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Joy C, Collyer TA, McMahon K. Accuracy of transcutaneous bilirubinometry in term infants after phototherapy: a prospective observational study. J Matern Fetal Neonatal Med 2024; 37:2295808. [PMID: 38146169 DOI: 10.1080/14767058.2023.2295808] [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: 08/19/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To test the accuracy of transcutaneous bilirubinometry (TcB) in neonates 12 h after discontinuing phototherapy. STUDY DESIGN In a prospective study of 91 neonates at ≥35 weeks of gestation, paired measurements of total serum bilirubin (TSB) and TcB were obtained 12 h after discontinuation of phototherapy. TcB measurements were obtained on the uncovered skin of the sternum and the covered skin of the lower abdomen. Bland-Altman plots were used to evaluate agreement between TSB and TcB. RESULTS TcB was found to systematically underestimate TSB on both covered and uncovered skin. The smallest but statistically significant difference between TSB and TcB was found on the covered lower abdomen (-1.03, p < .0001) compared with the uncovered skin of the sternum (-1.44, p < .0001). The correlation between TSB and TcB was excellent on both covered (r = 0.86, p < .001) and uncovered skin (r = 0.90, p < .001). Bland and Altman plots showed poor agreement between TcB and TSB. CONCLUSIONS This study demonstrated excellent correlation between TcB and TSB 12 h after phototherapy but poor TcB-TSB agreement. TcB cannot be reliably used in neonates exposed to phototherapy.
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Affiliation(s)
- Charissa Joy
- Department of Paediatrics, Peninsula Health, Frankston, Australia
| | - Taya A Collyer
- Biostatistics, Monash University, Peninsula Clinical School, Frankston, Australia
- National Centre for Healthy Ageing, Frankston Hospital, Frankston, Australia
| | - Kathryn McMahon
- Department of Paediatrics, Werribee Mercy Hospital, Werribee, Australia
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Okwundu CI, Bhutani VK, Uthman OA, Smith J, Olowoyeye A, Fiander M, Wiysonge CS. Transcutaneous bilirubinometry for detecting jaundice in term or late preterm neonates. Cochrane Database Syst Rev 2024; 5:CD011060. [PMID: 38804265 PMCID: PMC11131145 DOI: 10.1002/14651858.cd011060.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND The American Academy of Pediatrics and the Canadian Paediatric Society both advise that all newborns should undergo bilirubin screening before leaving the hospital, and this has become the standard practice in both countries. However, the US Preventive Task Force has found no strong evidence to suggest that this practice of universal screening for bilirubin reduces the occurrence of significant outcomes such as bilirubin-induced neurologic dysfunction or kernicterus. OBJECTIVES To evaluate the effectiveness of transcutaneous screening compared to visual inspection for hyperbilirubinemia to prevent the readmission of newborns (infants greater than 35 weeks' gestation) for phototherapy. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, ICTRP, and ISRCTN in June 2023. We also searched conference proceedings, and the reference lists of included studies. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-randomized, cluster-randomized, or prospective cohort studies with control arm that evaluated the use of transcutaneous bilirubin (TcB) screening for hyperbilirubinemia in newborns before hospital discharge. DATA COLLECTION AND ANALYSIS We used standard methodologic procedures expected by Cochrane. We evaluated treatment effects using a fixed-effect model with risk ratio (RR) and 95% confidence intervals (CI) for categorical data and mean, standard deviation (SD), and mean difference (MD) for continuous data. We used the GRADE approach to evaluate the certainty of evidence. MAIN RESULTS We identified one RCT (1858 participants) that met our inclusion criteria. The study included 1858 African newborns at 35 weeks' gestation or greater who were receiving routine care at a well-baby nursery, and were randomly recruited prior to discharge to undergo TcB screening. The study had good methodologic quality. TcB screening versus visual assessment of hyperbilirubinemia in newborns: - may reduce readmission to the hospital for hyperbilirubinemia (RR 0.25, 95% CI 0.14 to 0.46; P < 0.0001; moderate-certainty evidence); - probably has little or no effect on the rate of exchange transfusion (RR 0.20, 95% CI 0.01 to 14.16; low-certainty evidence); - may increase the number of newborns who require phototherapy prior to discharge (RR 2.67, 95% CI 1.56 to 4.55; moderate-certainty evidence). - probably has little or no effect on the rate of acute bilirubin encephalopathy (RR 0.33, 95% CI 0.01 to 8.18; low-certainty evidence). The study did not evaluate or report cost of care. AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests that TcB screening may reduce readmission for hyperbilirubinemia compared to visual inspection. Low-certainty evidence also suggests that TcB screening probably has little or no effect on the rate of exchange transfusion compared to visual inspection. However, moderate-certainty evidence suggests that TcB screening may increase the number of newborns that require phototherapy before discharge compared to visual inspection. Low-certainty evidence suggests that TcB screening probably has little or no effect on the rate of acute bilirubin encephalopathy compared to visual inspection. Given that we have only identified one RCT, further studies are necessary to determine whether TcB screening can help to reduce readmission and complications related to neonatal hyperbilirubinemia. In settings with limited newborn follow-up after hospital discharge, identifying newborns at risk of severe hyperbilirubinemia before hospital discharge will be important to plan targeted follow-up of these infants.
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Affiliation(s)
- Charles I Okwundu
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Vinod K Bhutani
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford School of Medicine, Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Johan Smith
- Department of Paediatrics and Child Health, Stellenbosch University, Faculty of Health Sciences, Stellenbosch, South Africa
| | - Abiola Olowoyeye
- Phoenix Children's Hospital and University of Arizona College of Medicine, Phoenix, Arizona, USA
| | | | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Dam-Vervloet AJ, Morsink CF, Krommendijk ME, Nijholt IM, van Straaten HLM, Poot L, Bosschaart N. Skin color influences transcutaneous bilirubin measurements: a systematic in vitro evaluation. Pediatr Res 2024:10.1038/s41390-024-03081-y. [PMID: 38368497 DOI: 10.1038/s41390-024-03081-y] [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: 10/03/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Concerns have been raised about the effect of skin color on the accuracy of transcutaneous bilirubin (TcB) measurements, a widely used method for hyperbilirubinemia diagnosis in newborns. Literature is inconclusive, with both reported under- and overestimations of the TcB with increasing skin pigmentation. Therefore, the influence of skin color on TcB measurements was systematically evaluated in a controlled, in vitro setting. METHODS A bilirubin meter (JM-105) was evaluated on layered phantoms that mimic neonatal skin with varying dermal bilirubin concentrations (0-250 µmol/L) and varying epidermal melanosome volume fractions (0-40%; light-dark skin color). RESULTS TcB measurements were influenced by skin pigmentation. Larger mimicked melanosome volume fractions and higher bilirubin levels led to larger underestimations of the measured TcB, compared to an unpigmented epidermis. In the in vitro setting of this study, these underestimations amounted to 26-132 µmol/L at a TcB level of 250 µmol/L. CONCLUSION This in vitro study provides insight into the effect of skin color on TcB measurements: the TcB is underestimated as skin pigmentation increases and this effect becomes more pronounced at higher bilirubin levels. Our results highlight the need for improved TcB meter design and cautious interpretation of TcB readings on newborns with dark skin. IMPACT Key message: Skin color influences transcutaneous bilirubin measurements: the darker the skin, the larger the underestimation. What this study adds to existing literature: Existing literature is inconclusive regarding the influence of skin color on transcutaneous bilirubin measurements. This study systematically evaluates and clarifies the influence of skin color on transcutaneous bilirubin measurements in a controlled, in vitro setting. IMPACT This study aids to better interpret the measured TcB level in patients with varying skin colors, and is particularly important when using TcB meters on patients with dark skin colors.
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Affiliation(s)
- Alida J Dam-Vervloet
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
- Medical Physics Department, Isala hospital, Zwolle, The Netherlands.
| | - Claudia F Morsink
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Marleen E Krommendijk
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Ingrid M Nijholt
- Innovation & Science Department, Isala hospital, Zwolle, The Netherlands
- Radiology Department, Isala hospital, Zwolle, The Netherlands
| | | | - Lieke Poot
- Medical Physics Department, Isala hospital, Zwolle, The Netherlands
| | - Nienke Bosschaart
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Ten Kate L, van Oorschot T, Woolderink J, Teklenburg-Roord S, Bekhof J. Transcutaneous Bilirubin Accuracy Before, During, and After Phototherapy: A Meta-Analysis. Pediatrics 2023; 152:e2023062335. [PMID: 37990609 DOI: 10.1542/peds.2023-062335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 11/23/2023] Open
Abstract
CONTEXT Transcutaneous bilirubinometry (TcB) is used as a valid screening to identify neonates requiring measurement of total serum bilirubin (TSB) before phototherapy. Its use during and after phototherapy is not advised yet because of unknown reliability. OBJECTIVES To determine the agreement of TcB and TSB measurements before, during, and after phototherapy. DATA SOURCES PubMed Medline, Cochrane Library, and references of eligible studies were searched. STUDY SELECTION Prospective and retrospective cohort and cross-sectional studies reporting Bland-Altman statistics of paired TcB and TSB measurements in term and preterm newborns. DATA EXTRACTION Meta-analysis was performed using the Mantel-Haenszel weighted approach. The agreement between TcB and TSB in μmol/L was described by pooled mean differences (MDs) and limits of agreement (LoA). RESULTS Fifty-four studies were included. The pooled MD before phototherapy is 2.5 μmol/L (LoA -38.3 to 43.3). The pooled MD during phototherapy is -0.3 μmol/L (LoA -34.8 to 34.2) on covered skin and -28.6 μmol/L (LoA -105.7 to 48.5) on uncovered skin. The pooled MD after phototherapy is -34.3 μmol/L (LoA -86.7 to 18.1) on covered skin and -21.1 μmol/L (LoA -88.6 to 46.4) on uncovered skin. Subgroup analysis revealed the best agreement at the forehead. We did not find any difference in agreement between term and preterm neonates. LIMITATIONS Language restriction. CONCLUSIONS TcB measurements before and during phototherapy on covered skin show good agreement compared with TSB in term and preterm newborns. More studies are needed to evaluate the accuracy after phototherapy.
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Affiliation(s)
| | | | - Jessica Woolderink
- Department of Pediatrics, Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | | | - Jolita Bekhof
- Department of Pediatrics, Isala Zwolle, Zwolle, Netherlands
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Abiha U, Banerjee DS, Mandal S. Demystifying non-invasive approaches for screening jaundice in low resource settings: a review. Front Pediatr 2023; 11:1292678. [PMID: 38054187 PMCID: PMC10694303 DOI: 10.3389/fped.2023.1292678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 12/07/2023] Open
Abstract
All national and international pediatric guidelines universally prescribe meticulous bilirubin screening for neonates as a critical measure to mitigate the incidence of acute bilirubin encephalopathy (ABE) and Kernicterus. The prevailing gold standard for jaundice detection in neonates necessitates invasive blood collection, followed by subsequent biochemical testing. While the invasive procedure provides dependable bilirubin measurements and continues to be the sole gold standard diagnostic method for assessing bilirubin concentration. There exists a pressing need to innovate non-invasive screening tools that alleviate the sampling stress endured by newborns, mitigate iatrogenic anemia, and expedite the turnaround time for obtaining results. The exploration of non-invasive modalities for bilirubin measurements is gaining momentum, driven by the overarching goal of minimizing the number of pricks inflicted upon neonates, thereby rendering screening a swift, efficient, comfortable, and dependable process. This comprehensive review article delves extensively into the array of non-invasive approaches and digital solutions that have been proposed, implemented, and utilized for neonatal bilirubin screening, with a particular emphasis on their application in low-resource settings. Within this context, the review sheds light on the existing methodologies and their practical applications, with a specific focus on transcutaneous bilirubin meters. Moreover, it underscores the prevailing open challenges in this domain and outlines potential directions for future research endeavors. Notably, the review underscores the imperative need for robust educational programs targeted at both families and healthcare personnel to expedite the process of seeking timely care for neonatal jaundice. Additionally, it underscores the necessity for the development of enhanced screening and diagnostic tools that can offer greater accuracy in clinical practice.
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Affiliation(s)
- Umme Abiha
- Department of Smart Healthcare, Indian Institute of Technology, Jodhpur, India
- All India Institute of Medical Science, Jodhpur, India
| | - Dip Sankar Banerjee
- Computer Science and Engineering, Indian Institute of Technology, Jodhpur, India
| | - Saptarshi Mandal
- Transfusion Medicine and Blood Bank, All India Institute of Medical Science, Jodhpur, India
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Gabbay JM, Agneta EM, Turkington S, Bajaj BM, Sinha B, Geha T. Rates of phototherapy among ABO-incompatible newborns with a negative direct antiglobulin test. J Perinatol 2023; 43:1357-1362. [PMID: 36959468 PMCID: PMC10034253 DOI: 10.1038/s41372-023-01650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE We analyze phototherapy rates after implementation of a Hyperbilirubinemia Clinical Pathway (HCP), which placed full-term ABOi DAT negative newborns on the low risk phototherapy nomogram, rather than medium risk, as previously done. STUDY DESIGN A chart review was performed for ABOi newborns born ≥36 weeks gestation between January 2020 and October 2021. Primary outcome measures were rates of phototherapy across pre- and post-intervention groups and among DAT negative newborns. RESULTS There was an increased proportion of newborns assigned to the low risk curve after the intervention. There were no significant differences in phototherapy rates among the intervention groups, although there was a non-significant decrease in phototherapy rates among DAT negative newborns after the intervention. There were no increases in adverse outcomes. CONCLUSIONS Providers adhered to the guidelines after implementation of the HCP. ABOi DAT negative newborns can be viewed as low risk for hyperbilirubinemia requiring phototherapy.
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Affiliation(s)
- Jonathan M Gabbay
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
| | - Elizabeth M Agneta
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | | | - Benjamin M Bajaj
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Bharati Sinha
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
- Department of Newborn Medicine, Boston Medical Center, Boston, MA, USA
| | - Tanya Geha
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
- Department of Newborn Medicine, Boston Medical Center, Boston, MA, USA
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Ng Y, Maul T, Viswanathan S, Chua C. The Accuracy of Transcutaneous Bilirubin as a Screening Test in Preterm Infants. Cureus 2023; 15:e42793. [PMID: 37538974 PMCID: PMC10394481 DOI: 10.7759/cureus.42793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To determine the accuracy of transcutaneous bilirubin (TcB) to predict total serum bilirubin (TSB) in preterm infants across gestational age (GA) ranges and to calculate the cost-effectiveness of TcB as the primary screening test of choice for neonatal jaundice in neonatal intensive care unit (NICU) settings. METHODS Single-center retrospective study of infants aged ≤ seven days admitted to the NICU over a six-month period with a paired TSB and TcB, with or without phototherapy as part of their routine clinical care. Infants were divided into GA-specific groups as term, late preterm, moderate preterm, and very preterm. Measurement bias (bias=TSB-TcB) was calculated on the paired TSB and TcB values, and a Bland-Altman analysis was carried out. The impacts of additional infant-specific variables on the bias were assessed with univariate and multivariate linear regression techniques. The potential direct cost savings associated with the use of TcB as the primary screening test were calculated. RESULTS A total of 263 paired TSB and TcB samples from 95 patients were included (130 paired samples from term (n=60), 75 from late preterm (n=21), 27 from moderate preterm (n=7), and 31 from very preterm (n=7)). The mean paired measurement bias across all the GA groups was -0.9 ± 2.9 mg/dL. The sensitivity and specificity of TcB in GA < 35 weeks were 92% and 62%, respectively. A conservative estimate of a one-third reduction in TSB measurement by using TcB as the primary screening test will have a direct cost saving of $3,148 over a six-month period. CONCLUSION Our data suggest that TcB is a safe and potentially cost-effective screening test for jaundice across GA groups.
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Affiliation(s)
- Yunfai Ng
- College of Medicine, University of Central Florida College of Medicine, Orlando, USA
- Emergency Medicine, Mount Sinai Hospital, New York, USA
| | - Timothy Maul
- Cardiac Center, Nemours Children's Health, Orlando, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
| | - Sreekanth Viswanathan
- Division of Neonatology, Nemours Children's Health, Orlando, USA
- Department of Pediatrics, University of Central Florida College of Medicine, Orlando, USA
| | - Caroline Chua
- Division of Neonatology, Nemours Children's Health, Orlando, USA
- Department of Pediatrics, University of Central Florida College of Medicine, Orlando, USA
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Ndabakuranye JP, Prawer S, Ahnood A. Bi-modal system-on-chip platform for bilirubin monitoring by using photometric and temporal degradation approaches. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Okwundu CI, Olowoyeye A, Uthman OA, Smith J, Wiysonge CS, Bhutani VK, Fiander M, Gautham KS. Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns. Cochrane Database Syst Rev 2023; 5:CD012660. [PMID: 37158489 PMCID: PMC10167941 DOI: 10.1002/14651858.cd012660.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Jaundice is a very common condition in newborns, affecting up to 60% of term newborns and 80% of preterm newborns in the first week of life. Jaundice is caused by increased bilirubin in the blood from the breakdown of red blood cells. The gold standard for measuring bilirubin levels is obtaining a blood sample and processing it in a laboratory. However, noninvasive transcutaneous bilirubin (TcB) measurement devices are widely available and used in many settings to estimate total serum bilirubin (TSB) levels. OBJECTIVES To determine the diagnostic accuracy of transcutaneous bilirubin measurement for detecting hyperbilirubinaemia in newborns. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL and trial registries up to 18 August 2022. We also checked the reference lists of all included studies and relevant systematic reviews for other potentially eligible studies. SELECTION CRITERIA We included cross-sectional and prospective cohort studies that evaluated the accuracy of any TcB device compared to TSB measurement in term or preterm newborn infants (0 to 28 days postnatal age). All included studies provided sufficient data and information to create a 2 × 2 table for the calculation of measures of diagnostic accuracy, including sensitivities and specificities. We excluded studies that only reported correlation coefficients. DATA COLLECTION AND ANALYSIS Two review authors independently applied the eligibility criteria to all citations from the search and extracted data from the included studies using a standard data extraction form. We summarised the available results narratively and, where possible, we combined study data in a meta-analysis. MAIN RESULTS We included 23 studies, involving 5058 participants. All studies had low risk of bias as measured by the QUADAS 2 tool. The studies were conducted in different countries and settings, included newborns of different gestational and postnatal ages, compared various TcB devices (including the JM 101, JM 102, JM 103, BiliChek, Bilitest and JH20-1C) and used different cutoff values for a positive result. In most studies, the TcB measurement was taken from the forehead, sternum, or both. The sensitivity of various TcB cutoff values to detect significant hyperbilirubinaemia ranged from 74% to 100%, and specificity ranged from 18% to 89%. AUTHORS' CONCLUSIONS The high sensitivity of TcB to detect hyperbilirubinaemia suggests that TcB devices are reliable screening tests for ruling out hyperbilirubinaemia in newborn infants. Positive test results would require confirmation through serum bilirubin measurement.
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Affiliation(s)
- Charles I Okwundu
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Abiola Olowoyeye
- Phoenix Children's Hospital and University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Johan Smith
- Department of Paediatrics and Child Health, Stellenbosch University, Faculty of Health Sciences, Stellenbosch, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Vinod K Bhutani
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford School of Medicine, Lucile Packard Children's Hospital, Palo Alto, California, USA
| | | | - Kanekal S Gautham
- Chair of Pediatrics and Pediatrician-in-Chief, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, Florida, USA
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Şahan H, Gülaşı S, Mert MK, Çekinmez EK. The predictive significance of umbilical cord bilirubin and bilirubin/albumin ratio for neonatal jaundice in healthy term newborns. Turk J Med Sci 2023; 53:511-517. [PMID: 37476881 PMCID: PMC10387865 DOI: 10.55730/1300-0144.5611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/03/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The aim of this study is to determine the value of the questions asked in routine follow-up, the cord blood bilirubin (CBB) and bilirubin/albumin (B/A) ratio in estimating the risk of developing hyperbilirubinemia. METHODS Term and healthy 217 newborns whose CBB and albumin could be obtained and whose needed to be measured bilirubin level at the 24thand 72nd hours of life were included. Nutrition, sex and nationality, consanguinity between parents, jaundice in the sibling (s), mother's medications were questioned. CBB and albumin, serum total bilirubin (STB), serum albumin and transcutaneous bilirubin (TcB) at the 24th and 72nd hours of life, were recorded. RESULTS CBB and cord B/A ratio, STB and serum B/A ratio, and TcB at the 24th and 72nd hours were found to be higher in the babies who received the phototherapy (p < 0.001 for all). The moderate positive correlation (correlation coefficient 0.383) at the 24th hour and strong positive correlation (correlation coefficient 0.759) at the 72nd hour between STB and TcB measurements was detected. In estimating the need for phototherapy the sensitivity and specificity of CBB were 74.2% and 56.5%, the sensitivity and specifity of cord B/A was 74.2%, and 61.8%. The cut-off value of CBB in estimating the need for phototherapy is 1.8, and the cut-off value of the cord B/A ratio is 0.56. When the cut-off value is 1.8 for the CCB and the cord B/A ratio is 0.56, the positive predictive values are low, but the negative predictive values are significantly high (92.9% and 93.5%, respectively) in determining the need for phototherapy. DISCUSSION CBB and B/A ratio are important in predicting the possibility of indirect hyperbilirubinemia (IHB) development. Babies should be followed closely in terms of IHB development when their CBB value is 1.8 mg/dL and above, and the cord blood B/A ratio is 0.56 and above.
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Affiliation(s)
- Handan Şahan
- Department of Pediatrics, Faculty of Medicine, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Selvi Gülaşı
- Department of Pediatrics, Faculty of Medicine, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Mustafa Kurthan Mert
- Department of Pediatrics, Faculty of Medicine, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Eren Kale Çekinmez
- Department of Pediatrics, Faculty of Medicine, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
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Banerjee A, Bhattacharyya N, Ghosh R, Singh S, Adhikari A, Mondal S, Roy L, Bajaj A, Ghosh N, Bhushan A, Goswami M, Ahmed ASA, Moussa Z, Mondal P, Mukhopadhyay S, Bhattacharyya D, Chattopadhyay A, Ahmed SA, Mallick AK, Pal SK. Non-invasive estimation of hemoglobin, bilirubin and oxygen saturation of neonates simultaneously using whole optical spectrum analysis at point of care. Sci Rep 2023; 13:2370. [PMID: 36759533 PMCID: PMC9911772 DOI: 10.1038/s41598-023-29041-w] [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: 09/29/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
The study was aimed to evaluate the performance of a newly developed spectroscopy-based non-invasive and noncontact device (SAMIRA) for the simultaneous measurement of hemoglobin, bilirubin and oxygen saturation as an alternative to the invasive biochemical method of blood sampling. The accuracy of the device was assessed in 4318 neonates having incidences of either anemia, jaundice, or hypoxia. Transcutaneous bilirubin, hemoglobin and blood saturation values were obtained by the newly developed instrument which was corroborated with the biochemical blood tests by expert clinicians. The instrument is trained using Artificial Neural Network Analysis to increase the acceptability of the data. The artificial intelligence incorporated within the instrument determines the disease condition of the neonate. The Pearson's correlation coefficient, r was found to be 0.987 for hemoglobin estimation and 0.988 for bilirubin and blood gas saturation respectively. The bias and the limits of agreement for the measurement of all the three parameters were within the clinically acceptance limit.
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Affiliation(s)
- Amrita Banerjee
- Department of Physics, Jadavpur University, 188, Raja S.C. Mallick Rd, Kolkata, 700032, India.,Technical Research Centre, S. N. Bose National Centre for Basic Sciences, Block JD, Sector III, Salt Lake, Kolkata, West Bengal, 700106, India.,Department of Paediatric Medicine, Nil RatanSircar Medical College & Hospital, 138, AJC Bose Road, Sealdah, Raja Bazar, Kolkata, 700014, India
| | - Neha Bhattacharyya
- Department of Radio Physics and Electronics, University of Calcutta, 92, Acharya Prafulla Chandra Rd, Machuabazar, Kolkata, 700009, India.,Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Block JD, Sector 3, Salt Lake, Kolkata, 700106, India
| | - Ria Ghosh
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Block JD, Sector 3, Salt Lake, Kolkata, 700106, India
| | - Soumendra Singh
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Block JD, Sector 3, Salt Lake, Kolkata, 700106, India.,Neo Care Inc, 27, Parker St, Dartmouth, NS, B2Y 2W1, Canada.,Electrical and Computer Engineering Department, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Halifax, Canada
| | - Aniruddha Adhikari
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Block JD, Sector 3, Salt Lake, Kolkata, 700106, India.,Chemical and Biomolecular Engineering, University of California, Los Angeles, CA, 90095, USA
| | - Susmita Mondal
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Block JD, Sector 3, Salt Lake, Kolkata, 700106, India
| | - Lopamudra Roy
- Technical Research Centre, S. N. Bose National Centre for Basic Sciences, Block JD, Sector III, Salt Lake, Kolkata, West Bengal, 700106, India.,Department of Applied Optics and Photonics, JD-2, Sector-III, Salt Lake, Kolkata, West Bengal, 700 106, India
| | - Annie Bajaj
- Department of Paediatric Medicine, Nil RatanSircar Medical College & Hospital, 138, AJC Bose Road, Sealdah, Raja Bazar, Kolkata, 700014, India
| | - Nilanjana Ghosh
- Department of Paediatric Medicine, Nil RatanSircar Medical College & Hospital, 138, AJC Bose Road, Sealdah, Raja Bazar, Kolkata, 700014, India
| | - Aman Bhushan
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Bhadson Road, Patiala, Punjab, 147004, India
| | - Mahasweta Goswami
- Technical Research Centre, S. N. Bose National Centre for Basic Sciences, Block JD, Sector III, Salt Lake, Kolkata, West Bengal, 700106, India
| | - Ahmed S A Ahmed
- Faculty of Medicine, Assiut University, Assiut, 71516, Egypt
| | - Ziad Moussa
- Department of Chemistry, College of Science, United Arab Emirates University, Al Ain, P.O. Box 15551, Abu Dhabi, United Arab Emirates
| | - Pulak Mondal
- Department of Radio Physics and Electronics, University of Calcutta, 92, Acharya Prafulla Chandra Rd, Machuabazar, Kolkata, 700009, India
| | - Subhadipta Mukhopadhyay
- Department of Physics, Jadavpur University, 188, Raja S.C. Mallick Rd, Kolkata, 700032, India
| | - Debasis Bhattacharyya
- Department of Gynecology & Obstetrics, Nil Ratan Sircar Medical College & Hospital, 138, AJC Bose Road, Sealdah, Raja Bazar, Kolkata, 700014, India
| | - Arpita Chattopadhyay
- Department of Basic Science and Humanities, Techno International, Kolkata, 700156, India.,Department of Physics, Sister Nivedita University, Kolkata, India
| | - Saleh A Ahmed
- Department of Chemistry, Faculty of Applied Science, Umm Al-Qura University, Makkah, 21955, Saudi Arabia.
| | - Asim Kumar Mallick
- Department of Paediatric Medicine, Nil RatanSircar Medical College & Hospital, 138, AJC Bose Road, Sealdah, Raja Bazar, Kolkata, 700014, India.
| | - Samir Kumar Pal
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Block JD, Sector 3, Salt Lake, Kolkata, 700106, India.
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12
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De Winter DP, Hulzebos C, Van 't Oever RM, De Haas M, Verweij EJ, Lopriore E. History and current standard of postnatal management in hemolytic disease of the fetus and newborn. Eur J Pediatr 2023; 182:489-500. [PMID: 36469119 DOI: 10.1007/s00431-022-04724-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 12/07/2022]
Abstract
UNLABELLED Since the discovery of the Rh blood group system in 1940, a greater understanding of hemolytic disease of the fetus and newborn (HDFN) was gained. In the years thereafter, researchers and clinicians came to the current understanding that fetal and neonatal red blood cells (RBC) are hemolyzed by maternal alloantibodies directed against RBC antigens potentially leading to severe disease. Preventative measures, such as Rhesus(D) immunoprophylaxis (RhIG), have greatly decreased the prevalence of Rh(D)-mediated HDFN, although a gap between high-income countries and middle- to low-income countries was created largely due to a lack in availability and high costs of RhIG. Other important developments in the past decades have improved the identification, monitoring, and care of pregnancies, fetuses, and neonates with HDFN. Prenatally, fetal anemia may occur and intrauterine transfusions may be needed. Postnatally, pediatricians should be aware of the (antenatally determined) risk of hemolysis in RBC alloimmunization and should provide treatment for hyperbilirubinemia in the early phase and monitor for anemia in the late phase of the disease. Through this review, we aim to provide an overview of important historic events and to provide hands-on guidelines for the delivery and postnatal management of neonates with HDFN. Secondarily, we aim to describe recent scientific findings and evidence gaps. CONCLUSION Multiple developments have improved the identification, monitoring, and care of pregnancies and neonates with HDFN throughout the centuries. Pediatricians should be aware of the (antenatally determined) risk of hemolysis in RBC alloimmunization and should provide treatment for hyperbilirubinemia in the early phase and monitor for late anemia in the late phase of the disease. Future studies should be set in an international setting and ultimately aim to eradicate HDFN on a global scale. WHAT IS KNOWN • Developments have led to a greater understanding of the pathophysiology, an improved serological identification and monitoring of at-risk cases and the current pre- and postnatal treatment. WHAT IS NEW • This review provides the pediatrician with hands-on guidelines for the delivery and postnatal management of neonates with HDFN. • Future studies should be set in an international setting with the ultimate aim of eradicating HDFN.
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Affiliation(s)
- Derek P De Winter
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Albinusdreef 2, 2333, Leiden, The Netherlands. .,Department of Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands.
| | - Christian Hulzebos
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Renske M Van 't Oever
- Department of Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Masja De Haas
- Department of Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ejt Joanne Verweij
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Albinusdreef 2, 2333, Leiden, The Netherlands
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13
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Ohishi A, Kondo M, Fujita T, Baba T, Iijima S. Accuracy of transcutaneous bilirubin level measured by a JM-105 bilirubinometer. Pediatr Neonatol 2023; 64:32-37. [PMID: 36088254 DOI: 10.1016/j.pedneo.2022.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/17/2022] [Accepted: 05/10/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Transcutaneous bilirubin (TcB) measurement is useful, but dissociation with total serum bilirubin (TSB) is a clinical problem in measurement. We verified the accuracy of the latest version of the JM-105 jaundice meter. METHODS The TcB, TSB, and hematocrit (Hct) measurements obtained in the first 4 days of life in 2788 term neonates were analyzed. RESULTS When divided into 2-mg/dL classes, the difference between the TcB and TSB measurements did not change as TcB increased, but both overestimation and underestimation of TcB increased as TcB increased. At TcB greater than 11 mg/dL, inaccurate measurements with dissociation greater than 2 mg/dL exceeded 10% of the TcB measurements. The Hct value was associated with overestimation and underestimation. CONCLUSION To evaluate neonatal jaundice accurately, it is desirable to measure TSB by blood sampling before discharge from obstetrics or in the case of worsening jaundice on day 4 or 5 of life.
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Affiliation(s)
- Akira Ohishi
- Maternal-Fetal and Neonatal Care Center, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Miyuki Kondo
- Maternal-Fetal and Neonatal Care Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoka Fujita
- Maternal-Fetal and Neonatal Care Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toru Baba
- Department of Regional Neonatal and Perinatal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shigeo Iijima
- Department of Regional Neonatal and Perinatal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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14
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Satrom KM, Farouk ZL, Slusher TM. Management challenges in the treatment of severe hyperbilirubinemia in low- and middle-income countries: Encouraging advancements, remaining gaps, and future opportunities. Front Pediatr 2023; 11:1001141. [PMID: 36861070 PMCID: PMC9969105 DOI: 10.3389/fped.2023.1001141] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/17/2023] [Indexed: 02/15/2023] Open
Abstract
Neonatal jaundice (NJ) is common in newborn infants. Severe NJ (SNJ) has potentially negative neurological sequelae that are largely preventable in high resource settings if timely diagnosis and treatment are provided. Advancements in NJ care in low- and middle-income countries (LMIC) have been made over recent years, especially with respect to an emphasis on parental education about the disease and technological advancements for improved diagnosis and treatment. Challenges remain, however, due to lack of routine screening for SNJ risk factors, fragmented medical infrastructure, and lack of culturally appropriate and regionally specific treatment guidelines. This article highlights both encouraging advancements in NJ care as well as remaining gaps. Opportunities are identified for future work in eliminating the gaps in NJ care and preventing death and disability related to SNJ around the globe.
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Affiliation(s)
- Katherine M Satrom
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, United States
| | - Zubaida L Farouk
- Department of Pediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria.,Centre for Infectious Diseases Research, Bayero University, Kano, Nigeria
| | - Tina M Slusher
- Department of Pediatrics, Global Health Program, Critical Care Division, University of Minnesota, Minneapolis, MN, United States.,Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
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15
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Khurshid F, Rao SPN, Sauve C, Gupta S. Universal screening for hyperbilirubinemia in term healthy newborns at discharge: A systematic review and meta-analysis. J Glob Health 2022; 12:12007. [PMID: 36579719 PMCID: PMC9798347 DOI: 10.7189/jogh.12.12007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background All term healthy neonates are screened for jaundice before hospital discharge as a standard clinical practice, but methods vary from clinical screening (visual inspection and/or risk factor assessment) to transcutaneous bilirubin (TcB) or total serum bilirubin (TSB) testing, depending on the setting. Methods This systematic review of randomized and non-randomized studies evaluated the effectiveness of universal TcB and universal TSB screening at discharge compared to clinical screening alone for term healthy neonates. The outcomes were neonatal mortality, readmission for jaundice, severe hyperbilirubinemia (>20 mg/dL), jaundice requiring exchange transfusion, and bilirubin-induced neurological dysfunction (BIND). We searched MEDLINE via Ovid, EBM reviews, Embase, CINAHL, clinical trials databases, and reference lists of retrieved articles. Two authors separately evaluated the risk of bias, extracted data, and synthesized effect estimates using relative risk (RR) for randomized and odds ratio (OR) for non-randomized studies. Results For universal TcB at discharge, we included one randomized trial enrolling 1858 participants and four non-randomized studies enrolling 375 956 participants. No study reported neonatal mortality. The randomized trial suggested that universal TcB at discharge may decrease readmission for jaundice (risk ratio (RR) = 0.24, 95% confidence interval (CI) = 0.13 to 0.46; low certainty evidence) and severe hyperbilirubinemia (RR = 0.27, 95% CI = 0.08 to 0.97; low certainty evidence), but the effect on jaundice requiring exchange transfusion (RR = 0.20, 95% CI = 0.01 to 41.6) and BIND (RR = 0.33, 95% CI = 0.01 to 8.17) was uncertain. Meta-analysis of non-randomized studies suggested that TcB may decrease severe hyperbilirubinemia (odds ratio (OR) = 0.25, 95% = CI 0.12 to 0.52; low certainty evidence) and jaundice requiring exchange transfusion (OR = 0.28, 95% CI = 0.19 to 0.42; low certainty evidence), but the effect on readmission for jaundice was uncertain (OR = 1.01, 95% CI = 0.38 to 2.7; very low certainty evidence). For universal TSB, we included three studies from the United States enrolling 490 426 participants. The effect on severe hyperbilirubinemia (OR = 0.37, 95% CI = 0.15 to 0.88), jaundice requiring exchange transfusion (OR = 0.53, 95% CI = 0.13 to 2.25) and readmission for jaundice (OR = 1.01, 95% CI = 0.62 to 1.67) was uncertain. Conclusions Universal TcB at discharge may improve clinical outcomes for term healthy neonates. Evidence for universal TSB is uncertain. Registration PROSPERO 2020 CRD42020187279.
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Affiliation(s)
- Faiza Khurshid
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Queens University, Kingston, Ontario, Canada
| | - Suman PN Rao
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization WHO
| | - Caroline Sauve
- Department of Education and Academy, Centre Hospitalier de l’Université de Montréal, Quebec, Canada
| | - Shuchita Gupta
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization WHO
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16
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Çerçi Kubur Ç, İşcan B, Duman N, Özkan H, Kumral A. Dermal Progression of Neonatal Jaundice of Newborn Under 35 Weeks of Gestational Age. THE JOURNAL OF PEDIATRIC RESEARCH 2022. [DOI: 10.4274/jpr.galenos.2022.56650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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17
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Dam-Vervloet AJ, de Boer FA, Nijholt IM, Poot L, Bosschaart N, van Straaten HLM. Quantification of cephalocaudal progression of jaundice in preterm infants. Pediatr Res 2022:10.1038/s41390-022-02396-y. [PMID: 36443401 DOI: 10.1038/s41390-022-02396-y] [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: 06/16/2022] [Revised: 11/03/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The cephalocaudal progression (CCP) of neonatal jaundice is a well-known phenomenon, but quantitative information on CCP in preterm infants is absent. In this study, CCP was quantified in preterm infants as a function of postnatal age and body location. METHODS 5.693 transcutaneous bilirubin (TcB) measurements were performed in 101 preterm infants from birth until postnatal day seven at five body locations (forehead, sternum, hipbone, tibia, ankle). Multi-level linear regression analysis was performed to evaluate the CCP as a function of body location and postnatal age. TcB measurements at all body locations and postnatal days were compared to total serum bilirubin (TSB) levels (N = 1.113). RESULTS The overall average change in ratio of TcB compared to forehead was for sternum +0.04 [95% CI -0.02;0.09]; hipbone +0.05 [0.00;0.01]; tibia -0.33 [-0.38;-0.27] and ankle -0.62 [-0.68;-0.57]. No effect modification of CCP by sex, gestational age, birthweight, phototherapy, and TSB was found. The TcB maximally underestimated the TSB at the ankle -79.5 µmol [-0.1;159.2]. CONCLUSIONS CCP is present in preterm infants and is relatively stable over time. Since TcB measurements on the tibia and ankle underestimate TSB significantly, we advise to use only measurement locations cephalic from the tibia; i.e., hipbone, sternum, and forehead. IMPACT Cephalocaudal progression (CCP) of jaundice in preterm infants, assessed by transcutaneous bilirubin (TcB) measurements, is substantial and rather stable over postnatal day 0 to 7. To the best of our knowledge, this study is the first to investigate CCP of jaundice in preterm infants as a function of postnatal age in preterm infants. Our results demonstrate that TcB measurements at the tibia and ankle differ from the TSB beyond the clinically used TcB safety margins. We advise to perform TcB measurements only at locations cephalic from the tibia; i.e., hipbone, forehead, and sternum.
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Affiliation(s)
- Alida J Dam-Vervloet
- Medical Physics Department, Isala Hospital, Zwolle, The Netherlands. .,Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | | | - Ingrid M Nijholt
- Innovation & Science Department, Isala Hospital, Zwolle, The Netherlands.,Radiology Department, Isala Hospital, Zwolle, The Netherlands
| | - Lieke Poot
- Medical Physics Department, Isala Hospital, Zwolle, The Netherlands
| | - Nienke Bosschaart
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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18
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Kemper AR, Newman TB, Slaughter JL, Maisels MJ, Watchko JF, Downs SM, Grout RW, Bundy DG, Stark AR, Bogen DL, Holmes AV, Feldman-Winter LB, Bhutani VK, Brown SR, Maradiaga Panayotti GM, Okechukwu K, Rappo PD, Russell TL. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics 2022; 150:188726. [PMID: 35927462 DOI: 10.1542/peds.2022-058859] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Thomas B Newman
- Departments of Epidemiology & Biostatistics and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | | | - M Jeffrey Maisels
- Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Jon F Watchko
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen M Downs
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - Randall W Grout
- Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana
| | - David G Bundy
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Debra L Bogen
- Allegheny County Health Department, Pittsburgh, Pennsylvania
| | - Alison Volpe Holmes
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Lori B Feldman-Winter
- Department of Pediatrics, Division of Adolescent Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Vinod K Bhutani
- Department of Pediatrics, Neonatal and Developmental Medicine Stanford University School of Medicine, Stanford, California
| | | | - Gabriela M Maradiaga Panayotti
- Division of Primary Care, Duke Children's Hospital and Health Center, Duke University Medical Center, Durham, North Carolina
| | - Kymika Okechukwu
- Department of Quality, American Academy of Pediatrics, Itasca, Illinois
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19
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Baranoski GVG, Varsa PM. In Silico Assessment of Tanning Masking Effects on Skin Chromatic Attributes Elicited by Anemia and Hyperbilirubinemia. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4716-4722. [PMID: 36085740 DOI: 10.1109/embc48229.2022.9871271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Changes in skin appearance are among the most recognizable symptoms of a number of medical conditions. The interpretation of such changes, however, may be inadvertently biased by normal physiological processes affecting skin optical properties. In this paper, we assess the impact of one of the most common of these processes, tanning, on variations in skin chromatic attributes elicited by two ubiquitous and serious medical conditions, anemia and hyperbilirubinemia. We employ a first-principles investigation approach centered on the use of predictive computer simulations of light and skin interactions, and on well-established colorimetry methods. In our in silico experiments, we considered skin chromatic attributes resulting from distinct anemia severity levels and hyperbilirubinemia tox-icity stages. Our findings highlight qualitative and quantitative aspects that need to be considered in the visual screening and monitoring of these conditions, notably when they occur with the concomitant presence of tanning-induced changes in the cutaneous tissues' melanin pigmentation and thickness.
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20
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Kumar D, Kumar D. A Prospective Comparison of Serum and Transcutaneous Bilirubin in Indian Neonates. J Pediatr Intensive Care 2022; 11:100-104. [PMID: 35734214 DOI: 10.1055/s-0040-1721067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022] Open
Abstract
The objective of this study was to compare the transcutaneous bilirubin (TcB) with total serum bilirubin (TSB) and to find out the effect of phototherapy on correlation of TcB and TSB during and after phototherapy in Indian neonates. Prospective observational study was performed at neonatal intensive care unit of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India. Blood samples for TSB estimation of 276 jaundiced neonates were sent, and simultaneously, TcB was measured at forehead and sternum on admission and 12 hourly till discontinuation of phototherapy as per the American Academy of Pediatrics nomogram chart and their correlation was assessed. The effect of phototherapy on correlation of TcB and TSB during and after phototherapy was also observed. The correlation between TSB and TcB was linear and significant for the entire study population over forehead (Pearson's r = 0.802, R 2 = 0.644, p < 0.001) as well as over sternum (Pearson's r = 0.825, R 2 = 0.681, p < 0.001) before starting the phototherapy. This correlation becomes slightly lower for TSB versus TcB forehead (Pearson's r = 0.753, R 2 = 0.568, p < 0.001) and for TSB versus TcB sternum (Pearson's r = 0.754, R 2 = 0.569, p < 0.001) after giving phototherapy for at least 24 hours. The correlation coefficients for TSB versus TcB measurements over forehead and sternum were 0.758 and 0.806, respectively, after 36 hours of phototherapy. TcB measurements using the transcutaneous bilirubinometer correlate closely with TSB levels, so it can be used as an easy and rapid noninvasive method of bilirubin measurement in jaundiced neonates.
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Affiliation(s)
- Durgesh Kumar
- Department of Pediatrics, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Dinesh Kumar
- Department of Pediatrics, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
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21
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Harrison-Smith B, Dumont AP, Arefin MS, Sun Y, Lawal N, Dobson D, Nwaba A, Grossarth S, Paed AM, Farouk ZL, Weitkamp JH, Patil CA. Development of a mobile phone camera-based transcutaneous bilirubinometer for low-resource settings. BIOMEDICAL OPTICS EXPRESS 2022; 13:2797-2809. [PMID: 35774304 PMCID: PMC9203089 DOI: 10.1364/boe.449625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 05/19/2023]
Abstract
Newborns in high-income countries are routinely screened for neonatal jaundice using transcutaneous bilirubinometery (TcB). In low-and middle-income countries, TcB is not widely used due to a lack of availability; however, mobile-phone approaches for TcB could help expand screening opportunities. We developed a mobile phone-based approach for TcB and validated the method with a 37 patient multi-ethnic pilot study. We include a custom-designed snap-on adapter that is used to create a spatially resolved diffuse reflectance detection configuration with the illumination provided by the mobile-phone LED flash. Monte-Carlo models of reflectance from neonatal skin were used to guide the design of an adapter for filtered red-green-blue (RGB) mobile-phone camera reflectance measurements. We extracted measures of reflectance from multiple optimized spatial-offset regions-of-interest (ROIs) and a linear model was developed and cross-validated. This resulted in a correlation between total serum bilirubin and mobile-phone TcB estimated bilirubin with a R 2= 0.42 and Bland-Altman limits of agreement of +6.4 mg/dL to -7.0 mg/dL. These results indicate that a mobile phone with a modified adapter can be utilized to measure neonatal bilirubin values, thus creating a novel tool for neonatal jaundice screening in low-resource settings.
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Affiliation(s)
- Brandon Harrison-Smith
- Department of Bioengineering, Temple University, 1801 N. Broad St., Philadelphia, PA 19121, USA
| | - Alexander P. Dumont
- Department of Bioengineering, Temple University, 1801 N. Broad St., Philadelphia, PA 19121, USA
| | | | - Yu Sun
- Department of Bioengineering, Temple University, 1801 N. Broad St., Philadelphia, PA 19121, USA
| | - Nuradeen Lawal
- Department of Pediatrics, Aminu Kano Teaching Hospital(AKTH), Kano 7002 31, Nigeria
| | - Dorianna Dobson
- Department of Pediatrics, Vanderbilt University Medical Center(VUMC), Nashville, TN 37203, USA
| | - Amy Nwaba
- Department of Pediatrics, Vanderbilt University Medical Center(VUMC), Nashville, TN 37203, USA
| | - Sarah Grossarth
- Department of Pediatrics, Vanderbilt University Medical Center(VUMC), Nashville, TN 37203, USA
| | | | - Zubaida L. Farouk
- Department of Pediatrics, Aminu Kano Teaching Hospital(AKTH), Kano 7002 31, Nigeria
| | - Jorn-Hendrik Weitkamp
- Department of Pediatrics, Vanderbilt University Medical Center(VUMC), Nashville, TN 37203, USA
| | - Chetan A. Patil
- Department of Bioengineering, Temple University, 1801 N. Broad St., Philadelphia, PA 19121, USA
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22
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Evaluation of a new transcutaneous bilirubinometer in newborn infants. Sci Rep 2022; 12:5835. [PMID: 35393482 PMCID: PMC8989875 DOI: 10.1038/s41598-022-09788-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/18/2022] [Indexed: 11/09/2022] Open
Abstract
To avoid brain damage in newborn infants, effective tools for prevention of excessive neonatal hyperbilirubinemia are needed. The objective of this study was to evaluate a new transcutaneous bilirubinometer (JAISY). For this purpose, 930 bilirubin measurements were performed in 141 newborn infants born near-term or at term (gestational age 35–41 weeks; postnatal age 1–6 days; 71 boys; including 29 infants with darker skin) and compared to those of a previously validated instrument (JM105). In each infant, the mean of three repeated measurements in the forehead was calculated for each instrument, followed by a similar measurement on the chest. The bilirubin values varied between 0 and 320 µmol/l (0–18.8 mg/dl). There was a high degree of agreement with significant correlations between bilirubin values measured with the two devices on the forehead (Pearson’s r = 0.94, p < 0.001) and the chest (r = 0.94, p < 0.001). The correlations remained after stratifying the data by gestational age, postnatal age and skin color. The coefficient of variation for repeated bilirubin measurements was 8.8% for JAISY and 8.0% for JM105 (p = 0.79). In conclusion, JAISY provides accurate and reproducible information on low to moderately high bilirubin levels in newborn infants born near-term or at term.
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Clinical and Genetic Etiologies of Neonatal Unconjugated Hyperbilirubinemia in the China Neonatal Genomes Project. J Pediatr 2022; 243:53-60.e9. [PMID: 34953813 DOI: 10.1016/j.jpeds.2021.12.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/09/2021] [Accepted: 12/13/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the clinical and genetic causes of neonatal unconjugated hyperbilirubinemia. STUDY DESIGN We included 1412 neonates diagnosed with unconjugated hyperbilirubinemia (total serum bilirubin >95 percentile for age), from the China Neonatal Genomes Project between August 2016 and September 2019, in the current study. Clinical data and targeted panel sequencing data on 2742 genes including known unconjugated hyperbilirubinemia genes were analyzed. RESULTS Among the 1412 neonates with unconjugated hyperbilirubinemia, 37% had severe unconjugated hyperbilirubinemia, with total serum bilirubin levels that met the recommendations for exchange transfusion. Known clinical causes were identified for 68% of patients. The most common clinical cause in the mild unconjugated hyperbilirubinemia group was infection (17%) and in the severe group was combined factors (21%, with infection combined with extravascular hemorrhage the most common). A genetic variant was observed in 55 participants (4%), including 45 patients with variants in genes associated with unconjugated hyperbilirubinemia and 10 patients with variants that were regarded as additional genetic findings. Among the 45 patients identified with unconjugated hyperbilirubinemia-related variants, the genes were mainly associated with enzyme deficiencies, metabolic/biochemical disorders, and red blood cell membrane defects. G6PD and UGT1A1 variants, were detected in 34 of the 45 patients (76%). CONCLUSIONS Known clinical causes, which varied with bilirubin levels, were identified in approximately two-thirds of the patients. Genetic findings were identified in 4% of the patients, including in patients with an identified clinical cause, with G6PD and UGT1A1 being the most common genes in which variants were detected.
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Thomas M, Greaves RF, Tingay DG, Loh TP, Ignjatovic V, Newall F, Oeum M, Tran MTC, Rajapaksa AE. Current and emerging technologies for the timely screening and diagnosis of neonatal jaundice. Crit Rev Clin Lab Sci 2022; 59:332-352. [PMID: 35188857 DOI: 10.1080/10408363.2022.2038074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Neonatal jaundice is one of the most common clinical conditions affecting newborns. For most newborns, jaundice is harmless, however, a proportion of newborns develops severe neonatal jaundice requiring therapeutic interventions, accentuating the need to have reliable and accurate screening tools for timely recognition across different health settings. The gold standard method in diagnosing jaundice involves a blood test and requires specialized hospital-based laboratory instruments. Despite technological advancements in point-of-care laboratory medicine, there is limited accessibility of the specialized devices and sample stability in geographically remote areas. Lack of suitable testing options leads to delays in timely diagnosis and treatment of clinically significant jaundice in developed and developing countries alike. There has been an ever-increasing need for a low-cost, simple to use screening technology to improve timely diagnosis and management of neonatal jaundice. Consequently, several point-of-care (POC) devices have been developed to address this concern. This paper aims to review the literature, focusing on emerging technologies in the screening and diagnosing of neonatal jaundice. We report on the challenges associated with the existing screening tools, followed by an overview of emerging sensors currently in pre-clinical development and the emerging POC devices in clinical trials to advance the screening of neonatal jaundice. The benefits offered by emerging POC devices include their ease of use, low cost, and the accessibility of rapid response test results. However, further clinical trials are required to overcome the current limitations of the emerging POC's before their implementation in clinical settings. Hence, the need for a simple to use, low-cost POC jaundice detection technology for newborns remains an unsolved challenge globally.
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Affiliation(s)
- Mercy Thomas
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Australia
| | - Ronda F Greaves
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Victorian Clinical Genetics Services, Melbourne, Australia.,International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy
| | - David G Tingay
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
| | - Tze Ping Loh
- International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy.,Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Hematology, Murdoch Children's Research Institute, Melbourne, Australia
| | - Fiona Newall
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Australia
| | - Michelle Oeum
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | - Mai Thi Chi Tran
- International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy.,National Children's Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - Anushi E Rajapaksa
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Think Project Global, Melbourne, Australia
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25
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Srinivasan R, Natarajan T, Raju S, Kannapan S. Predischarge screening of neonates with transcutaneous bilirubinometer: Comparison of various nomograms. J Clin Neonatol 2022. [DOI: 10.4103/jcn.jcn_129_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Abstract
Keeping the umbilical cord intact after delivery facilitates transition from fetal to neonatal circulation and allows a placental transfusion of a considerable amount of blood. A delay of at least 3 minutes improves neurodevelopmental outcomes in term infants. Although regarded as common sense and practiced by many midwives, implementation of delayed cord clamping into practice has been unduly slow, partly because of beliefs regarding theoretic risks of jaundice and lack of understanding regarding the long-term benefits. This article provides arguments for delaying cord clamping for a minimum of 3 minutes.
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Affiliation(s)
- Ola Andersson
- Department of Clinical Sciences, Lund, Pediatrics, Lund University, SE-221 85 Lund, Sweden; Department of Neonatology, Skåne University Hospital, Jan Waldenströms gata 47, Malmö SE-214 28, Sweden.
| | - Judith S Mercer
- Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA; University of Rhode Island, Kingston, RI, USA
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Sampurna MTA, Rohsiswatmo R, Primadi A, Wandita S, Sulistijono E, Bos AF, Sauer PJJ, Hulzebos CV, Dijk PH. The knowledge of Indonesian pediatric residents on hyperbilirubinemia management. Heliyon 2021; 7:e06661. [PMID: 33898814 PMCID: PMC8056408 DOI: 10.1016/j.heliyon.2021.e06661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/30/2021] [Accepted: 03/29/2021] [Indexed: 11/21/2022] Open
Abstract
Hyperbilirubinemia in the newborn occurs more frequently in Indonesia. Therefore, it is important that pediatric residents in Indonesia acquire adequate knowledge of hyperbilirubinemia management. This study aims to determine the pediatric residents' knowledge on hyperbilirubinemia management, whether they follow recommended guidelines, and whether differences exist between five large Indonesian teaching hospitals. We handed out a 25-question questionnaire on hyperbilirubinemia management to pediatric residents at five teaching hospitals. A total of 250 questionnaires were filled in completely, ranging from 14 to 113 respondents per hospital. Approximately 76% of the respondents used the Kramer score to recognize neonatal jaundice. Twenty-four percent correctly plotted the total serum bilirubin levels (TSB) on the phototherapy (PT) nomograms provided by the American Academy of Pediatrics (AAP) and the National Institute for Health and Care Excellence (NICE) for full-term and nearly full-term infants. Regarding preterm infants <35 weeks' gestational age, 66% of the respondents plotted TSB levels on the AAP nomogram, although this nomogram doesn't apply to this category of infants. Seventy percent of residents knew when to perform an exchange transfusion whereas 27% used a fixed bilirubin cut-off value of 20 mg/dL. Besides PT, 25% reported using additional pharmaceutical treatments, included albumin, phenobarbitone, ursodeoxycholic acid and immunoglobulins, while 47% of the respondents used sunlight therapy, as alternative treatment. The limited knowledge of the pediatric residents could be one factor for the higher incidence of severe hyperbilirubinemia and its sequelae. The limited knowledge of the residents raises doubts about the knowledge of the supervisors and the training of the residents since pediatric residents receive training from their supervisors.
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Affiliation(s)
- Mahendra T A Sampurna
- Neonatology Division, Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Rinawati Rohsiswatmo
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Aris Primadi
- Department of Pediatrics, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Setya Wandita
- Neonatology Division, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Eko Sulistijono
- Department of Pediatrics, Saiful Anwar Hospital, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | - Arend F Bos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter J J Sauer
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christian V Hulzebos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter H Dijk
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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28
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Serum bilirubin trend, hematological and clinical profile of late preterm and term neonates with unconjugated hyperbilirubinemia - A prospective observational study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2020.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Inamori G, Kamoto U, Nakamura F, Isoda Y, Uozumi A, Matsuda R, Shimamura M, Okubo Y, Ito S, Ota H. Neonatal wearable device for colorimetry-based real-time detection of jaundice with simultaneous sensing of vitals. SCIENCE ADVANCES 2021; 7:eabe3793. [PMID: 33658197 PMCID: PMC7929506 DOI: 10.1126/sciadv.abe3793] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/21/2021] [Indexed: 05/19/2023]
Abstract
Neonatal jaundice occurs in >80% of newborns in the first week of life owing to physiological hyperbilirubinemia. Severe hyperbilirubinemia could cause brain damage owing to its neurotoxicity, a state commonly known as kernicterus. Therefore, periodic bilirubin monitoring is essential to identify infants at-risk and to initiate treatment including phototherapy. However, devices for continuous measurements of bilirubin have not been developed yet. Here, we established a wearable transcutaneous bilirubinometer that also has oxygen saturation (SpO2) and heart rate (HR) sensing functionalities. Clinical experiments with neonates demonstrated the possibility of simultaneous detection of bilirubin, SpO2, and HR. Moreover, our device could consistently measure bilirubin during phototherapy. These results demonstrate the potential for development of a combined treatment approach with an automatic link via the wearable bilirubinometer and phototherapy device for optimization of the treatment of neonatal jaundice.
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Affiliation(s)
- Go Inamori
- Department of Mechanical Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, Kanagawa 240-8501, Japan
| | - Umihiro Kamoto
- Department of Mechanical Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, Kanagawa 240-8501, Japan
| | - Fumika Nakamura
- Department of Mechanical Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, Kanagawa 240-8501, Japan
| | - Yutaka Isoda
- Graduate School of System Integration, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, Kanagawa 240-8501, Japan
| | - Azusa Uozumi
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, 3-9 Fukura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Ryosuke Matsuda
- Department of Mechanical Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, Kanagawa 240-8501, Japan
| | - Masaki Shimamura
- Department of Mechanical Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, Kanagawa 240-8501, Japan
| | - Yusuke Okubo
- Division of Cellular and Molecular Toxicology, Biological Safety and Research Center, National Institute of Health Sciences, Tonomachi 3-25-26, Kawasaki, Kanagawa 210-9501, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, 3-9 Fukura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Hiroki Ota
- Department of Mechanical Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, Kanagawa 240-8501, Japan.
- Graduate School of System Integration, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, Kanagawa 240-8501, Japan
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30
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Reliability of transcutaneous bilirubin determination based on skin color determined by a neonatal skin color scale of our own. Eur J Pediatr 2021; 180:607-616. [PMID: 33409587 DOI: 10.1007/s00431-020-03885-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
Measurement of transcutaneous bilirubin (TcB) is widely used to estimate serum bilirubin (SB). However, its reliability depending on skin tone is still controversial. Ethnic classification does not correlate well with skin tone. We aimed to determine the reliability of transcutaneous bilirubin in a multiethnic population based on skin color according to our neonatal skin color scale. We conducted a prospective, observational study comparing SB and TcB among different skin colors. With the blood sample routinely obtained at 48-72 h for the screening of inborn errors of metabolism, we determined SB and TcB with a jaundice meter. We obtained data from 1359 newborns (color 1 337, color 2 750, color 3 249, color 4 23) and analyzed 1549 dyads SB/TcB. Correlation between TcB and serum bilirubin was very good (R2 = 0.908-0.956), globally and by color group, with slight differences between darker and lighter skin colors. Bland-Altman plots showed different mean bias depending on skin color. Conclusions: Our study not only supports the reliability of TcB to assess SB regardless of skin color, but also supports the fact that TcB tends to overestimate SB in a higher degree in dark-skinned neonates. This may help reduce the number of blood samples for newborns. What is Known: • Jaundice meters are extensively used to diagnose neonatal hyperbilirubinemia, although controversies exist on their reliability depending on skin color. • Only a few studies have analyzed their accuracy in multiethnic populations, but none has used a validated neonatal skin color scale. What is New: • We verified correlation between serum and transcutaneous bilirubin in a multiethnic population depending on skin color after classifying our neonates into color groups with our own validated neonatal skin color scale.
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31
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Abstract
New technologies have become available for noninvasive assessments of neonatal hyperbilirubinemia. Our objective is to review the noninvasive methods for measuring bilirubin in the newborn. We searched relevant literature from 1966 to January 1, 2020, which included cross-sectional studies to define the accuracy of any noninvasive methods for measuring or estimating total serum/plasma bilirubin (TB) levels in newborns. We identified and included 83 relevant studies of direct visual assessment, icterometry, mobile phone applications, and transcutaneous bilirubinometry (TcB). Compared with laboratory TB measurements, visual assessment was the least accurate and least reliable (r: 0.37 to 074), while TcB was the most accurate, but not always near-equivalent (r: 0.45 to 0.99). The sensitivity and specificity of TcB cut-off values to detect significant hyperbilirubinemia (TB>95th percentile for age in hours) ranged from 74% to 100% and 18% to 89%, respectively.
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Affiliation(s)
- Charles I Okwundu
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shiv Sajan Saini
- Department of Pediatrics, Division of Neonatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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32
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Kamineni B, Tanniru A, Vardhelli V, Sharma D, Pawale D, Kulkarni D, Muppidi PR, Deshabhotla S, Murki S. Accuracy of Bilistick (a Point-of-Care Device) to Detect Neonatal Hyperbilirubinemia. J Trop Pediatr 2020; 66:630-636. [PMID: 32433770 DOI: 10.1093/tropej/fmaa026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Early diagnosis and appropriate management of neonatal jaundice is crucial in avoiding severe hyperbilirubinemia and brain injury. A low-cost, minimally invasive, point-of-care (PoC) tool for total bilirubin (TB) estimation which can be useful across all ranges of bilirubin values and all settings is the need of the hour. OBJECTIVE To assess the accuracy of Bilistick system, a PoC device, for measurement of TB in comparison with estimation by spectrophotometry. DESIGN/METHODS In this cross-sectional clinical study, in infants who required TB estimation, blood samples in 25-µl sample transfer pipettes were collected at the same time from venous blood obtained for laboratory bilirubin estimation. The accuracy of Bilistick in estimating TB within ±2 mg/dl of bilirubin estimation by spectrophotometry was the primary outcome. RESULTS Among the enrolled infants, 198 infants were eligible for study analysis with the mean gestation of 36 ± 2.3 weeks and the mean birth weight of 2368 ± 623 g. The median age at enrollment was 68.5 h (interquartile range: 48-92). Bilistick was accurate only in 54.5% infants in measuring TB within ±2 mg/dl difference of TB measured by spectrophotometry. There was a moderate degree of correlation between the two methods (r = 0.457; 95% CI: 0.339-0.561, p value < 0.001). Bland-Altman analysis showed a mean difference of 0.5 mg/dl (SD ± 4.4) with limits of agreement between -8.2 and +9.1 mg/dl. CONCLUSION Bilistick as a PoC device is not accurate to estimate TB within the clinically acceptable difference (±2 mg/dl) of TB estimation by spectrophotometry and needs further improvement to make it more accurate.
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Affiliation(s)
- Bhargavi Kamineni
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
| | - Anusha Tanniru
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
| | | | - Deepak Sharma
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
| | - Dinesh Pawale
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
| | - Dattatray Kulkarni
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
| | | | - Saikiran Deshabhotla
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana 500029, India
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Abstract
Neonatal indirect hyperbilirubinemia (IHB) is caused by an imbalance in bilirubin production and elimination. Approximately 60% of term and 80% of preterm infants develop jaundice in the first week of age. This review seeks to provide the reader with a thorough understanding of the physiology of bilirubin, etiology of IHB, and management of severe IHB. Phototherapy and exchange transfusion remain the mainstays of treatment for severe IHB. Noninvasive screening tools, innovative treatments, and a better understanding of how prematurity and genetics contribute to severe IHB have improved our understanding of IHB and may help eliminate the hazards associated with severe IHB, including kernicterus spectrum disorder.
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Affiliation(s)
- Nicole B Anderson
- Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine UCLA, Los Angeles, CA
| | - Kara L Calkins
- Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine UCLA, Los Angeles, CA
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Dianova E, Fogel J, Verma RP. Predictability of transcutaneous bilirubinometry in late preterm and term infants at risk for pathological hyperbilirubinemia. J Neonatal Perinatal Med 2020; 14:261-267. [PMID: 33074197 DOI: 10.3233/npm-200486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim was to assess the predictability of transcutaneous bilirubinometry in late preterm and term neonates at risk for pathological hyperbilirubinemia, and to identify the neonatal population in which transcutaneous bilirubin most accurately predicts serum bilirubin level (SB, mg/dl). METHODS The correlations between transcutaneous bilirubin (TCB, mg/dl) and SB in different neonatal population subsets; and between ΔTSB (TCB-SB) and relevant neonatal variables and clinical groups were analyzed. RESULTS TCB correlated with SB (r = 0.82, p < 0.05) in the cohort (n = 350) and in population subsets (r = 0.81-0.9, p < 0.001). Black infants with gestational age (GA) >35 weeks and chronological age (CA) >3 days recorded strongest correlation (r = 0.9, p < 0.001) followed by Blacks, and non-Black infants with CA >3 days and GA >35 weeks. ΔTSB was positive in Blacks, and in infants with CA <3 days, or with no phototherapy. ΔTSB was negative in non-Blacks, in infants with positive direct Coombs test (DC+) or those receiving phototherapy. Black race [beta (SE) = 1.3(0.33), p < 0.001] had positive, while CA [beta (SE) =-1.74 (0.36), p < 0.001], DC + status [beta (SE) =-0.72 (0.25), p = 0.004] and receipt of phototherapy [beta (SE) =-0.84 (0.21), p < 0.001] each had negative correlation with ΔTSB. ΔTSB for Blacks was >Whites, Hispanics and Asians. CONCLUSION SB is best predicted by TCB in Black infants with CA over 3 days and GA over 35 weeks. Variability in SB estimation by TCB is race, CA and immune mediated hemolysis specific.
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Affiliation(s)
- E Dianova
- Department of Pediatrics, Nassau University Medical Center, East Meadow, NY, USA
| | - J Fogel
- Department of Academic Affairs, University Medical Center, East Meadow, NY, USA
| | - R P Verma
- Department of Pediatrics, Division of Neonatology, Nassau University Medical Center, East Meadow, NY, USA
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35
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Yasuda S, Suzuki H, Htun Y, Aye NSS, Oo H, Oo AK, Yu KZ, Sin KS, Itoh S, Kusaka T. Hour-specific nomogram for transcutaneous Bilirubin in newborns in Myanmar. Pediatr Int 2020; 62:1049-1053. [PMID: 32298504 DOI: 10.1111/ped.14251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/01/2020] [Accepted: 04/10/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neonatal hyperbilirubinemia is a significant health problem in Myanmar, and the rate of kernicterus is also higher than in developed countries. Non-invasive methods for early detection and treatment of hyperbilirubinemia are urgently needed. In this study, we used transcutaneous bilirubin (TcB) measurements to develop an hour-specific TcB nomogram for the effective management of hyperbilirubinemia in Myanmar newborns. METHODS The bilirubin levels of neonates born in Central Women Hospital in Yangon, Myanmar were measured three times a day within 72 h after birth using a transcutaneous bilirubinometer. An hour-specific TcB nomogram was created based on the data. RESULTS Participants were 512 infants (287 boys, 225 girls) born in Central Women's Hospital in Yangon. The mean (±SD) gestational age was 38.4 ± 1.2 weeks; birthweight was 3078 ± 412 g. A total of 3,039 plots were obtained, and the TcB nomogram was created with smoothed percentile curves (97.5th, 50th, and 2.5th percentiles) for 0-72 h after birth. CONCLUSIONS An hour-specific TcB nomogram was successfully created to manage hyperbilirubinemia in Myanmar newborns.
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Affiliation(s)
- Saneyuki Yasuda
- Department of Pediatrics, Faculty of Medicine, Kagawa University
| | - Hiromi Suzuki
- Department of Hygiene, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yinmon Htun
- Department of Pediatrics, Faculty of Medicine, Kagawa University
| | - Nant San San Aye
- Neonatal Intensive Care Unit, Central Women Hospital, Yangon, Myanmar
| | - Hnin Oo
- Neonatal Intensive Care Unit, Central Women Hospital, Yangon, Myanmar
| | - Aung Ko Oo
- Neonatal Intensive Care Unit, Central Women Hospital, Yangon, Myanmar
| | - Kay Zin Yu
- Neonatal Intensive Care Unit, Central Women Hospital, Yangon, Myanmar
| | - Khine Shwe Sin
- Neonatal Intensive Care Unit, Central Women Hospital, Yangon, Myanmar
| | - Susumu Itoh
- Department of Pediatrics, Faculty of Medicine, Kagawa University
| | - Takashi Kusaka
- Department of Pediatrics, Faculty of Medicine, Kagawa University
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36
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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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Large scale validation of a new non-invasive and non-contact bilirubinometer in neonates with risk factors. Sci Rep 2020; 10:11149. [PMID: 32636410 PMCID: PMC7341797 DOI: 10.1038/s41598-020-67981-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/11/2020] [Indexed: 11/08/2022] Open
Abstract
The study was aimed to evaluate the performance of a newly developed non-invasive and non-contact bilirubin measurement device (AJO-Neo) as an alternative to the conventional invasive biochemical method of total serum bilirubin (TSB) estimation in preterm and term neonates suffering from hyperbilirubinemia associated with risk factors, and/or undergoing phototherapy. The safety and efficacy of the device were assessed in 1968 neonates with gestational ages ranging from 28 to 41 weeks and suffering from incidences of hyperbilirubinemia. Linear regression analysis showed a good correlation between AJO-Neo and the conventional method of TSB (Pearson’s coefficient, r = 0.79). The small bias (0.27 mg/dL) and limits of agreements (− 3.44 to 3.99 mg/dL) were within the range of clinical acceptance. The device was also precise in the measurement of bilirubin levels in all subgroups of the study. The receiver operator curve (ROC), that takes account of both sensitivity and specificity of a device showed high efficacy of the device (area under the curve, AUC = 0.83) in the detection of bilirubin. While monitoring the bilirubin level during phototherapy, the device indicated promising results showing good agreement with TSB. Specificities and sensitivities of the device indicated a much higher accuracy in neonates with associated risk factors for hyperbilirubinemia. Hence, the newly developed device (AJO-Neo) is reliable in measuring bilirubin level in preterm, and term neonates irrespective of gestational or postnatal age, sex, risk factors, feeding behavior or skin color.
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Reducing Outpatient Infant Blood Draws with Transcutaneous Measurement of Bilirubin. Pediatr Qual Saf 2020; 5:e335. [PMID: 32766506 PMCID: PMC7351454 DOI: 10.1097/pq9.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/19/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction: Newborn jaundice is a common outpatient problem. Transcutaneous bilirubin (TcB) measurements correlate well with total serum bilirubin (SB) measurements below 15 mg/dl and are efficient and noninvasive. Some concern exists that TcB measurement may subsequently lead to an increase in the number of SB measurements performed in the outpatient setting. We aimed to implement the use of a TcB device in an outpatient clinic. By doing so, we sought to increase the number of newborns screened solely by TcB as opposed to SB, by 30%, within 12 months. Methods: We conducted plan-do-study-act cycles with targeted interventions to promote the use of TcB in an outpatient clinic for eligible newborns older than 35 weeks gestational age, aged 1–20 days, and without a history of transfusion, phototherapy, extensive bruising, or risk of hemolysis. We used statistical process control methods to measure proportions of newborns evaluated with TcB (run chart) and patients-between SB measurements (G-chart) over time in the outpatient clinic. Results: We collected preintervention data for 18-months and intervention data for 12 months. For newborns attending the outpatient clinic, the proportion of TcB measurements increased after implementation of the use of TcB measurement. There was an increase in patients-between SB measurements. At project inception, SB was drawn for every 8 eligible patients. By the end of the project, there were 98 eligible newborns between instances of SB testing. Conclusion: Implementation of a quality-improvement initiative to measure TcB in the outpatient clinic was feasible and reduced the number of SB tests.
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Jašprová J, Dvořák A, Vecka M, Leníček M, Lacina O, Valášková P, Zapadlo M, Plavka R, Klán P, Vítek L. A novel accurate LC-MS/MS method for quantitative determination of Z-lumirubin. Sci Rep 2020; 10:4411. [PMID: 32157102 PMCID: PMC7064611 DOI: 10.1038/s41598-020-61280-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/21/2020] [Indexed: 02/07/2023] Open
Abstract
Although phototherapy (PT) is a standard treatment for neonatal jaundice, no validated clinical methods for determination of bilirubin phototherapy products are available. Thus, the aim of our study was to establish a such method for clinical use. To achieve this aim, a LC-MS/MS assay for simultaneous determination of Z-lumirubin (LR) and unconjugated bilirubin (UCB) was conducted. LR was purified after irradiation of UCB at 460 nm. The assay was tested on human sera from PT-treated neonates. Samples were separated on a HPLC system with a triple quadrupole mass spectrometer detector. The instrument response was linear up to 5.8 and 23.4 mg/dL for LR and UCB, respectively, with submicromolar limits of detection and validity parameters relevant for use in clinical medicine. Exposure of newborns to PT raised serum LR concentrations three-fold (p < 0.01), but the absolute concentrations were low (0.37 ± 0.16 mg/dL), despite a dramatic decrease of serum UCB concentrations (13.6 ± 2.2 vs. 10.3 ± 3.3 mg/dL, p < 0.01). A LC-MS/MS method for the simultaneous determination of LR and UCB in human serum was established and validated for clinical use. This method should help to monitor neonates on PT, as well as to improve our understanding of both the kinetics and biology of bilirubin phototherapy products.
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Affiliation(s)
- Jana Jašprová
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Aleš Dvořák
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marek Vecka
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Leníček
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Petra Valášková
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Miloš Zapadlo
- Department of Pediatrics and Neonatology, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Richard Plavka
- Department of Pediatrics and Neonatology, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Klán
- Department of Chemistry and Recetox, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Libor Vítek
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic. .,4th Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
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Starowicz O, Edwards P, Schmidt P, Birch P. Evaluation of the Kejian KJ-8000 bilirubinometer in an Australian setting. J Paediatr Child Health 2020; 56:283-288. [PMID: 31464033 DOI: 10.1111/jpc.14597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/28/2019] [Accepted: 07/20/2019] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the accuracy of the Kejian 8000 (KJ-8000) transcutaneous bilirubinometer in infants of differing ethnicity and gestational age. METHODS This was a prospective study of infants in the Newborn Care Unit at Gold Coast University Hospital. Transcutaneous bilirubin (TcB) and serum bilirubin (SBR) results were compared using linear regression and a Bland-Altman plot. Predicted indices were calculated to assess the KJ-8000 as a screening tool using local jaundice management guidelines. RESULTS A total of 416 paired samples were collected from 201 infants. There was a strong correlation between TcB and SBR with a Pearson correlation coefficient of 0.8 (<0.00001). The bias was -5.9 μmol/L (95% confidence interval: -101, 89). The bias was not evenly spread, with the KJ-8000 tending to underestimate at higher SBR levels. Infants <32 weeks' gestation had a poor correlation of 0.48. Non-Caucasian infants were more likely to have TcB overestimation, and measurements were less precise. As a screening tool using local guidelines, the KJ-8000 had a sensitivity, specificity, positive predictive value and negative predictive value of 83, 53, 20 and 96%, respectively, and is predicted to avoid blood tests in 48% of infants screened. CONCLUSIONS In this study, the correlation and agreement of TcB measurements using the KJ-8000 were not as good as has been reported with other more studied devices but may still have value as a screening tool. The poor correlation in preterm infants suggests that use should be restricted to term infants. The overall results of this study are affected by an underrepresentation of term infants, and so, further clinical assessment of this device should be undertaken before it can be recommended for widespread use.
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Affiliation(s)
- Olivia Starowicz
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Philippa Edwards
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Peter Schmidt
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Pita Birch
- Department of Neonatology, Mater Health Services, Brisbane, Queensland, Australia
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The accuracy of transcutaneous bilirubinometry in preterm infants. J Perinatol 2020; 40:212-218. [PMID: 31363143 DOI: 10.1038/s41372-019-0445-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the correlation between total serum and transcutaneous bilirubin and to determine the reliability of transcutaneous bilirubinometry for screening and monitoring of neonatal jaundice among preterms. STUDY DESIGN Ninety nine infants with gestational ages ≤34 weeks were prospectively enrolled. Babies were classified into three groups as; 24-28, 29-31, and 32-34 weeks. Total serum bilirubin and simultaneous transcutaneous bilirubin were measured before the onset of phototheraphy, during and at 24 h after discontinuing phototherapy. RESULTS Total serum bilirubin significantly correlated with transcutaneous bilirubin in the whole cohort (r = 0.867, p < 0.001) and in each group before, during and after phototheraphy. Hypotension was the only variable which effects the difference between two methods at postnatal first day of life (p = 0.039). CONCLUSION Transcutaneous bilirubin levels were highly correlated with total serum bilirubin levels even in 24-28 GW babies. Transcutaneous bilirubin may be useful for screening and monitoring of jaundice in very preterm newborns.
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Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer. J Perinatol 2020; 40:226-231. [PMID: 31767979 PMCID: PMC6985020 DOI: 10.1038/s41372-019-0557-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/07/2019] [Accepted: 11/07/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Determine the suitability of transcutaneous bilirubin (TCB) as a tool to assess the effectiveness of phototherapy on patched skin. STUDY DESIGN A prospective observational study was conducted. We covered a fragment of skin (sternum) with a photo-opaque patch. Several simultaneous TCB and TSB measurements were performed with the JM-105 bilirubinometer. Bland and Altman test evaluated the agreement between bilirubin levels. RESULT A total of 217 patients were studied, 48.8% were preterm. The mean difference between TSB and TCB before the start of treatment was 1.07 mg/dL. During phototherapy, differences on covered skin were 0.52, 0.27, and 0.39 mg/dL at 24, 48, and 72 h of therapy respectively. The best correlation was observed at 48 h in preterm infants. CONCLUSION The measurement of TCB on patched skin (PTCB) is useful for monitoring the response to phototherapy in term and preterm infants. We use a patch with a removable flap that eases successive measures without disturbing the patients.
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Shapiro SM, Riordan SM. Review of bilirubin neurotoxicity II: preventing and treating acute bilirubin encephalopathy and kernicterus spectrum disorders. Pediatr Res 2020; 87:332-337. [PMID: 31581172 DOI: 10.1038/s41390-019-0603-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 11/09/2022]
Abstract
Previously in Part I of this two-part review, we discussed the current and recent advances in the understanding of the molecular biology and neuropathology of bilirubin neurotoxicity (BNTx). Here in Part II, we summarize current treatment options available to treat the severely jaundiced infants to prevent significant brain damage and improve clinical outcomes. In addition, we review potential novel therapies that are in various stages of research and development. We will emphasize treatments for both prevention and treatment of both acute bilirubin encephalopathy (ABE) and kernicterus spectrum disorders (KSDs), highlighting the treatment of the most disabling neurological sequelae of children with mild-to-severe KSDs whose "rare disease" status often means they are overlooked by the clinical research community at large. As with other secondary dystonias, treatment of the dystonic motor symptoms in kernicterus is the greatest clinical challenge.
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Affiliation(s)
- Steven M Shapiro
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA. .,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA. .,Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA. .,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.
| | - Sean M Riordan
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
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Transcutaneous bilirubin nomogram for Taiwanese newborns - A single center study. Pediatr Neonatol 2019; 60:291-296. [PMID: 30172626 DOI: 10.1016/j.pedneo.2018.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/18/2018] [Accepted: 07/27/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hour-specific bilirubin nomogram has been recommended to predict postdischarge hyperbilirubinemia in newborns. However, it may not be applicable in Taiwan due to ethnic differences. The aim of this study was to construct a 12-h specific transcutaneous bilirubin (TCB) nomogram in newborns for clinical reference. METHODS We prospectively enrolled full term or late preterm neonates born in a tertiary care hospital between October 2013 and July 2014. The exclusion criteria included chromosome anomaly, glucose-6-phosphate dehydrogenase deficiency, and receiving phototherapy within 60 h after birth. TCB measurements were performed by a single technician using the Bilichek device, and measured every 12 h until neonates were discharged. Patient data including sex, delivery mode, gestational age, body weight with daily change, and feeding pattern were collected for analysis. A TCB nomogram was constructed with 40th, 75th, and 95th percentile lines. RESULTS A total of 498 newborns were enrolled, and the characteristics between the hyperbilirubinemia and nonhyperbilirubinemia groups were not different. The mean TCB curve revealed that the peak TCB level was 14.2 ± 2.9 mg/dL at 100.6 ± 3.6 h of age. The peak 95th percentile TCB level was 19.4 mg/dL at 121.9 ± 5 h of age. Mean TCB levels increased at a rate of 0.01-0.21 mg/dL/h initially, followed by a decrease after 96-108 h of age. Twenty newborns (4%) were diagnosed with hyperbilirubinemia. Regarding TCB distribution, 11 of 60 (18%) had peak TCB levels above the 95th percentile, 5 of 151 (3%) had TCB levels between the 75th and 95th percentile, 4 of 200 (2%) had levels between the 40th and 75th percentiles, and none had a level below the 40th percentile. CONCLUSION A 12-h specific TCB nomogram could be a useful reference for workup for hyperbilirubinemia, particularly when it is above the 95th percentile line.
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Karamavuş Y, Özkan M. Newborn jaundice determination by reflectance spectroscopy using multiple polynomial regression, neural network, and support vector regression. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2019.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tabrizi SO, Mirghafourvand M, Dost AJ, Mohammad-Alizadeh-Charandabi S, Javadzadeh Y, Seyedi R. Effect of metoclopramide administration to mothers on neonatal bilirubin and maternal prolactin: a randomized, controlled, clinical trial. World J Pediatr 2019; 15:135-142. [PMID: 30519818 DOI: 10.1007/s12519-018-0217-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/22/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Jaundice is a common neonatal problem. This study was conducted to determine the effect of metoclopramide on neonatal bilirubin and maternal prolactin (primary outcomes) and milk volume (secondary outcome). METHODS This triple-blind, randomized, controlled, clinical trial was conducted on 112 mothers. The participants were assigned to the intervention (metoclopramide) and control groups (placebo) using block randomization. Ten-mg metoclopramide and placebo tablets were taken by the participants three times a day. The intervention began in the first 2-10 hours after childbirth and continued until the fifth day. The mothers' prolactin level was measured on the first morning after the intervention and on the sixth day (1 day after the intervention was over). Neonatal total bilirubin was also measured before the intervention and on the sixth day. RESULTS After the intervention, the two groups did not differ significantly in terms of the mean neonatal indirect bilirubin (P = 0.565) and milk volume (P = 0.261), but the mean serum prolactin was significantly higher in the metoclopramide group compared to the placebo group (adjusted mean difference 37; 95% confidence interval 58.1-16.5; P = 0.001). CONCLUSIONS Metoclopramide increased maternal serum prolactin but had no effects on neonatal jaundice. The insufficient numbers of studies on this subject mandate further research.
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Affiliation(s)
- Shirin Osouli Tabrizi
- Department of Midwifery, Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Midwifery Department, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | | | | | - Yousef Javadzadeh
- Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Robabe Seyedi
- Department of Midwifery, Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Leung TS, Outlaw F, MacDonald LW, Meek J. Jaundice Eye Color Index (JECI): quantifying the yellowness of the sclera in jaundiced neonates with digital photography. BIOMEDICAL OPTICS EXPRESS 2019; 10:1250-1256. [PMID: 30891343 PMCID: PMC6420273 DOI: 10.1364/boe.10.001250] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/12/2019] [Accepted: 01/21/2019] [Indexed: 06/01/2023]
Abstract
The sclera is arguably a better site than the skin to measure jaundice-especially in dark-skinned patients-since it is free of skin pigment (melanin), a major confounding factor. This work aims to show how the yellowness of the sclera can be quantified by digital photography in color spaces including the native RGB and CIE XYZ. We also introduce a new color metric we call "Jaundice Eye Color Index" (JECI) which allows the yellowness of jaundiced sclerae to be predicted for a specific total serum bilirubin level in the neonatal population.
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Affiliation(s)
- Terence S. Leung
- Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Felix Outlaw
- Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Lindsay W. MacDonald
- Department of Civil, Environmental & Geomatic Engineering, University College London, UK
| | - Judith Meek
- The Neonatal Care Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals Trust, UK
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Seyedi R, Mirghafourvand M, Dost AJ, Mohammad-Alizadeh-Charandabi S, Jafarabadi MA, Tabrizi SO. Transcutaneous bilirubin nomogram for evaluating the risk of hyperbilirubinemia in Iranian healthy newborns. World J Pediatr 2019; 15:72-77. [PMID: 30465124 DOI: 10.1007/s12519-018-0208-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/06/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hyperbilirubinemia, which is mostly benign, is one of the most common problems in neonates. This study was conducted to draw a skin bilirubin nomogram for evaluating the risk of hyperbilirubinemia requiring treatment. METHODS This cross-sectional study recruited 1066 healthy infants. The first transcutaneous bilirubin (TcB) measurement was performed before hospital discharge and within 12-48 h of birth. The neonates were followed up for 6 days after discharge based on their age at the time of discharge. The neonates were divided into four groups based on the TcB values before discharge and age in hours, including the low-risk, medium-low-risk, medium-high-risk and high-risk groups. The percentage of neonates who progressed toward severe hyperbilirubinemia was then calculated in each percentile based on the follow-up TcB measurement. Stata software was used to draw the nomogram. Based on the TcB values at discharge and the neonate's age in hours, the skin bilirubin nomogram was drawn in 40, 75 and 95 percentiles. RESULTS A total of 4.9% of the neonates were in the high-risk group, 18.9% in the medium-high-risk group, 34.8% in the medium-low-risk group and 41.2% in the low-risk group. The risk of severe jaundice in the follow-up of the neonates in the highest-risk to the lowest-risk groups was 48.9, 14.5, 9.7 and 3.3%, respectively. CONCLUSION The skin bilirubin nomogram can be used to predict severe hyperbilirubinemia in Iranian infants.
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Affiliation(s)
- Robabe Seyedi
- Department of Midwifery, Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Shariati-e-jonobi Street, Tabriz, 347-51745, Iran.
| | | | - Sakineh Mohammad-Alizadeh-Charandabi
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Shariati-e-jonobi Street, Tabriz, 347-51745, Iran
| | | | - Shirin Osouli Tabrizi
- Department of Midwifery, Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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van Erk MD, Dam-Vervloet AJ, de Boer FA, Boomsma MF, Straaten HV, Bosschaart N. How skin anatomy influences transcutaneous bilirubin determinations: an in vitro evaluation. Pediatr Res 2019; 86:471-477. [PMID: 31234196 PMCID: PMC6768284 DOI: 10.1038/s41390-019-0471-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/13/2019] [Accepted: 06/12/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Transcutaneous bilirubinometry is an effective screening method for neonatal hyperbilirubinemia. Current transcutaneous bilirubin (TcB) meters are designed for the "standard" situation of TcB determinations on the forehead or sternum of term newborns. We hypothesize that skin anatomy can considerably influence TcB determinations in non-standard situations-e.g., on preterm newborns or alternative body locations. METHODS A commercially available TcB meter (JM-105) was evaluated in vitro on phantoms that accurately mimic neonatal skin. We varied the mimicked cutaneous hemoglobin content (0-2.5 g/L), bone depth (0.26-5.26 mm), and skin maturity-related light scattering (1.36-2.27 mm-1) within the clinical range and investigated their influence on the TcB determination. To obtain a reference frame for bone depth at the forehead, magnetic resonance head scans of 46 newborns were evaluated. RESULTS The TcB meter adequately corrected for mimicked hemoglobin content. However, TcB determinations were influenced considerably by clinically realistic variations in mimicked bone depth and light scattering (deviations up to 72 µmol/L). This greatly exceeds the specified accuracy of the device (±25.5 µmol/L). CONCLUSION As bone depth and light scattering vary with gestational maturity and body location, caretakers should be cautious when interpreting TcB measurements on premature newborns and non-standard body locations.
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Affiliation(s)
- Marlijn D. van Erk
- 0000 0004 0399 8953grid.6214.1Biomedical Photonic Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Alida J. Dam-Vervloet
- 0000 0001 0547 5927grid.452600.5Medical Physics Department, Isala Hospital, Zwolle, The Netherlands
| | - Foky-Anna de Boer
- 0000 0001 0547 5927grid.452600.5Neonatology Department, Isala Hospital, Zwolle, The Netherlands
| | - Martijn F. Boomsma
- 0000 0001 0547 5927grid.452600.5Radiology Department, Isala Hospital, Zwolle, The Netherlands
| | - Henrica van Straaten
- 0000 0001 0547 5927grid.452600.5Neonatology Department, Isala Hospital, Zwolle, The Netherlands
| | - Nienke Bosschaart
- Biomedical Photonic Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
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Thielemans L, Hashmi A, Priscilla DD, Kho Paw M, Pimolsorntong T, Ngerseng T, Van Overmeire B, Proux S, Nosten F, McGready R, Carrara VI, Bancone G. Laboratory validation and field usability assessment of a point-of-care test for serum bilirubin levels in neonates in a tropical setting. Wellcome Open Res 2018; 3:110. [PMID: 30271889 PMCID: PMC6137410 DOI: 10.12688/wellcomeopenres.14767.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Screening and monitoring serum bilirubin (SBR) in neonates is crucial to prevent neonatal hyperbilirubinemia (NH)-associated morbidity and mortality worldwide. A lack of resources is often a barrier for measuring SBR in developing countries. Reliable, cost-effective, easy to use point-of-care (POC) SBR tests are needed. This study aimed to evaluate the technical accuracy and usability of the Bilistick System (BS), a new bilirubin POC test, in a tropical setting. Methods: This was a mixed-methods study, including laboratory validation of the BS, direct observation of technical procedures as performed by the midwives and midwives' assessment of the device's easiness of use through focus group discussions (FGD) and a self-administered questionnaire. The study was conducted in a field clinic of the Shoklo Malaria Research Unit along the Thailand-Myanmar border between January and December 2017. Results: A total of 173 samples were tested at a median age of 4 days. BS generated an error message-providing no SBR readout-in 48.6% of the tests performed. For the tests that yielded a result, the correlation coefficient (95% CI) between BS and routine laboratory bilirubinometer SBR was 0.87 (0.77-0.93). The accuracy decreased with increasing haematocrit and at higher humidity (≥75%). Direct observation of the operators using the device and analysis of the focus group discussions and questionnaires indicated that the BS was considered easy to use and required limited training. Conclusions: This evaluation showed that the BS, in its current formulation, does not provide reliable results for measuring SBR in a tropical, low-resource setting but has acceptable usability features.
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Affiliation(s)
- Laurence Thielemans
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
- Neonatology, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, 1070, Belgium
| | - Ahmar Hashmi
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Dah Dah Priscilla
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Tekel Pimolsorntong
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Thatsanun Ngerseng
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Bart Van Overmeire
- Neonatology, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, 1070, Belgium
| | - Stephane Proux
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Verena I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
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