading cause of blindness in infants and is a condition in which the immature retina experiences abnormal blood vessel growth. The development of ROP is multifactorial; nevertheless, the risk factors are controversial. This study aimed to identify risk factors of time to development of ROP in Iran. METHODS This historical cohort study utilized data from the hospital records of all newborns referred to the ROP department of Farabi Hospital (from 2017 to 2021) and the NICU records of infants referred from Mahdieh Hospital to Farabi Hospital. Preterm infants with birth weight (BW) ≤ 2000 g or gestational age (GA) < 34 wk, as well as selected infants with an unstable clinical course, as determined by their pediatricians or neonatologists, with BW > 2000 g or GA ≥ 34 wk. The outcome variable was the time to development of ROP (in weeks). Random survival forest was used to analyze the data. RESULTS A total of 338 cases, including 676 eyes, were evaluated. The mean GA and BW of the study group were 31.59 ± 2.39 weeks and 1656.72 ± 453.80 g, respectively. According to the criteria of minimal depth and variable importance, the most significant predictors of the time to development of ROP were duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of Total Parenteral Nutrition (TPN), mother age, birth order, number of surfactant administration, and on time screening. The concordance index for predicting survival of the fitted model was 0.878. CONCLUSION Our findings indicated that the duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of TPN, mother age, birth order, number of surfactant administrations, and on time screening are potential risk factors of prognosis of ROP. The associations between identified risk factors were mostly nonlinear. Therefore, it is recommended to consider the nature of these relationships in managing treatment and designing early interventions.
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Affiliation(s)
- Leili Tapak
- Department of Biostatistics, School of Public Health and Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Naeeme Taslimi Taleghani
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Elias Khalili Pour
- Farabi Eye Hospital, Retina Ward, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Omid Hamidi
- Department of Science, Hamedan University of Technology, Hamedan, Iran.
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Gulden S, Cervellini G, Colombo M, Marangoni MB, Taccani V, Pesenti N, Raffaeli G, Araimo G, Osnaghi S, Fumagalli M, Garrido F, Villamor E, Cavallaro G. Hyperbilirubinemia and retinopathy of prematurity: a retrospective cohort study. Eur J Pediatr 2024:10.1007/s00431-024-05630-3. [PMID: 38877325 DOI: 10.1007/s00431-024-05630-3] [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] [Received: 04/09/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/16/2024]
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease in preterm infants. Oxidative stress plays a key role in the pathogenesis of ROP. Due to its antioxidant effects, bilirubin has been proposed to be protective against ROP. This study explored the association between hyperbilirubinemia and ROP. We analyzed a 10-year cohort from a neonatal intensive care unit in Milan, Italy, including 1606 infants born under 32 weeks and/or < 1500 g. Data from 1606 infants meeting specific inclusion criteria were reviewed. Eighty infants were excluded due to lack of data, 1526 were deemed eligible for analysis, and 1269 had hyperbilirubinemia requiring phototherapy. There was a higher incidence of ROP among infants with hyperbilirubinemia (13.8%) versus those without (7.8%, p<0.01). Infants with any ROP, non-severe or severe ROP, were exposed to hyperbilirubinemia for a significantly higher number of days compared with those without ROP. Each additional day of exposure increases the risk of developing any ROP by 5%, non-severe ROP by 4%, and severe ROP by 6%. However, this correlation was not observed in infants with gestational age less than 27 weeks and/or body weight less than 1000 g. Conclusion: Our data show that hyperbilirubinemia requiring phototherapy is associated with an increased risk of developing ROP. However, severe hyperbilirubinemia and ROP share many of their risk factors. Therefore, rather than being a risk factor itself, hyperbilirubinemia may be a surrogate for other risk factors for ROP. Clinical Trial Registration: NCT05806684. What is Known: • The development of retinopathy of prematurity (ROP) is influenced by several critical risk factors, including low gestational age, low birth weight, supplemental oxygen use, and increased oxidative stress. • In vitro, unconjugated bilirubin is an effective scavenger of harmful oxygen species and a reducing agent, highlighting its potential protective role against oxidative stress. What is New: • Hyperbilirubinemia requiring phototherapy was associated with an increased risk of developing ROP, but this association was not observed in the most vulnerable population of extremely preterm infants. • Every additional day of phototherapy for hyperbilirubinemia increases the risk of ROP by 5% for any ROP, 4% for non-severe ROP, and 6% for severe ROP.
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Affiliation(s)
- Silvia Gulden
- Neonatal Intensive Care Unit, Sant'Anna Hospital, 22042, Como, Italy
| | - Gaia Cervellini
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
| | - Marta Colombo
- Neonatal Intensive Care Unit, Sant'Anna Hospital, 22042, Como, Italy
| | - Maria Beatrice Marangoni
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
| | - Vittoria Taccani
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
| | - Nicola Pesenti
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Revelo Datalabs S.R.L, 20142, Milan, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy.
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Silvia Osnaghi
- Department of Ophthalmology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
| | - Felipe Garrido
- Neonatal Intensive Care Unit, Clínica Universidad de Navarra, 28027, Madrid, Spain
| | - Eduardo Villamor
- Division of Neonatology, MosaKids Children's Hospital, Maastricht University Medical Center (MUMC+), Research Institute for Oncology and Reproduction (GROW), Maastricht University, 6202AZ, Maastricht, The Netherlands
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
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Eroglu SA, Unsal AIA, Abdullayev OK, Guler D, Turkmen MK, Özkan SB, Demirci B, Omurlu IK. The role of hepatic and renal functions in the development of retinopathy of prematurity: Is proteinuria a new risk factor? Int Ophthalmol 2023; 43:483-490. [PMID: 35930082 DOI: 10.1007/s10792-022-02445-9] [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: 03/17/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To investigate the association of hepatic and renal parameters with the development of retinopathy of prematurity (ROP) in premature infants with a gestational age ≤ 32 weeks. METHODS Medical records of 240 preterm infants were reviewed retrospectively, 85 of them were grouped as type 1, type 2 ROP, and control group. The 4th week hepatic and renal function test results of the groups, on the day of their first ROP examinations, were compared for the risk of development of ROP and the development of type 1 ROP. RESULTS In this study, 12, 35, and 38 infants were enrolled in the type 1, type 2 ROP, and control group, respectively. The average gestational age and birth weight were higher; however, the duration of oxygen treatment was lower in the control group (p < 0.001). The blood glucose level was significantly higher in the type 1 ROP group than in the other groups (p = 0.023). The mean of total serum bilirubin of the type 1 ROP group was significantly lower than those of the type 2 ROP and control group (p = 0.032). Proteinuria was present in 85.7% of preterms with treatment-requiring ROP and proteinuria increased the risk of ROP by 3.9 times (OR with 95% CI 3.9 (1.19-12.75), p = 0.042). CONCLUSION We found significantly higher blood glucose and lower total bilirubin level in the type 1 ROP group. Moreover, our findings suggest that proteinuria may not be only a comorbidity factor but also related to a higher frequency of ROP and type 1 ROP in preterm infants.
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Affiliation(s)
- Sayime Aydin Eroglu
- Department of Ophthalmology, Bakircay University Cigli Training and Research Hospital, Izmir, Turkey.
| | - Ayse Ipek Akyuz Unsal
- Department of Ophthalmology, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
| | | | - Duygu Guler
- Department of Ophthalmology, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
| | - Munevver Kaynak Turkmen
- Department of Neonatology, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
| | | | - Buket Demirci
- Department of Medical Pharmacology, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
| | - Imran Kurt Omurlu
- Department of Biostatistics, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
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Association between Serum Total Bilirubin Level and Patients with Primary Open-Angle Glaucoma in China: A Cross-Sectional, Case-Control Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2023; 2023:8206298. [PMID: 36718279 PMCID: PMC9884161 DOI: 10.1155/2023/8206298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/19/2022] [Accepted: 01/04/2023] [Indexed: 01/23/2023]
Abstract
Objective To investigate the relationship between peripheral blood total bilirubin (TBIL) levels and the risk of primary open-angle glaucoma (POAG). Methods This study was a cross-sectional, case-control study design. Between April 2021 and January 2022, 198 POAG patients and 205 healthy subjects were recruited from the EENT Hospital of Fudan University. Their clinical information (intraocular pressure, central corneal thickness, vertical cup-disk ratios (VCDR), and axial length) and demographic data were collected. Serum levels of TBIL were measured in enzymes using a Roche C702 biochemical analyzer. The POAG subgroups were classified by gender and VCDR: mild (VCDR ≤ 0.64), moderate (VCDR ≤ 0.85), and severe (VCDR > 0.85). Univariate and multivariate logistic regression analyses were performed. Results The level of TBIL (11.58 ± 5.16 μmol/L) in the POAG group was higher than that in the control group (10.18 ± 3.38 μmol/L; p < 0.05). In the male subgroup, TBIL was also significantly higher than in the normal control group; TBIL levels were lower in the mild subgroup (10.82 ± 4.48 μmol/L), followed by the moderate subgroup (12.00 ± 5.55 μmol/L) and the severe subgroup (14.47 ± 5.45 μmol/L). The results of the multivariate logistic regression analysis showed that high TBIL levels were a risk factor for male POAG, at 1.126 (95% CI 1.009-1.256). Pearson's analysis revealed that TBIL was positively correlated with intraocular pressure (r = 0.134, p = 0.012), VCDR (r = 0.142, p = 0.046), anterior chamber depth (r = 0.190, p = 0.014), and axial length (r = 0.179, p = 0.019) in the patients. However, no statistical difference (p < 0.05) was observed in the female patients with POAG. Conclusion The results showed that high levels of TBIL may be related to the pathogenesis of POAG and that the severity of the disease is positively correlated, especially in male patients.
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Boskabadi H, Shoeibi N, Bagheri F, Pourbadakhshan N, Moradi A, Zakerihamidi M. Potential Role of Bilirubin in Preventing Retinopathy of Prematurity. Curr Pediatr Rev 2023; 19:197-202. [PMID: 35986544 DOI: 10.2174/1573396318666220819151154] [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] [Received: 01/20/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND One of the most common problems in preterm neonates is retinopathy of prematurity (ROP). It has been shown antioxidants may be effective in preventing the development and progression of ROP. Considering the antioxidant properties of bilirubin, we decided to investigate the bilirubin level in neonates with ROP and compare it with healthy neonates. METHODS This case-control study was performed on VLBW neonates admitted to the NICU of Ghaem Hospital in Mashhad between 2014 and 2020 for a Jaundice evaluation. Complete neonate's characteristics, maternal history and laboratory results were collected in a questionnaire. Then the neonates were examined for ROP by a fellowship of the retina of an ophthalmologist at 32 weeks or four weeks after birth. The highest bilirubin levels during their hospitalization were also recorded. RESULTS Of 427 neonates examined, 121 (37.7%) had a normal eye examination, and 266 (62.3%) had ROP. The mean weight, gestational age and bilirubin were 1455.8 ± 431.4 grams, 31.6 ± 2.3 weeks and 8.8 ± 2.4 mg/dl, respectively. There was a significant difference between controls and neonates with ROP with regard to birth weight, duration of intermittent positive pressure ventilation (IPPV), duration of oxygen therapy, first and fifth minute Apgar scores, the maximum level of bilirubin and gestational age (P < 0.05). It was observed that the maximum level of bilirubin was lower in neonates with higher stages of ROP. CONCLUSION According to the results of this study, higher levels of bilirubin in neonates may be a protective factor against ROP. Moreover, increased levels of bilirubin are associated with reduced severity of ROP. Therefore, prophylaxis phototherapy in premature infants may need to be reconsidered.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naser Shoeibi
- Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Bagheri
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | - Nafiseh Pourbadakhshan
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- PhD (Tissue Engineering), Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
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Elshahawy II, Elshanat S, Arab MM, Nayel M, Salama A, El-Sify A, Aly M. Hepatic biomarkers and coprology as indicators of clinical bovine fasciolosis in Chad. Vet World 2021; 14:1153-1157. [PMID: 34220116 PMCID: PMC8243696 DOI: 10.14202/vetworld.2021.1153-1157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Fasciolosis is a cosmopolitan parasitic disease of food-producing animals and is typically caused by digenetic trematodes, Fasciola gigantica and Fasciola hepatica. It has a direct negative impact on the liver and consequently affects liver metabolism. It has indirect effects, including lowered milk production and effects on quality and general health conditions leading to extensive economic losses. This study aimed to focus on the link between clinical fasciolosis and some biochemical analysis of the hepatic profile of cattle in Chad. Materials and Methods: This study was initiated in response to emerging complaints from dairy cattle owners detecting a bitter milk cream and butter taste. Furthermore, those animals had shown poor health conditions by presenting with diarrhea. Preliminary surveillance for possible causes was performed, including fecal and serum biochemical analyses and clinical observation to diagnose the possible disease. Results: The results obtained, including the finding of parasite stages during the coprological examination, confirmed the role of fasciolosis. The independent sample t-test indicated highly significantly altered values of all biochemical liver indicators in the infected animals. All animals were treated with two doses of rafoxanide (3 mg/kg b.w.) S/C, at 21 days intervals, with vitamin supplements, mineral mixtures, and food additives. Surprisingly, the main complaint was restored after treatment. This is another evident clue of fasciolosis. To the best of our knowledge, this is the first recent study that diagnosed fasciolosis in Chad. Conclusion: This study emphasized the importance of fasciolosis, its negative impact on milk taste, and the necessity for veterinary advice regarding routine examination and prophylactic measures, especially before autumn, to minimize economic losses. However, regardless of the small sample size, this study could serve as a cornerstone for future studies on evaluating the accurate epidemiological status of fasciolosis in Chad. This study reported a close association between the alteration of liver enzymes and total protein levels in fasciolosis and the bitter milk cream taste, which could be used as a diagnostic tool for fasciolosis.
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Affiliation(s)
- Ibrahim I Elshahawy
- Department of Animal Medicine, Faculty of Veterinary Medicine, Alexandria University, Egypt
| | - Sherif Elshanat
- Department of Parasitology, Faculty of Veterinary Medicine, Alexandria University, Egypt
| | - Mayo Mahamat Arab
- Department of Biology, College of Exact and Applied Sciences, The University of N'Djamena, Chad
| | - Mohamed Nayel
- Department of Biology, College of Exact and Applied Sciences, The University of N'Djamena, Chad
| | - Akram Salama
- Department of Animal Medicine and Infectious Diseases (Infectious disease), Faculty of Veterinary Medicine, University of Sadat City, Egypt
| | - Ahmed El-Sify
- Department of Animal Medicine and Infectious Diseases (Infectious disease), Faculty of Veterinary Medicine, University of Sadat City, Egypt
| | - Mahmoud Aly
- Department of Animal Medicine and Infectious Diseases (Animal Medicine), Faculty of Veterinary Medicine, University of Sadat City, Egypt
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Spectral-domain OCT changes in retina and optic nerve in children with hypoxic-ischaemic encephalopathy. Graefes Arch Clin Exp Ophthalmol 2020; 259:1343-1355. [PMID: 33141256 PMCID: PMC8102460 DOI: 10.1007/s00417-020-04996-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose To evaluate the effect of neonatal hypoxic–ischaemic injury on the retina and the optic nerve and to correlate ocular damage with systemic parameters, laboratory tests, neurological imaging and therapeutic hypothermia at birth. Methods Forty-one children with hypoxic–ischaemic encephalopathy (HIE) at birth (9.09 ± 3.78 years) and a control group of 38 healthy subjects (9.57 ± 3.47 years) were enrolled in a cohort study. The HIE population was divided into three subgroups, based on the degree of encephalopathy according to Sarnat score and the treatment with therapeutic hypothermia (TH): Sarnat score I not treated with hypothermia, Sarnat score II-III treated with TH and Sarnat score II-III not subjected to TH. Total macular thickness, individual retinal layers and peripapillary nerve fibre layer thickness were measured with spectral-domain optical coherence tomography. Clinical data of perinatal period of HIE children were collected: APGAR score, pH and base excess of funiculus blood at birth, apnoea duration, brain ultrasound, cerebral MRI ischaemic lesions and blood chemistry tests. Results Children with Sarnat score I did not show a reduction of peripapillary nerve fibres and ganglion cell layer compared to the control group (p = 0.387, p = 0.316). Peripapillary nerve fibre layer was 109.06 ± 7.79 μm in children with Sarnat score II-III treated with TH, 108.31 ± 7.83 μm in subjects with Sarnat score II-III not subjected to TH and 114.27 ± 6.81 μm in the control group (p = 0.028, p = 0.007). Ganglion cell layer was thinner in children with Sarnat score II-III treated with TH (50.31 ± 5.13 μm) compared to the control group (54.04 ± 2.81 μm) (p = 0.01). Inner retinal layers damage correlated with C-reactive protein and lactate dehydrogenase increase, while higher levels of total bilirubin were protective against retinal impairment (p < 0.05). Cerebral oedema was related to peripapillary nerve fibre layer damage (p = 0.046). Conclusions Thickness reduction of inner retinal layer and peripapillary nerve fibre impairment was related to encephalopathy severity. Ocular damage was associated with inflammation and cerebral oedema following hypoxic–ischaemic damage.
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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: 45] [Impact Index Per Article: 11.3] [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 Y, Zhang L, Yu Z, Zhang A, Wu W, Chen W, Yan X, Liu H, Hu Y, Jiang C, Xu Y, Wang X, Han S. Peptidomic analysis reveals multiple protection of human breast milk on infants during different stages. J Cell Physiol 2019; 234:15510-15526. [PMID: 30741421 DOI: 10.1002/jcp.28199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/05/2019] [Accepted: 01/10/2019] [Indexed: 01/24/2023]
Abstract
It has been shown that human breast milk (HBM) is an important nutrient for the growth and development of newborns. Currently, peptide drugs provide promising regimes in neonatal disease treatment, especially peptides from HBM that exhibit multiple functions within cells. To explore the potential biological function peptides among the colostrum, transition and mature milk from mother of extremely low birth weight children (the samples were collected from Women's Hospital of Nanjing Medical University from December 2016 to February 2017). A total of 3,182 nonredundant peptides were identified and compared among colostrum, transitional and mature milk using liquid chromatography/mass spectrometry technology, and the numbers and fragments of peptides were various. The isoelectric point and molecular weight analysis of the differentially expressed peptides basically accord with the range of mass spectrometry identification (<3 kDa). Gene Ontology analysis and Pathway analysis, restriction sites analysis, as well as bioinformatics analysis showed that these differentially expressed peptides enriched a variety of biological processes. We identified several putative peptides that might have bioactive effects in diseases and development of newborns, which will inform further functional investigations. Our preliminary research provided a better understanding of the function of peptides during the newborn periods. Furthermore, it laid a foundation for discovering new peptide drugs in neonatal disease treatment.
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Affiliation(s)
- Yahui Zhou
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.,Institute of pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China.,Department of Pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China
| | - Le Zhang
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.,Institute of pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China.,Department of Neonatology, Wuxi Children's Hospital affiliated to Nanjing Medical University, Wuxi, China
| | - Zhangbin Yu
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Aiqing Zhang
- Department of Pediatric Nephrology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weimin Wu
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Wenjuan Chen
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.,Institute of pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China.,Department of Pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China
| | - Xiangyun Yan
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.,Institute of pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China.,Department of Pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China
| | - Heng Liu
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.,Institute of pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China.,Department of Pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China
| | - Yin Hu
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.,Institute of pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China.,Department of Pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China
| | - Chengyao Jiang
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.,Institute of pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China.,Department of Pediatrics, Fourth Clinical Medicine College, Nanjing Medical University, Nanjing, China
| | - Yan Xu
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.,Department of Pediatrics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xingyun Wang
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Shuping Han
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
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11
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Potential protective effects of bilirubin following the treatment of neonatal hypoxic-ischemic encephalopathy with hypothermia therapy. Biosci Rep 2019; 39:BSR20182332. [PMID: 31101685 PMCID: PMC6549084 DOI: 10.1042/bsr20182332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/21/2019] [Accepted: 05/07/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Therapeutic hypothermia (TH) is the standard therapy for hypoxic-ischemic encephalopathy (HIE) and is associated with a wide range of physiological changes. Objective: We re-evaluated the effects of HIE and TH on bilirubin measurements following HIE in a center involved in the China cooling randomized controlled trial (RCT). Methods: Serial serum bilirubin concentrations measured during the first week of life were compared among the HIE + NT (normothermia) group, HIE + TH treatment group and control group (without HIE). Survivors of HIE were followed and assessed at approximately 2 years of age, and the results were correlated with peak bilirubin levels during the first week of life. Results: One hundred and thirty-eight infants were available for analysis. Significantly lower bilirubin levels were recorded in the HIE + NT group than in the controls (P<0.05). Significant differences were not observed among the patients in the HIE + NT group (mild to severe) or between the HIE + TH group and the HIE + NT group at any time point (P>0.05). The peak serum bilirubin concentrations recorded at 96 h of age showed a good correlation with the results of the Bayley Scales of Infant and Toddler Development, third edition (BSID-III) (P=0.02). Conclusion: Bilirubin potentially exerts a neuroprotective effect during the first week of life, and low temperature does not affect the possible antioxidant function of bilirubin during TH following HIE.
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12
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Kimyon S, Mete A. Effects of Breastfeeding and Perinatal Factors on Development of Retinopathy of Prematurity. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.534838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Moloney L, Rozga M, Fenton TR. Nutrition Assessment, Exposures, and Interventions for Very-Low-Birth-Weight Preterm Infants: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2019; 119:323-339. [DOI: 10.1016/j.jand.2018.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/26/2018] [Indexed: 01/01/2023]
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14
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Kim SJ, Port AD, Swan R, Campbell JP, Chan RVP, Chiang MF. Retinopathy of prematurity: a review of risk factors and their clinical significance. Surv Ophthalmol 2018; 63:618-637. [PMID: 29679617 DOI: 10.1016/j.survophthal.2018.04.002] [Citation(s) in RCA: 289] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 01/09/2023]
Abstract
Retinopathy of prematurity (ROP) is a retinal vasoproliferative disease that affects premature infants. Despite improvements in neonatal care and management guidelines, ROP remains a leading cause of childhood blindness worldwide. Current screening guidelines are primarily based on two risk factors: birth weight and gestational age; however, many investigators have suggested other risk factors, including maternal factors, prenatal and perinatal factors, demographics, medical interventions, comorbidities of prematurity, nutrition, and genetic factors. We review the existing literature addressing various possible ROP risk factors. Although there have been contradictory reports, and the risk may vary between different populations, understanding ROP risk factors is essential to develop predictive models, to gain insights into pathophysiology of retinal vascular diseases and diseases of prematurity, and to determine future directions in management of and research in ROP.
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Affiliation(s)
- Sang Jin Kim
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA; Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Alexander D Port
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Ryan Swan
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - J Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA; Center for Global Health, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael F Chiang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA.
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15
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Bharwani SK, Green BF, Pezzullo JC, Bharwani SS, Bharwani SS, Dhanireddy R. Systematic review and meta-analysis of human milk intake and retinopathy of prematurity: a significant update. J Perinatol 2016; 36:913-920. [PMID: 27416321 DOI: 10.1038/jp.2016.98] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/27/2016] [Accepted: 06/03/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Two recent meta-analyses have studied the association of exclusive or mainly human milk intake (HMI) on retinopathy of prematurity (ROP). One of these meta-analysis found a protective effect of only or mainly HMI on Severe ROP but not on any stage ROP. However, both these meta-analyses did not find protection from any stage ROP or Severe ROP with any amount of HMI. The objective of this study was to study the association between any amount of HMI and the development of All ROP and Severe ROP in very-low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI) by systematic review using PRISMA-P guidelines and meta-analysis. STUDY DESIGN Exposure, controls and outcomes studied were any amount of HMI vs no HMI and All ROP/Severe ROP in VLBWI/ELBWI. All ROP was defined as all stages of ROP pooled together, and Severe ROP as ⩾stage 3 ROP and ROP requiring intervention. Results and effect sizes are expressed as odds ratio (OR), relative risk (RR), risk difference (RD) and number needed to treat (NNT) with 95% confidence intervals (95% CI). Data sources used were PubMed, MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, Scopus and CINAHL until 24 April 2015. Extracted data were pooled using a fixed effects model. Heterogeneity was assessed. Sensitivity analysis was performed. RESULTS Five hundred nine of 1701 infants who received any amount of HMI developed All ROP vs 310 of 760 infants without HMI developed All ROP with a pooled OR 0.63* (0.51,0.78), RR 0.76* (0.67,0.86) and RD -0.09* (-0.13,-0.05). The NNT with any amount of HMI was 11* (8,20) (*P<0.0001) to prevent one case of All ROP. 204 of 2465 infants who received any amount of HMI developed Severe ROP vs 85 of 764 infants without HMI developed Severe ROP with a pooled OR 0.74* (0.56,0.98), RR 0.77* (0.60,0.98) and RD -0.03* (-0.05,-0.00). The NNT with any amount of HMI was 33* (*P=0.04) to prevent one case of Severe ROP. CONCLUSION Any amount of HMI is strongly associated with the protection from All ROP and Severe ROP.
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Affiliation(s)
- S K Bharwani
- Neonatologist, Pediatrix Medical Group and The Womans Hospital of Texas, Houston, TX, USA
| | - B F Green
- Head of Education, Research and Clinical Services, Biomedical Libraries, Dartmouth College, Hanover, NH, USA
| | - J C Pezzullo
- Department of Medicine, Georgetown University, Washington, DC, USA
| | | | | | - R Dhanireddy
- Department of Pediatrics, Division of Neonatology, University of Tennessee Health Science Center, E201 Rout Center for Women and Newborns, Memphis, TN, USA
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16
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Ginovart G, Gich I, Verd S. Human milk feeding protects very low-birth-weight infants from retinopathy of prematurity: a pre-post cohort analysis. J Matern Fetal Neonatal Med 2016; 29:3790-5. [PMID: 26918740 DOI: 10.3109/14767058.2016.1145648] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To examine the effect of early human milk (HM) feeding on the incidence of retinopathy of prematurity (ROP) among very low-birth-weight (VLBW) infants. METHODS Observational cohort research in a Level III neonatal intensive care unit. A total of 186 infants were enrolled in this pre-post cohort study (114 infants were included in the HM-fed group and 72 in the formula-fed group). ROP, type of feeding (early exclusive HM versus any formula), and potential confounding variables were measured. Differences between groups were explored. RESULTS The clinical characteristics of the neonates did not differ between the two groups. By bivariate analysis, HM feeding was associated with 75% lower odds of Stage 2 or 3 ROP (OR = 0.25, 95% CI: 0.091 to 0.705; p = 0.009) At multivariate logistic regression, type of milk feeding retained significance, exclusive HM being protective with p = 0.002. CONCLUSIONS This study found an association between early exposure to formula in VLBW infants and ROP. An initial HM diet, devoid of cow milk-containing products before achieving full enteral feeding, may help prevent ROP.
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Affiliation(s)
- Gemma Ginovart
- a Neonatal Unit, Department of Paediatrics , Hospital De La Santa Creu I Sant Pau, Barcelona Free University (UAB) , Barcelona , Spain
| | - Ignasi Gich
- b Department of Clinical Epidemiology , Hospital De La Santa Creu I Sant Pau , Barcelona , Spain , and
| | - Sergio Verd
- c Health Sciences Research Institute (IUNICS), Balearic University , Palma De Mallorca , Spain
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17
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Raiten DJ, Steiber AL, Carlson SE, Griffin I, Anderson D, Hay WW, Robins S, Neu J, Georgieff MK, Groh-Wargo S, Fenton TR. Working group reports: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr 2016; 103:648S-78S. [PMID: 26791182 PMCID: PMC6459074 DOI: 10.3945/ajcn.115.117309] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The "Evaluation of the Evidence to Support Practice Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project" is the first phase in a process to present the current state of knowledge and to support the development of evidence-informed guidance for the nutritional care of preterm and high-risk newborn infants. The future systematic reviews that will ultimately provide the underpinning for guideline development will be conducted by the Academy of Nutrition and Dietetics' Evidence Analysis Library (EAL). To accomplish the objectives of this first phase, the Pre-B Project organizers established 4 working groups (WGs) to address the following themes: 1) nutrient specifications for preterm infants, 2) clinical and practical issues in enteral feeding of preterm infants, 3) gastrointestinal and surgical issues, and 4) current standards of infant feeding. Each WG was asked to 1) develop a series of topics relevant to their respective themes, 2) identify questions for which there is sufficient evidence to support a systematic review process conducted by the EAL, and 3) develop a research agenda to address priority gaps in our understanding of the role of nutrition in health and development of preterm/neonatal intensive care unit infants. This article is a summary of the reports from the 4 Pre-B WGs.
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Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD;
| | | | | | | | | | | | - Sandra Robins
- Fairfax Neonatal Associates at Inova Children's Hospital, Fairfax, VA
| | - Josef Neu
- University of Florida, Gainesville, FL
| | | | - Sharon Groh-Wargo
- Case Western Reserve University-School of Medicine, Cleveland, OH; and
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Boon AC, Hawkins CL, Bisht K, Coombes JS, Bakrania B, Wagner KH, Bulmer AC. Reduced circulating oxidized LDL is associated with hypocholesterolemia and enhanced thiol status in Gilbert syndrome. Free Radic Biol Med 2012; 52:2120-7. [PMID: 22521902 PMCID: PMC3377994 DOI: 10.1016/j.freeradbiomed.2012.03.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 03/09/2012] [Accepted: 03/10/2012] [Indexed: 12/22/2022]
Abstract
A protective association between bilirubin and atherosclerosis/ischemic heart disease clearly exists in vivo. However, the relationship between bilirubin and in vivo oxidative stress parameters in a clinical population remains poorly described. The aim of this study was to assess whether persons expressing Gilbert syndrome (GS; i.e., unconjugated hyperbilirubinemia) are protected from thiol oxidation and to determine if this, in addition to their improved lipoprotein profile, could explain reduced oxidized low-density lipoprotein (oxLDL) status in them. Forty-four matched GS and control subjects were recruited and blood was prepared for the analysis of lipid profile and multiple plasma antioxidants and measures of oxidative stress. GS subjects possessed elevated plasma reduced thiol (8.03±1.09 versus 6.75±1.39 nmol/mg protein; P<0.01) and glutathione concentrations (12.7±2.39 versus 9.44±2.45 μM; P<0.001). Oxidative stress status (reduced:oxidized glutathione; GSH:GSSG) was significantly improved in GS (0.49±0.16 versus 0.32±0.12; P<0.001). Protein carbonyl concentrations were negatively associated with bilirubin concentrations and were significantly lower in persons with >40 μM bilirubin versus controls (<17.1 μmol/L; P<0.05). Furthermore, absolute oxLDL concentrations were significantly lower in GS subjects (P<0.05). Forward stepwise regression analysis revealed that bilirubin was associated with increased GSH:GSSG ratio and reduced thiol concentrations, which, in addition to reduced circulating LDL, probably decreased oxLDL concentrations within the cohort. In addition, a marked reduction in total cholesterol concentrations in hyperbilirubinemic Gunn rats is presented (Gunn 0.57±0.09 versus control 1.69±0.40 mmol/L; P<0.001), arguing for a novel role for bilirubin in modulating lipid status in vivo. These findings implicate the physiological importance of bilirubin in protecting from atherosclerosis by reducing thiol and subsequent lipoprotein oxidation, in addition to reducing circulating LDL concentrations.
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Key Words
- bmi, body mass index
- cvd, cardiovascular disease
- dtnb, 5,5-dithiobis(2-nitrobenzoic acid)
- frap, ferric reducing ability of plasma
- gs, gilbert syndrome
- gsh, reduced glutathione
- gssg, oxidized glutathione
- hdl, high-density lipoprotein
- ho-1, heme oxygenase-1
- hplc, high-performance liquid chromatography
- ldl, low-density lipoprotein
- oxldl, oxidized low-density lipoprotein
- tca, trichloroacetic acid
- teac, trolox equivalent antioxidant capacity
- ugt, uridine diphosphate glucuronosyltransferase
- cardiovascular disease
- bile pigment
- thiol
- glutathione
- bilirubin
- free radicals
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Affiliation(s)
- Ai-Ching Boon
- Heart Foundation Research Center, Griffith Health Institute, Griffith University, Gold Coast, Qld 4222, Australia
| | | | - Kavita Bisht
- Heart Foundation Research Center, Griffith Health Institute, Griffith University, Gold Coast, Qld 4222, Australia
| | - Jeff S. Coombes
- School of Human Movement Studies, University of Queensland, St. Lucia, Qld 4067, Australia
| | - Bhavisha Bakrania
- Heart Foundation Research Center, Griffith Health Institute, Griffith University, Gold Coast, Qld 4222, Australia
| | - Karl-Heinz Wagner
- Department of Nutritional Science, University of Vienna, Vienna 1090, Austria
| | - Andrew C. Bulmer
- Heart Foundation Research Center, Griffith Health Institute, Griffith University, Gold Coast, Qld 4222, Australia
- Corresponding author. Fax: +61 755528908.
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Zhu J, Xu Y, Zhang G, Wu M, Du L. Total serum bilirubin level in umbilical cord blood and respiratory distress syndrome in very low birth weight infants. J Perinat Med 2011; 40:91-5. [PMID: 22085151 DOI: 10.1515/jpm.2011.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/16/2011] [Indexed: 11/15/2022]
Abstract
AIMS To explore the association between total serum bilirubin (TSB) level in umbilical cord blood (UCB) and the occurrence and/or severity of respiratory distress syndrome (RDS) in very low birth weight (VLBW) infants. METHODS We performed a prospective study of 579 VLBW infants. The mean TSB level in UCB (1.8 mg/dL) was used to divide the cohort into two groups: neonates with levels <1.8 mg/dL and those with levels >1.8 mg/dL. Demographic and clinical characteristics of the 2 groups, including diagnosis of RDS, need for ventilation, peak fraction of inspired oxygen (FiO2), oxygenation index (OI), and duration of respiratory support, were compared. RESULTS Three hundred and twenty-four infants were included in the low-TSB group and 255 infants were included in the high-TSB group. RDS was less frequent in the high TSB group than in the low one (46.3% vs. 56.6%, P=0.01). A negative association between TSB level in UCB and the occurrence of RDS [odds ratio (OR)=0.620; 95% confidence interval (CI) 0.440-0.873, P=0.006] was observed. However, lower TSB in UCB was not associated with the maximum FiO2, OI, or duration of mechanical ventilation. CONCLUSIONS VLBW infants with low TSB levels in UCB were more likely to develop RDS. However, in conjunction with surfactant replacement therapy, no correlation was found between TSB levels in UCB and the severity of RDS. The negative association between high TSB in UCB and RDS warrants further investigation.
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Affiliation(s)
- Jiajun Zhu
- Department of Neonatology, Children's Hospital, Zhejiang University, School of Medicine, Hangzhou 310003, China
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