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Saloojee H. Innovative approaches to neonatal jaundice diagnosis and management in low-resourced settings. S Afr Fam Pract (2004) 2024; 66:e1-e5. [PMID: 38572885 PMCID: PMC10913041 DOI: 10.4102/safp.v66i1.5833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 04/05/2024] Open
Abstract
Persistent challenges in addressing severe neonatal hyperbilirubinaemia in resource-constrained settings have led to ongoing and often unacceptable rates of morbidity, disability and mortality. These challenges stem from limitations such as inadequate, inefficient or financially inaccessible diagnostic and therapeutic options. However, over the past decade, noteworthy innovations have emerged to address some of these hurdles, and these innovations are increasingly poised for broader implementation. This review provides a concise summary of these novel, economically viable diagnostic solutions, encompassing point-of-care assays and smartphone applications, as well as treatment modalities, notably more effective phototherapy and filtered sunlight. These advancements hold promise and have the potential to meaningfully reduce the burden of neonatal hyperbilirubinaemia, signifying a promising shift in the landscape of neonatal healthcare.
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Affiliation(s)
- Haroon Saloojee
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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Shekoni O, Iversen S, Diaz GJ, Aune A, Ubuane PO, Imam Z, André B. Healthcare workers' perceptions about the use of mobile health technologies in public health facilities in Lagos, Nigeria. SAGE Open Med 2024; 12:20503121231224568. [PMID: 38347851 PMCID: PMC10860469 DOI: 10.1177/20503121231224568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/05/2023] [Indexed: 02/15/2024] Open
Abstract
Background Mobile health has enormous potential in healthcare due to the increasing use of mobile phones in low- and middle-income countries; its effective deployment, uptake, and utilization may result in improved health outcomes, including a reduction in neonatal deaths. However, there is a suboptimal uptake of mobile health technologies among healthcare workers in low-resource settings like Nigeria, which are often context-specific. Objective To investigate healthcare workers' perceptions of mobile health technologies in public health facilities in Lagos, Nigeria. Method A qualitative study was conducted, and data were collected through six focus group discussions with 26 healthcare workers (doctors, nurses, and community health extension workers) from three public health facilities in Lagos, Nigeria. The collected data were analyzed using a thematic approach, where themes and subthemes were created. Results Although the participants acknowledged that mobile health enhances patient-provider communication and saves time, they identified altering of healthcare workers' routine practices, information overload, power and network failure, skepticism, lack of trust, and concerns over diagnostic accuracy as potential barriers to its uptake. Conclusion Addressing healthcare workers' perceptions of mobile health technologies may enhance the deployment and uptake of such solutions in Nigeria and similar low-resource settings. Developers and implementers of such can use them to create new or enhance existing mobile health solutions to better meet the needs and requirements of healthcare workers in low- to middle-income health settings, such as Lagos, Nigeria.
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Affiliation(s)
- Oluwatobi Shekoni
- Department of Public Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Synne Iversen
- Department of Public Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Gabriela J Diaz
- Department of Public Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Picterus AS, Trondheim, Norway
| | - Anders Aune
- Department of Public Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Picterus AS, Trondheim, Norway
| | - Peter Odion Ubuane
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja Lagos, Nigeria
| | - Zainab Imam
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja Lagos, Nigeria
| | - Beate André
- Department of Public Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Merino-Andrés J, Pérez-Nombela S, Álvarez-Bueno C, Hidalgo-Robles Á, Ruiz-Becerro I, Fernández-Rego FJ. Neonatal hyperbilirubinemia and repercussions on neurodevelopment: A systematic review. Child Care Health Dev 2024; 50:e13183. [PMID: 37842871 DOI: 10.1111/cch.13183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 07/11/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Accumulation of bilirubin above normal levels is considered a neurological risk factor for both premature and full-term newborns. This systematic review aimed to determine the effect of neonatal hyperbilirubinemia on neurodevelopment in preterm and full-term newborns. METHODS PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, Scopus and Lilacs databases were searched for articles published until 1 June 2022. The quality of cohort and case-control studies was assessed with the Newcastle-Ottawa Scale, and the MINCir scale was used to evaluate the methodological quality of therapy studies or the therapeutic procedures. Premature neonates without neurological conditions and those born at term with hyperbilirubinemia as the sole risk factor were included. Studies reporting one or more neurodevelopmental outcomes were included with an inter-group comparison of a hyperbilirubinemia group versus a non-hyperbilirubinemia or non-pathological hyperbilirubinemia group. The main outcomes were auditory function, visual function, cognitive function, motor function, behavior, global development and neurological risk. RESULTS The search identified 951 studies, 19 of which (n = 2210 newborns) were finally included. Fifteen of the cohort and case-control studies presented low risk of bias, and six studies showed high methodological quality. Within the preterm population, hyperbilirubinemia as the sole risk factor was not shown to affect neurodevelopment. Auditory, neurological and motor development alterations were found in the population of full-term newborns with hyperbilirubinemia, which were more evident during the first year of life. CONCLUSIONS Elevated bilirubin levels may be a trigger for the onset of neurodevelopmental disorders in full-term infants during the first year of life. More studies are warranted in the preterm population with hyperbilirubinemia to draw conclusions about its impact on their neurodevelopment.
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Affiliation(s)
- Javier Merino-Andrés
- Faculty of Physiotherapy and Nursing, Physiotherapy Research Group of Toledo (GITFO), Universidad de Castilla-La Mancha, Toledo, Spain
- Physiotherapy Research Group of Toledo (GIFTO), Universidad de Castilla-La Mancha, Toledo, Spain
- Centro Crecer, Toledo, Spain
| | - Soraya Pérez-Nombela
- Faculty of Physiotherapy and Nursing, Physiotherapy Research Group of Toledo (GITFO), Universidad de Castilla-La Mancha, Toledo, Spain
- Physiotherapy Research Group of Toledo (GIFTO), Universidad de Castilla-La Mancha, Toledo, Spain
| | - Celia Álvarez-Bueno
- Social and Health Care Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Álvaro Hidalgo-Robles
- Physiotherapy Research Group of Toledo (GIFTO), Universidad de Castilla-La Mancha, Toledo, Spain
- Universidad Internacional de La Rioja, La Rioja, Spain
| | | | - Francisco Javier Fernández-Rego
- Physiotherapy Department, University of Murcia, Murcia, Spain
- Early Care Research Group (GIAT), University of Murcia, Murcia, Spain
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Jiang P, Huang Y, Mao K, Lin Y, Li D, Chen F, Lin N. Association between hepatitis B virus replication during pregnancy and perinatal outcomes: a retrospective cohort study. Ann Med 2023; 55:2295396. [PMID: 38134759 PMCID: PMC10763828 DOI: 10.1080/07853890.2023.2295396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The effect of hepatitis B virus (HBV) replication during pregnancy on the outcomes of pregnancies remains to be elucidated. OBJECTIVES This study aimed to investigate the association between HBV replication and adverse maternal and infant outcomes. METHODS We retrospectively analysed the clinical data of 836 pregnant inpatients with hepatitis B surface antigen positivity who delivered at two provincial tertiary grade A hospitals in the Fujian province between June 2016 and October 2020. RESULTS The incidence of intrahepatic cholestasis of pregnancy, hypertensive syndrome complicating pregnancy, gestational diabetes mellitus, preterm birth, macrosomia, growth restriction, and vaginal infections did not differ in the HBV replication and non-replication groups (p > 0.05); however, the rates of caesarean section (p = 0.017; OR, 1.423; 95% CI, 1.065-1.902) and neonatal jaundice (p < 0.001; OR, 2.361; 95% CI, 1.498-3.721) were higher in the replication group than that in the non-replication group. After using propensity score analysis to adjust for alanine transaminase and aspartate aminotransferase levels in both groups, the replication group was still found to have an increased risk for caesarean section (p < 0.001; OR, 2.367; 95% CI, 1.668-3.359) and their infants had higher rates of neonatal jaundice (p < 0.001; OR, 12.605; 95% CI, 4.456-35.656). CONCLUSIONS Our findings contribute to a better understanding of the association between maternal HBV replication status and perinatal outcomes. Pregnant women with HBV replication face an increased risk of caesarean section, and their infants appear to have a higher risk for neonatal jaundice.
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Affiliation(s)
- Pingying Jiang
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yongzhu Huang
- Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Kaiyi Mao
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yongxu Lin
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Dan Li
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fenglin Chen
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Na Lin
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Clinical Research Center for Digestive System Tumors and Upper Gastrointestinal Diseases, Fuzhou, China
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Moosa AS, Ngeow AJH, Yang Y, Poon Z, Ng DX, Yi Ling EK, Tan NC. A Novel Smartphone App for Self-Monitoring of Neonatal Jaundice Among Postpartum Mothers: Qualitative Research Study. JMIR Mhealth Uhealth 2023; 11:e53291. [PMID: 38153797 PMCID: PMC10766163 DOI: 10.2196/53291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Background Neonatal jaundice (NNJ) or hyperbilirubinemia is a ubiquitous condition in newborn infants. Currently, the transcutaneous bilirubinometer is used to screen for NNJ in health care facilities, where neonates need to be physically present (ie, a centralized model of care for NNJ screening). Mobile health (mHealth) apps present a low-cost, home-based, and noninvasive system that could facilitate self-monitoring of NNJ and could allow mothers the convenience of screening for NNJ remotely. However, end users' acceptability of such mHealth apps is of fundamental importance before the incorporation of such apps into clinical practice. Objective The study aimed to explore the perception of postpartum mothers toward self-monitoring of NNJ using a novel mHealth app. Methods Mothers attending video consultations for early postpartum care at 2 Singapore primary care clinics watched an instructional video for a hyperbilirubinemia-screening mHealth app (HSMA). An independent researcher used a semistructured topic guide to conduct in-depth interviews with 25 mothers, assessing their views on HSMAs. All interviews were audio recorded, transcribed verbatim, and checked for accuracy before data analysis. Two researchers independently analyzed the transcripts via thematic analysis. Data were managed using NVivo qualitative data management software. Results The identified themes were grouped under perceived usability and utility. Mothers valued the convenience and utility of HSMAs for remote monitoring of NNJ. They appreciated the objectivity the app readings provided compared to visual inspection. However, they perceived that the app's applicability would be restricted to severe jaundice, were concerned about its accuracy and restriction to the English language, and lacked confidence in using it. Nevertheless, they were willing to use it once its accuracy was proven and when they received adequate guidance from health care professionals. They also suggested including an action plan for the measured readings and clinical signs within the app. Mothers proposed pairing teleconsultations with HSMAs to boost their confidence and enhance adoption. Conclusions Mothers were receptive to using HSMAs but had concerns. Multiple languages, proof of accuracy, and resources to guide users should be incorporated into the app in the next phase to increase its successful adoption. Complementing such apps with a teleconsultation service presents a plausible and pragmatic NNJ care delivery model in general practice.
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Affiliation(s)
- Aminath Shiwaza Moosa
- SingHealth Polyclinics, Primary Care Research Institute, Singapore, Singapore
- Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Alvin Jia Hao Ngeow
- Department of Neonatology, Singapore General Hospital, Singapore, Singapore
- Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Department of Paediatrics, Yong Loo Ling School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yuhan Yang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Zhimin Poon
- SingHealth Polyclinics, Primary Care Research Institute, Singapore, Singapore
- Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Ding Xuan Ng
- SingHealth Polyclinics, Primary Care Research Institute, Singapore, Singapore
| | - Eileen Koh Yi Ling
- SingHealth Polyclinics, Primary Care Research Institute, Singapore, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Primary Care Research Institute, Singapore, Singapore
- Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
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Zaitoon H, Shnaider M, Shoris I, Khalil H, Riskin A, Gover A. Intrapartum Maternal Prophylactic Antimicrobial Treatment and Neonatal Jaundice. Clin Pediatr (Phila) 2023; 62:1562-1567. [PMID: 36999882 DOI: 10.1177/00099228231165879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Intrapartum antibiotics are widely used and may potentially affect bilirubin levels and neurotoxicity in the newborn. The aim of this study was to examine the effect of intrapartum antibiotic exposure on neonatal jaundice. We retrospectively collected data from 972 neonates born to 963 mothers. Five hundred forty-five mothers (56.6%) received intrapartum antibiotics. There were no statistically significant differences in maximum bilirubin level (7.82 ± 3.65 vs 7.63 ± 3.71, P = .43) or need for phototherapy (9 [1.62%] vs 4 [0.94%], P = .52) between exposed and non-exposed newborns. The rate of phototherapy was significantly higher only in the group of infants born to mothers who received broad-spectrum antibiotics at 2 to 3.9 hours prior to delivery (χ2 = 10.453, P = .015) and was not higher in the group of exposure >4 hours, which may represent a short transient effect of antibiotics exposure on bilirubin turnover. Further studies are needed to validate this finding.
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Affiliation(s)
- Hussein Zaitoon
- Department of Pediatrics, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Morya Shnaider
- Department of Pediatrics, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Irit Shoris
- Department of Neonatology and Neonatal Intensive Care, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Arieh Riskin
- Department of Neonatology and Neonatal Intensive Care, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ayala Gover
- Department of Neonatology and Neonatal Intensive Care, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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NAMBINGA NDAPEWOSHALI, NGHITANWA EMMAMAANO. Knowledge, attitude and practices of registered nurses regarding neonatal jaundice at the neonatal intensive care unit in a tertiary hospital in Khomas region, Namibia. J Public Health Afr 2023; 14:2476. [PMID: 38020278 PMCID: PMC10658459 DOI: 10.4081/jphia.2023.2476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/01/2023] [Indexed: 12/01/2023] Open
Abstract
Neonatal jaundice is a significant cause of neonatal morbidity worldwide and accounts for 75% of hospital readmissions in the first week of life. New-born babies can develop severe neonatal jaundice that may cause irreversible brain damage or even death. To assess the knowledge, attitude and practices of registered nurses on neonatal jaundice among neonates at Neonatal Intensive Care Unit at Windhoek Central hospital. A quantitative, descriptive, cross sectional research design was used. The population was all 34 registered nurses working at Windhoek Central Hospital neonatal intensive care unit. Census sampling was used to include all 34 registered nurses working in the neonatal intensive care unit of the selected hospital due to the limited small number of the population. Data were collected using a self-developed questionnaires that collected socio-demographic information and knowledge, attitudes and practices questions. Data was analysed using SPSS version 27. Descriptive statistics was used to generate frequencies and percentages. The study found that majority of the participants have adequate knowledge, positive attitudes, and good practices regarding neonatal jaundice. The study found that most participants 21 (60%) were aged between 20 to 29 years. Participants have adequate knowledge, positive attitudes, and good practices on neonatal jaundice. The researchers recommends that future studies using different research approaches should be conducted in other regions in Namibia.
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He Z, Zhang B, Zhang J, Xiao Z, He L, Yang G. A wireless physiological parameter monitoring system with a treatment feedback function during neonatal phototherapy. Physiol Meas 2023; 44:095002. [PMID: 37625435 DOI: 10.1088/1361-6579/acf43c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/25/2023] [Indexed: 08/27/2023]
Abstract
Objective. Neonatal jaundice is a common condition in the early stages of newborns, and phototherapy is a fast, safe and effective method that is used to treat it. However, recent studies have shown that phototherapy may elicit side effects in infants, such as hypothermia, hyperthermia and dehydration. To improve the quality of phototherapy and the prognosis of patients, the changes in neonatal physiological parameters during phototherapy should be monitored to give better feedback to pediatricians or the phototherapy system. However, the current standard of clinical care during neonatal phototherapy with hard-wired devices limits this realization.Approach. Here, we developed a prototype of a neonatal wearable device, which can wirelessly potentially monitor the jaundice value, transepidermal water loss, skin wettedness factor and body orientation during phototherapy, and conducted prototype validation experiments. We also set up user-friendly interfaces and an analysis system on custom software, all designed to make the future addition of data interfaces for treatment feedback functions easier.Main results. The preliminaryin vitroexperiment demonstrated the effectiveness of simultaneous monitoring of the required physiological parameters. And further suggestions and specific operations are discussed in terms of optimization of the treatment of neonatal jaundice.Significance. It is believed that the established system has the potential to provide a basis for future phototherapy nursing guidelines and physiological monitoring standards.
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Affiliation(s)
- Ziliang He
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Benjin Zhang
- Department of Pediatrics, Dazhou Central Hospital, Dazhou, People's Republic of China
| | - Jing Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Zhenghua Xiao
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Ling He
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Gang Yang
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
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Hernández-Ochoa B, Ortega-Cuellar D, González-Valdez A, Martínez-Rosas V, Morales-Luna L, Rojas-Alarcón MA, Vázquez-Bautista M, Arreguin-Espinosa R, Pérez de la Cruz V, Castillo-Rodríguez RA, Canseco-Ávila LM, Vidal-Limón A, Gómez-Manzo S. An Overall View of the Functional and Structural Characterization of Glucose-6-Phosphate Dehydrogenase Variants in the Mexican Population. Int J Mol Sci 2023; 24:12691. [PMID: 37628871 PMCID: PMC10454679 DOI: 10.3390/ijms241612691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency, affecting an estimated 500 million people worldwide, is a genetic disorder that causes human enzymopathies. Biochemical and genetic studies have identified several variants that produce different ranges of phenotypes; thus, depending on its severity, this enzymopathy is classified from the mildest (Class IV) to the most severe (Class I). Therefore, understanding the correlation between the mutation sites of G6PD and the resulting phenotype greatly enhances the current knowledge of enzymopathies' phenotypic and genotypic heterogeneity, which will assist both clinical diagnoses and personalized treatments for patients with G6PD deficiency. In this review, we analyzed and compared the structural and functional data from 21 characterized G6PD variants found in the Mexican population that we previously characterized. In order to contribute to the knowledge regarding the function and structure of the variants associated with G6PD deficiency, this review aimed to determine the molecular basis of G6PD and identify how these mutations could impact the structure, stability, and function of the enzyme and its relation with the clinical manifestations of this disease.
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Affiliation(s)
- Beatriz Hernández-Ochoa
- Laboratorio de Inmunoquímica, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City 06720, Mexico;
| | - Daniel Ortega-Cuellar
- Laboratorio de Nutrición Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City 04530, Mexico;
| | - Abigail González-Valdez
- Departamento de Biología Molecular y Biotecnología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
| | - Víctor Martínez-Rosas
- Laboratorio de Bioquímica Genética, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City 04530, Mexico; (V.M.-R.); (L.M.-L.); (M.A.R.-A.); (M.V.-B.)
- Programa de Posgrado en Biomedicina y Biotecnología Molecular, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Laura Morales-Luna
- Laboratorio de Bioquímica Genética, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City 04530, Mexico; (V.M.-R.); (L.M.-L.); (M.A.R.-A.); (M.V.-B.)
- Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Miriam Abigail Rojas-Alarcón
- Laboratorio de Bioquímica Genética, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City 04530, Mexico; (V.M.-R.); (L.M.-L.); (M.A.R.-A.); (M.V.-B.)
- Programa de Posgrado en Biomedicina y Biotecnología Molecular, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Montserrat Vázquez-Bautista
- Laboratorio de Bioquímica Genética, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City 04530, Mexico; (V.M.-R.); (L.M.-L.); (M.A.R.-A.); (M.V.-B.)
- Programa de Posgrado en Biomedicina y Biotecnología Molecular, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Roberto Arreguin-Espinosa
- Departamento de Química de Biomacromoléculas, Instituto de Química, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
| | - Verónica Pérez de la Cruz
- Neurobiochemistry and Behavior Laboratory, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City 14269, Mexico;
| | | | - Luis Miguel Canseco-Ávila
- Facultad de Ciencias Químicas, Campus IV, Universidad Autónoma de Chiapas, Tapachula City 30580, Mexico;
| | - Abraham Vidal-Limón
- Red de Estudios Moleculares Avanzados, Clúster Científico y Tecnológico BioMimic®, Instituto de Ecología A.C. (INECOL), Carretera Antigua a Coatepec 351, El Haya, Xalapa 91073, Mexico;
| | - Saúl Gómez-Manzo
- Laboratorio de Bioquímica Genética, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City 04530, Mexico; (V.M.-R.); (L.M.-L.); (M.A.R.-A.); (M.V.-B.)
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Kiros BM, Fisseha G, Gebreslassie AA, Gufue ZH, Ebuy H, Belew MT, Reda GZ, Mohammed HM. Neonatal Jaundice: Its Determinants Among Neonates Admitted to Neonatal Intensive Care Units of Tigray Region General Hospitals, Northern Ethiopia. Glob Pediatr Health 2023; 10:2333794X231190518. [PMID: 37546380 PMCID: PMC10402284 DOI: 10.1177/2333794x231190518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
Background. Despite the significant public health impact of neonatal jaundice on neonatal survival, local epidemiologic data are scarce. Methods. A multi-centered, unmatched case-control study was conducted among 180 consecutively admitted neonates (60 cases and 120 controls). The independent determinants of newborn jaundice were determined using a multivariable binary logistic regression model, and a P-value of <0.05 was used to indicate statistical significance. Results. Maternal medical complications during the index pregnancy (AOR = 2.45; 95% CI 1.01-5.97), rural residence (AOR = 3.1; 95% CI 1.02-9.42), being a low birthweight neonate (AOR = 3.42; 95% CI 1.12-10.41), neonatal B blood group (AOR = 10.19; 95% CI 2.89-35.9), neonatal O blood group (AOR = 2.99; 95% CI 1.04-8.59), and a longer duration of hospital stay (AOR = 9.83; 95% CI 3.11-31.02) were the independent determinants of neonatal jaundice. Conclusions. Early assessment of high-risk neonates might reduce the long-term neurodevelopmental consequences.
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Affiliation(s)
- Berhe Mengesha Kiros
- Department of Nursing, Dr. Tewelde Legesse Health Sciences College, Mekelle, Ethiopia
| | - Girmatsion Fisseha
- 2School of Public Health, College of Health Sciences, Mekelle University, Ethiopia
| | | | - Zenawi Hagos Gufue
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Ethiopia
| | - Haftamu Ebuy
- 2School of Public Health, College of Health Sciences, Mekelle University, Ethiopia
| | - Molla Teferi Belew
- 2School of Public Health, College of Health Sciences, Mekelle University, Ethiopia
| | | | - Hayat Maeruf Mohammed
- Department of Nursing, College of Medicine and Health Sciences, Adigrat University, Ethiopia
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11
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Naeem H, Ullah K, Ochani S, Naeem K, Ahmad HB, Hasibuzzaman MA. The need for neonatal jaundice screening awareness in the Pakistani population: short communication. Ann Med Surg (Lond) 2023; 85:4187-4189. [PMID: 37554868 PMCID: PMC10406009 DOI: 10.1097/ms9.0000000000000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/10/2023] [Indexed: 08/10/2023] Open
Abstract
Neonatal jaundice is a common illness that affects around 80% of preterm and 50-60% of full-term newborn infants. It is one of the most common causes of neonatal death. Neonatal jaundice may be physiological or pathological. Physiologic jaundice is far more common than pathologic jaundice and accounts for most hyperbilirubinemia. Physiologic jaundice in neonates is due to greater hemoglobin breakdown compared to bilirubin clearance. While pathological jaundice occurs due to various infections, drug toxicity, inborn enzyme deficiencies, Rhesus fetal-maternal incompatibility, hypothyroidism, and congenital biliary duct obstruction diseases. In many parts of the world, midwives, and nurses perform spontaneous vaginal deliveries and they only rely on visual screening for neonatal jaundice. However, this is not reliable, especially for newborns having darker skin. Educating the mothers on screening for early detection of neonatal jaundice and seeking medical treatment in a country like Pakistan, which is considered a high-risk population, is crucial. Also, as most females give birth at home, hence, midwives' knowledge about neonatal jaundice also needs to be improved.
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Affiliation(s)
- Hafsa Naeem
- Department of Medicine, Dow International Medical College, Karachi
| | - Kaleem Ullah
- Department of Liver Transplantation, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat
| | - Sidhant Ochani
- Department of Medicine, Khairpur Medical College, Khairpur Mir’s, Pakistan
| | - Khadija Naeem
- Department of Medicine, Dow International Medical College, Karachi
| | - Hafiz B. Ahmad
- Department of Liver Transplantation, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat
| | - Md. Al Hasibuzzaman
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
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12
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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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13
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Yang YK, Lin CF, Lin F, Chen ZK, Liao YW, Huang YC, Xiao BR, Huang SH, Xu YM, Chen YE, Cao YB, Yang LY. Etiology analysis and G6PD deficiency for term infants with jaundice in Yangjiang of western Guangdong. Front Pediatr 2023; 11:1201940. [PMID: 37492600 PMCID: PMC10364441 DOI: 10.3389/fped.2023.1201940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Objective Glucose 6-phosphate dehydrogenase (G6PD) deficiency increases the risk of neonatal hyperbilirubinemia. The aim of this study is to evaluate the risk factors associated with hyperbilirubinemia in infants from the western part of Guangdong Province, and to assess the contribution of G6PD deficiency to neonatal jaundice. Methods The term infants with neonatal hyperbilirubinemia in People's Hospital of Yangjiang from June 2018 to July 2022 were recruited for the retrospective analysis. All the infants underwent quantitative detection of the G6PD enzyme. The etiology was determined through laboratory tests and clinical manifestations. Results Out of 1,119 term infants, 435 cases presented with jaundice. For the etiology analysis, infection was responsible for 16.09% (70/435), G6PD deficiency accounted for 9.66% (42/435), of which 3 were complicated with acute bilirubin encephalopathy), bleeding accounted for 8.05% (35/435), hemolytic diseases accounted for 3.45% (15/435), and breast milk jaundice accounted for 2.53% (11/435). One case (0.23%) was attributed to congenital hypothyroidism, multiple etiologies accounted for 22.3% (97/435), and 35.63% (155/435) were of unknown etiology. Of the jaundiced infants, 19.54% (85/435) had G6PD deficiency, while only 10.23% (70/684) of non-jaundiced infants had G6PD deficiency; this difference was found to be statistically significant (P < 0.001). Furthermore, the hemoglobin levels in the jaundiced infants with G6PD deficiency (146.85 ± 24.88 g/L) were lower than those without G6PD deficiency (156.30 ± 22.07 g/L) (P = 0.001). 65 jaundiced infants with G6PD deficiency underwent G6PD mutation testing, and six different genotypes were identified, including c.95A > G, c.392G > T, c.1024C > T, c.1311C > T, c.1376G > T, c.1388G > A, c.871G > A/c.1311C > T, c.392G > T/c.1388G > A, and c.1376G > T/c.1311C > T.65iciency. Conclusion In newborns in Yangjiang, G6PD deficiency, infection, and neonatal hemolytic disease were identified as the main causes of hyperbilirubinemia and acute bilirubin encephalopathy. Specifically, Hemolytic factors in infants with G6PD deficiency may lead to reduced hemoglobin and increased bilirubin levels in jaundiced infants.
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Affiliation(s)
- Yi-Kang Yang
- Institute of Medicine and Nursing, Hubei University of Medicine, Shiyan, China
- Precision Medical Lab Center, People’s Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
| | - Chun-Fan Lin
- Department of Neonatology, People’s Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
| | - Fen Lin
- Precision Medical Center, Chaozhou Central Hospital Affiliated to Southern Medical University, Chaozhou, China
| | - Zi-Kai Chen
- School of Life Science and Food Engineering, Hanshan Normal University, Chaozhou, China
| | - Yu-Wei Liao
- Precision Medical Lab Center, People’s Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
- Yangjiang Branch, Biochip Beijing National Engineering Research Center, Yangjiang, China
| | - Yu-Chan Huang
- Precision Medical Lab Center, People’s Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
- Yangjiang Branch, Biochip Beijing National Engineering Research Center, Yangjiang, China
| | - Bei-Ru Xiao
- Department of Neonatology, People’s Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
| | - Shan-Hua Huang
- Department of Neonatology, People’s Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
| | - Yu-Mei Xu
- Department of Neonatology, People’s Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
| | - Yue-E. Chen
- Department of Neonatology, People’s Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
| | - Yan-Bin Cao
- Precision Medical Lab Center, People’s Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
- Yangjiang Branch, Biochip Beijing National Engineering Research Center, Yangjiang, China
| | - Li-Ye Yang
- Precision Medical Lab Center, People’s Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
- Yangjiang Branch, Biochip Beijing National Engineering Research Center, Yangjiang, China
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14
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Lin J, Yang Y, Nuermaimaiti A, Ye T, Liu J, Zhang Z, Chen Y, Li Q, Wu C, Liu B, Xu R, Xia Y, Xiang J. Impact of ambient temperature on adverse pregnancy outcomes: a birth cohort study in Fuzhou, China. Front Public Health 2023; 11:1183129. [PMID: 37483924 PMCID: PMC10359494 DOI: 10.3389/fpubh.2023.1183129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/08/2023] [Indexed: 07/25/2023] Open
Abstract
Background Previous studies have identified a series of specific adverse pregnancy outcomes (APOs) linked with temperature extremes. Most of them focus on preterm birth, low birth weight, and stillbirth. Other possible adverse outcomes were under-researched. This study aimed to investigate the impact of ambient temperature on maternal complications, white blood cell count (WBC), newborn hearing, and neonatal jaundice. Methods A total of 418 participants were recruited from Fuzhou Maternity & Child Healthcare Hospital in 2016. Participants were invited to fill out a structured questionnaire. The gridded near-surface air temperatures at a resolution of 0.1°* 0.1° for Fuzhou were extracted from a published dataset. Meteorological data and PM2.5 were extracted based on participants' residential addresses using R packages "ncdf4" and "raster." Multivariate logistic regression models were used to quantify the effects of ambient temperature on APOs after controlling for confounders. Results Overall, there were 107 APOs, accounting for 25.6% of all participants. Every 1°C increase in mean temperature was associated with a 10.0% increase in APOs (aOR = 1.100, 95%CI 1.006-1.203) during the period of early pregnancy. However, negative associations were observed in the middle pregnancy period, and a 1°C increase in mean temperature was associated 8.8% decrease in APOs (aOR = 0.912, 95%CI 0.846-0.982). Diurnal temperature variation had a significant impact on APOs in the third trimester. Infant jaundice was negatively associated with temperature exposure in the middle and late pregnancy periods. The risk of neonatal jaundice increased at lag weeks 2-9 in the first trimester, with the greatest lagged effect (aOR = 1.201, 95%CI 1.020-1.413) observed at lag week 3. A 1°C increase in mean temperature led to a 29.6% (aOR = 1.296, 95%CI 1.019-1.649) increase in high WBC. A 1°C increase in temperature variation was associated with more than two times (aOR = 2.469, 95%CI 1.001-6.089) increase of high WBC in the first trimester and about five times (aOR = 4.724, 95%CI 1.548-14.409) increase in the third trimester. Conclusion Ambient temperature affects neonatal jaundice, newborn hearing loss, and infections during pregnancy. In addition to the identified epidemiologic link and susceptible exposure windows, there is a need to understand the underlying biological mechanisms for better recommendations for climate change adaptation policies.
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Affiliation(s)
- Jinfeng Lin
- Fujian Center for Prevention and Control of Occupational Diseases and Chemical Poisoning, Fuzhou, Fujian, China
| | - Yan Yang
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Ayinasaer Nuermaimaiti
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jingwen Liu
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Zitong Zhang
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Yifeng Chen
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Qingyu Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Chuancheng Wu
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Baoying Liu
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Rongxian Xu
- Department of Nutrition and Food Safety, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Yong Xia
- Fuzhou Maternity and Child Health Care Hospital, Fuzhou, Fujian, China
| | - Jianjun Xiang
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
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15
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Wang Y, Wang H, Zhang Q, Li S, Mao Y, Lu J, Shen Y, Han Y. Correlation between hyperbilirubinemia risk and immune cell mitochondria parameters in neonates with jaundice. Front Pediatr 2023; 11:1200099. [PMID: 37397145 PMCID: PMC10313225 DOI: 10.3389/fped.2023.1200099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose To explore the correlation between mitochondria parameters of immune cells and hyperbilirubinemia risk in hospitalized neonates with jaundice. Methods This retrospective study included jaundiced neonates born between September 2020 and March 2022 at Shaoxing Keqiao Women & Children's Hospital. The neonates were divided into low, intermediate-low, intermediate-high, and high-risk groups according to the hyperbilirubinemia risk. The purpose parameters including percentage, absolute count, mitochondrial mass (MM), and single-cell MM (SCMM) of peripheral blood T lymphocytes detected by flow cytometry were collected. Results Finally, 162 neonates with jaundice (47, 41, 39, and 35 with low, intermediate-low, intermediate-high, and high-risk) were included. CD3+ SCMM was significantly higher in the high-risk group compared with the low and intermediate-low-risk groups (both P < 0.0083), CD4+ SCMM was significantly higher in the high-risk group compared with the three other groups (all P < 0.0083), and CD8+ SCMM was significantly higher in the intermediate-low and high-risk groups compared with the low-risk group (both P < 0.0083). CD3+ (r = 0.34, P < 0.001) and CD4+ (r = 0.20, P = 0.010) SCMM positively correlated with bilirubin levels. Conclusions The mitochondrial SCMM parameters differed significantly among jaundiced neonates with different hyperbilirubinemia risks. CD3+ and CD4+ T cell SCMM values were positively correlated with the serum bilirubin levels, and might correlated with hyperbilirubinemia risk.
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16
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Luo L, Jiang L. Study on the value of KMC combined with blue light irradiation in improving the therapeutic effect of neonatal jaundice. Biotechnol Genet Eng Rev 2023:1-11. [PMID: 37036958 DOI: 10.1080/02648725.2023.2199512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Neonatal jaundice is a common problem that affects newborns. We aim to investigate the effect of Kangaroo Mother Care (KMC) combined with blue-light irradiation on enhancing the therapeutic effect in the treatment of neonatal jaundice. From May 2020 to August 2022, 89 neonates with pathological jaundice and their mothers were selected as participants. All neonates received blue-light irradiation. The participants were divided into two groups: 46 neonates cared for by KMC as the research group (RG) and 43 neonates receiving routine nursing as the control group (CG). The first lactation time, first breastfeeding duration, and scores of Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) before and after nursing were recorded and compared between the groups. Pre- and post-interventional total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL) levels of both groups of newborns were measured, and the time of jaundice resolution, first defecation, and meconium yellowing were recorded. Neonatal adverse reactions (ARs) during treatment were counted, and a nursing satisfaction survey was conducted at discharge. KMC group mothers had earlier lactation and longer first breastfeeding durations (P < 0.05). Both groups' SAS and SDS scores decreased post-nursing, with greater improvement in the KMC group (P < 0.05). KMC group newborns had lower bilirubin levels and faster resolution of jaundice and meconium yellowing, with fewer adverse reactions and higher nursing satisfaction (P < 0.05). KMC can effectively improve the efficacy of blue light irradiation in the treatment of neonatal jaundice, and promote the healthy development of newborns and the efficiency of maternal breastfeeding.
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Affiliation(s)
- Li Luo
- Department of Paediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Ling Jiang
- Department of Paediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
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17
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Aune A, Vartdal G, Jimenez Diaz G, Gierman LM, Bergseng H, Darj E. Iterative Development, Validation, and Certification of a Smartphone System to Assess Neonatal Jaundice: Development and Usability Study. JMIR Pediatr Parent 2023; 6:e40463. [PMID: 36853753 PMCID: PMC10015352 DOI: 10.2196/40463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/16/2022] [Accepted: 01/16/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Medical device development is an area facing multiple challenges, resulting in a high number of products not reaching the clinical setting. Neonatal hyperbilirubinemia, manifesting as neonatal jaundice (NNJ), is an important cause of newborn morbidity and mortality. It is important to identify infants with neonatal hyperbilirubinemia at an early stage, but currently there is a lack of tools that are both accurate and affordable. OBJECTIVE This study aimed to develop a novel system to assess the presence of NNJ. The device should provide accurate results, be approved as a medical device, be easy to use, and be produced at a price that is affordable even in low-resource settings. METHODS We used an iterative approach to develop a smartphone-based system to detect the presence of NNJ. We performed technical development, followed by clinical and usability testing in parallel, after which we initiated the regulatory processes for certification. We updated the system in each iteration, and the final version underwent a clinical validation study on healthy term newborns aged 1 to 15 days before all documentation was submitted for conformity assessment to obtain Conformité Européenne (CE) certification. We developed a system that incorporates a smartphone app, a color calibration card, and a server. RESULTS Three iterations of the smartphone-based system were developed; the final version was approved as a medical device after complying with Medical Device Regulation guidelines. A total of 201 infants were included in the validation study. Bilirubin values using the system highly correlated with total serum or plasma bilirubin levels (r=0.84). The system had a high sensitivity (94%) to detect severe jaundice, defined as total serum or plasma bilirubin >250 µmol/L, and maintained a high specificity (71%). CONCLUSIONS Our smartphone-based system has a high potential as a tool for identifying NNJ. An iterative approach to product development, conducted by working on different tasks in parallel, resulted in a functional and successful product. By adhering to the requirements for regulatory approval from the beginning of the project, we were able to develop a market-ready mobile health solution.
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Affiliation(s)
- Anders Aune
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Picterus AS, Trondheim, Norway
| | | | - Gabriela Jimenez Diaz
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Picterus AS, Trondheim, Norway
| | | | - Håkon Bergseng
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neonatology, St.Olav Hospital, Trondheim, Norway
| | - Elisabeth Darj
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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18
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Al-Hinai A, AlSawafi AS. Severe Hyperbilirubinemia Secondary to Henna Application in a Neonate With G6PD Deficiency: A Case Report and Literature Review. Cureus 2023; 15:e34540. [PMID: 36879691 PMCID: PMC9985141 DOI: 10.7759/cureus.34540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
Henna is a natural product commonly used for cosmetics, healing, and social occasions in the Middle East and South Asian countries. It usually carries no significant medical complications in a healthy individual. However, henna in a patient with G6PD deficiency can cause serious medical complications, including severe hyperbilirubinemia and hemolytic anemia, due to its oxidative stress on the erythrocyte. This paper reports a previously undiagnosed G6PD deficient neonate who presented with severe hyperbilirubinemia without the classical laboratory findings of hemolytic anemia. In addition, we reviewed the literature and summarized the clinical and laboratory findings of 31 G6PD-deficient pediatric patients with henna-induced hemolytic anemia (HIHA). The reported adverse effects of HIHA included death (N: 2), kernicterus (N: 3), life-threatening hemolytic anemia that required blood transfusion (N: 9), and severe hyperbilirubinemia requiring exchange transfusion (N: 7). Although HIHA in G6PD deficiency is a well-known fact in the literature, we believe it is still under-reported. Given the high prevalence of G6PD deficiency and the widespread practice of henna application, we recommend avoiding it, especially in infancy, until the G6PD status is known. Society awareness should be raised about it.
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Sun Y, Petersen JP, Wu C, Dreier JW, Maimburg RD, Henriksen TB, Christensen J. Neonatal Phototherapy and Clinical Characteristics: The Danish National Patient Registry 2000-2016. Clin Epidemiol 2023; 15:123-136. [PMID: 36721458 PMCID: PMC9884443 DOI: 10.2147/clep.s373289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023] Open
Abstract
Purpose Phototherapy is the standard treatment for neonatal hyperbilirubinemia. It is important to collect data on phototherapy to support research related to the efficacy and safety of phototherapy. We explored the registration of phototherapy in the Danish National Patient Registry (DNPR) and the clinical characteristics of neonates treated with phototherapy. Methods We identified children born alive in Denmark from 1 January 2000 through 30 November 2016 from the DNPR (N=1,044,502). We calculated the proportion of children registered that received phototherapy during the neonatal period and examined temporal trends, both nationwide and at the level of individual hospitals. In a sub-cohort of children born at Aarhus University Hospital (AUH) in 2002-2016 (N=71,781), we analyzed the proportions of children registered that received phototherapy, according to sex, gestational age, birth weight, and neonatal characteristics, like Apgar score, birth asphyxia, and infections. Results We identified 11,295 (1.1%) registered that received phototherapy. The proportions of children registered that received phototherapy differed among hospitals (range: 0 to 4.1%). Nationwide registration was low during the study period, but it increased to 1.8% in 2016. For the AUH sub-cohort the proportion of children registered with phototherapy averaged 4.4% (N=3182, range:3.9-5.1%). The proportion of children registered with phototherapy was inversely correlated with gestational age and birth weight, and positively correlated with neonatal characteristics, including low Apgar score, birth asphyxia, and infections. Conclusion Phototherapy was under-reported in the DNPR and the proportions of children registered that received phototherapy differed among hospitals. The non-compulsory policy for reporting treatment and care in hospitals to the DNPR might explain the variation. The most consistent reporting was observed among children born in an university hospital, where 4.4% of children registered that received phototherapy, and phototherapy was inversely associated with gestational age, birth weight, and positively associated with clinical characteristics like birth asphyxia, and infections.
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Affiliation(s)
- Yuelian Sun
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark,Correspondence: Yuelian Sun, Department of Neurology, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark, Email
| | - Jesper Padkær Petersen
- Department of Paediatrics, Clinical Institute, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Chunsen Wu
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Julie Werenberg Dreier
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark,Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Rikke Damkjær Maimburg
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Occupational Health, Aarhus University Hospital, Aarhus, Denmark,Department of Midwifery, University College of Northern Denmark, Hjørring, Denmark,School of Nursing and Midwifery, Western Sydney University, Blacktown, NSW, Australia
| | - Tine Brink Henriksen
- Department of Paediatrics, Clinical Institute, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Dzantor EK, Serwaa D, Abdul-Mumin A. Neonatal Jaundice Management: Improving Clinical Knowledge of Jaundice for Improved Attitudes and Practices to Enhance Neonatal Care. SAGE Open Nurs 2023; 9:23779608231220257. [PMID: 38107652 PMCID: PMC10722953 DOI: 10.1177/23779608231220257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/02/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023] Open
Abstract
Neonatal jaundice is a common medical condition that affects neonates in the early days of life. Nurses and midwives play important role in the identification and management of neonatal jaundice and the promotion of good neonatal health and education. Their clinical knowledge of neonatal jaundice may influence their attitude and practices toward the identification and management of neonatal jaundice. The study results showed that the level of good knowledge, attitudes, and practices toward neonatal jaundice management was 69.30% (140/202), 64.90% (131/202), and 62.90% (127/202), respectively. The inferential statistics showed a positive association between good knowledge and attitudes toward neonatal jaundice and good practices of neonatal jaundice management. Suggestively, nurses and midwives who have and demonstrate better clinical knowledge and exhibit positive attitudes are more likely to implement appropriate practices for the management of neonatal jaundice. Healthcare providers should therefore invest in life-long learning activities for staff, especially in the study setting.
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Affiliation(s)
- Edem Kojo Dzantor
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Research and Innovation Unit, College of Nursing and Midwifery, Nalerigu, Ghana
| | - Dorcas Serwaa
- Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia
| | - Alhassan Abdul-Mumin
- Department of Pediatrics and Child Health, School of Medicine, University for Development Studies, Tamale, Ghana
- Department of Pediatrics, Tamale Teaching Hospital, Tamale, Ghana
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21
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Honbe K, Hayakawa M, Morioka I, Arai H, Maruo Y, Kusaka T, Kunikata T, Iwatani S, Okumura A. Current status of neonatal jaundice management in Japan. Pediatr Int 2023; 65:e15617. [PMID: 37658617 DOI: 10.1111/ped.15617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND This nationwide survey aimed to determine the status of jaundice management in Japan. METHODS A questionnaire about bilirubin level measurements and neonatal jaundice treatment was sent to 330 institutions providing neonatal care. The responses were analyzed according to institution level. RESULTS Of 330 institutions, 172 responded (52.1% response rate). Total bilirubin levels were measured in the central laboratory using spectrophotometry at 134 institutions and a blood gas analyzer at 81 institutions. Unbound bilirubin (UB) levels were measured by 79 institutions, while transcutaneous bilirubin measurements were taken at 63 institutions. There was no association between institution level and UB or transcutaneous bilirubin measurement. For phototherapy criteria, the Murata-Imura criteria were adopted by 67 institutions, Nakamura criteria by 36, and Morioka criteria by 39. Light-emitting diodes (LED) were used by 160 institutions versus fluorescent lights by 31. When a blue LED was used, 119 institutions used the high mode. There is no standard for increasing light intensity. No association was found between institution level and phototherapy criteria. UB was measured in 14 of 63 institutions using the Murata-Imura criteria. CONCLUSIONS There is a large variation in the management and treatment of neonatal jaundice among institutes in Japan.
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Affiliation(s)
- Kazuya Honbe
- Department of Pediatrics, Tosei General Hospital, Seto, Japan
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Arai
- Department of Pediatric Neurology, Bobath Memorial Hospital, Osaka, Japan
| | - Yoshihiro Maruo
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Takashi Kusaka
- Department of Pediatrics, Kagawa University School of Medicine, Miki-cho, Kita-gun, Japan
| | - Tetsuya Kunikata
- Department of Pediatrics, Division of Neonatal Medicine, Saitama Medical University Hospital, Moroyama-machi, Iruma-gun, Japan
| | - Sota Iwatani
- Department of Neonatology, Kobe Children's Hospital, Kobe, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
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22
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Satrom KM, Farouk ZL, Slusher TM. Corrigendum: Management challenges in the treatment of severe hyperbilirubinemia in low-and middle-income countries: encouraging advancements, remaining gaps, and future opportunities. Front Pediatr 2023; 11:1181023. [PMID: 37205216 PMCID: PMC10186343 DOI: 10.3389/fped.2023.1181023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2023.1001141.].
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Affiliation(s)
- Katherine M. Satrom
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, United States
- Correspondence: Katherine M. Satrom
| | - 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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23
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Chen LW, Zhang Y, Xu DD, Wang Y, Gao H. Causal relationships of neonatal jaundice, direct bilirubin and indirect bilirubin with autism spectrum disorder: A two-sample Mendelian randomization analysis. Front Public Health 2023; 11:1137383. [PMID: 37124814 PMCID: PMC10133461 DOI: 10.3389/fpubh.2023.1137383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Background Multiple systematic reviews and meta-analyses have examined the association between neonatal jaundice and autism spectrum disorder (ASD) risk, but their results have been inconsistent. This may be because the included observational studies could not adjust for all potential confounders. Mendelian randomization study can overcome this drawback and explore the causal relationship between the both. Methods We used the data of neonatal jaundice, direct bilirubin (DBIL), indirect bilirubin (IBIL), and ASD collected by genome-wide association study (GWAS) to evaluate the effects of neonatal jaundice, DBIL and IBIL on ASD by using a two-sample Mendelian randomized (MR). The inverse variance-weighted method (IVW) was the main method of MR analysis in this study. Weighted median method, MR-Egger regression and mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) test were used for sensitivity analysis. Results There was no evidence of an effect of neonatal jaundice (OR, 1.002, 95% CI, 0.977-1.027), DBIL (OR, 0.970, 95% CI, 0.884-1.064) and IBIL (OR, 1.074, 95% CI, 0.882-1.308) on ASD risk by IVW test. In the weighted median method, MR-Egger regression and leave-one-out analysis, the results were robust and no heterogeneity or pleiotropy was observed. Conclusions We found that neonatal jaundice, DBIL and IBIL were not associated with ASD in this study. However, this paper did not explore the effect of severity and duration of jaundice on ASD in different ethnic populations, which may require further research.
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Affiliation(s)
- Li-wen Chen
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yi Zhang
- Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People's Republic of China, Anhui Medical University, Hefei, Anhui, China
| | - Dou-dou Xu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yang Wang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- *Correspondence: Yang Wang
| | - Hui Gao
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Ministry of Education Key Laboratory for Full Life Cycle Population Health, Anhui Medical University, Hefei, Anhui, China
- Hui Gao
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Walz L, Brooks JC, Newman T. Evidence Suggests a Decrease in the Incidence of Kernicterus in California. J Pediatr 2022; 255:220-223.e1. [PMID: 36563899 DOI: 10.1016/j.jpeds.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/21/2022] [Accepted: 11/07/2022] [Indexed: 12/25/2022]
Abstract
We identified children diagnosed with kernicterus in the California Department of Developmental Services and estimated an incidence of 0.42 per 100 000 births from 1988 to 2014, significantly decreasing to 0.04 per 100 000 births after 2009. We also examined national infant kernicterus mortality from 1979 to 2016 using CDC data. It did not decrease significantly.
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Affiliation(s)
- Lucas Walz
- Life Expectancy Project, San Francisco, CA
| | | | - Thomas Newman
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA; Department of Pediatrics, University of California-San Francisco, San Francisco, CA
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26
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Choi S, Jeon Y, Kwon JH, Ihm C, Kim SY, Choi KC. Wearable Photomedicine for Neonatal Jaundice Treatment Using Blue Organic Light-Emitting Diodes (OLEDs): Toward Textile-Based Wearable Phototherapeutics. Adv Sci (Weinh) 2022; 9:e2204622. [PMID: 36310107 PMCID: PMC9762290 DOI: 10.1002/advs.202204622] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Neonatal jaundice is a very common disease in newborns and can lead to brain damage or death in severe cases. Phototherapy with light-emitting diode (LED) arrays is widely used as the easiest and fastest way to relieve jaundice in newborns, but it has distinct disadvantages such as loss of water in the patient, damage to the retina, and separation from parents. In this paper, a novel light source-based phototherapy for neonatal jaundice is proposed using a textile-based wearable organic light-emitting diode (OLED) platform that can move flexibly and conform to the curvature of the human body. The soft and flexible textile-based blue OLED platform is designed to have a peak wavelength of 470 nm, suitable for jaundice treatment, and shows performance (>20 µW cm-2 nm- 1 ) suitable for intensive jaundice treatment even at low voltage (<4.0 V). The textile-based OLEDs fabricated in this study exhibit an operating reliability of over 100 h and low-temperature operation (<35 °C). The results of an in vitro jaundice treatment test using a large-area blue OLED confirm that the bilirubin level decreases to 12 mg dL-1 with 3 h of OLED irradiation.
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Affiliation(s)
- Seungyeop Choi
- School of Electrical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141Republic of Korea
| | - Yongmin Jeon
- Department of Biomedical EngineeringGachon UniversitySeongnam13120Republic of Korea
| | - Jeong Hyun Kwon
- Department of Display and Semiconductor EngineeringSUN MOON UniversityChoongcheongnam‐doAsan31460Republic of Korea
| | - Chunhwa Ihm
- Department of Laboratory MedicineDaejeon Eulji Medical CenterEulji University School of MedicineDaejeon35233Republic of Korea
| | - Seung Yeon Kim
- Department of PediatricsNowon Eulji Medical CenterEulji University School of MedicineSeoul01830Republic of Korea
| | - Kyung Cheol Choi
- School of Electrical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141Republic of Korea
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Tsai ML, Lin WY, Chen YT, Lin HY, Ho HH, Kuo YW, Lin JH, Huang YY, Wang HS, Chiu HY, Lin HC. Adjuvant probiotic Bifidobacterium animalis subsp. lactis CP-9 improve phototherapeutic treatment outcomes in neonatal jaundice among full-term newborns: A randomized double-blind clinical study. Medicine (Baltimore) 2022; 101:e31030. [PMID: 36397441 PMCID: PMC9666203 DOI: 10.1097/md.0000000000031030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Probiotics had been used to decreased bilirubin level in neonatal jaundice (NJ) without being further studied mechanism and stratification. The intestinal pathogen Escherichia coli produced β-glucuronidase would increase enterohepatic circulation and elevate serum bilirubin levels (SBLs) which might worsen the disease process of NJ. STUDY OBJECTIVE We hypothesized that some probiotics could decrease bilirubin level through inhibiting the growth of E. coli. It's assumed that adjuvant probiotic intervention might accelerate the phototherapy for NJ and alleviate the severity of the NJ. Besides, it's further study the efficacy of the probiotic intervention in NJ among the full-term and preterm newborns. MATERIALS AND METHODS Firstly, the Bifidobacterium animalis subsp. lactis CP-9 was screened for its anti-E. coli activity. Then, it was orally administered to newborns with NJ in combination with conventional phototherapy (wavelength 425-457 nm) to determine its efficacy. 83 neonatal patients whose serum bilirubinemia was at a concentration of ≥ 15 mg/dL were participated the double-blind randomized trial and conducted in the neonatal ward of China Medical University Children's Hospital (CMUCH, Taichung, Taiwan). The test was conducted in 2 groups: experimental group: phototherapy + B. animalis subsp. lactis CP-9 (n = 43; 5 × 109 CFU/capsule) and control group: phototherapy + placebo (n = 40). The SBL and total phototherapy duration were measured. RESULTS The experimental group showed improved serum bilirubin decline rate (-0.16 ± 0.02 mg/dL/h; P = .009, 95% CI -0.12 to -0.2), particularly in the first 24 hour of in-hospital care, and reduced total phototherapy duration (44.82 ± 3.23 h; P = .011, 95% CI: 51.3-38.2) compared with the control group. Especially, probiotics had a significant therapeutic effect (serum bilirubin decline rate: -0.18 ± 0.02 mg/dL/h, 95% CI -0.12 to -0.23, P = .014; phototherapy duration: 43.17 ± 22.72 h, 95% CI 51.9-34.3, P = .019) in the low-risk subgroup (full-term newborns). CONCLUSIONS In conclusion, B. animalis subsp. lactis CP-9 synergistically improves treatment outcomes of NJ during in-hospital phototherapy including reduced total phototherapy duration and improved serum bilirubin decline rate, particularly in full-term newborns.
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Affiliation(s)
- Ming-Luen Tsai
- Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Yang Lin
- Research and Development Department, Glac Biotech Co., Ltd., Tainan, Taiwan
| | - Yin-Ting Chen
- Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiang-Yu Lin
- Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsieh-Hsun Ho
- Research and Development Department, Glac Biotech Co., Ltd., Tainan, Taiwan
| | - Yi-Wei Kuo
- Research and Development Department, Glac Biotech Co., Ltd., Tainan, Taiwan
| | - Jia-Hung Lin
- Research and Development Department, Glac Biotech Co., Ltd., Tainan, Taiwan
| | - Yen-Yu Huang
- Research and Development Department, Glac Biotech Co., Ltd., Tainan, Taiwan
| | - Hui-Shan Wang
- Research and Development Department, Glac Biotech Co., Ltd., Tainan, Taiwan
| | - Hsiao-Yu Chiu
- Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- *Correspondence: Hung-Chih Lin and Hsiao-Yu Chiu, Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, No. 2, Yude Rd., North Dist., Taichung City 404, Taiwan (R.O.C.) (e-mail: ; )
| | - Hung-Chih Lin
- Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Asia University Hospital, Asia University, Taichung, Taiwan
- *Correspondence: Hung-Chih Lin and Hsiao-Yu Chiu, Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, No. 2, Yude Rd., North Dist., Taichung City 404, Taiwan (R.O.C.) (e-mail: ; )
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28
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Salvi PS, Fawaz R, Cowles RA. Comparing Serum Matrix Metalloproteinase-7 in Parenteral Nutrition-Associated Liver Disease and Biliary Atresia. J Pediatr 2022; 249:97-100. [PMID: 35714967 DOI: 10.1016/j.jpeds.2022.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/17/2022] [Accepted: 06/09/2022] [Indexed: 11/26/2022]
Abstract
In this cross-sectional study, serum matrix metalloproteinase-7 levels were significantly lower in infants with jaundice and parenteral nutrition-associated liver disease compared with those with confirmed biliary atresia. Serum metalloproteinase-7 may aid in excluding biliary atresia and thus may minimize invasive testing in infants with a history of parenteral nutrition.
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Affiliation(s)
- Pooja S Salvi
- Department of Surgery, Division of Pediatric Surgery, Yale School of Medicine, New Haven, CT
| | - Rima Fawaz
- Section of Pediatric Gastroenterology and Hepatology, Yale-New Haven Hospital, New Haven, CT
| | - Robert A Cowles
- Department of Surgery, Division of Pediatric Surgery, Yale School of Medicine, New Haven, CT.
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Treesirichod A, Eiamkulbutr S, Laohathai P, Vongbhavit K, Panburana J. The efficacy of infrared filter window film to prevent hyperthermia in neonatal hyperbilirubinemia with conventional phototherapy: a randomized control trial. Pediatr Neonatol 2022; 63:489-495. [PMID: 35697592 DOI: 10.1016/j.pedneo.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/06/2021] [Accepted: 12/06/2021] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Phototherapy is the first-line treatment of neonatal hyperbilirubinemia. Possible side effects caused by phototherapy include hyperthermia and dehydration. Currently, there are many types of infrared blocking film for potential use in reducing infrared radiation exposure and preventing hyperthermia. This study aims to evaluate the efficacy of infrared blocking film in preventing hyperthermia during the first 24 h of phototherapy. METHODS The randomized controlled trial study was carried out in 44 newborns with hyperbilirubinemia. Infrared filter film with 75% visible light transmission and 90% infrared rejection was used in the study. Body temperature was measured for the assessment of the efficacy of filter film from axillary and rectal routes. RESULTS There was a significantly lower incidence of hyperthermia from the axillary temperature in the group with infrared blocking film compared to the control group (p = 0.031). The axillary temperature between before and after initiation of phototherapy in filter film group was significantly better (p = 0.008). According to efficacy of treatment, the study demonstrated that infrared filter film did not interfere with the efficacy of phototherapy in reducing bilirubin level. CONCLUSIONS The infrared filter film was significantly more effective in preventing hyperthermia from phototherapy in the first 24 h without causing any significant difference in reduction of bilirubin level. THAI CLINICAL TRIALS REGISTRY TCTR20190619001.
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Affiliation(s)
- Arucha Treesirichod
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Thailand.
| | - Sutha Eiamkulbutr
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Thailand
| | - Phakwan Laohathai
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Thailand
| | - Kannikar Vongbhavit
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Thailand
| | - Jantana Panburana
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Thailand
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30
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Lee HJ, Lee MS, Kim JY. ['Triangular Cord' Sign in Biliary Atresia]. J Korean Soc Radiol 2022; 83:1003-1013. [PMID: 36276196 PMCID: PMC9574273 DOI: 10.3348/jksr.2022.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/05/2022] [Accepted: 09/11/2022] [Indexed: 12/03/2022]
Abstract
Biliary atresia is an unknown etiology of extrahepatic bile duct obstruction with a 'fibrous ductal remnant,' which represents the obliterated ductal remnant in the porta hepatis. The sonographic'triangular cord' (TC) sign has been reported to indicate a fibrous ductal remnant in the porta hepatis. In this review, we discuss the correlations among surgicopathological and sonographic findings of the porta hepatis and the definition, objective criteria, diagnostic accuracy, and differential diagnosis of the TC sign in biliary atresia.
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Li L, Wang J, Geng S, Liu F, Ping L, Gu X, Fan X, Yang M, Liang L, Guo W. Efficacy of adenosylmethionine combined with Si Mo Tang in treatment of neonatal jaundice. Am J Transl Res 2022; 14:3926-3935. [PMID: 35836853 PMCID: PMC9274584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the efficacy of S-adenosylmethionine (SAM-e) combined with Si Mo Tang in the treatment of neonatal jaundice and its effect on liver function, cardiac enzymes, immune function, serum transferrin (TRF) and C-reactive protein (CRP) levels. METHODS The clinical data of 149 infants with neonatal jaundice were collected retrospectively. The infants were grouped according to the treatment methods. All neonates were treated with blue light phototherapy. Besides, group A was treated with SAM-e, group B was treated with Si Mo Tang, and group C was treated with SAM-e combined with Si Mo Tang. The treatment efficacy, serum bilirubin level, neonatal behavioral neurological assessment (NBNA) score, liver function, cardiac enzymes, immune function, serum TRF and CRP level were compared among the three groups before and after treatment. RESULTS The total effective rate of treatment in group C was 96.00%, which was higher than group A (73.47%) and group B (78.00%) (P < 0.05), but no significant difference was observed between groups A and B (P > 0.05). Compared with groups A and B, group C had higher NBNA scores, lower serum bilirubin levels, and lower serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase-MB (CK-MB) levels (all P < 0.05); however, there was no statistical differences in NBNA scores, serum bilirubin levels, serum AST and ALT, LDH, CK and CK-MB levels between group A and group B (all P > 0.05). Compared with groups A and B, group C showed higher CD4+, CD4+/CD8+, TRF levels and lower serum CRP levels (P < 0.05), while there was no statistical differences in CD4+, CD4+/CD8+, CD8+, TRF levels and serum CRP levels between group A and group B (all P > 0.05). CONCLUSION SAM-e combined with Si Mo Tang promoted the regression of jaundice, improved liver function, neurodevelopmental conditions and the myocardial enzyme spectrum, reduced the level of inflammation, and improved the immunity of newborns with neonatal jaundice.
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Affiliation(s)
- Ling Li
- Department of Neonatology, Xingtai People’s HospitalXingtai, Hebei, China
| | - Jingqun Wang
- Department of Neonatology, Xingtai People’s HospitalXingtai, Hebei, China
| | - Shuxia Geng
- Department of Neonatology, Xingtai People’s HospitalXingtai, Hebei, China
| | - Fang Liu
- Department of Neonatology, Bethune International Peace HospitalShijiazhuang, Hebei, China
| | - Lili Ping
- Department of Neonatology, Handan Central HospitalHandan, Hebei, China
| | - Xiaohong Gu
- Department of Neonatology, Zhangjiakou Maternal and Child Health Care HospitalZhangjiakou, Hebei, China
| | - Xueai Fan
- Department of Neonatology, Xingtai Third HospitalXingtai, Hebei, China
| | - Mei Yang
- Department of Neonatology, Baoding First Central HospitalBaoding, Hebei, China
| | - Lixia Liang
- Department of Neonatology, Hengshui Harrison International Peace HospitalHengshui, Hebei, China
| | - Wei Guo
- Department of Neonatology, Xingtai People’s HospitalXingtai, Hebei, China
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32
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Shaw SC, Negi V, Bhat V, Kumar A, Joshi RK, Venkatnarayan K, Gupta R, Kunwar BRB, Gopalakrishnan S, Tewari VV, Kanitkar M. Gestational Age-Specific Nomogram of Transcutaneous Bilirubin in First 120 h of Life for Term and Late Preterm Indian Neonates. J Trop Pediatr 2022; 68:6602429. [PMID: 35666181 DOI: 10.1093/tropej/fmac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To create a nomogram based on transcutaneous bilirubin values (TCB) in first week of life for term and late preterm (>34 weeks) neonates. METHODS AND DESIGN Prospective longitudinal study. SETTING Four tertiary-care teaching hospitals (one each in eastern and southern India, two in northern India) between February 2019 and March 2020. PARTICIPANTS A total of 2492 term and late preterm (>34 weeks) neonates. INTERVENTION Bilirubin was measured by transcutaneous bilirubinometer (Drager JM-105, Germany) in all neonates in pre-specified times of the day, 12 hourly every day since birth till discharge between 48 and 72 h, and data were recorded in epochs of 6 hourly intervals. Post-discharge, all neonates were called for review in next 48 h. OUTCOME MEASURES Primary-TCB in first week of life. Secondary-factors having significant association with significant hyperbilirubinaemia requiring phototherapy. RESULTS Total of 2492 neonates (males 1303 and female 1189), with a total of 14 162 TCB recordings were analysed and mean hourly bilirubin (TCB) at hourly intervals till 120 h and then daily bilirubin values on Days 6 and 7 were tabulated. We have constructed hour-specific bilirubin nomogram with percentiles as per gestational age in term and near-term Indian neonates till 120 h of life. Amongst the known risk factors, delayed cord clamping, primipara and breastfeeding jaundice had significant association for hyperbilirubinaemia needing phototherapy. CONCLUSIONS We have created gestation-specific nomogram of TCB levels in 6 hourly intervals for the first 120 postnatal hours, obtained from a large predominantly breast fed healthy, term and near-term Indian neonates.
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Affiliation(s)
| | - Vandana Negi
- Department of Pediatrics, Command Hospital, Lucknow, India
| | - Vivek Bhat
- Department of Pediatrics, Indian Naval Hospital Ship, Asvini, Mumbai, India
| | - Ashutosh Kumar
- Department of Pediatrics, Command Hospital, Lucknow, India
| | - Rajneesh K Joshi
- Department of Community Medicine, Armed Forces Medical College, Pune, India
| | | | - Rakesh Gupta
- Govt Institute of Medical Sciences, Noida, India
| | | | | | | | - Madhuri Kanitkar
- Vice Chancellor, Maharashtra University of Health Sciences (MUHS), Nashik, India
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Bugaiski-Shaked A, Shany E, Mesner O, Sergienko R, Wainstock T. Association Between Neonatal Phototherapy Exposure and Childhood Neoplasm. J Pediatr 2022; 245:111-116. [PMID: 35120988 DOI: 10.1016/j.jpeds.2022.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/08/2022] [Accepted: 01/26/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To study the association between phototherapy for the treatment of neonatal jaundice and the risk of childhood neoplasms. STUDY DESIGN This population-based retrospective cohort study included all infants born at ≥32 weeks of gestation at a single medical center between 1988 and 2018. The incidence of neoplastic diseases was compared between infants exposed to phototherapy and those unexposed. Kaplan-Meier curves and log-rank tests were used for cumulative incidence comparison, and multivariable Cox and Weibull survival analysis were used to adjust for confounding or clinically significant variables. RESULTS The study population included 342 172 infants, of whom 18 797 (5.5%) were exposed to phototherapy. The median duration of follow-up was 9.5 years (range, birth to 18 years). Phototherapy was associated with a significantly increased risk for childhood malignancies and benign tumors (preterm birth and maternal age-adjusted hazard ratio, 1.89 [95% CI, 1.35-2.67] for malignancies and 1.27 [95% CI, 1.02-1.57] for benign tumors) Specifically, phototherapy was associated with hematopoietic cancers and leukemia (hazard ratio, 2.29 [95% CI, 1.48-3.54; P < .01] for hematopoietic cancers and 2.51 [95% CI, 1.52-4.14; P < .001] for leukemia), but not with solid tumors and lymphoma. CONCLUSIONS Phototherapy may be associated with a slightly increased childhood risk of neoplasm. It is important to strictly follow phototherapy treatment guidelines to minimize unnecessary exposure.
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Affiliation(s)
- Adva Bugaiski-Shaked
- Obstetrics and Gynecology Division, Soroka University Medical Center, Be'er- Sheva, Israel.
| | - Eilon Shany
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Neonatal Department, Soroka University Medical Center, Be'er- Sheva, Israel
| | - Oded Mesner
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Neonatal Department, Soroka University Medical Center, Be'er- Sheva, Israel
| | - Ruslan Sergienko
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Medical Computing Unit, School of Public Health, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Tamar Wainstock
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Department of Public Health, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
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Mukerji S, Popat H, Chung JZY. Accuracy of bilirubin on the Siemens RAPIDPoint 500 blood gas analyser: A data mining study. J Paediatr Child Health 2022; 58:1013-1015. [PMID: 35129247 PMCID: PMC9303911 DOI: 10.1111/jpc.15890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
AIM Blood gas analysers which can measure bilirubin in whole blood are commonly available in neonatal intensive care units; however, the accuracy of these measurements is not well established. We sought to determine accuracy of whole blood bilirubin on the Siemens RAPIDPoint 500 blood gas analyser with reference to formal laboratory total serum bilirubin on the Ortho Vitros 5600. METHODS A method comparison of the bilirubin results from the blood gas analysers compared with the chemistry analysers was performed by data mining of results obtained as part of routine patient care. Results were included if patients underwent bilirubin testing by blood gas analyser and formal TSB, with both samples being collected within 20 min. Retrospective laboratory data was collected over a 28-month period, 1 January 2019 to 1 May 2021. RESULTS 449 eligible sample pairs were included. A Bland-Altman plot was generated to identify systematic differences between the methods. A mean bias of -11 μmol/L was observed with 95% limits from -60 μmol/L to 38 μmol/L. Some blood gas bilirubin results were up to 70 μmol/L lower than formal TSB measurements around the clinically significant concentration range of 200 to 300 μmol/L. CONCLUSION Clinicians need to be aware of potential differences between the results from their blood gas analysers compared to formal TSB results. Sole reliance on blood gas bilirubin results which underestimate TSB may lead to under-recognition of neonatal jaundice that meets treatment thresholds. Formal measurement of TSB should be sought to inform decisions regarding treatment of neonatal jaundice.
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Affiliation(s)
- Shohini Mukerji
- Department of Clinical BiochemistryThe Children's Hospital at WestmeadSydneyNew South WalesAustralia,Department of Chemical PathologySydPath, St Vincent's HospitalSydneyNew South WalesAustralia
| | - Himanshu Popat
- Grace Centre for Newborn CareThe Children's Hospital at WestmeadSydneyNew South WalesAustralia,The Children's Hospital at Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Jason ZY Chung
- Department of Clinical BiochemistryThe Children's Hospital at WestmeadSydneyNew South WalesAustralia,The Children's Hospital at Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
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Singh A, Murki S, Sharma D, Vardhelli V, Subramanian S, Mekarthi A. Development and evaluation of a novel method "bilirubin color card" for screening of treatable jaundice in neonates: prospective comparative diagnostic study. J Matern Fetal Neonatal Med 2022; 35:9830-9833. [PMID: 35350962 DOI: 10.1080/14767058.2022.2056442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Various methods of screening or diagnosis of severe hyperbilirubinemia like transcutaneous bilirubinometer and laboratory testing havemethodological or practical limitations. In this perspective, we designed and evaluated an invasive but simple screening Color Card method in rapid assessment of various levels of bilirubin categories. OBJECTIVE This prospective comparative diagnostic study objectives were to create "Color Card" initially by yellow color shades that fall into 4 bilirubin categories, i.e. TSB up to 7 mg/dl, 7.1 to 12 mg/dl, 12.1 to 18 mg/dl and >18 mg/dl from the samples analyzed by diazo method, and to study its sensitivity and specificity for the diagnosis of moderate or severe hyperbilirubinemia in comparison to total serum bilirubin (TSB) by diazo method. RESULTS Out of total 188 samples obtained, 134 were unique patients. The specificity, negative predictive value and accuracy of the color card for the observations made by observer 1 comparing with lab TSB were >95% for clinically important categories of <7 mg/dl and >18 mg/dl. The overall accuracy of color card in measuring various TSB ranges varied from 75% to 96.8%. The agreement between two observers was 85.6% (Cohen's kappa co-efficient: 0.61, p-value: .0001) overall and was 92.3%, 86%, 84%, 81.2% for each of the four bilirubin categories in ascending order. CONCLUSION Bilirubin color card has good accuracy and may be very useful in the low resource settings, especially in the first referral units and community settings, where laboratory TSB estimation is not available easily. However, it requires centrifugation and easier methods of centrifugation will make this method simpler.
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Affiliation(s)
- Abhishek Singh
- Department of Neonatology, Paramitha Mother and Child Care, Hyderabad, India
| | - Srinivas Murki
- Department of Neonatology, Paramitha Mother and Child Care, Hyderabad, India
| | - Deepak Sharma
- Department of Neonatology, NIMS Medical College, Jaipur, India
| | | | - Sreeram Subramanian
- Department of Neonatology, Paramitha Mother and Child Care, Hyderabad, India
| | - Abhinav Mekarthi
- Department of Neonatology, Paramitha Mother and Child Care, Hyderabad, India
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Chen CC, Chen SM, Chang YZ, Sun HL, Ku MS. Maternal Exposure to Air Pollution Is Associated with Neonatal Jaundice: A Retrospective Cohort Study. J Pediatr 2022; 242:99-105.e4. [PMID: 34687690 DOI: 10.1016/j.jpeds.2021.09.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the association between maternal ambient pollutant exposure and neonatal jaundice in multiple pollutant species and examine sex differences. STUDY DESIGN Epidemiologic study: Records of 13 297 newborns (6153 male, 7144 female) born in Taichung, Taiwan were obtained from a national database. Average concentrations of prenatal air pollutants 3 months prior to birth were divided into low, middle, and high levels. Neonatal jaundice phototherapy rates between mothers who suffered varying air pollutant levels were compared. Clinical study: Three hundred seventy-six newborns (189 male, 187 female) born and received jaundice treatment with phototherapy in a hospital in Taichung, Taiwan were recruited. The correlation between prenatal exposure to air pollutants 3 months prior to birth, newborn's serum bilirubin, and serum hemoglobin were calculated. RESULTS Epidemiologic study: Male newborns born to mothers exposed to high carbon monoxide (CO), nitric oxide (NO), nitrogen dioxide (NO2), and methane (CH4) levels had higher phototherapy rates. In female newborns, the same was noted for CO and CH4. Clinical study: Male newborns had a positive correlation between CO, ≤2.5 μm diameter particles, ≤10 μm diameter particles, NO, NO2, nonmethane hydrocarbon, and CH4 exposure 3 months prior to birth and serum bilirubin levels. Female newborns had a positive correlation for CH4. A positive correlation between CO, ≤2.5 μm diameter particles, ≤10 μm diameter particles, NO2, nonmethane hydrocarbon, CH4 exposure, and serum hemoglobin levels was noted in male newborns. CONCLUSION Maternal exposure to air pollutants may increase neonatal jaundice treatment rates for phototherapy and higher neonatal serum total bilirubin level. Higher hemoglobin levels because of higher pollutant exposures may explain our findings. The association was more obvious in male newborns.
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Affiliation(s)
- Chian-Chi Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Pediatrics, Nurse Practitioner, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shan-Ming Chen
- Division of Gastroenterology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yan-Zin Chang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hai-Lun Sun
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Min-Sho Ku
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Wu FF, Huang C, Lin MJ, Wang L, Xu K, Zhou X. Effect of acupressure combined with Yinzhihuang granules on neonatal jaundice: a systematic review and meta-analysis of randomized controlled trials. Transl Pediatr 2022; 11:219-228. [PMID: 35282023 PMCID: PMC8905108 DOI: 10.21037/tp-22-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND With the improvement of living standards in recent years, people are paying increasing attention to neonatal jaundice. Yinzhihuang granule is a common Chinese herbal drug for the treatment of neonatal jaundice. The aim of this paper was to study the efficacy of acupressure-assisted Yinzhihuang granule in the treatment of neonatal jaundice by meta-analysis. METHODS We performed a search in the databases of PubMed, Embase, Cochrane Library, Chinese Journal Full-text Database (CNKI), VIP, Wanfang Science and Technology Journal Full-text Database, and Chinese Biomedical Literature Search Database (CBM) for articles on the therapeutic effect of acupressure-assisted Yinzhihuang granule on neonatal jaundice from database establishment to October 2021. The software Endnote X9 was used to check and eliminate the articles, screen the articles according to the required inclusion and exclusion criteria, extract the data, and perform quality evaluation according to the risk of bias tool of Cochrane Collaboration. The software Stata 15.1 and RevMan 5.3 were used to record the data, and a meta-analysis was performed on the effective rate of acupressure-assisted Yinzhihuang granule in the treatment of neonatal jaundice, according to serum total bilirubin values after treatment and duration of jaundice. And show the efficacy of Yinzhihuang particles through these results. The reliability of the results was assessed by sensitivity analysis. Funnel plots were used to test the publication bias of the articles. RESULTS A total of 3 articles were included. The results of meta-analysis showed that when acupressure-assisted Yinzhihuang granule was used to treat neonatal jaundice, the effective rate of the test group was not significantly different from that in the control group; the serum total bilirubin level in the test group was significantly lower than that in the control group after treatment; the duration of jaundice in the test group was significantly shorter than that in the control group. DISCUSSION Acupressure combined with Yinzhihuang granule is effective in treating neonatal jaundice, which has a positive effect on reducing the level of serum total bilirubin and reducing the duration of jaundice.
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Affiliation(s)
- Fang-Fang Wu
- Department of Neonatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Chan Huang
- Department of Pediatrics, Chengmai County People's Hospital, Chengmai, China
| | - Ming-Jing Lin
- Department of Neonatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Ling Wang
- Department of Pediatrics, Chengmai County People's Hospital, Chengmai, China
| | - Ke Xu
- Department of Pediatrics, Chengmai County People's Hospital, Chengmai, China
| | - Xuan Zhou
- Department of Pediatrics, Haikou Hospital of the Maternal and Child Health, Haikou, China
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Ramachandran RM, Srinivasan R. Clinical Profile and Outcome Following Exchange Transfusion for Neonatal Jaundice in a Tertiary Care Centre. J Trop Pediatr 2022; 68:6515780. [PMID: 35084035 DOI: 10.1093/tropej/fmac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Phototherapy has reduced the need for exchange transfusion (ET) to manage jaundiced neonates. Hence there are concerns about increased risk of complication due to lack of opportunity to sustain skills in performing ET. We studied the complications and treatment outcomes of neonates treated for jaundice with ET. METHODOLOGY A retrospective observational study was conducted from June 2013 to June 2020 in a tertiary care hospital in India. All neonates treated with ET for jaundice were included. RESULTS Twenty-eight neonates underwent 31 ET during the study period. Their mean gestational age and birth weight were 37 weeks and 3200 g, respectively. Predisposing factor for jaundice observed were Coomb's positive status (11), hepatosplenomegaly suggesting hemolysis (3), cephalhematoma (2) and birth asphyxia (1). Abnormal neurological status before ET was seen in seven neonates. Adverse clinical events that happened during or within 8 h after ET were desaturation (4), tachycardia (3), tachypnea (2), bradycardia (2), shock (2) and temperature instability (2). One neonate developed acute kidney injury after ET and required peritoneal dialysis. Abnormal lab parameters observed during or within 8 h after ET were hypocalcemia (20), anemia (8), hypokalemia (7), hypernatremia (3), thrombocytopenia (3) and hyperkalemia (2). Post ET sepsis was seen in five neonates: two had only blood culture positive sepsis, two had bone and joint infection and one had liver abscess. CONCLUSION The neonates undergoing ET are at high risk of developing complications which may be life threatening. Hence careful monitoring during the procedure is needed.
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Affiliation(s)
- Rajashree M Ramachandran
- Department of Pediatrics, PSG Institute of Medical Science & Research, Coimbatore, Tamil Nadu 641004, India
| | - Ramesh Srinivasan
- Department of Pediatrics, PSG Institute of Medical Science & Research, Coimbatore, Tamil Nadu 641004, India
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Suzuki H, Yasuda S, Htun Y, Aye NSS, Oo H, Oo TP, Htut ZL, Koyano K, Nakamura S, Kusaka T. Transcutaneous bilirubin-based screening reduces the need for blood exchange transfusion in Myanmar newborns: A single-center, retrospective study. Front Pediatr 2022; 10:947066. [PMID: 36147809 PMCID: PMC9485474 DOI: 10.3389/fped.2022.947066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Neonatal hyperbilirubinemia is a significant health problem in Myanmar. We introduced transcutaneous bilirubin (TcB) measurements in 2017 and developed an hour-specific TcB nomogram for early detection and treatment of hyperbilirubinemia in Myanmar neonates. This study aimed to evaluate whether our screening method for hyperbilirubinemia decreased the requirement of blood exchange therapy (ET). METHODS This retrospective cohort study was conducted at the Central Women's Hospital, Yangon. Two groups were included as follows: group 1 (control group; comprising infants born in 2016 and screened on the basis of Kramer's rule), and group 2 (intervention group; comprising infants born in 2019 and screened by TcB measurement using a nomogram). The number of ETs was analyzed based on causes of hyperbilirubinemia and number of days after birth. RESULTS Groups 1 and 2 comprised 12,968 and 10,090 infants, respectively. Forty-six and two infants in Groups 1 and 2, respectively, required an ET. The odds ratio for ET was 18.0 (Group 1 to Group 2; 95% confidence interval [CI]: 4.8-67.1; p = 0.000). Serum bilirubin values at the time ET was administered were significantly higher in Group 1 than those in Group 2 (median: 23.0 and 16.8, respectively). CONCLUSION The management of hyperbilirubinemia using our screening method (TcB Nomogram) can effectively reduce the need for ET in neonates in Myanmar.
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Affiliation(s)
- Hiromi Suzuki
- Department of Hygiene, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Saneyuki Yasuda
- Post Graduate Clinical Education Center, Kagawa University Hospital, Kagawa, Japan
| | - Yinmon Htun
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Nant San San Aye
- Neonatal Intensive Care Unit, Central Women's Hospital, Yangon, Myanmar
| | - Hnin Oo
- Neonatal Intensive Care Unit, Central Women's Hospital, Yangon, Myanmar
| | - Thet Paing Oo
- Poole Hospital, University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | - Zaw Lin Htut
- Neonatal Intensive Care Unit, Central Women's Hospital, Yangon, Myanmar
| | - Kosuke Koyano
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Shinji Nakamura
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Kusaka
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Lee HY, Ithnin A, Azma RZ, Othman A, Salvador A, Cheah FC. Glucose-6-Phosphate Dehydrogenase Deficiency and Neonatal Hyperbilirubinemia: Insights on Pathophysiology, Diagnosis, and Gene Variants in Disease Heterogeneity. Front Pediatr 2022; 10:875877. [PMID: 35685917 PMCID: PMC9170901 DOI: 10.3389/fped.2022.875877] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/02/2022] [Indexed: 01/04/2023] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a prevalent condition worldwide and is caused by loss-of-function mutations in the G6PD gene. Individuals with deficiency are more susceptible to oxidative stress which leads to the classical, acute hemolytic anemia (favism). However, G6PD deficiency in newborn infants presents with an increased risk of hyperbilirubinemia, that may rapidly escalate to result in bilirubin induced neurologic dysfunction (BIND). Often with no overt signs of hemolysis, G6PD deficiency in the neonatal period appears to be different in the pathophysiology from favism. This review discusses and compares the mechanistic pathways involved in these two clinical presentations of this enzyme disorder. In contrast to the membrane disruption of red blood cells and Heinz bodies formation in favism, G6PD deficiency causing jaundice is perhaps attributed to the disruption of oxidant-antioxidant balance, impaired recycling of peroxiredoxin 2, thus affecting bilirubin clearance. Screening for G6PD deficiency and close monitoring of affected infants are important aspects in neonatal care to prevent kernicterus, a permanent and devastating neurological damage. WHO recommends screening for G6PD activity of all infants in countries with high prevalence of this deficiency. The traditional fluorescent spot test as a screening tool, although low in cost, misses a significant proportion of cases with moderate deficiency or the partially deficient, heterozygote females. Some newer and emerging laboratory tests and diagnostic methods will be discussed while developments in genomics and proteomics contribute to increasing studies that spatially profile genetic mutations within the protein structure that could predict their functional and structural effects. In this review, several known variants of G6PD are highlighted based on the location of the mutation and amino acid replacement. These could provide insights on why some variants may cause a higher degree of phenotypic severity compared to others. Further studies are needed to elucidate the predisposition of some variants toward certain clinical manifestations, particularly neonatal hyperbilirubinemia, and how some variants increase in severity when co-inherited with other blood- or bilirubin-related genetic disorders.
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Affiliation(s)
- Heng Yang Lee
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Azlin Ithnin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Raja Zahratul Azma
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Ainoon Othman
- Department of Medical Science II, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Armindo Salvador
- CNC-Centre for Neuroscience Cell Biology, University of Coimbra, Coimbra, Portugal.,Coimbra Chemistry Centre-Institute of Molecular Sciences (CQC-IMS), University of Coimbra, Coimbra, Portugal.,Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
| | - Fook Choe Cheah
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
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Itoh S, Okada H, Koyano K, Nakamura S, Konishi Y, Iwase T, Kusaka T. Fetal and neonatal bilirubin metabolism. Front Pediatr 2022; 10:1002408. [PMID: 36824297 PMCID: PMC9941200 DOI: 10.3389/fped.2022.1002408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/30/2022] [Indexed: 02/10/2023] Open
Abstract
Human fetal and neonatal bilirubin metabolism is centered on 4Z,15Z-bilirubin IXα (BR) due to the extremely low BR conjugating capacity of the liver. BR is a unique, highly lipophilic substance with physiological and toxic effects in the cell membranes of organs and body tissues. The fetus excretes BR through the placenta to the maternal circulation. After birth, BR is thought to act as an antioxidant against the increase in reactive oxygen species caused by the rapid increase in oxygen concentration during the adaptation process from in amniotic fluid to in air. However, bilirubin encephalopathy is a toxic effect of bilirubin. Due to the lipophilic nature of BR, it must be bound to a carrier to be distributed to various parts of the body by hydrophilic blood. This carrier of BR is human serum albumin (HSA). In humans, BR can be excreted efficiently after undergoing photochemical reactions upon high affinity binding to HSA. HSA also plays an important role in the prevention of bilirubin encephalopathy. This review focuses on the developmental and physiological role of bilirubin metabolism during the fetal and neonatal periods.
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Affiliation(s)
- Susumu Itoh
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hitoshi Okada
- Division of Analytical Technology, Department of Medical Technology, Kagawa Prefectural University of Health Sciences, Kagawa, Japan
| | - Kosuke Koyano
- Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Shinji Nakamura
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yukihiko Konishi
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Iwase
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Kusaka
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Akagawa S, Akagawa Y, Yamanouchi S, Teramoto Y, Yasuda M, Fujishiro S, Kino J, Hirabayashi M, Mine K, Kimata T, Hashiyada M, Akane A, Tsuji S, Kaneko K. Association of Neonatal Jaundice with Gut Dysbiosis Characterized by Decreased Bifidobacteriales. Metabolites 2021; 11:metabo11120887. [PMID: 34940645 PMCID: PMC8705620 DOI: 10.3390/metabo11120887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Neonatal jaundice, caused by excess serum bilirubin levels, is a common condition in neonates. Imbalance in the gut microbiota is believed to play a role in the development of neonatal jaundice. Thus, we aimed to reveal the gut microbiota characteristics in neonates with jaundice. 16S rRNA gene sequencing was performed on stool samples collected on day 4 from 26 neonates with jaundice (serum total bilirubin > 15.0 mg/dL) and 17 neonates without jaundice (total serum bilirubin < 10.0 mg/dL). All neonates were born full term, with normal weight, by vaginal delivery, and were breastfed. Neonates who were administered antibiotics, had serum direct bilirubin levels above 1 mg/dL, or had conditions possibly leading to hemolytic anemia were excluded. The median serum bilirubin was 16.0 mg/dL (interquartile range: 15.5-16.8) and 7.4 mg/dL (interquartile range: 6.8-8.3) for the jaundice and non-jaundice groups, respectively. There was no difference in the alpha diversity indices. Meanwhile, in the jaundice group, linear discriminant analysis effect size revealed that Bifidobacteriales were decreased at the order level, while Enterococcaceae were increased and Bifidobacteriaceae were decreased at the family level. Bifidobacteriaceae may act preventatively because of their suppressive effect on beta-glucuronidase, leading to accelerated deconjugation of conjugated bilirubin in the intestine. In summary, neonates with jaundice had dysbiosis characterized by a decreased abundance of Bifidobacteriales.
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Affiliation(s)
- Shohei Akagawa
- Department of Pediatrics, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (S.A.); (Y.A.); (S.Y.); (Y.T.); (M.Y.); (S.F.); (J.K.); (M.H.); (K.M.); (T.K.); (S.T.)
| | - Yuko Akagawa
- Department of Pediatrics, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (S.A.); (Y.A.); (S.Y.); (Y.T.); (M.Y.); (S.F.); (J.K.); (M.H.); (K.M.); (T.K.); (S.T.)
| | - Sohsaku Yamanouchi
- Department of Pediatrics, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (S.A.); (Y.A.); (S.Y.); (Y.T.); (M.Y.); (S.F.); (J.K.); (M.H.); (K.M.); (T.K.); (S.T.)
| | - Yoshiki Teramoto
- Department of Pediatrics, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (S.A.); (Y.A.); (S.Y.); (Y.T.); (M.Y.); (S.F.); (J.K.); (M.H.); (K.M.); (T.K.); (S.T.)
| | - Masahiro Yasuda
- Department of Pediatrics, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (S.A.); (Y.A.); (S.Y.); (Y.T.); (M.Y.); (S.F.); (J.K.); (M.H.); (K.M.); (T.K.); (S.T.)
| | - Sadayuki Fujishiro
- Department of Pediatrics, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (S.A.); (Y.A.); (S.Y.); (Y.T.); (M.Y.); (S.F.); (J.K.); (M.H.); (K.M.); (T.K.); (S.T.)
| | - Jiro Kino
- Department of Pediatrics, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (S.A.); (Y.A.); (S.Y.); (Y.T.); (M.Y.); (S.F.); (J.K.); (M.H.); (K.M.); (T.K.); (S.T.)
| | - Masato Hirabayashi
- Department of Pediatrics, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (S.A.); (Y.A.); (S.Y.); (Y.T.); (M.Y.); (S.F.); (J.K.); (M.H.); (K.M.); (T.K.); (S.T.)
| | - Kenji Mine
- Department of Pediatrics, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (S.A.); (Y.A.); (S.Y.); (Y.T.); (M.Y.); (S.F.); (J.K.); (M.H.); (K.M.); (T.K.); (S.T.)
| | - Takahisa Kimata
- Department of Pediatrics, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (S.A.); (Y.A.); (S.Y.); (Y.T.); (M.Y.); (S.F.); (J.K.); (M.H.); (K.M.); (T.K.); (S.T.)
| | - Masaki Hashiyada
- Department of Legal Medicine, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (M.H.); (A.A.)
| | - Atsushi Akane
- Department of Legal Medicine, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (M.H.); (A.A.)
| | - Shoji Tsuji
- Department of Pediatrics, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (S.A.); (Y.A.); (S.Y.); (Y.T.); (M.Y.); (S.F.); (J.K.); (M.H.); (K.M.); (T.K.); (S.T.)
| | - Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, Hirakata-shi, Osaka 573-1010, Japan; (S.A.); (Y.A.); (S.Y.); (Y.T.); (M.Y.); (S.F.); (J.K.); (M.H.); (K.M.); (T.K.); (S.T.)
- Correspondence: ; Tel.: +81-72-804-0101
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Franchinard L, Maisonneuve E, Friszer S, Toly Ndour C, Huguet-Jacquot S, Maurice P, Mailloux A, Cortey A, Jouannic JM. Perinatal risk factors associated with severity of haemolytic disease of the foetus and newborn due to Rhc maternal-foetal incompatibility: A retrospective cohort study. Vox Sang 2021; 117:570-579. [PMID: 34743337 DOI: 10.1111/vox.13215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Anti-c is the third red blood cell antibody responsible for haemolytic disease of the foetus and newborn (HDFN) requiring intrauterine transfusion. We aimed to identify risk factors associated with HDFN and severe HDFN due to Rhc maternal-foetal incompatibility. MATERIALS AND METHODS A retrospective cohort study was conducted in Paris and the surrounding area (France), between 2013 and 2015. We included mothers and their children managed by the National Reference Centre in Perinatal Hemobiology for alloimmunization and maternal-foetal incompatibility for the Rhc antigen (N = 121). We conducted bivariate analyses to assess a relationship between perinatal factors (e.g., titre and concentration of anti-c antibodies, direct antiglobulin test) and HDFN, its severity and duration. RESULTS The incidence of HDFN was 30% (n = 36), including 11% of severe HDFN (n = 13). Seven percent (n = 9) of neonates received at least one transfusion during the first week and 21% (n = 26) after this period until 3 weeks of life. During pregnancy, a concentration ≥7.5 IU/ml and a titre ≥4 and above were associated with HDFN and severe HDFN (p < 0.05). At birth, the high intensity of the quantitative direct antiglobulin test was associated with HDFN and severe HDFN (p < 0.05). A concentration ≥15 IU/ml is the best factor (area under curve [AUC] = 0.78) in predicting HDFN, followed by a titre ≥8 (AUC = 0.76). CONCLUSION Anti-c alloimmunization causes neonatal anaemia, which is often belated. Paediatricians have to be aware of these risk factors and organize prolonged monitoring of neonates.
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Affiliation(s)
- Loriane Franchinard
- Department of Fetal Medicine, Sorbonne University, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Unité Fonctionnelle Clinique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Armand Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Emeline Maisonneuve
- Department of Fetal Medicine, Sorbonne University, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Unité Fonctionnelle Clinique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Armand Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Stéphanie Friszer
- Department of Fetal Medicine, Sorbonne University, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Toly Ndour
- Unité Fonctionnelle Biologique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Stéphanie Huguet-Jacquot
- Unité Fonctionnelle Biologique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Paul Maurice
- Department of Fetal Medicine, Sorbonne University, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Unité Fonctionnelle Clinique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Armand Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Agnès Mailloux
- Unité Fonctionnelle Biologique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Anne Cortey
- Unité Fonctionnelle Clinique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Armand Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jean-Marie Jouannic
- Department of Fetal Medicine, Sorbonne University, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Unité Fonctionnelle Clinique, Centre National de Référence en Hémobiologie Périnatale (CNRHP), Armand Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
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Abstract
Insufficient milk intake in breastfed neonates is common, frequently missed, and causes preventable hospitalizations for jaundice/hyperbilirubinemia, hypernatremia/dehydration, and hypoglycemia - accounting for most U.S. neonatal readmissions. These and other consequences of neonatal starvation and deprivation may substantially contribute to fully preventable morbidity and mortality in previously healthy neonates worldwide. Previous advanced civilizations recognized this problem of breastfeeding insufficiencies and had an infrastructure to solve it: Wetnursing, shared nursing, and prelacteal feeding traditions used to be well-organized and widespread. Modern societies accidentally destroyed that infrastructure. Then, modern reformers missing a few generations of direct knowledge transmission about safe breastfeeding invented a new, historically anomalous conception of breastfeeding defined in terms of exclusivity. As that new intervention has become increasingly widespread, so too have researchers widely reported associated possible harms of the longer neonatal starvation/deprivation and later infant under-nutrition periods that it creates when breastfeeding is insufficient. Early insufficient nutrition/hydration has possible long-term effects including neurodevelopmental consequences such as attention deficit hyperactivity disorder, autism, cerebral palsy, cognitive and developmental delay, epilepsy, hearing impairment, kernicterus, language disorder, mood disorders, lower IQ, and specific learning disorder. Current early infant feeding guidelines conflict with the available evidence. Recent reform efforts have tended to focus on using more technology and measurement to harm fewer neonates instead of proposing the indicated paradigm shift in early infant feeding to prevent more harm. The scientific evidence is already sufficient to mandate application of the precautionary principle to feed neonates early, adequate, and often milk before mothers' milk comes in and whenever signs of hunger persist, mitigating possible risks including death or disability. In most contexts, the formula is the best supplementary milk for infants at risk from breastfeeding insufficiencies. National-level reviews of scientific evidence, health policy, and research methods and ethics are needed to initiate the early infant feeding paradigm shift that the data already support. Policy experiments and related legislative initiatives might also contribute to the shift, as insurers might decline or be required by law to decline reimbursing hospitals for costs of this type of preventable hospitalization, which otherwise generates profit.
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Affiliation(s)
- Vera K Wilde
- Methods, Ethics, and Technology, Independent Researcher, Berlin, DEU
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Tunç G, Uzun Çiçek A, Kılıçbay F. Risk of autism spectrum disorder in children with a history of hospitalization for neonatal jaundice. Turk J Med Sci 2021; 51:2657-2665. [PMID: 34344142 PMCID: PMC8742497 DOI: 10.3906/sag-2103-263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited research has focused explicitly on the association between neonatal jaundice and autism spectrum disorder (ASD), and inconclusive evidence exists in the literature within this framework. This study aimed specifically to investigate whether neonatal jaundice is a potential risk factor for ASD and whether there is a connection between the types of neonatal jaundice and the severity of ASD. METHODS This study involved 119 children with ASD [90 males (75.6%), 29 females (24.4%), mean age: 45.39 ± 11.29 months] and 133 healthy controls [100 males (75.2%), 33 females (24.8%), mean age: 46.92 ± 11.42 months]. Psychiatric disorders were diagnosed through the Diagnostic and Statistical Manual of Mental Disorders criteria. Childhood Autism Rating Scale (CARS) was used to assess the screening and diagnosis of autism. A specially prepared personal information sheet was employed to investigate sociodemographic characteristics and birth and clinical histories. RESULTS The rate of the history of jaundice and pathological jaundice requiring hospitalization and phototherapy were significantly higher in the ASD group compared to the controls. CARS total score and the mean scores of nearly all items were statistically higher in children with a history of pathological jaundice than those with a history of physiological jaundice. DISCUSSION Neonatal jaundice, depends on its severity, seems to be one of the possible biological factors associated with subsequent development of and the severity of ASD. Establishing a causal relationship between neonatal jaundice and ASD by more comprehensive studies may contribute to alleviating of the severity of ASD for individuals at risk.
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Affiliation(s)
- Gaffari Tunç
- Department of Neonatology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - Ayla Uzun Çiçek
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - Fatih Kılıçbay
- Department of Neonatology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
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46
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Ho SR, Lin YC, Chen CN. The Impact of Phototherapy on the Accuracy of Transcutaneous Bilirubin Measurements in Neonates: Optimal Measurement Site and Timing. Diagnostics (Basel) 2021; 11:diagnostics11091729. [PMID: 34574069 PMCID: PMC8466921 DOI: 10.3390/diagnostics11091729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/02/2021] [Accepted: 09/17/2021] [Indexed: 11/21/2022] Open
Abstract
Transcutaneous bilirubinometer devices are widely applied to assess neonatal hyperbilirubinemia. However, the optimal skin site and timing of transcutaneous bilirubin (TCB) measurements for the strongest correlation with total serum bilirubin (TSB) levels after phototherapy are still unclear. We conducted a retrospective observational study evaluating the correlation of TCB and TSB levels in neonates postphototherapy. The TCB measurements on the forehead and mid-sternum at 0 and 30 min postphototherapy were assessed by using a JM-103 bilirubinometer. Paired TCB and TSB measurements were assessed by Pearson correlation and Bland–Altman plots. We analyzed 40 neonates with 96 TSB and 384 TCB measurements. The TSB level correlated moderately with the forehead TCB level at 30 min postphototherapy (r = 0.65) and less strongly with the midsternum TCB level at 0 min postphototherapy (r = 0.52). The forehead at 30 min after cessation of phototherapy was the best time point and location of TCB measurement for the assessment of neonatal jaundice status. The reliability of TCB measurements varied across skin sites and durations after phototherapy. The effectiveness of TCB measurement to assess neonatal hyperbilirubinemia is much better on covered skin areas (foreheads) 30 min postphototherapy. The appropriate application of transcutaneous bilirubinometers could aid in clinical practice and avoid unnecessary management.
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Affiliation(s)
- Shau-Ru Ho
- Department of Pediatrics, National Taiwan University Hospital Hsin-chu Branch, Hsin-chu 30059, Taiwan; (S.-R.H.); (Y.-C.L.)
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei 10041, Taiwan
| | - Yu-Chen Lin
- Department of Pediatrics, National Taiwan University Hospital Hsin-chu Branch, Hsin-chu 30059, Taiwan; (S.-R.H.); (Y.-C.L.)
- Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei 10041, Taiwan
| | - Chi-Nien Chen
- Department of Pediatrics, National Taiwan University Hospital Hsin-chu Branch, Hsin-chu 30059, Taiwan; (S.-R.H.); (Y.-C.L.)
- Department of Pediatrics, National Taiwan University College of Medicine, Taipei 10051, Taiwan
- Correspondence: ; Tel.: +886-3-532-6151 (ext. 2304)
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Ichimura S, Kakita H, Asai S, Mori M, Takeshita S, Ueda H, Kondo T, Ohashi W, Okumura A, Yamada Y. Acetaminophen elevates unbound bilirubin levels by the glucose oxidase-peroxidase method. Pediatr Int 2021; 63:1069-1074. [PMID: 33464662 DOI: 10.1111/ped.14608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/17/2020] [Accepted: 01/14/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acetaminophen is widely administered to neonates but its effect on unbound bilirubin (UB) levels remains unclear. The aim of this study was to clarify whether administration of acetaminophen is related to an elevation of UB levels. METHOD Infants with a birthweight of ˂1,500 g admitted to our neonatal intensive care unit between January 2017 and April 2020 were retrospectively reviewed. Seventy-one infants were enrolled, five of whom had received acetaminophen. Clinical data were analyzed when the highest UB value (UB peak) in each infant was recorded. Demographic data and information on treatment within the 24 h before the UB peak were also collected. UB was determined by the glucose oxidase-peroxidase (GOD-POD) method. Infants were categorized according to the presence or absence of acetaminophen administration (acetaminophen and no acetaminophen groups) within 24 h of the UB peak. The relationship between UB values and various clinical variables was then compared. RESULTS Both the peak UB value and the ratio of gastrointestinal disease were higher in the acetaminophen group than in the no acetaminophen group. Univariate analysis revealed that a total of seven variables were potentially correlated with UB peak values (P < 0.10). Multivariate analysis showed that acetaminophen and direct bilirubin were independently associated with UB peak values. CONCLUSION Our study suggests that administration of acetaminophen is related to higher UB levels by the GOD-POD method. UB values measured by the GOD-POD method should not be used in infants treated with acetaminophen for evaluation of bilirubin neurotoxicity avoidance.
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Affiliation(s)
- Shintaro Ichimura
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Aichi, Japan
| | - Hiroki Kakita
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Aichi, Japan
| | - Shimpei Asai
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Aichi, Japan
| | - Mari Mori
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Aichi, Japan
| | - Satoru Takeshita
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Aichi, Japan
| | - Hiroko Ueda
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Aichi, Japan
| | - Tomoko Kondo
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Aichi, Japan
| | - Wataru Ohashi
- Department of Biostatistics, Clinical Research Center, Aichi Medical University, Aichi, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Yasumasa Yamada
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Aichi, Japan
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Abolurin OO, Adekoya AO, Ogunlesi TA, Ajibola ED, Adekanye TE, Adeniran EM. Pattern of serum bilirubin changes following double volume exchange blood transfusion in neonates at a tertiary health facility in Nigeria. Pan Afr Med J 2021; 39:60. [PMID: 34422183 PMCID: PMC8363959 DOI: 10.11604/pamj.2021.39.60.26408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/12/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction exchange blood transfusion (EBT) is a form of massive transfusion useful in rapidly reducing serum bilirubin levels, but serum bilirubin levels frequently rebound within hours of completing the procedure, due to equilibration of extravascular bilirubin as well as on-going hemolysis. The study was carried out to determine the pattern of reduction in serum bilirubin levels following EBT among neonates with severe hyperbilirubinemia, as well as the factors contributing to this pattern, so as to establish evidence-based expectations following EBT. Methods a retrospective descriptive study covering a two-year period in a Nigerian tertiary hospital. Details of the EBT procedures, including serial serum bilirubin levels, were obtained from the hospital records of all newborn babies who had double volume EBT done for severe hyperbilirubinaemia during the study period. Data was analyzed using the statistical software SPSS version 21.0. Results the mean total serum bilirubin (TSB) before EBT in the 36 babies was 17.9 ± 6.3 mg/dl. The mean percentage decrease in TSB immediately following EBT was 44.3 ± 10.2%. Six hours after EBT, TSB levels had increased from the immediate post-EBT values by an average of 57.5 ± 32.2%. Twenty-four hours after the procedure, TSB values in most (87.1%) cases were still higher than the immediate post-EBT values, but lower than the pre-EBT values. Post-EBT anemia was recorded among 33.3% of the babies. Conclusion EBT is effective in rapidly reducing serum bilirubin levels and preventing acute bilirubin encephalopathy in neonates with severe hyperbilirubinemia, despite the rebound increase that occurs in TSB values after the procedure.
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Affiliation(s)
| | | | - Tinuade Adetutu Ogunlesi
- Department of Paediatrics, Babcock University Teaching Hospital, Ilishan, Ogun State, Nigeria.,Department of Paediatrics, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria
| | | | | | - Eniola Mary Adeniran
- Nursing Services Unit, Department of Paediatrics, Babcock University Teaching Hospital, Ilishan, Ogun State, Nigeria
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Rezaie M, Gholami R, Jafari M, Haghighinejad H. Evaluating the effect of ursodeoxycholic acid on total bilirubin of neonates with glucose-6-phosphate dehydrogenase deficiency complicated by indirect hyperbilirubinaemia. J Paediatr Child Health 2021; 57:1175-1181. [PMID: 33682983 DOI: 10.1111/jpc.15411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/10/2021] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to investigate the effect of adding ursodeoxycholic acid (UDCA) to phototherapy in neonates with glucose-6-phosphate dehydrogenase (G6PD) deficiency and hyperbilirubinaemia. G6PD deficiency is a common cause of severe hyperbilirubinaemia in neonates. METHODS This study was a triple blind, clinical trial study of 40 neonates with G6PD deficiency and hyperbilirubinaemia who admitted for phototherapy in hospitals affiliated to the University of Medical Sciences. The treatment group (n = 20) received UDCA 10 mg/kg (2 cc/kg) daily divided into 2 doses every 12 h. The control group (n = 20) received the same volume of placebo syrup. The drug and placebo treatments were continued until the bilirubin level dropped below 171 μmol/L. Both the control and treatment group received continuous phototherapy. Independent sample t-test, survival analysis and logrank test were used to statistically analyse the results. RESULTS The mean total bilirubin level was 231.9 ± 18.8 μmol/L and 184.3 ± 18.6 μmol/L in the control and intervention group respectively, 24 h after drug administration and 209.7 ± 19.3 μmol/L and 157.4 ± 16.4 μmol/L, respectively, 48 h after intervention (P < 0.05). The median length of hospitalisation in the treatment group was approximately 1 day lower than the control group (logrank test P value: <0.001). CONCLUSION The study showed that the addition of UDCA to phototherapy accelerates the reduction of total bilirubin level in neonates with G6PD deficiency and can reduce the duration of hospitalisation.
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Affiliation(s)
- Mehrdad Rezaie
- Department of Family Medicine and Department of Pediatric Medicine and Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roya Gholami
- Department of Family medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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50
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Routray SS, Behera R, Mallick B, Acharya D, Sahoo JP, Kanungo GN, Pati B. The Spectrum of Hemolytic Disease of the Newborn: Evaluating the Etiology of Unconjugated Hyperbilirubinemia Among Neonates Pertinent to Immunohematological Workup. Cureus 2021; 13:e16940. [PMID: 34513509 PMCID: PMC8418802 DOI: 10.7759/cureus.16940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective The exact burden of hemolytic disease of the newborn (HDN) attributed to neonatal unconjugated hyperbilirubinemia (NUH) in developing nations is still unclear. Still, anti-D is reported to be the most common cause of HDN in India. ABO incompatibility has emerged as a leading cause of exchange transfusion (ET) in many countries. But many centers in our country rely on direct antiglobulin test (DAT) as a screening tool to evaluate immunological causes, whereas advanced immunohematological workup like antibody screening, identification, and elution tests are also required. Early identification of implicated antibodies resulting in HDN can aid in the proper selection of blood units when ET is indicated, and hence also in managing the subsequent pregnancy. This study focused on determining the causes of neonatal hyperbilirubinemia (NH), especially with respect to immunohematological evaluation. This cross-sectional study was conducted on 240 neonates requiring neonatal intensive care unit (NICU) support for NUH at a tertiary care hospital. Materials and methods Demographic data, along with detailed history pertaining to the cause of hyperbilirubinemia, was collected. Clinical and laboratory evaluation and complete immunohematological work including DAT, heat elution, antibody screening, antibody identification, and Rh Kell phenotyping were performed from neonate blood samples. Data were analyzed using SPSS Statistics version 19 (IBM Corp., Armonk, NY). Results Pathological jaundice was more common (62.1%) than physiological jaundice (37.9%). The various pathological causes identified were HDN (42.6%), sepsis (12%), cephalohematoma (5.4%), and idiopathic (1.7%). Among HDN cases, ABO incompatibility (39.2%) was the most prevalent cause, followed by Rh HDN and G6PD deficiency (1.7% each). DAT was positive in only 14 cases out of 94 ABO-incompatible cases. Elution revealed antibodies in four DAT-negative neonates with ABO incompatibility and more specificity to the OA setting. DAT was positive with 100% sensitivity in Rh HDN cases (n=4). Elution demonstrated the presence of anti-D (n=2), anti-D + anti-C (n=1) and anti-E (n=1), confirming Rh HDN. DAT strength was found to be significantly associated with hemoglobin (Hb) level (p=0.048). The majority of cases were treated with phototherapy only (94.1%), and 10 cases received both ET and phototherapy. Four neonates' condition improved without any intervention. Conclusion This study highlighted the shift in the trend from Rh HDN to ABO incompatibility as the cause of hemolytic jaundice in NICU neonates. Elution tests can aid in the diagnosis of DAT-negative ABO-incompatible hemolytic anemia. Early diagnosis, along with timely intervention and appropriate measures, can prevent neonatal morbidity and mortality. Negative DAT does not rule out HDN. Sensitive techniques like elution must be used in the presence of clinical suspicion.
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Affiliation(s)
- Suman S Routray
- Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Rachita Behera
- Department of Transfusion Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Bhabagrahi Mallick
- Department of Pediatrics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Devi Acharya
- Department of Transfusion Medicine, AMRI Hospitals, Bhubaneswar, IND
| | - Jagdish P Sahoo
- Department of Neonatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Girija N Kanungo
- Department of Transfusion Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Bibudhendu Pati
- Department of Transfusion Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
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