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Cui Z, Shen W, Sun X, Li Y, Liu Y, Sun Z. Developing and evaluating a predictive model for neonatal hyperbilirubinemia based on UGT1A1 gene polymorphism and clinical risk factors. Front Pediatr 2024; 12:1345602. [PMID: 38487473 PMCID: PMC10937529 DOI: 10.3389/fped.2024.1345602] [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: 11/28/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Background Neonatal hyperbilirubinemia (NHB) is one of the most common diseases in the neonatal period. Without timely diagnosis and treatment, it can lead to long-term complications. In severe cases, it may even result in fatality. The UGT1A1 gene and clinical risk factors play important roles in the development and progression of NHB. Methods In this study, we conducted a cohort study and analyzed 3258 newborns from the Jilin Women And Children Health Hospital in northern China, including 372 children with hyperbilirubinemia. We established a predictive model using a logistic regression model based on clinical risk factors and the polymorphism of the G211A locus in the UGT1A1 gene of newborns. Furthermore, the performance of the prediction model was evaluated using the ROC curve. Results The logistic regression model indicates that the following factors are associated with an increased risk of NHB: the time when stool turns yellow [P ≤ 0.001, OR 1.266 (95% CI: 1.125-1.425)]; neonatal cephalohematoma [P ≤ 0.001, OR 33.642 (95% CI: 21.823-51.861)]; hemolytic disease of newborn [P ≤ 0.001, OR 33.849 (95% CI: 18.589-61.636)]; neonatal weight loss [P ≤ 0.001, OR 11.275 (95% CI: 7.842-16.209)]; neonatal premature rupture of membranes (PROM) history [P = 0.021, OR 1.422 (95% CI: 1.056-1.917)]; genetic polymorphism at the UGT1A1 gene G211A locus. Gestational age is a protective factor [P ≤ 0.001, OR 0.766 (95% CI: 0.686-0.855)]. Compared to natural labor, cesarean section is a protective factor [P = 0.011, OR 0.711 (95% CI: 0.546-0.926)], while assisted delivery is a risk factor [P = 0.022, OR 2.207 (95% CI: 1.121-4.346)]. The area under the curve (AUC) of this prediction model is 0.804 (95% CI: 0.777-0.831), indicating good discrimination ability and value for predicting the risk of NHB after birth. Conclusion We have developed and evaluated a predictive model that combines UGT1A1 gene polymorphism and clinical risk factors for the first time. By using this nomogram and taking into account the results of serum total bilirubin measurement or transcutaneous bilirubin measurement, early prediction of the risk of neonatal hyperbilirubinemia can be achieved.
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Affiliation(s)
- Zhaoyang Cui
- Department of Toxicology, School of Public Health, Jilin University, Changchun, China
| | - Wensheng Shen
- Department of Neonatology, Jilin Women and Children Health Hospital, Changchun, China
| | - Xuetong Sun
- NHC Key Laboratory of Radiobiology, School of Public Health, Jilin University, Changchun, China
| | - Yan Li
- Department of Toxicology, School of Public Health, Jilin University, Changchun, China
| | - Ying Liu
- Department of Toxicology, School of Public Health, Jilin University, Changchun, China
| | - Zhiyong Sun
- Department of Neonatology, Jilin Women and Children Health Hospital, Changchun, China
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Shoris I, Gover A, Toropine A, Iofe A, Zoabi-Safadi R, Tsuprun S, Riskin A. "Light" on Phototherapy-Complications and Strategies for Shortening Its Duration, A Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1699. [PMID: 37892362 PMCID: PMC10605061 DOI: 10.3390/children10101699] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/01/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
Neonatal hyperbilirubinemia is an extremely common metabolic complication of the neonatal period which may be associated with bilirubin encephalopathy and even death. Adverse neurological consequences are preventable if a timely diagnosis and treatment are provided. Phototherapy is usually the preferred option to decrease hyperbilirubinemia. Although considered to be safe, evidence in recent years has shown that this treatment may not be free of side effects and short- and long-term unfavorable outcomes. These are usually mild or rare, but should be decreased or avoided if possible. Many useful complementary measures and treatments have been described that could shorten the duration of exposure to phototherapy. However, there is no current unequivocal recommendation to use any of the methods presented in this review. Our review aims to depict the wide range of possible complementary treatments to phototherapy, and to provide the scientific and clinical evidence available regarding their usefulness. It is essential that, while utilizing the full potential of phototherapy to treat hyperbilirubinemia, caregivers are aware of its side effects and possible inherent dangers, and seek ways to minimize the exposure to phototherapy to what is really needed for the newborn. Further studies are needed to clarify the preferred complementary treatments that could reduce the duration of exposure to phototherapy without impairing its effectiveness.
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Affiliation(s)
- Irit Shoris
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
| | - Ayala Gover
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
| | - Arina Toropine
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
| | - Adir Iofe
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
| | - Rasha Zoabi-Safadi
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
| | - Svetlana Tsuprun
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
| | - Arieh Riskin
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, P.O. Box 9697, Haifa 32000, Israel; (I.S.); (A.G.); (A.T.); (A.I.); (R.Z.-S.); (S.T.)
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Jefferson L, Ramanan AV, Cummins M, Roderick M. Tailing growth, neonatal jaundice and anaemia. Arch Dis Child Educ Pract Ed 2023; 108:377-384. [PMID: 37263765 DOI: 10.1136/archdischild-2022-324990] [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] [Received: 10/11/2022] [Accepted: 05/11/2023] [Indexed: 06/03/2023]
Abstract
At medical school, there is a phrase to help us remember that common things are common: 'If you hear hooves think horses, not zebras'. However, zebras do exist, and from time to time in general paediatric and neonatal practice, we will encounter these rare diagnoses, more of which we can now accurately diagnose through the ever-expanding field of genomics. Our case demonstrates how a rare diagnosis can present with common features of growth restriction, jaundice and anaemia. Paediatricians therefore require a high index of suspicion and increasing knowledge of the logistics of genetic testing.
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Affiliation(s)
- Lucy Jefferson
- Paediatrics, Bristol Royal Hospital for Children, Bristol, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Michelle Cummins
- Paediatric Haematology, Bristol Royal Hospital for Children, Bristol, UK
| | - Marion Roderick
- Paediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, UK
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Bao Y, Zhu J, Ma L, Zhang H, Sun L, Xu C, Wu J, He Y, Du L. An End-Tidal Carbon Monoxide Nomogram for Term and Late-Preterm Chinese Newborns. J Pediatr 2022; 250:16-21.e3. [PMID: 35835229 DOI: 10.1016/j.jpeds.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/09/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To establish a reference nomogram for end-tidal CO corrected for ambient CO (ETCOc) levels in term and late-preterm Chinese newborns and then assess its efficacy to identify hemolytic hyperbilirubinemia. STUDY DESIGN We conducted a prospective study by measuring concurrent ETCOc and total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) levels collected postnatally at 12, 24, 48, 72, 96, and 120 hours of age. ETCOc at the 25th, 50th, 75th, and 95th percentiles at each epoch were used to construct the reference nomogram. We then explored the ability of predischarge ETCOc and TSB/TcB metrics to predict the development of hyperbilirubinemia requiring phototherapy in early postnatal period and jaundice readmission in late postnatal period. RESULTS Our nomogram, based on 990 measurements from 455 infants who were not nonhemolytic, displayed a steady line within 3 postnatal days, followed by a subsequent decline. From a cohort of infants with a serial ETCOc measurements (n = 130) and those readmitted (n = 21), we found that ETCOc and TSB/TcB ≥75th percentile can identify most hemolytic hyperbilirubinemia between 12 and 72 hours after birth with an area under the curve (AUC) of 0.741. An ETCOc ≥1.7 ppm alone between 96 and 120 hours after birth can identify most hemolytic hyperbilirubinemia with an AUC of 0.816. In addition, 90.5% of readmitted infants had an ETCOc ≥75th percentile. CONCLUSIONS An ETCOc reference nomogram during the first 5 postnatal days in nonhemolytic term and late-preterm newborns can be used to identify hemolytic hyperbilirubinemia requiring phototherapy in the early postnatal period and readmission in the late postnatal period.
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Affiliation(s)
- Yingying Bao
- Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiajun Zhu
- Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lixin Ma
- Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zhang
- Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ling Sun
- Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chuncai Xu
- Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingyuan Wu
- Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuanyuan He
- Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lizhong Du
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China; National Clinical Research Center for Child Health, Hangzhou, China
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Effect of Massage Therapy for the Treatment of Neonatal Jaundice: A Systematic Review and Dose-Response Meta-analysis. Int J Pediatr 2022; 2022:9161074. [PMID: 35356100 PMCID: PMC8958079 DOI: 10.1155/2022/9161074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background The effectiveness of massage therapy in the treatment of neonatal jaundice has been established in previous literature, but how much the level of massage can reduce the mean of bilirubin in neonates with jaundice is a question that has been addressed in this review. Methods Four electronic databases, including Cochrane, PubMed, Scopus, and Web of Science, were searched for relevant literature. For the dose-response association between massage therapy and treatment of neonatal icterus, we conducted a meta-analysis using the random-effects model. For any level of intervention, we calculated the overall mean difference (MD) with 95% confidence intervals (CI). Results Twenty studies were included in our meta-analysis. There was a positive and significant increasing dose-response trend between massage therapy and the mean reduction of bilirubin in neonates with hyperbilirubinemia as follows: <50 minutes massage during the experiment -0.36 (95% CI: -0.67, -0.06; I2 = 66%), 50-60 minutes massage during the experiment -0.41 (95% CI: -0.95, 0.13; I2 = 84%), and ≥101 minutes massage during the experiment -1.20 (95% CI: -1.63, -0.78; I2 = 83%). The heterogeneity across studies was mild to moderate. Conclusions The presence of a dose-response relationship favors the causal relationship between massage therapy and reduction of neonatal jaundice.
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