Severe hemolytic disease of the newborn caused by JKb antibody: Two case reports and literature review.

BACKGROUND: JKb antibody rarely causes severe hemolytic disease in the newborn except in 1 case, required blood exchange transfusion but later died of intractable seizure and renal failure. Here we describe 2 cases of JKb-induced severe neonatal jaundice requiring blood exchange transfusion with good neurological outcome. CASE PRESENTATION: Two female Chinese, ethnic Han, term infants with severe jaundice were transferred to us at the age of 5- and 4-day with a total bilirubin of 30.9 and 25.9 mg/dL while reticulocyte counts were 3.2% and 2.2%, respectively. Both infants were not the firstborn to their corresponding mothers. Direct and indirect Coombs' tests were positive, and JKb antibody titers were 1:64 (+) for both mothers. Phototherapy was immediately administered, and a blood exchange transfusion was performed within 5 hours of admission. Magnet resonance image showed no evidence of bilirubin-induced brain damage, and no abnormal neurological finding was detected at 6 months of life. CONCLUSION: JKb antibody-induced hemolytic disease of the newborn usually leads to a benign course, but severe jaundice requiring blood exchange transfusion may occur. Our cases suggest good outcomes can be achieved in this minor blood group-induced hemolytic disease of the newborn if identified and managed early enough.

Associations between neonatal jaundice and autism spectrum disorder or attention deficit hyperactivity disorder: Nationwide population based cohort study.

BACKGROUND/PURPOSE: Neonatal jaundice might result brain insults. Both autistic spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are developmental disorders, which might result from early brain injury at neonatal period. We aimed to explore the association between neonatal jaundice treated with phototherapy and the ASD or ADHD. METHODS: This retrospective nationwide population cohort study was based on a nationally representative database of Taiwan, and neonates born from 2004 to 2010 were enrolled. All eligible infants were divided into 4 groups, without jaundice, jaundice with no treatment, jaundice with simple phototherapy only and jaundice with intensive phototherapy or blood exchange transfusion (BET). Each infant was follow-up until the date of incident primary outcomes, death, or 7-year-old, whichever occurred first. Primary outcomes were ASD, ADHD. Using cox proportional hazard model to analyze their associations. RESULTS: In total, 118,222 infants with neonatal jaundice were enrolled, including diagnosed only (7260), simple phototherapy (82,990), intensive phototherapy or BET (27,972 infants). The cumulative incidences of ASD in each group was 0.57%, 0.81%, 0.77%, and 0.83%, respectively. The cumulative incidences of ADHD in each group was 2.83%, 4.04%, 3.52% and 3.48%, respectively. Jaundice groups were significantly associated with ASD, ADHD, or either one, even after all other extraneous maternal and neonatal variables were adjusted. After stratification, the associations were still existed in subgroup with birth weights ≥2500 grams and in male subgroup. CONCLUSION: Neonatal jaundice correlated with the ASD and ADHD. The associations were significant in infants of both sexes and with birth weights larger than 2500 grams.

Clinical outcomes associated with complementary and alternative medicine-related "immunity-boosting" practices in patients with cirrhosis during the COVID-19 pandemic - an observational study.

During the coronavirus disease 2019 pandemic, Ayurvedic herbal supplements and homeopathic immune boosters (IBs) were promoted as disease-preventive agents. The present study examined the clinical outcomes among patients with chronic liver disease who presented with complications of portal hypertension or liver dysfunction temporally associated with the use of IBs in the absence of other competing causes. This single-center retrospective observational cohort study included patients with chronic liver disease admitted for the evaluation and management of jaundice, ascites, or hepatic encephalopathy temporally associated with the consumption of IBs and followed up for 180 days. Chemical analysis was performed on the retrieved IBs. From April 2020 to May 2021, 1022 patients with cirrhosis were screened, and 178 (19.8%) were found to have consumed complementary and alternative medicines. Nineteen patients with cirrhosis (10.7%), jaundice, ascites, hepatic encephalopathy, or their combination related to IBs use were included. The patients were predominantly male (89.5%). At admission, 14 (73.75%) patients had jaundice, 9 (47.4%) had ascites, 2 (10.5%) presented with acute kidney injury, and 1 (5.3%) had overt encephalopathy. Eight patients (42.1%) died at the end of the follow up period. Hepatic necrosis and portal-based neutrophilic inflammation were the predominant features of liver biopsies. IB analysis revealed detectable levels of (heavy metals) As (40%), Pb (60%), Hg (60%), and various hepatotoxic phytochemicals. Ayurvedic and Homeopathic supplements sold as IBs potentially cause the worsening of preexisting liver disease. Responsible dissemination of scientifically validated, evidence-based medical health information from regulatory bodies and media may help ameliorate this modifiable liver health burden.

Differential effects of delayed cord clamping on bilirubin levels in normal and diabetic pregnancies.

The purpose of the study is to investigate the effects of delayed cord clamping on bilirubin levels and phototherapy rates in neonates of diabetic mothers. This was a prospective study that enrolled pregnant women without pregnancy complications and those with diabetes. Their neonates were randomized in a 1:1 ratio to delayed cord clamping. The main outcomes were the neonatal transcutaneous bilirubin values on 2-4 days postpartum and the rate of requiring phototherapy in infants. A total of 261 pregnant women were included in the final analysis (132 women with diabetic pregnancies and 129 women with normal pregnancies). In diabetic pregnancies, neonatal bilirubin levels on the 2-4 days postpartum and phototherapy rates were significantly higher in the delayed cord clamping group than in the immediate cord clamping group (7.65 ± 1.83 vs 8.25 ± 1.96, P = 0.039; 10.35 ± 2.23 vs 11.54 ± 2.56, P = 0.002; 11.54 ± 2.94 vs 12.83 ± 3.07 P = 0.024, 18.2% vs 6.3%, P = 0.042), while in normal pregnancies, there was no statistical difference in bilirubin values and phototherapy rates between the delayed cord clamping group and the immediate cord clamping group (P > 0.05). After receiving delayed cord clamping, bilirubin levels on the third postnatal day and the rate of requiring phototherapy in infants were higher in the diabetic pregnancy group than in the normal pregnancy group (10.35 ± 2.23 vs 11.54 ± 2.56, P = 0.013). CONCLUSION: Delayed cord clamping increased the risk of jaundice in newborns born to diabetic mothers, but had no effect in newborns from mothers with normal pregnancies. DCC may be a risk factor for increased bilirubin in infants of diabetic mothers. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04369313; date of registration: April 27, 2020 (retrospectively registered). WHAT IS KNOWN: • Delayed cord clamping had significant benefits for newborns by increasing neonatal hemoglobin levels and reducing the risk of neonatal anemia, etc. • Delayed cord clamping may lead to neonatal hyperemia, erythrocytosis, and hyperbilirubinemia, which increases the risk of neonatal jaundice. WHAT IS NEW: • Our trial focused on the differential effects of delayed cord clamping on jaundice in full-term newborns between diabetic pregnancies and normal pregnancies. And newborns of diabetic mothers who received delayed cord clamping had a significantly increased risk of jaundice compared to newborns with normal pregnancy. • Delayed cord clamping may be a risk factor for increased bilirubin levels in neonates of diabetic mothers.

Fenobarbital en el síndrome de Crigler-Najjar tipo 1: una opción terapéutica / Phenobarbital in Crigler-Najjar syndrome type 1: A therapeutic option

No disponible

Malestar e ictericia. Hepatitis tóxica por Copalchi / Illness and jaundice. Copalchi toxic hepatitis

No disponible

[Lipemia and bilirubin influences for twenty-four biochemical parameters measurement]. / Interférences de la lipémie et de l'ictère sur le dosage de 24 paramètres biochimiques.

The study of the influence of the lipemia and icterus was performed experimentally for twenty-four biochemistry parameters on the Roche Cobas 6000 CE analyzer. Overloads in Intralipid(®) or ditaurate of bilirubin were performed on several plasma pools. The limit of 10% was chosen to define interference on the measurement. The parameters studied were classified into different categories depending on their measurement is affected or not. Knowledge of these data allows the biologist to adapt its reporting procedures in the case of lactescent and/or icteric samples.

In vivo growth of retinoblastoma in a newborn infant.

Retinoblastoma is a rare malignancy of the retina seen exclusively in children. It is known to cause rapid growth inside the eye and hence treatment should be started as soon as it is diagnosed. We report a case in a five-day-old infant in whom treatment (chemotherapy) was delayed by a month due to high bilirubin levels secondary to physiological jaundice, which gave us the unique opportunity to measure the growth of the tumor over a month. This case emphasizes that immediate treatment is warranted once this rare disease is diagnosed.

Prolonged intrahepatic cholestasis after exposure to loxoprofen.

OBJECTIVE: The objective of this report was to describe a case of prolonged intrahepatic cholestasis likely associated with the use of loxoprofen, a phenylpropionate NSAID. METHODS: A 36-year-old female patient was transferred to Gunma University Hospital, Maebashi, Japan, with progressive pruritus and jaundice that developed after 5-day treatment with 120 mg/d of loxoprofen (maximum recommended dose, 180 mg/d) for menstrual pain. Liver function tests found the following concentrations: total bilirubin, 27.5 mg/dL (normal [nl] range, 0.3-1.2 mg/dL); aspartate aminotransferase, 151 IU/L (nl, 13-33 IU/L); alkaine aminotransferase, 470 IU/L (nl, 8-42 IU/L); alkaline phosphatase, 1082 IU/L (n1, 115-359 IUAL); and gamma-glutamyl transpeptidase, 795 IU/L (nl, 10-47 IU/L) indicative of intrahepatic cholestasis. No use of alcohol or other drugs or herbal products was reported. The patient had a history of elevated hepatic enzymes of unknown origin following the use of mefenamic acid. The patient was prescribed ursodeoxycholic acid 3 weeks after the onset of symptoms of intrahepatic cholestasis. Thereafter, due to progressive cholestasis, an IV pulse of methylprednisolone (1000 mg/d) and the herbal product Inchin-ko-to (TJ-135) were administered. Plasma bilirubin adsorption (PA) and plasma exchange (PE) were performed. RESULTS: Following treatment with PA and PE for 3 weeks with administration of methylprednisolone and Inchin-ko-to, signs and symptoms of intrahepatic cholestasis began to resolve (3.5 months after the onset); they were completely resolved 8 months after the initial episode. A Naranjo scale score of 6 suggested that loxoprofen was likely the cause of the prolonged cholestasis in this patient. CONCLUSION: Based on the Naranjo score, this case of prolonged intrahepatic cholestasis in a young woman was likely associated with loxoprofen use.

Is neonatal phototherapy associated with an increased risk for hospitalized childhood bronchial asthma?

This population-based register study examined if factors during the fetal and neonatal period influence the risk for the child to develop bronchial asthma (asthma). From the Swedish Hospital Discharge Register we identified children, born between 1987 and 1999, who had been hospitalized for asthma up to 2001. Thus, the outcome measure contains only hospitalized cases, not all children with asthma. Children younger than 2 yr at admission were excluded because of the uncertainty about the diagnosis of asthma in younger children. The remaining 14,803 children were compared with all children born the same years, recorded in the Swedish Medical Birth Registry, for information on pre- and perinatal characteristics. Odds ratios (ORs) were calculated with Mantel-Haenszel technique and 95% confidence intervals (CIs) with Miettinen's test-based method. The presence of various maternal and neonatal confounders were identified and adjusted for in the analyses. The association between some known factors and childhood asthma were confirmed: young maternal age, maternal smoking, period of unwanted childlessness, low maternal level of education, maternal diabetes, preterm birth, low birth weight, small-for-gestational age, caesarean section, and instrumental vaginal delivery. A number of neonatal characteristics were shown to be independent risk factors: sepsis or pneumonia, neonatal respiratory problems and treatments, neonatal icterus, and/or neonatal phototherapy. The association with icterus and phototherapy remained after exclusion of cases showing other neonatal risk factors and after adjustment for maternal factors (OR 1.27, 95% CI: 1.08-1.50), and increased to 1.5 if the children had been hospitalized for asthma more than once. In conclusion, our results suggest an association between neonatal icterus and/or treatment with neonatal phototherapy and hospitalized childhood asthma. This association needs further exploration.

¿Es frecuente la deshidratación hipernatrémica como causa de readmisión hospitalaria en recién nacidos? / Is hypernatremic dehydration a common readmission cause in newborns?

Objetivo: conocer la incidencia de deshidratación hipernatrémica (DH) asociada a ictericia así como sus características clínicas en neonatos ingresados a un hospital general. Material y Métodos: estudio exploratorio, prospectivo, descriptivo. Se incluyeron neonatos de término, ingresados por hiperbilirrubinemia, divididos en dos grupos, con y sin hipernatremia. Se compararon características perinatales, edad en la readmisión, pérdida de peso, fiebre, bilirrubina, manejo con antimicrobianos, presencia de alteraciones neurológicas y mortalidad. Resultados: se ingresaron 24 pacientes en un año, de los cuales 12 tuvieron sodio sérico elevado, con un promedio de 163,92 mmol/L. La incidencia fue de 5/1000 nacidos vivos. No se encontraron diferencias en cuanto a las características perinatales o cifras de bilirrubinas. La pérdida ponderal fue mayor en el grupo con DH. Dos pacientes presentaron alteraciones neurológicas y uno falleció. Conclusiones: la incidencia de la triada de deshidratación hipernatrémica, fiebre e ictericia puede ser mayor a la reportada.

[Icterus of the newborn caused by indirect bilirubin--recent progress]. / Ujszülöttek indirekt bilirubin okozta icterusa--újabb ismeretek és szempontok.

Recently a big shift has taken place in the judgment and treatment of jaundice in newborn, caused by increased unconjugated bilirubin level. New techniques evolved for assessing the prognosis of developing jaundice. An important major discovery is the antioxidant effect of bilirubin. We have a broader range of knowledge concerning the mechanism of bilirubin toxicity and for judging the chance of developing kernicterus. The prevention techniques do not stop at prohibiting anti-D immunisation but go on to preventing hydrops foetalis, the life-threatening form of haemolytic disease. There are data about the complications of phototherapy and EPO treatment for prolonged anaemia.

Diclofenac-induced thrombocytopenic purpura with renal and hepatic involvement.

A case of diclofenac-induced thrombocytopenic purpura in a 59-year-old woman is described. Unlike the majority of earlier cases, ours was associated with renal insufficiency and jaundice. Despite the dramatic clinical picture, with severe thrombocytopenia and marked renal insufficiency, the prognosis appears to be excellent, as is shown in our case and in similar ones reported in the literature. A high dose of steroids is the treatment of choice.

Staphylococcal bacteraemia and endocarditis and fusidic acid.

In 1980, we reported an association between the use of fusidic acid (particularly the intravenous formulation) and jaundice in patients who had received the drug for the treatment of Staphylococcus aureus bacteraemia during the previous 10 years. We have continued to use fusidic acid for severe staphylococcal infections, but have recommended oral administration whenever possible. In the earlier study the incidence of jaundice in patients given intravenous fusidic acid was 48%, but in the recent study of 145 patients it was 17%. Whereas 71% of patients receiving fusidic acid in the earlier series were given the intravenous drug (with or without oral) only 25% of patients were given the intravenous drug in the recent series. The incidence of jaundice in those patients treated only with the oral formulation was 13% in the earlier study and 6% in the recent study. Although jaundice was usually reversible, it is nevertheless an unwanted side effect. Resistance of S. aureus to fusidic acid remains at around 1%; it may be present on primary isolation or arise during treatment. This seems to occur particularly in patients with endocarditis or bone infection despite the use of fusidic acid in combination with another antibiotic. After some 25 years of clinical use, fusidic acid remains a most useful anti-staphylococcal antibiotic; the intravenous preparation should be avoided when possible.

Randomised study of prophylactic parenteral sulbactam/ampicillin and cephazolin in biliary surgery: significant benefit in jaundiced patients.

Two hundred consecutive patients undergoing biliary-tract surgery were entered into a randomized trial of prophylactic single dose cephazolin or sulbactam/ampicillin. There was no overall difference in the infection rates between the two antibiotic groups, but in the group of patients with jaundice there was an excess of wound infections in the cephazolin group compared to the sulbactam/ampicillin group (35% vs. 14%). We conclude that sulbactam/ampicillin is a satisfactory prophylactic agent for use in biliary-tract surgical sepsis, and that it may be superior to cephazolin in jaundiced patients.

[Endogenous toxicity in acute hepatic failure and ways of eliminating it]. / Ob éndogennoi intoksikatsii pri ostroi pechenochnoi nedostatochnosti i vozmozhnostiakh ee ustraneniia.

The structure of causes of the endogenous intoxication in 39 patients with acute hepatic insufficiency is studied. Eleven toxic compounds of an organic nature were found responsible for genesis fo the disorders and outcomes of acute hepatic insufficiency. Possible use of hemosorption and hyperbaric oxygenation for the elimination of toxic products is analysed. A combination of them is proved to be expedient. The selectivity of sorption for each toxin separately in various types of hepatic insufficiency is established.

X-ray microanalysis of spontaneously formed urinary calculi in a jaundiced strain of rat.

A high incidence of spontaneously formed urinary stone was found in the females of a jaundiced strain of rat developed from a cross between Gunn's rat and Wistar-Imamichi rat. In this colony, 42.3% of the females had urinary calculi. Elemental analyses of these urinary calculi were carried out with an analytical electron microscope, a high-resolution transmission electron microscope fitted with an energy dispersive type X-ray microanalyzer and a scanning device. In the surface and middle areas of the stone, the main components were recognized as magnesium (Mg) and phosphorus (P). In the central region of the stone, calcium (Ca) and phosphorus (P) were found as the main elements with trace amounts of sodium (Na), chlorine (Cl), and potassium (K). The analyses indicated that the spontaneous urinary stone consisted of phosphate salts with calcium or magnesium. In addition, the mass ratio of the Mg/P or Ca/P in the stones was calculated from X-ray pulse intensity ratios and compared with the mass ratio of a standard sample. The results suggested that the magnesium and phosphorus in the urinary stones existed as ammonium magnesium phosphate, MgNH4PO4, and the calcium and phosphorus as tribasic calcium phosphate, Ca3(PO4)2.

Acute renal failure in Indian and Black patients.

This preliminary study of 50 patients suffering from acute renal failure showed the aetiology to be medical in 30 patients, gynaecological in 9 patients, abstetric in 6 patients, and surgical in 5 patients. The commonest medical causes of acute renal failure were septicaemia and nephrotoxins (mainly from herbal medicines). The commonest gynaecological cause of acute renal failure was self-induced abortion. The relevant clinical and biochemical features are described. In spite of adequate dialysis and antibiotic therapy, the mortality was 34%. Adverse factors affecting prognosis were septicaemia, jaundice, the cause itself of the acute renal failure, and delay in beginning dialysis.