Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 70
Filtrar
Más filtros

País/Región como asunto
Tipo del documento
Intervalo de año de publicación
1.
J Pediatr ; 226: 285-288, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32526232

RESUMEN

We measured end-tidal CO levels in 50 jaundiced newborns readmitted for phototherapy at age 54-244 hours. The median end-tidal CO level was 1.55 ppm, suggesting that hemolysis is not the primary contributor to the hyperbilirubinemia in many readmitted newborns.


Asunto(s)
Monóxido de Carbono/sangre , Hemo/metabolismo , Hemólisis , Ictericia Neonatal/etiología , Biomarcadores/sangre , Femenino , Humanos , Recién Nacido , Ictericia Neonatal/sangre , Ictericia Neonatal/patología , Ictericia Neonatal/terapia , Masculino , Readmisión del Paciente , Fototerapia
2.
Acta Paediatr ; 107(8): 1350-1356, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29532503

RESUMEN

AIM: To identify neonates at risk of haemolytic hyperbilirubinaemia through near-concurrent measurements of total serum/plasma bilirubin (TB) or transcutaneous bilirubin (TcB) and end-tidal breath carbon monoxide (CO), corrected for ambient CO (ETCOc), an index of bilirubin production and haemolysis. METHODS: Paired TB/TcB (mg/dL) and ETCOc (ppm) measurements were obtained in newborns (n = 283) at 20 to <60 hours of age in five nurseries. TB/TcB values were assigned TB/TcB percentile risk values using the Bhutani hour-specific nomogram. In infants having two serial TB/TcB measurements (n = 76), TB rate of rise (ROR, mg/dL/h) was calculated. RESULTS: For the entire cohort (n = 283), 67.1% and 32.9% had TB/TcB<75th and ≥75th percentile, respectively. TB/TcB (5.79 ± 1.84 vs 9.14 ± 2.25 mg/dL) and ETCOc (1.61 ± 0.45 vs 2.02 ± 1.35 ppm, p = 0.0002) were different between the groups. About 36.6% of infants with TB/TcB ≥75th percentile had ETCOc ≥ 2.0 ppm. In the subcohort of infants with serial TB/TcB measurements (n = 76), 44.7% and 55.3% had TB/TcB<75th and ≥75th percentile, respectively. TB/TcB (5.28 ± 1.97 vs 9.53 ± 2.78 mg/dL), ETCOc (1.72 ± 0.48 vs 2.38 ± 1.89 ppm, p = 0.05) and TB ROR (0.011 ± 0.440 vs 0.172 ± 0.471 mg/dL/h) were different between the groups. CONCLUSION: The combined use of TB/TcB percentile risk assessments and ETCOc measurements can identify infants with haemolytic hyperbilirubinaemia. The addition of TB ROR can identify those infants with elimination disorders.


Asunto(s)
Bilirrubina/sangre , Monóxido de Carbono/análisis , Hiperbilirrubinemia Neonatal/diagnóstico , Hiperbilirrubinemia Neonatal/terapia , Tamizaje Neonatal/métodos , Fototerapia/métodos , Análisis de Varianza , Estudios de Cohortes , Femenino , Edad Gestacional , Hemólisis/fisiología , Humanos , Recién Nacido , Masculino , Casas Cuna , Valor Predictivo de las Pruebas , Estudios Prospectivos , Medición de Riesgo , Volumen de Ventilación Pulmonar , Resultado del Tratamiento
6.
J Pediatr ; 172: 212-214.e1, 2016 05.
Artículo en Inglés | MEDLINE | ID: mdl-26898809

RESUMEN

In pediatric office practices, we compared transcutaneous bilirubin levels in 689 newborns, age 3-10 days, with and without conjunctival icterus. In this age range, and in the absence of other clinical or laboratory indications, the presence of conjunctival icterus does not imply the need to measure the transcutaneous bilirubin or serum bilirubin level, but the absence of conjunctival icterus helps to rule out significant hyperbilirubinemia.


Asunto(s)
Enfermedades de la Conjuntiva/diagnóstico , Ictericia Neonatal/diagnóstico , Bilirrubina/sangre , Humanos , Hiperbilirrubinemia/sangre , Recién Nacido , Ictericia Neonatal/sangre , Pacientes Ambulatorios
8.
J Pediatr ; 214: 238-241, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31655699
9.
J Pediatr ; 164(6): 1416-20, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24679610

RESUMEN

OBJECTIVE: To define normal levels of glucose-6-phosphate dehydrogenase (G6PD) activity in a population of North American white newborns. STUDY DESIGN: We studied 2 white newborn populations, ≥35 weeks of gestation. In the retrospective study, G6PD activity was measured (on clinical indication) in 242 newborns aged ≤7 days. In the prospective study, we measured G6PD activity in umbilical cord blood samples in 347 newborns and daily transcutaneous bilirubin levels in these infants. RESULTS: The mean G6PD activity level was 12.3 ± 3.1 units per gram hemoglobin (U/gHb) in the retrospective population and 13.3 ± 1.8 U/gHb in the prospective population, and there was no difference between males and females. The distribution of values suggested that infants with activity levels <7 U/gHb should be considered deficient and 8 infants (6 males and 2 females), all in the retrospective population had such levels. CONCLUSIONS: As in other ethnic populations, the mean G6PD activity in white newborn infants is substantially greater than that of white adults. The lower limits of normal are also similar to those of other newborn ethnic groups and of adults. The diagnosis of G6PD deficiency should be considered in any white infant whose G6PD activity is <7 U/gHb.


Asunto(s)
Deficiencia de Glucosafosfato Deshidrogenasa/diagnóstico , Deficiencia de Glucosafosfato Deshidrogenasa/etnología , Glucosafosfato Deshidrogenasa/sangre , Tamizaje Neonatal/métodos , Población Blanca , Bilirrubina/sangre , Femenino , Humanos , Recién Nacido , Masculino , Estudios Prospectivos , Valores de Referencia , Estudios Retrospectivos , Sensibilidad y Especificidad
12.
J Perinatol ; 42(6): 695-701, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35145210

RESUMEN

A review of the literature demonstrates that severe total hyperbilirubinemia (total serum bilirubin ≥ 20 mg/dL [340 µmol/L]) in some cholestatic term (≥37 weeks) and late-preterm (≥340/7-366/7 weeks) gestation neonates poses a risk for bilirubin-induced brain damage. When the direct bilirubin fraction is <50% of the total serum bilirubin this risk is associated with the total serum bilirubin alone and treatment decisions should be based on the total serum bilirubin. On the other hand, there are limited data on the risk of bilirubin-induced brain damage in the neonate with severe total hyperbilirubinemia and a direct bilirubin fraction that is equal to or exceeds 50% of the total serum bilirubin. When this rare combination occurs, efforts to keep the indirect bilirubin fraction from reaching severe levels might, nevertheless, be prudent.


Asunto(s)
Colestasis , Hiperbilirrubinemia Neonatal , Bilirrubina , Colestasis/complicaciones , Colestasis/terapia , Humanos , Hiperbilirrubinemia/terapia , Hiperbilirrubinemia Neonatal/terapia , Recién Nacido
13.
Acta Paediatr ; 105(12): e567, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27657925
14.
J Perinatol ; 41(4): 873-878, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33398058

RESUMEN

BACKGROUND AND OBJECTIVE: Due to selection bias and other issues, the only available serum bilirubin-based nomogram does not reflect the natural history of early neonatal bilirubinemia. Our objective was to obtain a global picture of the natural history of early post-natal bilirubin trajectories. STUDY DESIGN: We pooled readings from 19 published transcutaneous bilirubin nomogram reports including many newborns at multiple sites. We constructed a universal transcutaneous bilirubin nomogram which included the 25th, 50th, 75th, and 95th percentiles from 12 to 120 h. RESULTS: The global transcutaneous bilirubin nomogram included >119,000 readings from 44,392 apparently normal, predominantly breastfed newborns ≥35 weeks gestation. The pooled transcutaneous bilirubin trajectories increased during the first 3 post-natal days, and peaked or plateaued between the 3rd and 4th days. CONCLUSIONS: We provide the first globally derived transcutaneous bilirubin nomogram that reflects the natural history of early neonatal bilirubinemia in neonates ≥35 weeks gestation.


Asunto(s)
Hiperbilirrubinemia Neonatal , Tamizaje Neonatal , Bilirrubina , Edad Gestacional , Humanos , Hiperbilirrubinemia Neonatal/diagnóstico , Recién Nacido , Nomogramas
16.
J Perinatol ; 40(2): 180-193, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31420582

RESUMEN

A breakthrough discovery 60 years ago by Cremer et al. has since changed the way we treat infants with hyperbilirubinemia and saved the lives of millions from death and disabilities. "Photobiology" has evolved by inquiry of diverse light sources: fluorescent tubes (wavelength range of 400-520 nm; halogen spotlights that emit circular footprints of light; fiberoptic pads/blankets (mostly, 400-550 nm range) that can be placed in direct contact with skin; and the current narrow-band blue light-emitting diode (LED) light (450-470 nm), which overlaps the peak absorption wavelength (458 nm) for bilirubin photoisomerization. Excessive bombardment with photons has raised concerns for oxidative stress in very low birthweight versus term infants treated aggressively with phototherapy. Increased emphasis on prescribing phototherapy as a "drug" that is dosed cautiously and judiciously is needed. In this historical review, we chronicled the basic to the neurotoxic components of severe neonatal hyperbilirubinemia and the use of standardized interventions.


Asunto(s)
Ictericia Neonatal/terapia , Fototerapia , Historia del Siglo XV , Historia del Siglo XVIII , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Hiperbilirrubinemia Neonatal/historia , Hiperbilirrubinemia Neonatal/terapia , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/terapia , Recién Nacido de muy Bajo Peso , Ictericia Neonatal/historia , Fototerapia/efectos adversos , Fototerapia/instrumentación , Control de Calidad
18.
J Pediatr Surg ; 54(9): 1800-1803, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30905416

RESUMEN

PURPOSE: To examine what proportion of caregivers, if given a choice, would choose medical versus surgical treatment of appendicitis and what factors would be important in their decision. METHODS: A survey was devised and given to the caregivers of children presenting to the pediatrician for a routine visit in community and academic pediatric clinics. The survey presented a summary of outcomes after medical (non-operative) and surgical treatment of uncomplicated appendicitis. Participants were then asked to choose medical versus surgical treatment if their child were to develop appendicitis. They were also asked to rate the importance of certain factors in their decision -1 being "not important" and 5 being "very important". RESULTS: Four hundred surveys were distributed with an 86.2% (345/400) response rate. Six percent (21/342) of respondents reported a history of appendicitis and 49.4% (168/340) reported having known someone who had appendicitis. The majority of respondents, 85.3% (284/333), were mothers. A minority of respondents, 41.7% (95% CI: 36.7, 47.0), chose medical treatment over surgery for appendicitis. There was no statistical difference in the proportion of mothers (41.6%) versus fathers who chose medical treatment (41.3%). Caregivers who chose medical treatment were more likely to rate time in hospital (p = .008) and time out of school (p = 05) as important in decision making when compared with those who chose surgery. Those who chose surgical treatment were more likely to rate risk of recurrent appendicitis (p < .001) as important to decision making. In the multivariate analysis, those who rated time in hospital as very important had more than twice the odds of choosing medical therapy (OR 2.20, p = 0.02) when compared with those who rated it as less important. Not knowing someone who has had appendicitis was significantly associated with choosing medical therapy when compared with those who do know someone who has had appendicitis, OR 2.3, p = .002. Rating pain as very important was also significantly associated with choosing medical therapy, when compared to those rating pain 1-3, OR 3.38, p = .03. CONCLUSIONS: In this survey of caregivers of children presenting for routine care, 41.7% would choose medical, or non-operative, therapy for their children with acute appendicitis. The risk of recurrence, time in hospital, and time out of school, pain, and knowing someone who has had appendicitis were all important factors that families may consider when making a decision. These data may be useful for surgeons counseling patients on which treatment to pursue.


Asunto(s)
Apendicectomía/estadística & datos numéricos , Apendicitis/terapia , Toma de Decisiones , Padres , Cuidadores/estadística & datos numéricos , Niño , Humanos , Recurrencia , Encuestas y Cuestionarios
19.
J Perinatol ; 38(9): 1246-1251, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29915375

RESUMEN

OBJECTIVE: To evaluate the frequency, age at phototherapy (PT) initiation, and duration of PT use in infants 230/7 to 346/7 weeks of gestation in two neonatal intensive care units (NICUs) over 4 time periods. STUDY DESIGN: We reviewed the charts of all infants born at 230/7-346/7 weeks of gestational age (GA) and admitted to the NICUs of two hospitals between January 2009 and September 2015. We calculated the proportion of infants who received PT and the total duration of PT exposure. RESULTS: Overall 2023 (81.8%) received PT, and PT use was inversely related to GA and birthweight. More infants received PT when GA was added as a criterion for initiating PT. The median duration (interquartile range (IQR)) of PT for all infants was 50 (27-85) h and in the lowest GA group was 74 (42-111) h. CONCLUSIONS: Recent US consensus guidelines appear to have led to an increased use of PT in our NICUs and studies from Norway indicate that we use PT considerably more frequently and for longer durations than do our Norwegian colleagues.


Asunto(s)
Hiperbilirrubinemia Neonatal/terapia , Fototerapia/métodos , Peso al Nacer , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Masculino , Michigan , Factores de Tiempo
20.
J Perinatol ; 38(11): 1532-1535, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30120424

RESUMEN

OBJECTIVES: Transcutaneous bilirubin measurements (TcBs) provide a noninvasive method for screening infants for hyperbilirubinemia and have been used extensively in term and late preterm newborns in well baby nurseries, offices, and outpatient clinics. Several studies have also demonstrated the utility of TcBs as a screening tool for infants > 28 weeks' gestation and their ability to reduce the need for blood sampling. The objectives of this study are to identify how often TcBs are used among California Newborn Intensive Care Units (NICUs) in preterm, late preterm and term infants, and other aspects of jaundice management. METHODS: We conducted a survey on TcB use and practices relating to jaundice management in 150 California NICUs between April and October 2016. RESULTS: TcB screening is routinely used in 28% (42/150) of NICUs. Only 7% (11/150) of NICUs use TcB in preterm infants < 28 weeks. Practice varied similarly across NICU levels of care. Among the subset of NICUs that responded to questions related to phototherapy and screening practices, prophylactic phototherapy was used in 38% (23/59) and 90% (55/61) screened for glucose-6-phosphate dehydrogenase deficiency based on race, ethnicity, and/or family history. CONCLUSION(S): Despite studies validating the accuracy of TcB in preterm infants > 28 weeks, only 28% of California NICUs routinely use TcB devices. TcB screening in infants < 28 weeks gestation is not widely used and no recommendation can be made in this regard until there is more experience with its application using a standardized protocol in these infants and on a large scale.


Asunto(s)
Bilirrubina/análisis , Recien Nacido Prematuro , Ictericia Neonatal/diagnóstico , Tamizaje Neonatal/instrumentación , Bilirrubina/sangre , California , Edad Gestacional , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Ictericia Neonatal/terapia , Tamizaje Neonatal/métodos , Fototerapia/efectos adversos , Factores de Tiempo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA