Determination of Serum Unbound Bilirubin and Its Clinical Application Value in Neonates / 中山大学学报(医学科学版)

ObjectiveTo investigate the clinical appropriateness and application value of the peroxidase （POD） method for the detection of unbound bilirubin （UB） in neonatal serum. MethodsHydrogen peroxide （0.33 mol/L） and three different final concentrations （0.019， 0.038， 0.075 μg/mL） of horseradish peroxidase （HRP） were added to standard bilirubin solution （1， 2， 3 μmol/L） to obtain a standardized HRP primary rate constant Kp. Then 25 μL of neonatal serum was diluted by 41.6 fold， and measured with 2.4 and 4.8 μg/mL HRP at 37 ℃ under the dark， to determine the UB concentration. The accuracy， precision， and stability of the methodology were validated. The clinical characteristics of 33 jaundiced neonates were collected， including total serum bilirubin （TSB）， indirect bilirubin （IDB）， albumin （ALB）， bilirubin to albumin molar ratio （BAMR）， etc. The experimental data were analyzed by Graphpad Prism 8.0. ResultsA standardized Kp of （7.20±1.08） mL·μg-1·min-1 was determined at pH 7.4±0.2， 37 ℃ in the dark. The HRP activity and UB concentrations remained stable at -20 ℃ for 3 weeks and a week， respectively. The mean intra-day and inter-day coefficients of variation of the serum samples with different UB concentrations were less than 10%. In this study， the UB concentrations in 33 jaundiced neonates （gestational age ≥35 weeks） were measured by the POD method in the range of （0.32～1.20） μg/dL， which was positively correlated with TSB， IDB and BAMR. Of the five infants whose UB concentrations measured more than 1 μg/dL， three received intensive phototherapy （60%）. ConclusionsThe POD method combined with a standard equipment spectrophotometer to detect serum UB concentrations in neonates is easy to operate， rapid to detect， and low cost. This method has good accuracy and precision， which is convenient for clinical implementation. Moreover， the measurement of serum UB may assist us in better management of neonatal jaundice in clinical practice.

Percepções de enfermeiras sobre a assistência realizada ao recém-nascido com icterícia neonatal / Nurses perceptions on assistance performed to newborns with neonatal jaundice / Percepciones de enfermeras en la asistencia realizada al recién nacido con icterícia neonatal

Objetivo: Descrever as percepções de enfermeiras sobre a assistência realizada ao recém-nascido com icterícia neonatal. Método: Estudo descritivo, qualitativo, desenvolvido com 18 enfermeiras de uma Maternidade Pública de alta complexidade localizada na cidade de Belém, Pará. Os dados foram produzidos por meio de entrevista individual, utilizando-se roteiro semiestruturado, posteriormente submetidos à análise de conteúdo temática. Resultados: Assim, a análise propiciou a organização de três categorias temáticas, denominadas: "O conhecimento de enfermeiras sobre icterícia neonatal", "A importância da educação continuada sobre icterícia neonatal" e "A necessidade de elaboração de protocolo assistencial sobre icterícia neonatal". Conclusão: Por meio do estudo, identificou-se as percepções de enfermeiras sobre a icterícia neonatal, demonstrando que possuíam conhecimento sobre o distúrbio, suas complicações, assistência adequada e importância de orientação da família, porém também mostraram a ausência de atividades de educação permanente, visando a atualização dos enfermeiros, e de um protocolo assistencial que pudesse subsidiar a assistência prestada. (AU)

Objective: To describe nurses' perceptions do care provided to newborns with neonatal jaundice. Methods: A descriptive, qualitative study, developed with 18 nurses from a highly complex Public Maternity Hospital located at Belém, Pará. The data were produced through individual interviews, using a semi-structured script, later submitted to thematic content analysis. Results: Thus, the analysis led to the organization of three thematic categories, called: "Nurses' knowledge about neonatal jaundice", "The importance of continuing education on neonatal jaundice" and "The need to elaborate a care protocol on neonatal jaundice". Conclusion: Through the study, nurses' perceptions of neonatal jaundice were identified, demonstrating that they had knowledge about the disorder, its complications, adequate assistance and the importance of family guidance, but also showed the absence of permanent education activities, aimed at updating nurses, and a care protocol that could subsidize the care provided. (AU)

Objetivo: Describir las percepciones de las enfermeras sobre la atención brindada a los recién nacidos con ictericia neonatal. Método: Estudio descriptivo, cualitativo, desarrollado con 18 enfermeras de un Hospital de maternidad público alta complejidad ubicado en la ciudad de Belém, Pará. Los datos fueron producidos a través de entrevistas individuales, utilizando un guión semiestructurado, luego sometido a análisis de contenido temático. Resultados: Por lo tanto, el análisis condujo a la organización de tres categorías temáticas, llamadas: "Conocimiento de las enfermeras sobre la ictericia neonatal", "La importancia de la educación continua sobre la ictericia neonatal" y "La necesidad de elaborar un protocolo de atención sobre la ictericia neonatal". Conclusión: A través del estudio, se identificaron las percepciones de las enfermeras sobre la ictericia neonatal, demostrando que tenían conocimiento sobre el trastorno, sus complicaciones, asistencia adecuada y la importancia de la orientación familiar, pero también mostraron la ausencia de actividades de educación permanente, destinado a actualizar a las enfermeras y un protocolo de atención que podría subsidiar la atención brindada. (AU)

El contacto piel a piel como promotor de la lactancia materna, y su posible relación con la disminución de la hiperbilirrubinemia / Skin-to-skin contact as a promoter of breastfeeding, and its possible relationship with the reduction of hyperbilirubinemia

INTRODUCCIÓN: El contacto piel a piel (CPP) postparto es una práctica de atención de salud fuertemente aconsejada por la OMS, por los beneficios a largo y a corto plazo que conlleva tanto para la salud de la madre como para la del recién nacido. OBJETIVO: Realizar una búsqueda bibliográfica con el objetivo de determinar los beneficios que tiene la CPP durante el periodo del postparto inmediato sobre la lactancia materna (LM) y la ictericia neonatal (IN). RESULTADOS: Los resultados muestran que el CPP aumenta diversos indicadores de éxito de lactancia materna, dentro de los cuales destacan: aumento en la efectividad de la primera lactancia, mayor probabilidad de mantener la LM a 4 meses, aumento del periodo de LM en promedio, mayor probabilidad de LM exclusiva a 6 meses. No se encontraron mayores beneficios al iniciar el CPP antes de los 10 minutos, ni al prolongarlo más de 60 minutos. Además, el CPP indirectamente disminuye la probabilidad de presentar IN, debido a que aumenta la frecuencia de LM, indicador que se asocia de manera indirecta a los niveles de bilirrubina en el recién nacido. CONCLUSIÓN: La revisión de la literatura especializada nos permite concluir que el contacto temprano entre la madre y su hijo en sala de partos, piel a piel, tiene efectos significativamente positivos en la lactancia materna y puede llegar a representar un factor protector de la hiperbilirrubinemia no conjugada en el RN.

Postpartum skin-to-skin contact (SSC) is a health care practice strongly advised by the WHO because of the long- and short-term benefits for both maternal and newborn health. This update summarizes the main findings supporting the recommendation to perform SSC during the immediate postpartum period, specifically the benefits on breastfeeding (BF) and neonatal jaundice (NI). The results show that SSC increases several indicators of breastfeeding success, including: increased effectiveness of the first breastfeeding, greater probability of maintaining BF at 4 months, increased BF period on average, greater probability of exclusive BF at 6 months. No greater benefits were found when initiating SSC before 10 minutes, nor when prolonging it for more than 60 minutes. In addition, SSC indirectly decreases the probability of presenting NI, because it increases the frequency of BF, an indicator that is indirectly associated with bilirubin levels in the newborn. CONCLUSION: A review of the specialized literature allows us to conclude that postpartum skin-to-skin contact (SSC) has significantly positive effects on breastfeeding and may represent benefits in bilirubin levels in the newborn.

Accuracy of transcutaneous bilirubin measurement in full-term newborns at 3400 meters above sea level / Precisión de la bilirrubinometría transcutánea en recién nacidos a término a 3400 metros sobre el nivel del mar

Abstract Background: Neonatal jaundice is a frequent benign condition in newborns. However, a rapid diagnosis must be established for its most appropriate treatment. The objective of this study was to measure the correlation between total serum bilirubin (TSB) and transcutaneous bilirubin (in forehead and sternum) in full-term newborns at 3400 m above sea level. Methods: We conducted a prospective and cross-sectional study in full-term newborns with clinical jaundice from the Hospital Regional in Cusco-Peru. General characteristics and measurement of TSB, transcutaneous forehead bilirubin (TcBF), and transcutaneous bilirubin in the sternum (TcBS) were explored. Correlation, sensitivity, and specificity were calculated. Receiver operating characteristic (ROC) curves were constructed using the SPSS statistical package, version 22.0. Results: A total of 123 newborns were evaluated. The mean bilirubin values were 13.7 ± 3.5 for TcBF, 14.1 ± 3.1 for TcBS, and 13.8 ± 3.9 for TSB. In addition, Pearson correlation coefficients between TSB/TcBF and TSB/TcBS were 0.90 and 0.91, respectively (p < 0.001). For the percentile 95 cut-off point, a sensitivity of 93% and 100% and a specificity of 89% and 80% were obtained for TcBF and TcBS, respectively, with an area under the curve of 0.813 for TcBF and 0.815 for TcBS (p < 0.001) Conclusions: Measurement of transcutaneous bilirubin is a fast and painless method that can be considered a reliable tool for screening and monitoring neonatal jaundice, but not for a definitive diagnosis to decide the use of phototherapy in full-term newborns at 3400 m above sea level.

Resumen Introducción: La ictericia neonatal es una condición benigna y frecuente en los recién nacidos, en quienes es preciso hacer un diagnóstico rápido para el tratamiento más adecuado. El objetivo de este estudio fue determinar la correlación entre la bilirrubina sérica total (BST) y la bilirrubina transcutánea (frente y esternón) en recién nacidos a término a 3400 metros sobre el nivel del mar. Método: Estudio prospectivo y transversal en recién nacidos con ictericia clínica en el Hospital Regional de la Ciudad de Cusco, Perú. Se exploraron las características generales y se midieron la BST, la bilirrubina transcutánea en la frente (BTcF) y la bilirrubina transcutánea en el esternón (BTcE). Se calcularon la correlación, la sensibilidad y la especificidad, y se elaboraron las curvas de características operativas del receptor (ROC) con el paquete estadístico SPSS 22.0. Resultados: Se evaluaron 123 recién nacidos. El promedio de la BST fue de 13.8 ± 3.9, el de la BTcF fue de 13.7 ± 3.5 y el de la BTcE fue de 14.1 ± 3.1. La correlación entre BST/BTcF y BST/BTcE fue de 0.90 y 0.91, respectivamente (p < 0.001). Para el punto de corte del percentil 95 según el nomograma Bhutani se obtuvo una sensibilidad del 93% y el 100%, y una especificidad del 89% y el 80%, para la BTcF y la BTcE, respectivamente, con un área bajo la curva ROC de 0.813 para la BTcF y de 0.815 para la BTcE (p < 0.001). Conclusiones: La medición de la bilirrubina transcutánea es un método rápido e indoloro, y podría ser considerado confiable para el despistaje y el seguimiento de la ictericia neonatal, mas no para un diagnóstico definitivo con el fin de decidir el uso de fototerapia en recién nacidos a término a 3400 metros sobre el nivel del mar.

Hemorragia suprarrenal neonatal en el contexto de ictericia neonatal isoinmune. Reporte de caso / Neonatal adrenal hemorrhage in the context of isoimmune neonatal jaundice. Case report

La hemorragia de las glándulas suprarrenales en el período neonatal se produce secundariamente a traumatismos del parto y a modificaciones de la presión venosa. La ictericia neonatal tiene como causa infrecuente la presencia de un hematoma suprarrenal. Los casos sintomáticos son poco frecuentes y, si se manifiestan, suele ser como ictericia prolongada.Se presenta el caso de un neonato que ingresó a las 20 horas de vida por ictericia isoinmune anti-A. Por aumento de bilirrubina directa, se solicitó una ecografía abdominal a los 10 días de vida, que mostró una masa suprarrenal derecha no vascularizada, de 50 x 21 mm, con imágenes quísticas en su interior, compatible con hemorragia de glándula suprarrenal derecha. La ecografía seriada mostró una resolución progresiva hasta desaparecer, y el paciente se mantuvo asintomático y sin ictericia. Cuando persiste una ictericia en el período neonatal, hay que evaluar la posibilidad de una hemorragia suprarrenal significativ

Hemorrhage of the adrenal glands in the neonatal period happens secondarily to birth trauma and to changes in venous pressure. Neonatal jaundice has as an infrequent etiology the presence of an adrenal gland hematoma. Symptomatic cases are rare, and if they manifest, it is usually as prolonged jaundice.We present the case of a neonate who was admitted at 20 hours of life due to isoimmune jaundice. Due to an increase in conjugated bilirubin, an abdominal ultrasound was requested at 10 days of life, which showed a non-vascularized right adrenal mass, 50 x 21 mm, with cystic images inside, compatible with bleeding of the right adrenal gland. Serial ultrasound showed a progressive resolution until its disappearance, keeping the baby asymptomatic and without jaundice. In cases of prolonged jaundice in the neonatal period, the possibility of significant adrenal hemorrhage must be assessed.

Prevalence of UGT1A1 (TA)n promoter polymorphism in Panamanians neonates with G6PD deficiency

A relationship between the polymorphism in promoter region of the UGT1A1 gene and the development of jaundice has been demonstrated recently. This polymorphism leads to 30% of normal rate transcription initiation of UGT1A1 gene, thus decreasing the bilirubin glucuronidation. The combination of the G6PD deficiency and polymorphism in neonates and adults may cause pronounced hyperbilirubinaemias. The aim of this study was to analyse the variations in the UGT1A1 gene promoter in Panamanians neonates with G6PD deficiency and its association with neonatal jaundice (NJ). We identified five different genotypes of TA repeats, in 17 neonates (42.5%) the normal variant TA6/TA6 and in the other 57.5% of the subjects: TA7/TA7 (12.5%), TA6/TA7 (40%), TA6/ TA8 (2.5%) and TA6/TA5 (2.5%). Additionally 75% of the 16 newborns that showed NJ had an abnormal variant in the promoter sequence, although, there was no significant difference (P = 0.068). The risk of jaundice in neonates with TA7 variant was thrice higher in subjects than with other alleles (P = 0.093, CI: 0.81–11.67). The TA7 allele frequency in this study (0.325) was consistent with the global frequency and similar to Caucasians. The results proved that there is no significant relationship between promoter polymorphism in UGT1A1 and NJ in G6PD deficient Panamanian newborns. Further studies with a greater number of subjects would determine the exact relationship between marked NJ and UGT1A promoter variations.

A critical review on neonatal hyperbilirubinemia-an Ayurvedic perspective

Neonatal hyperbilirubinemia is the elevation of the bilirubin level in the newborns blood, which results in yellowish staining of the skin and sclera of the newborn eyes by pigment of bile. It is due to the breakdown of RBC's (which release bilirubin into the blood) and the immaturity of newborns liver (which cannot effectively metabolize the bilirubin and prepare it for excretion into the urine). Increased bilirubin production, reduced hepatic clearance and enhanced enterohepatic circulation are the sole causes of increased prevalence of jaundice in newborn. The science of Ayurveda is supposed to add a step in order to understand the pathophysiology of neonatal jaundice that have resemblance with clinical entity of kamala (jaundice) mentioned in Kashyapa Samhita. The concept of neonatal hyperbilirubinemia in Ayurveda can be understood in the context of Pittaja stanya dushti along with the physiological variations in the newborns leading to the raised level of unconjugated bilirubin. Therefore, the patho-physiology should be known by a pediatrician in Ayurveda based on the involvement of dosha, dhatu, mala and srotas. Hence, an attempt is made in this review to discuss about the hidden concept of pathology of neonatal jaundice described in Ayurveda. These findings to understand the concept of neonatal jaundice in Ayurveda add up to the Ayurvedic science that has been developed through ages.

Prolonged Neonatal Jaundice with Deranged Thyroid Function Test

@#Congenital central hypothyroidism (CCH) is a rare disorder that results from deficient biosynthesis of thyroid hormone due to defective thyroid gland stimulation by thyroid stimulating hormone (TSH). Diagnosis is typically established biochemically by low free thyroxine (fT4) and inappropriately low or normal TSH levels after excluding all other causes of discordant thyroid function test (TFT). Here, we report a case of a baby girl who presented with prolonged jaundice at day 15 of life with normal cord blood TSH performed as routine screening for congenital hypothyroidism. Serial TFT revealed declining serum fT4 with normal TSH consistent with CCH. Her jaundice resolved prior to levothyroxine replacement. CCH is commonly missed on cord blood TSH-based newborn screening leading to a delay in diagnosis, potentially resulting in neurodevelopmental delay. Hence, although CCH has a lower incidence than congenital primary hypothyroidism, a high index of suspicion is essential for timely diagnosis.

A comparative study to determine intermittent versus continuous phototherapy for reducing neonatal hyperbilirubinemia at tertiary care hospital in Chennai, Tamil Nadu, India

Background: Phototherapy is safe and effective in neonatal hyperbilirubinemia. Despite its worldwide application, questions regarding methods of optimizing efficacy remain unanswered, turning the infant is believed to be one of the methods to improve. Severe neonatal hyperbilirubinemia is associated with kernicterus, condition characterized by athetoid spasticity, gaze and visual abnormalities, and sensory-neural hearing loss. It may also be associated with mental retardation. Aim of this study was conducted to compare the efficacy of intermittent with continuous phototherapy.Methods: Study was conducted in 100 neonates from February 2018 to July 2018 in Sree Balaji medical college and hospital. Inclusion criteria were weight >2000 grams, absence of other concomitant diseases, and hyperbilirubinemia not requiring exchange transfusion. The neonates were randomly divided into two groups. Continuous phototherapy group received phototherapy on and off for 2 hours and half an hour respectively and the intermittent phototherapy group on and then off for one hour. Serum total bilirubin levels were measured in every 36 hours.Results: Mean age of the patients was 3.89'1.83(p=.91) days, mean baseline bilirubin was 17.56mg/dl'1.42 (p=0.36), while the mean follow-up bilirubin was 12.85mg/dl'1.65 (p=.95), and the mean difference between the baseline and follow-up bilirubin was 4.7 mg/dl'1.19 (p=.32). For group A and B babies, the mean difference between the baseline and follow-up bilirubin was 4.78 mg/dl'1.20 (p=.32) and 4.63mg/dl'1.18(p=0.32) respectively. The difference between the mean age, mean baseline bilirubin, mean follow-up bilirubin, and the mean decrease in bilirubin for both the groups was statistically not significant.Conclusions: Intermittent and continuous phototherapies were found to be equally effective for reducing neonatal hyperbilirubinemia.

Etiological study of jaundice in neonates

: Jaundice is the commonest abnormal finding with an incidence of about 60% in term babies and 80% in preterm babies. It is the commonest cause of admission to hospitals in the newborn period. In preterm babies, the percentage is exceedingly high due to their physiological handicaps and other hazards of prematurity like Asphyxia, septicemia, respiratory and circulatory Insufficiency. Non-physiological or pathological jaundice is also known to occur in (8-9)% of newborns. Its timely detection and optimal management are crucial to prevent brain damage and subsequent neuro-motor retardation. Aims of this study to find out the etiology of jaundice in neonates, admitted in neonates unit attached to SMS medical college Jaipur.Method: This Observational study was conducted in Neonatal Intensive Care Unit (NICU) and Post Natal Ward attached to SMS medical college Jaipur, after approval from the hospital ethical committee, over a period of 12 months(October 2011 to September 2012. Study was carried on 500 neonates presenting clinically with neonatal hyperbilirubinemia.Result: The onset of jaundice was seen maximum between live hour 24-72 hours (n=290, 58% cases), followed by live hour 72 hours-14 days (n=160, 32%). At more than 2 weeks there was only 3 case (0.6%). The etiological factors in the causation of jaundice in the decreasing order of frequency were exaggerated physiological jaundice accounts for (28%), ABO-incompatibility (24.4%), Rh-incompatibility (13.8%), Idiopathic (10.4%), cephalhematoma (10.2%), septicemia (6%), intrauterine infections (4%), BMJ (1.8%), Galactocemia (0.8%) and G6PD' Deficiency (0.6%) respectively.Conclusion: Hyperbilirubinemia is more severe in newborns, therefore precautionary measure should be adopted by both parents, and clinicians to diagnose and treat the diseases properly.

Frequency of Exchange Transfusion in Newborns with Neonatal Hyperbilirubinemia

Background: Almost all newborn infants develop some degree of hyperbilirubinemia as a normal transition in physiology. High levels of unbound unconjugated bilirubin can cross the blood-brain barrier and cause neurological symptoms. Objectives: To determine the frequency of exchange transfusion in neonates with hyperbilirubinemia and to describe the characteristics of neonates with hyperbilirubinemia including those who underwent exchange transfusion. Methods: A retrospective study was conducted to know the frequency of exchange transfusion in neonates admitted to hospital with hyperbilirubinemia and to study selected characteristics of these babies including; sex, gestational age, body weight, type of feeding, and mode of delivery, and to identify the causes of hyperbilirubinemia. Results: A total of 120 neonates were enrolled in the study, 70 males and 50 females. Most of them (67%) were fullterm, weighing more than 2.5 kg. The majority (77%) was delivered vaginally, and mixed feeding with breast and artificial milk formula was the main source of feeding. The mean value of serum bilirubin at time of admission was 14.7 mg/dl and for those underwent exchange transfusion was 22 mg/dl at the time of exchange. In 92 babies (77%), the cause of hyperbilirubinemia was unknown. Hemolytic anemia due to Rh and ABO incompatibility was identified in 16% of babies, and G6PD deficiency was identified in 7%. Exchange transfusion was performed in 16.6% of patients. Conclusion: Although neonatal jaundice is a benign condition in most cases, pathologic harmful hyperbilirubinemia can occur, and despite the benefits of phototherapy, exchange transfusion is still performed and kernicterus is still occurring. Recommendation: Newborn babies should be screened for hyperbilirubinemia and correctly managed to reduce the frequency of exchange transfusion which carries many risks for newborns, and to prevent kernicterus.

A study on bacterial vaginosis in pregnancy and its effect on pregnancy outcome

Background: Bacterial vaginosis is an extremely prevalent vaginal condition and one of the causes of vaginitis among both pregnant and non pregnant women and associated with severe sequelae. Fifty percent of the women are asymptomatic. Current studies have found that the prevalence of BV ranges from 15% to 30% among non-pregnant women and 10% to 41% among pregnant women.Methods: This is a prospective study conducted among 150 pregnant women who attended the antenatal outpatient and inpatient clinic in the Department of Obstetrics and Gynaecology at Narayana Medical College and Hospital, Nellore over a period of two years from Oct 2016 to Oct 2018. Obstetric cases fulfilling the inclusion and exclusion criteria were enrolled in the study by convenient sampling technique. They were followed till the outcome of pregnancy. The data was subjected to usual statistical analysis by employing the chi-square tests.Results: Prevalence of the bacterial vaginosis was 20% in the present study. BV was significantly (p<0.05) associated with preterm delivery, PPROM, low birth weight, low APGAR and neonatal jaundice. Neonatal sepsis and congenital abnormalities showed no statistically significant difference (p>0.05) between BV positive and negative women.Conclusions: Considering the vast spectrum of maternal and fetal morbidity associated with this infection, and the availability of rapid inexpensive diagnostic tests it may be prudent to screen BV in pregnancy, so that it may be treated early and hence prevent the adverse pregnancy outcomes.

Prediction of neonatal hyperbilirubinemia using umbilical cord blood bilirubin

Background: Neonatal hyperbilirubinemia is a common problem among newborns.' Neonatal hyperbilirubinemia has a potential complication of kernicterus which is still seen in many newborns. In present study authors used umbilical cord blood bilirubin to predict the development of significant hyperbilirubinemia in the early neonatal period. The objective of this study is to evaluate the correlation between concentration of bilirubin in the cord blood and occurrence of hyperbilirubinemia in term newborns.Methods: In this prospective study authors included 500 term healthy consecutively born babies whose umbilical cord blood was collected and were followed up for first 7 days for the appearance of jaundice. The clinical assessment of jaundice was done by Kramer rule. The data was analyzed by using SPSS 17 statistical software.Results: Study found that umbilical cord blood bilirubin was 90% sensitive and 87% specific with a PPV of 75% and NPV of 92% in predicting significant neonatal hyperbilirubinemia.Conclusions: The study conducted clearly points that the use of cord blood bilirubin for identifying newborns at risk of hyperbilirubinemia helps in early detection and treatment of jaundice. There by preventing the potential complication kernicterus. This method is economical and socially acceptable. Hence cord blood bilirubin should be done on all healthy term newborns.

Niemann-Pick disease type C-presenting as persistent neonatal jaundice: a rare case report

Neimann-Pick disease (NPD) is an autosomal recessive lysosomal storage disorder caused by inherited deficiency of acid sphingomyelinase enzyme or its transport which leads to deposition of sphingomylin and cholesterol in the lysosomes of reticuloendothelial system. It is characterized by failure to thrive, hepatospleenomeagaly and neurodegenerative changes. There are four subgroups of neimann pick disease, type A, B, C and D. Here authors are reporting a case of 5 months old female child presenting with persistent jaundice since neonatal period, progressive abdominal distention and failure to thrive. On examination patient had significant abdominal distension with moderate hepatosplenomegaly. On laboratory evaluation child diagnosed to have NPD type C. This case emphasizes the need to keep NPD in differential diagnosis of children presenting with persistent neonatal jaundice, hepatosplenomegaly, failure to thrive.

Utility of cord blood albumin as a predictor of significant neonatal jaundice in healthy term newborns

Background: The aim is to study the association between cord blood albumin level and subsequent development of significant neonatal jaundice (NNJ) in healthy term newborns.Methods: A prospective study was conducted on 106 term healthy neonates. Genders, gestational age, mode of delivery were taken into consideration. It was ascertained that there was no other risk factor for hyperbilirubinemia amongst the neonates. The neonates were divided into two groups based on cord blood albumin level of <3.2gm/dl and >3.2gm/dl.Results: Out of the 106 babies included in the study, 44 babies were under group A (<3.2mg/dl) and 62 babies were under group B(>3.2mg/dl). 24 babies (55%) in group A and 16 babies (26%) in group B developed clinical icterus of which 16(66.6%) in group A and 4(25%) in group B required phototherapy. There was no significant difference between the cases who did and who did not develop significant neonatal jaundice with respect to various factor such as type of delivery, gender and meconium stain liquor.Conclusions: Cord albumin levels help to determine and predict the possibility of hyperbilirubinemia among neonates. Hence this can help to identify the at-risk neonates. So routine determination of cord albumin can be advocated to keep a track on at risk neonates.

Awareness Regarding Neonatal Jaundice Treatment Among Mothers: A Descriptive Study in Tertiary Level Hospital

Background: Neonatal Jaundice (NNJ) is a major publichealth problem worldwide and is present among 50 – 60 % offull term and 80% of preterm newborns. This study wascarried out in order to assess the knowledge on neonataljaundice treatment among the mothers in a selected tertiarylevel hospital of Jessore district town.Methodology: It was a descriptive type of cross – sectionalstudy. 110 samples were selected by non – randomizedpurposive sampling technique with the administration of apretested modified and semi – structured questionnaire by faceto face interview.Results: Study found that majority of the respondents(54.55%) was in the age group 20 – 25 years. Regardingknowledge on preventive measures of NNJ 95.45%respondents had knowledge on ‘‘putting jaundiced baby underdirect sun light’’, 41.82% had knowledge on ‘phototherapy’.97.27% indicated’’ consult with doctor` A significant associationwas also found between age and `consultation with doctor`(p=0.025).Conclusion: Awareness should be created among theexpecting mothers about neonatal jaundice and encouragethem to take preventive measures to reduced neonatalmortality and morbidity.

Effects of kangaroo mother care on neonatal jaundice and breastfeeding after delivery by cesarean section / 中华健康管理学杂志

Objective@#To examine the effects of kangaroo mother care on breastfeeding by women who delivered via cesarean section and on neonatal jaundice.@*Methods@#The study sample consisted of 120 pairs of women who delivered via cesarean section and newborns born by cesarean delivery between August 2017 and February 2018 in the Second Hospital of Shanxi Medical University. They were randomly divided into a conventional nursing group and a kangaroo mother care group by random number table method. A total of 120 pairs of newborns and mothers met the exclusion criteria. The conventional nursing group received routine nursing, while the kangaroo mother care group was given routine nursing and received the kangaroo mother care. By determining the lactation start time, and using the Breastfeeding Assessment Tool (BAT) and Breastfeeding Self-Efficacy Scale (BSES), we evaluated the condition of breastfeeding by the women who delivered via cesarean section. We measured the transcutaneous bilirubin level using the jaundice measuring instrument to evaluate neonatal jaundice.@*Results@#The subjects in both groups were of Han nationality and delivered via cesarean section at a gestational age of >37 weeks. No statistically significant differences were found between the two groups in terms of age, occupation, number of pregnancies, and educational background (P>0.05). No statistically significant differences were found between the two groups in terms of the newborns’ sex, birth weight, Apgar score, and birth length (P>0.05). The lactation start time in the kangaroo mother care group (42.1±10.9 h) was earlier than that in the conventional nursing group (52.7±12.8 h), with a statistically significant difference (t=4.880, P<0.001). The success rate of the initial breastfeeding in the kangaroo mother care group reached 80%, which is significantly higher than that in the conventional nursing group by 43% (χ2=17.062, P<0.001). The breastfeeding self-efficacy score (117.0±13.7) in the kangaroo mother care group was significantly higher than that in the conventional nursing group (111.3±15.9, t=2.126, P=0.036). The transcutaneous bilirubin levels in the forehead, chest, and legs (173.7±39.3, 174.1±40.1, and 120.4±32.7 μmol/L, respectively) at 72 h after birth in the kangaroo mother care group were lower than those in the conventional nursing group (194.3±43.9, 193.1±39.0, and 138.0±34.6 μmol/L, respectively), with statistically significant differences (t=-2.706, -2.640, and -2.852, respectively, P<0.05). The newborns’ defecation frequencies at 24, 48, and 72 h after birth in the kangaroo mother care group (5.5±1.7, 5.2±1.9, and 5.2±2.3, respectively) were higher than those in the conventional nursing group (4.5±1.7, 4.3±1.9, and 4.3±1.6, respectively), with statistically significant differences (t=3.122, 2.631, and 2.332, P<0.05).@*Conclusion@#The kangaroo mother care method can effectively improve the success rate of first breastfeeding and early lactation initiation time, and increase breastfeeding confidence in women who undergo cesarean section, and reduce the incidence of neonatal jaundice.

False-negative Hepatobiliary Scintigraphy for Biliary Atresia / 대한핵의학회잡지

We present the case of a patient with biliary and duodenal atresia who showed false-negative hepatobiliary scintigraphy results. The patient was born at 37 weeks and 2 days of gestation. Her mother had undergone amnioreduction after detection of a double-bubble ultrasound sign in the fetal abdomen. At 2 days of age, total serum bilirubin level was elevated. On hepatobiliary scintigraphy 4 days later, the gallbladder was visualized from 30 min and it showed duodeno-gastric reflux at 240 min. After 24 h, the radiotracer was almost washed out in the hepatic parenchyma, but there was retention in the gastroduodenal junction. Because the biliary to duodenal transit was visible, biliary atresia seemed unlikely. Abdominal ultrasonography at 7 days of age showed a small dysmorphic gallbladder, but triangular cord sign was not definite. Magnetic resonance cholangiography revealed atretic gallbladder. Although cystic and common bile ducts were visible, the proximal common hepatic bile duct was not visible. The next day, serum total bilirubin levels remained elevated (17.1 mg/dl) with direct bilirubin level of 1.2 mg/dl. Kasai portoenterostomy with duodeno-duodenostomy was performed at 10 days of age. Histopathological evaluation showed a fibrous obliteration of the common bile duct, consistent with that of biliary atresia.

Novel Non-Surgical Interventions for Benign Inflammatory Biliary Strictures in Infants: A Report of Two Cases and Review of Current Pediatric Literature / 대한소아소화기영양학회지

Benign biliary strictures are uncommon in children. Classically, these cases are managed surgically, however less invasive approaches with interventional radiology and or endoscopy may have similar results and improved safety profiles While benign biliary strictures have been described in literature on several occasions in young children, (most older than 1 year and once in an infant 3 months of age), all reported cases were managed surgically. We present two cases of benign biliary strictures in infants less than 6 months of age that were managed successfully with novel non-invasive procedures and a review of all current pediatric cases reported in the literature. Furthermore, we describe the use of a Rendezvous procedure, which has not been reported as a treatment approach for benign biliary strictures.

Comparison of Purgative Manna Drop and Phototherapy with Phototherapy Treatment of Neonatal Jaundice: A Randomized Double-Blind Clinical Trial

OBJECTIVES: Herbal remedies such as purgative manna are used to treat neonatal jaundice. In this study Bilineaster drop (purgative manna) and phototherapy, and phototherapy treatment alone were compared by assessing phototherapy duration and number of days in hospital. METHODS: There were 150 consecutive term neonates with jaundice, weighting from 2,500 g to 4,000 g enrolled in this randomized double blind clinical trial. The neonates were randomly assigned to intervention and control groups. The control patients received only phototherapy and the intervention group underwent phototherapy treatment and purgative manna drop (5 drops per kg of body weight, 3 times a day). Direct and total measurements of bilirubin concentration in the serum were measured and the reduction in concentration of bilirubin was calculated. RESULTS: There were 28% of patients whose hospital duration following phototherapy was 2 days, for Bilineaster and phototherapy treatment this was 49.3% of patients. At 48 hours and 72 hours the reduction in the concentration of total bilirubin in the serum was statistically significantly different across groups (p 0.05). The reduction in direct bilirubin concentration in the serum was significantly different between groups at 72 hours and 96 hours (p > 0.001). CONCLUSION: Purgative manna and phototherapy, can statistically significantly reduce total bilirubin concentration at 48 hours and 72 hours compared with phototherapy alone, and reduce the length of hospital stay for jaundiced neonates at 2 days compared with phototherapy treatment.