Purpuric phototherapy-induced eruption in transfused neonates: relation to transient porphyrinemia

Phototherapy causing a purpuric eruption in a neonate

Neonatal jaundice is a frequent condition in newborns and is commonly treated with phototherapy. We describe the case of a neonate with hemolytic disease of the newborn who developed a rarely described purpuric eruption. Laboratory testing revealed elevated porphyrins.

Role of Saccharomyces boulardii in Reduction of Neonatal Hyperbilirubinemia

INTRODUCTION

Probiotics are known to reduce the severity of hyperbilirubinemia.

AIM

This study was done to evaluate the effect of probiotic on neonatal hyperbilirubinemia in term neonates.

MATERIALS AND METHODS

A total of 181 healthy term neonates after birth were divided into a control group (n=95) and a treatment group (n=86) randomly and treated with placebo and probiotic (Saccharomyces boulardii) respectively. A total of two doses were given orally in the first two consecutive days. The serum bilirubin levels were detected on day three of life. Babies were exclusively breastfed, clinical outcome was recorded. Comparison between groups was made by the non-parametric Mann-Whitney test. Analysis of Variance (ANOVA) was used to assess the quantitative variables. A p-value of <0.05 using a two-tailed test was taken as being of significance for all statistical tests.

RESULTS

On day 3, mean total serum bilirubin in control group among patient who has not developed clinical jaundice is 6.5mg% and in the treatment group is 5mg%. In patient with clinical jaundice, it is 13.6mg% in control group and 10.7mg% in the treatment group. The p-value was found to be <0.05 which is statistically significant. No obvious adverse reactions noted in either group.

CONCLUSION

Probiotics lowered the serum bilirubin level of healthy neonate with jaundice safely and significantly without any adverse reaction.

Transient Porphyrinemia in a Neonate: A Case Report

We describe a neonate with anemia, thrombocytopenia, and hyperbilirubinemia secondary to hemolytic disease of the newborn. After phototherapy for hyperbilirubinemia, the neonate developed a photodistributed eruption with high serum and urine porphyrin levels. This transient porphyrinemia resolved at 1 month.

Phototherapy induced cutaneous eruption in a neonate with transient porphyrinemia

Phototherapy for hyperbilirubinemia has rare complications. We report a case of phototherapy induced eruption in a neonate with transient porphyrinemia. Our patient received phototherapy due to hyperbilirubinemia secondary to erythroblastosis fetalis (hemolytic disease of the newborn). He developed a cutaneous rash in the light-exposed areas of his skin. Erythrocyte and plasma porphyrins were elevated at the time. Phototherapy induced eruption with a transient porphyrinemia is rare. Upon review of the literature, we found only 5 other cases of patients with phototherapy induced rash and elevated porphyrins reported. We compared the five other reported cases to our case, looking at drug exposure, age, and receipt of exchange transfusion.

CONCLUSION

While this is an uncommon occurrence, transient porphyrinemia should be considered in neonates with phototherapy induced cutaneous eruption and erythroblastosis fetalis.

Purpuric eruption in a transfused neonate receiving phototherapy

We describe the clinical and biochemical findings in a neonate requiring multiple blood transfusions and phototherapy for alloimmune hemolytic anemia and unconjugated hyperbilirubinemia, respectively. In this newborn, a severe photosensitivity reaction developed and laboratory testing revealed elevated serum and urine porphyrins at the time of the eruption. The cause of the transient porphyrinemia was likely multifactorial. Possible mechanisms include poor hepatic metabolism and reticulocyte hemolysis. However, the exact pathogenesis remains unclear at this time.

Phototherapy rash in newborn infants: does it differ between conventional and light emitting diode phototherapy?

Data comparing the cutaneous side effects of light emitting diode (LED) phototherapy (LP) and conventional phototherapy (CP) devices in jaundiced newborn infants are very limited. We investigated the incidence and extent of skin eruptions caused by different phototherapy devices in preterm infants who are more prone to neonatal jaundice. This prospective, randomized controlled trial was conducted in the neonatal intensive care unit (NICU) of Hacettepe University Ihsan Dogramaci Childrens' Hospital in Ankara, Turkey. Preterm infants without skin lesions before and requiring phototherapy in the first week of life were included in the study. The infants were randomly assigned to receive CP or LP and were monitored closely for skin eruptions during phototherapy. Fifty-eight infants were included in the study: 25 (43.1%) received CP while 33 (56.9%) received LP. The duration of phototherapy was similar in the two groups (30.4 ± 9.6 hours and 31.8 ± 15.6 hours, respectively). Baseline and control bilirubin levels were similar for the two groups (p = 0.101 and p = 0.105, respectively). The frequency of skin eruptions was 36% in the CP group and 33% in the LP group (p = 0.83). The skin eruptions were macules in 13 (22.4%), papules in 5 (8.6%), and maculopapular rashes in 2 (3.4%) infants.There were no differences in the incidence and extent of skin eruptions in preterm infants who received CP or LP.

Pediatric photosensitivity disorders

Photosensitivity disorders in childhood are rare, with the notable exception of overexposure as sunburn, and therefore require a more circumspect approach. Practitioners who treat children are key players in identifying and managing the many photosensitivity disorders that rarely present in childhood. A classic photodistribution of skin findings may suggest photosensitivity, but a correct diagnosis depends on a detailed history correlated with clinical findings.

Severe neonatal congenital erythropoietic porphyria

Congenital erythropoietic porphyria is a rare form of porphyria, presenting during the neonatal period or during infancy. Clinical features include photosensitive blistering and severe anemia. Wood's lamp fluorescence of the diaper is a useful screening test. We describe a severely affected neonate with systemic involvement due to a homozygous mutation. Because of ongoing severe hemolytic anemia and severe photosensitivity, bone-marrow transplantation was performed, but the patient ultimately succumbed to chemotherapy-induced lung damage, as well as severe pulmonary hypertension, likely due to his chronic hemolytic anemia.

Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation

Jaundice occurs in most newborn infants. Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy while minimizing the risks of unintended harm such as maternal anxiety, decreased breastfeeding, and unnecessary costs or treatment. Although kernicterus should almost always be preventable, cases continue to occur. These guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. In every infant, we recommend that clinicians 1) promote and support successful breastfeeding; 2) perform a systematic assessment before discharge for the risk of severe hyperbilirubinemia; 3) provide early and focused follow-up based on the risk assessment; and 4) when indicated, treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia and, possibly, bilirubin encephalopathy (kernicterus).

Treatment of jaundice in low birthweight infants

Exchange transfusion and phototherapy remain the staples of intervention for the jaundiced newborn. Clinical management of the jaundiced low birthweight infant is discussed.