Neonatal jaundice incidence, risk factors and outcomes in referral-level facilities in Nigeria.

OBJECTIVE: To determine the incidence, risk factors and outcomes of babies with neonatal jaundice in a network of referral-level hospitals in Nigeria. DESIGN: A cross-sectional analysis of perinatal data collected over a 1-year period. SETTING: Fifty-four referral-level hospitals (48 public and 6 private) across the six geopolitical zones of Nigeria. POPULATION: A total of 77 026 babies born at or admitted to the participating facilities (67 697 hospital live births; plus 9329 out-born babies), with information on jaundice between 1 September 2019 and 31 August 2020. METHODS: Data were extracted and analysed to calculate incidence and sociodemographic and clinical risk factors for neonatal jaundice. MAIN OUTCOME MEASURES: Incidence and risk factors of neonatal jaundice in the 54-referral hospitals in Nigeria. RESULTS: Of 77 026 babies born in or admitted to the participating facilities, 3228 had jaundice (41.92 per 1000 live births). Of the 67 697 hospital live births, 845 babies had jaundice (12.48 per 1000 live births). The risk factors associated with neonatal jaundice were no formal education (adjusted odds ratio [aOR] 1.68, 95% CI 1.11-2.52) or post-secondary education (aOR 1.17, 95% CI 0.99-1.38), previous caesarean section (aOR 1.68, 95% CI 1.40-2.03), booked antenatal care at <13 weeks or 13-26 weeks of gestation (aOR 1.58, 95% CI 1.20-2.08; aOR 1.15, 95% CI 0.93-1.42, respectively), preterm birth (aOR 1.43, 95% CI 1.14-1.78) and labour more than 18 hours (aOR 2.14, 95% CI 1.74-2.63). CONCLUSIONS: Hospital-level and regional-level strategies are needed to address newborn jaundice, which include a focus on management and discharge counselling on signs of jaundice.

Association of gestational hepatitis B virus infection and antiviral therapy with pregnancy outcomes: A retrospective study.

OBJECTIVE: To explore the relationships between gestational hepatitis B virus (HBV) infection, antiviral therapy, and pregnancy outcomes. METHODS: We retrospectively selected hepatitis B surface antigen (HBsAg)-positive pregnant women hospitalized for delivery at Fujian Medical University Affiliated Hospital from October 1, 2016 to October 1, 2020. The control group included randomly selected healthy pregnant women hospitalized for delivery during the same time. RESULTS: Overall, 1115 participants were enrolled and grouped into control (n = 380) and HBsAg-positive groups (n = 735), which were further divided into groups I (n = 407; low viral load), II (n = 207; high viral load without antiviral therapy), and III (n = 121; high viral load with antiviral therapy). Pregnant women with HBV were positively correlated with the incidence of intrahepatic cholestasis of pregnancy (ICP) (adjusted odds ratio [aOR] 5.1, 95% confidence interval [CI] 2.62-9.92, P < 0.001), neonatal jaundice (aOR 10.56, 95% CI 4.49-24.83, P < 0.001), and neonatal asphyxia (aOR 5.03, 95% CI 1.46-17.27, P = 0.01). Aspartate aminotransferase (AST) greater than the upper limit of normal (ULN) was an independent risk factor for increased ICP incidence (aOR 3.49, 95% CI 1.26-9.67, P = 0.019). Antiviral therapy considerably reduced HBV DNA and improved liver function. High viral load and antiviral therapy did not correlate significantly with adverse pregnancy outcomes (P < 0.05). CONCLUSION: Pregnant women with HBV have significantly elevated incidence of ICP, neonatal jaundice, and neonatal asphyxia not significantly correlated with viral load. AST greater than ULN independently increases the risk of ICP. Antiviral therapy effectively reduces viral replication and improves liver function without increasing the risk of adverse outcomes.

Comparison of prognosis between hyperbilirubinemic infants with and without hypernatremia.

OBJECTIVES: Hypernatremia may facilitate the diffusion of bilirubin through the blood-brain barrier and increase the risk of bilirubin encephalopathy. This study was conducted to compare the prognosis of jaundice infants with those with jaundice and hypernatremia. METHODS: A total of 615 term infants with idiopathic jaundice with or without hypernatremia were enrolled in this cohort study with 24-months follow-up at Ghaem Hospital, Mashhad, Iran, between 2010 and 2022. An in-house questionnaire including the laboratory evaluation and neonatal characteristics was used as the data collection tool. The follow-up of neonatal development status was performed using the Denver test II at 6, 12, 18, and 24 months after discharging from hospital. RESULTS: Normal outcomes were seen in 555 (90.2%) out of 615 studied infants, while 60 cases (9.8%) showed abnormal outcomes. Serum levels of sodium (P = 0.017), bilirubin (P = 0.001), urea (P = 0.024), and creatinine (P = 0.011) as well as hyperthermia (P = 0.046) and unconsciousness (P = 0.005) showed significant differences between the two groups. Approximately 16% of the newborns with both jaundice and hypernatremia, and 9% of those with only jaundice had unfavorable prognoses. Also, bilirubin level had the most predictive power (91.3%). CONCLUSIONS: Our results suggest that hypernatremia or jaundice alone, may affect the prognosis of infants aged 2 years; but jaundice and hypernatremia together, will intensify the developmental problems in jaundice infants. However, the role of hyperbilirubinemia in the incidence of complications is more than hypernatremia.

Neonatal jaundice is associated with increased risks of congenital anomalies of the kidney and urinary tract and concomitant urinary tract infection.

The link between neonatal jaundice and urinary tract infection (UTI) remains debated, with congenital kidney and urinary tract anomalies (CAKUT) potentially playing a role. This population-based study aimed to analyze the correlations between neonatal jaundice, CAKUT, and concomitant UTI. The study cohort consisted of 2,078,122 live births from 2004 to 2014. We linked several population-based datasets in Taiwan to identify infants with unexplained neonatal jaundice and their mothers. The primary outcome was the rate of CAKUT occurring within 3 years after delivery, and the presence of concomitant UTI during neonatal jaundice hospitalization. Infants with neonatal jaundice had a significantly higher risk of CAKUT (adjusted odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.11-1.39) during early childhood. Among the subtypes of CAKUT, obstructive uropathy, vesicoureteral reflux and other CAKUT were associated with an increased risk of neonatal jaundice. Infants who underwent intensive phototherapy, had a late diagnosis (> 14 days of postnatal age) or underwent a prolonged duration of phototherapy (> 3 days) exhibited a higher risk of concomitant UTI compared to other infants with jaundice. Our findings indicate a notable association between neonatal jaundice and increased risks of UTIs in the context of CAKUT. This study underscore the importance of vigilant monitoring and timely interventions for neonates presenting with jaundice, while acknowledging the complexity and variability in the progression of CAKUT and its potential connection to UTIs.

Glucose-6-phosphate dehydrogenase deficiency and neonatal indirect hyperbilirubinemia: a retrospective cohort study among 40,305 consecutively born babies.

BACKGROUND AND OBJECTIVE: Glucose-6-phosphate dehydrogenase deficiency (G6PDD) being highly prevalent in the Middle East, the primary objective was to estimate the incidence of neonatal jaundice among G6PD-deficient neonates and to explore its association with various risk factors. METHODS: This retrospective cohort study includes 7 years data of neonates diagnosed with G6PDD between 1st January 2015, and 30 September 2022, from Al Wakra Hospital, HMC Qatar. RESULTS: Among the 40,305 total births, 1013 had G6PDD with an incidence of 2.51%. Of all the G6PDD babies, 24.6% (249/1013) received phototherapy and three babies required exchange transfusion. Statistically significant associations were noted between the need for phototherapy and gestational age, gestational age groups, birth weight, and birth weight groups, but logistic regression analysis showed significant association for phototherapy only with the gestational age group. CONCLUSION: Universal screening and proper follow-up is essential for G6PDD as it plays crucial role in neonatal jaundice.

Factors associated with neonatal jaundice among neonates admitted at referral hospitals in northeast Ethiopia: a facility-based unmatched case-control study.

BACKGROUND: Neonatal jaundice is a significant contributor to illness and death in newborns, leading to frequent admissions to neonatal intensive care units. To better understand this issue, a study was conducted to identify the factors contributing to neonatal jaundice among newborns admitted to Dessie and Woldia comprehensive specialized hospitals in northeast Ethiopia. METHODS: The study took place from April 1 to May 30, 2022, using unmatched case-control design. A total of 320 neonates paired with their mothers were involved, including 64 cases and 256 controls. Data were collected through a structured interviewer-administered questionnaire and a review of medical records. The collected data were analyzed using SPSS Version 23, and a multivariate logistic regression model was employed to understand the relationship between independent factors and the occurrence of neonatal jaundice. Statistical significance was determined at a threshold of P value less than 0.05. RESULTS: The study findings revealed that maternal age over 35 years, residing in urban areas [adjusted odds ratio (AOR) = 2.4, 95% confidence interval (CI): 1.23, 4.82], male gender (AOR = 4.3, 95% CI: 1.90, 9.74), prematurity (AOR = 3.9, 95% CI: 1.88, 8.09), and ABO incompatibility (AOR = 2.6, 95% CI: 1.16, 5.96) were significant determinants of neonatal jaundice. Conversely, the study indicated that cesarean birth was associated with a 76% lower likelihood of infant jaundice compared to vaginal delivery (AOR = 0.24, 95% CI: 0.08, 0.72). CONCLUSION: To prevent, diagnose, and treat neonatal jaundice effectively, efforts should primarily focus on managing ABO incompatibility and early detection of prematurity. Additionally, special attention should be given to neonates born through vaginal delivery, those with mothers over 35 years old, and those residing in urban areas, as they are at higher risk of developing newborn jaundice. Close monitoring of high-risk mother-infant pairs during the antenatal and postnatal periods, along with early intervention, is crucial for reducing the severity of neonatal jaundice in this study setting.

Global disease burden of neonatal jaundice from 1990 to 2019 / 中国当代儿科杂志

OBJECTIVES@#To examine the global, regional, and national disease burden of neonatal jaundice.@*METHODS@#The 2019 Global Burden of Disease database was searched to collect incident cases/incidence and deaths/mortality of neonatal jaundice, as well as global socio-demographic index (SDI) and universal health coverage index (UHCI). The epidemiological trend of neonatal jaundice from 1990 to 2019 was analyzed. The correlations between incidence/mortality of neonatal jaundice and SDI and UHCI were evaluated.@*RESULTS@#From 601 681 in 1990 to 626 005 in 2019, with a 4.04% increase in global incident cases of neonatal jaundice. The overall age-standardized incidence rate exhibited an increase [estimated annual percent change=0.13 (95%CI: 0.03 to 0.23)] during this period. Additionally, deaths due to neonatal jaundice decreased by 58.83%, from 128 119 in 1990 to 52 742 in 2019. The overall age-standardized mortality rate showed a decrease [estimated annual percent change=-2.78 (95%CI: -3.00 to -2.57)] over the same period. Countries with lower SDI, such as India, Pakistan, and Nigeria, reported a higher proportion of neonatal morbidity and mortality. In 2019, a negative correlation was observed between estimated annual percent change in age-standardized mortality rate and SDI (ρ=-0.320, P<0.05) or UHCI (ρ=-0.252, P<0.05).@*CONCLUSIONS@#The global incidence of neonatal jaundice is on the rise, while the mortality rate is declining. The burden of neonatal jaundice is influenced by social development, economic factors, and the level of medical care.

Recomendaciones para la prevención, la detección y el manejo de la hiperbilirrubinemia en los recién nacidos con 35 o más semanas de edad gestacional / Guidelines for prevention, detection and management of hyperbilirubinaemia in newborns of 35 or more weeks of gestation

La hiperbilirrubinemia representa la causa más común de reingreso hospitalario en la primera semana de vida. Su detección continúa siendo un desafío, debido especialmente al alta precoz que puede asociarse con un retraso en el diagnóstico. La identificación de los niños con riesgo de desarrollar hiperbilirrubinemia significativa es una de las principales prioridades de la sanidad pública. En este documento, se presenta un enfoque para el manejo de la ictericia del recién nacido, según recomendaciones basadas en la evidencia médica y en la opinión del Comité de Estándares de la Sociedad Española de Neonatología (AU)

Hyperbilirubinaemia is one of the most frequent causes of hospital readmission during the first week of life. Its detection is still a big challenge, mainly due to the early discharge from the hospital that can be associated with a delay of the diagnosis. The identification of those newborns at risk of developing significant hyperbilirubinaemia is one of the main priorities in the public health care system. An approach to the management of newborn jaundice is presented in this article, following the recommendations based on the medical evidence and on the opinion of the Standards Committee of the Spanish Society of Neonatology (AU)

Epidemiology of neonatal jaundice at the University Hospital of the West Indies / Epidemiología de la ictericia neonatal en el Hospital Universitario de West Indies

OBJECTIVE: To describe the epidemiology of neonatal jaundice at the University Hospital of the West Indies (UHWI). METHODS: A retrospective review of all neonates at the UHWI with clinically significant jaundice between January 1, 2006 and June 30, 2007 was performed. Demographic, clinical and laboratory data were collected. Descriptive analyses were performed. RESULTS: The incidence of clinically significant neonatal jaundice at the UHWI was 4.6% for the study period. There were 103 male (61%) and 67 (39%) female infants. The aetiology of jaundice in the infant was attributed to ABO incompatibility in 59 (35%), infection in 30 (18%), prematurity in 19 (11%), G6PD deficiency in 8 (5%), Rhesus incompatibility in 6 (3.5%) and no cause was identified in 16 (9%) infants. There was a low incidence (26%) of screening for G6PD deficiency although it was the most common aetiology for infants presenting from home. Nine (5%) neonates required exchange blood transfusion. Infants admitted from home had a significantly higher mean total bilirubin value at presentation, a significantly higher mean peak bilirubin level and presented significantly later than those who were admitted from the postnatal ward (p < 0.001). One patient was discharged with a diagnosis of bilirubin encephalopathy but defaulted from follow-up. Two neonates died but from causes unrelated to neonatal jaundice. Sixty-two patients (37%) were followed-up post discharge; 50% had hearing tests done, all tests were normal. Sixty-one (98%) infants had normal development at the time of the study; one patient had impaired motor development but this infant also had a myelomeningocoele. CONCLUSION: To further reduce morbidity associated with neonatal jaundice at the UHWI, there should be increased screening for G6PD deficiency; current systems in place for follow-up and monitoring of infants discharged from hospital prior to 72 hours must also be expanded and strengthened.

OBJETIVO: Describir la epidemiología de ictericia neonatal en el Hospital Universitario de West Indies (UHWI). MÉTODOS: Se llevó a cabo una revisión retrospectiva de todos los recién nacidos con ictericia clínicamente significativa, en UHWI entre el 1ero de enero de 2006 y el 30 de junio de 2007. Se recogieron datos demográficos, clínicos y de laboratorio. Se realizaron análisis descriptivos. RESULTADOS: La incidencia de la ictericia neonatal clínicamente significativa en UHWI fue de 4.6% para el periodo en estudio. Había 103 recién nacidos varones (61%) y 67 (39%) hembras. La etiología de la ictericia en los neonatos se atribuyó a la incompatibilidad de ABO en 59 (35%), infección en 30 (18%), prematuridad en 19 (11%), deficiencia de G6PD en 8 (5%), e incompatibilidad de Rhesus en 6 (3.5%). No se identificó ninguna causa en 16 (9%) de los recién nacidos. Hubo una baja incidencia (26%) de tamizaje para la deficiencia de G6PD, aún cuando ésta es la etiología más común en el caso de los infantes provenientes de casa. Nueve (5%) recién nacidos requirieron cambio de sangre mediante transfusión. Infantes ingresados desde sus casas presentaban un valor promedio de bilirrubina total significativamente mayor en el momento de su hospitalización, así como un nivel pico promedio de bilirrubina significativamente más alto, y se presentaron significativamente más tarde que aquellos ingresados directamente de las sala de atención postnatal (p < 0.001). Un paciente fue dado de alta con un diagnóstico de encefalopatía bilirrubínica, pero no se presentó a las sesiones de seguimiento. Dos recién nacidos murieron, pero por causas no relacionadas con la ictericia neonatal. Sesenta y dos pacientes (37%) tuvieron seguimiento luego del alta; al 50% se les realizó pruebas de audición; todas las pruebas arrojaron resultados normales. Sesenta y un infantes (98%) presentaban un desarrollo normal en el momento del estudio. Un paciente tenía discapacidad del desarrollo motor, pero también presentaba un mielomeningocele CONCLUSIÓN: A fin de lograr una reducción de la morbosidad asociada con la ictericia neonatal en UHWI, debe realizarse un tamizaje de la deficiencia de G6PD. Asimismo, es necesario ampliar y fortalecer los sistemas actuales establecidos para el seguimiento y monitoreo de los infantes dados de alta del hospital antes de las 72 horas.

Enfermedad de Niemann-Pick tipo C: desde una colestasis neonatal hacia un deterioro neurológico. Variabilidad fenotípica / Niemann-Pick type C disease: From neonatal cholestasis to neurological degeneration. Different phenotypes

Introducción: La enfermedad de Niemann-Pick tipo C está causada por un defecto en el transporte intracelular de colesterol que produce un acúmulo de lípidos en los lisosomas de diferentes tejidos. Es una enfermedad rara, debida generalmente a mutaciones en el gen NPC1 y solo unos pocos casos se asocian a mutaciones en el gen NPC2. Frecuentemente se manifiesta en la edad pediátrica, presentando gran variabilidad en las manifestaciones clínicas. La enfermedad conduce a un deterioro neurológico con diferentes síntomas que están relacionados con la edad. Una colestasis neonatal transitoria, la aparición de esplenomegalia y/o hepatomegalia pueden preceder en años a los síntomas neurológicos. Pacientes y métodos: Presentamos los 6 casos diagnosticados en nuestra unidad en los últimos 20 años. Se han revisado las manifestaciones clínicas, los hallazgos neurorradiológicos (RM) y el análisis molecular de todos ellos. Resultados: Todos se presentaron antes de los 6 años y 5 casos tuvieron afectación hepática y/o colestasis en el periodo neonatal. En 2 casos se detectó ascitis en el periodo prenatal. La presencia de esplenomegalia se objetivó en 5 casos. En todos los casos se detectaron mutaciones en el gen NPC1. Conclusión: Es importante el conocimiento de esta enfermedad y la identificación de los síntomas clínicos precoces para poder diagnosticarla precozmente, lo que conllevaría a un tratamiento adecuado, pudiendo evitar procedimientos innecesarios. Por otra parte es importante asesorar adecuadamente a las familias y proporcionar un consejo genético (AU)

Introduction: Niemann-Pick type C is a lysosomal storage disorder caused by a defect in intracellular trafficking of cholesterol. It is a rare disease, usually caused by mutations in NPC1 gene, but in some cases by mutations in NPC2 gene. Usually it is present in the paediatric age with a great variability of clinical manifestations. This disease leads to neurological degeneration with various age-related symptoms. Transient neonatal cholestasis, the appearance of splenomegaly and/or hepatomegaly may occur years before the neurological symptoms. Patients and methods: We report 6 cases diagnosed in our unit in the last 20 years. We reviewed the clinical manifestations, neuroradiological findings (MRI) and molecular analysis of all of them. Results: The disease began before 6 years of age and 5 cases had liver dysfunction and cholestasis in the neonatal period. Ascites was detected in 2 cases in prenatal period. Five cases have or had splenomegaly. Mutations in NPC1 gene were detected in all of them. Conclusions: It is important to understand this disease and the identification of early clinical symptoms to make an early diagnosis, leading to appropriate treatment and avoiding unnecessary tests. Moreover, it is important to suitably advise families and provide them with genetic counseling (AU)

Morbilidad en recién nacidos de término en relación a su edad gestacional / Morbidity risk and gestational age among full-term newborns

Introduction: Newborns of Gestational Age (GA) ³ 37 weeks are considered to be full-term, but they might show increased morbidity. Objective: To evaluate morbidity risk between newborns 37-38 weeks GA vs those over 39 weeks. Patients and Methods: Cohort study of all children born at a private clinic in Buenos Aires between January 1, 2006 and July 31, 2007, product of simple pregnancies and without major congenital abnormalities. A total of 1829 children met the criteria, among which 823 (45 percent) were 37-38 weeks GA, and 1006 (55 percent) were 39 weeks or over. The following parameters were recorded: birth route, maternal history and morbidity. Morbidity included at least one of the following: respiratory distress > 2 hours post-birth, use of intravenous solutions, jaundice and use of antibiotics. The association between morbidity and GA was evaluated using Chi-square, and logistical regression was used to evaluate the relationship between newborn morbidity and GA, birth route or maternal hypertension. Results: Newborns of 37-38 weeks GA showed higher incidence of each component of morbidity: respiratory distress (OR = 2,55 IC 95 percent = 1,70-3,82), jaundice (OR = 2,24 IC95 percent 1,72-2,29), antibiotic use (OR = 2,31 IC 95 percent= 1,15-4,69) and IV use (OR = 2,29 IC95 percent = 1,57-3,33). Multivariate analysis showed that GA 37-38 weeks (OR= 1,89 IC95 percent= 1,31-2,71) and a C-section (OR = 1,65 IC95 percent = 1,18-2,32) constituted independent predictors of morbidity. Conclusion: In this experience, a gestational age under 39 weeks increases morbidity risk.

Introducción: A pesar de considerarse recién nacidos (RN) de término a aquellos con edad gestacional (EG) ³ 37 semanas, aún dentro de este grupo, los de menor EG podrían presentar mayor morbilidad. Objetivo: Evaluar si existen diferencias en la frecuencia de morbilidad entre recién nacidos de 37-38 semanas de EG y aquellos de EG ³ de 39 semanas. Pacientes y Método: Estudio de cohorte incluyendo todos los RN de una institución privada de Buenos Aires, nacidos entre 01/01/06 y 31/07/07, con EG ³ 37 semanas, producto de gestas simples y sin malformaciones congénitas mayores (n = 1 829). De ellos, 823 (45 por ciento) tenían EG 37-38 semanas y 1 006 (55 por ciento) EG > 39 semanas. Se registró vía de nacimiento, antecedentes maternos y morbilidad (presencia de al menos una de las siguientes condiciones: dificultad respiratoria > 2 horas del nacimiento, aporte de líquidos intravenosos, ictericia y uso de antibióticos). Se evaluó asociación entre morbilidad (en general y para cada uno de sus componentes) y EG por medio de Chi cuadrado y se utilizó regresión logística para evaluar asociación entre EG, vía de parto (cesárea o vaginal), hipertensión arterial materna y morbilidad. Resultados: Los RN de 37-38 semanas presentaron mayor prevalencia de cada componente de morbilidad: dificultad respiratoria (OR = 2,55 IC 95 por ciento = 1,70-3,82), ictericia (OR = 2,24 IC95 por ciento 1,72-2,29), uso de antibióticos (OR = 2,31 IC 95 por ciento = 1,15-4,69) y accesos vasculares (OR = 2,29 IC95 por ciento = 1,57-3,33). El análisis multivariado mostró que EG 37-38 semanas(OR= 1,89IC95 por ciento= 1,31-2,71) y el parto por cesárea (OR = 1,65 IC95 por ciento = 1,18-2,32) constituían predictores independientes de morbilidad. Conclusión: En recién nacidos de término, la EG < 39 semanas incrementa la morbilidad.

Icterícia como causa de internação neonatal: a experiência em um serviço terciário de Porto Alegre, RS / Jaundice in healthy term newborns treated at a tertiary center in Porto Alegre, RS

Introdução: Cerca de 60-80% dos recém-nascidos (RN) tornam-se ictéricos durante os primeiros dias de vida. Apesar de geralmente representar um fenômeno transitório, alguns pacientes necessitam de tratamento hospitalar. O objetivo deste estudo foi determinar a causa principal de icterícia neonatal em recém-nascidos saudáveis internados no Hospital Luterano e possíveis associações com diversas variáveis clínicas. Metodologia: Estudo retrospectivo em que foram estudados todos os casos de RN com icterícia neonatal internados para tratamento de hiperbilirrubinemia na UTI Neonatal do Hospital Luterano da ULBRA, no período de abril de 2007 a dezembro de 2008. Os resultados foram expressos em estatística descritiva e foi utilizado o teste exato de Fischer e o teste Qui-quadrado. O limite alfa considerado foi de 5%, com nível de significância de 0,05. Resultados: Dentre os RNs estudados (74), 52,7% eram do sexo masculino e 45,9% eram do sexo feminino. 14,8% dos pacientes nasceram de parto vaginal, enquanto que 85,1% nasceram de cesárea. A maioria dos recém-nascidos estudados (74,3%) foi considerada a termo. O diagnóstico mais frequente (37,8%) de icterícia dos pacientes internados para tratamento no serviço foi o de baixo aporte. Os pacientes do sexo masculino necessitaram de maior tempo de fototerapia do que as pacientes do sexo feminino (p=0,056). Conclusão: O diagnóstico de baixo aporte recebido pelos pacientes foi a causa mais frequente de icterícia. Os meninos necessitaram de um tempo significativamente maior de fototerapia para o tratamento da icterícia do que as meninas; também houve associação positiva da hiperbilirrubinemia com a baixa idade.

Introduction: About 60-80% of the newborns (NB) experience jaundice in the first days of life. Although jaundice is often a transitory phenomenon, some infants require hospital care. The aim of this study was to determine the main cause of neonatal jaundice among healthy newborns admitted to the Hospital Luterano and the possible associations with a number of clinical variables. Methods: A retrospective study in which all cases of NB with neonatal jaundice admitted for treatment of hyperbilirubinemia at the Neonatal ICU of the Hospital Luterano of ULBRA were studied, from Apr 2007 to Dec 2008. The results were expressed as descriptive statistics, and Fisher’s exact test and the Chi-square test were applied. The alpha limit considered was 5%, with level of significance at 0.05. Results: Among the 74 NB studied, 52.7% were males and 45.9% were females. 14.8% of the infants had a vaginal birth, while 85.1% had a cesarean delivery. Most of the studied infants (74.3%) were born full term. The most frequent cause for (37.8%) jaundice among these patients was inadequate intake. The male patients needed to stay longer on phototherapy than female patients (p=0.056). Conclusion: Low intake by the patient was the most frequent cause of jaundice in this series. The boys needed significantly more time on phototherapy than females, and there was a positive association of hyperbilirubinemia with low age.

Ictericia neonatal: evaluación clínica de un bilirrubinómetro transcutáneo / Neonatal jaundi Clinical evaluation of a transcutaneous bilirubinometer

Introducción: Los bilirrubinómetros transcutáneos actuales han demostrado ser útiles como instrumentos de medida de la ictericia neonatal. En este estudio se evalúa si las medidas de la bilirrubina transcutánea (TCB) se correlacionan con las determinaciones de la bilirrubina sérica (TSB), y si la edad gestacional, peso al nacimiento, raza u horas de vida interfieren en esas medidas. Material y métodos: Estudio transversal, observacional y descriptivo sobre una muestra de 65 determinaciones simultáneas de TCB y de TSB. Resultados: Se obtiene un coeficiente de correlación de 0,923 entre ambos métodos. El análisis de covarianza muestra cómo la edad gestacional, raza y peso parecen no ser contribuidores significativos sobre los valores de la TCB. Conclusiones: Aunque el aparato transcutáneo tiende a infraestimar a la TSB, sobre todo con concentraciones elevadas, es una técnica útil para la medición orientativa de la concentración de la bilirrubina en recién nacidos (AU)

Background: Transcutaneous bilirubinometers provide non-invasive data on newborn jaundice. The aim of this study is to evaluate whether the measurement of transcutaneous bilirubin can be correlated with serum bilirubin, and to find out whether gestational age, weight birth, race or hours of life affect those measurements .Method: Descriptive observational cross-sectional study on a sample of 65 simultaneous measurement of transcutaneous (TcB) and serum bilirubin (TSB). Results: The correlation coefficient between both methods was 0.923. Race, gestational age and birth weight tends to not have any effects on the levels of transcutaneous bilirubin. Conclusion: Although bilirubinometer measurements tend to underestimate serum bilirubin, especially in patients with high levels, it is a useful technique as a screening tool in the evaluation of hyperbilirubinaemia (AU)

Importancia clínica de la incompatibilidad ABO madre-hijo / The clinical significance of ABO blood group maternal-infant incompatibily

Objetivo. Conocer la prevalencia y significación clínica de la incompatibilidad madre-hijo de grupo sanguíneo ABO. Material y métodos. Estudio de cohorte de todos los neonatos vivos en nuestro Hospital durante 6 años. Descripción de su grupo sanguíneo ASO y cuantificación de las incompatibilidades materno-filiales. Análisis clínico y terapéutico de las incompatibilidades con aglutininas y test de Coombs directo positivos en sangre del niño. Resultados. De 10.829 neonatos vivos consecutivos, 4.970 (46 por ciento) eran del grupo A, 877 (8 por ciento) del grupo B, 401 (4 por ciento) del grupo AB y 4.575 (42 por ciento) del grupo O. En 2.206 (20 por ciento) existía posible incompatibilidad materno-filial y en 218, incompatibilidad con aglutininas y test de Coombs directo positivo en el niño (2 por ciento de los recién nacidos vivos y 10 por ciento de las incompatibilidades). De los 218 pudimos revisar la historia clínica de 217: el 57 por ciento presentó ictericia en algún momento de su presencia en nuestro hospital y el 31 recibió fototerapia; se trasfundieron 7 niños de los que 3 presentaban la incompatibilidad como única causa de su anemia; ninguno precisó exanguinotransfusión. No encontramos diferencias significativas en la expresión clínica entre los anti-A y los anti-B. Conclusión. La incompatibilidad de grupo sanguíneo ABO materno-filial es frecuente (20 por ciento de los recién nacidos vivos) pero su repercusión clínica y terapéutica es muy escasa (AU)

Comportamiento actual del ictero en el neonato / Behavior of icterus in neonate: state of the art

Se realizó un estudio descriptivo, longitudinal, prospectivo del comportamiento del íctero en los neonatos del policlínico docente "Jimmy Hirtzel" de Bayamo; el universo estuvo constituido por todos los nacidos vivos de enero a diciembre de 1998. Se estudiaron las variables peso al nacer, edad de aparición del íctero, edad gestacional materna, causas más frecuentes, tratamiento empleado y su evolución; se aplicó el conteo simple y el cálculo porcentual. Se demostró el predominio del íctero entre las 24 y 27 horas de vida (89,7 por ciento), el fisiológico aportó el mayor número de casos (88,7 por ciento). Detectamos que los baños de sol se utilizaron como principal tratamiento (64,9 por ciento). La evolución satisfactoria predominó en los casos estudiados(AU)

Problems experienced by the mother and baby in the postnatal period

A cross sectional study was conducted in St. Thomas, Jamaica, among postnatal mothers and babies to identify problems experienced during this crucial period. One hundred and twenty seven mothers were interviewed 3-6 weeks after delivery. The mothers' ages ranged from 14-39 years; 94.0 percent had normal delivery and 96.0 percent of births took place in the hospital. The mean length of stay in the hospital was 1.56 days. Sixty five (52.0 percent) of babies had one or more complaints. The two most frequent complaints were jaundice and infected eyes. Nine of the babies with complaints were admitted to hospital. There were 75 (59.0 percent) mothers with complaints. The mothers most frequently complained of engorged breasts and backache, but 18.0 percent of the mothers had complaints including heavy bleeding, offensive vaginal loss (lochia), pain on urination and fever. The most frequently occurring antenatal problems were anaemia 18.9 percent, oedema 18.1 percent, vaginal discharge 17.3 percent and high blood pressure 15.7 percent. The results showed that there was an association between mothers with antenatal problems developing postnatal problems. Seventy four percent of the mothers who had antenatal problems also had postnatal problems. On discharge from hospital, mothers were given advice mainly on care of the baby not on self care. Approximately half (49.6 percent) of the mothers were visited at home postnatally and 76.2 percent of these visits were done by the Community Health Aide.(Au)

Icterícia neonatal: levantamento dos casos ocorridos no Hospital Universitário Regional de Maringá (HUM), entre novembro de 1993 e julho de 1995 / Newborn jaundice: survey of the cases occured in the Hospital Universitário Regional de Maringá (HUM) from November 1993 to July 1995

O objetivo do estudo foi traçar o perfil do serviço de neonatologia do HUM quanto ao atendimento ao recém-nascido ictérico. Foram levantados todos os prontuários com diagnóstico de trabalho de parto registrados entre novembro de 1993 e julho de 1995 no HUM e considerados como populaçäo de estudo todos os recém-nascidos que apresentaram icterícia entre o nascimento e a alta hospitalar. Os dados foram processados pelo sistema EPI-info/Excel e utilizado teste näo-paramétrico (Qui-quadrado) para análise dos resultados. No período, nasceram 574 crianças, das quais 281 (48,95 por cento) tiveram icterícia neonatal, sendo 53,38 por cento do sexo masculino e 46,62 por cento do sexo feminino. As crianças ictéricas foram distribuídas em 2 grupos (tratadas e näo tratadas) e classificadas de acordo com a idade gestacional, peso ao nascimento, tipo de parto, presença de asfixia ao nascimento, distúrbios associados. O teste do Qui-quadrado revelou-se significativo entre todas as variáveis, exceto quanto ao tipo de parto. Dos RN ictéricos, 74,38 por cento näo receberam tratamento, 25,27 por cento foram submetidos à fototerapia isolada e 0,35 por cento a exsangüíneo-transfusäo. Dentre os tratado, em 70,83 por cento o diagnóstico foi de icterícia fisiológica e em 9,72 por centro foi referido algum grau de desidrataçäo como complicaçäo da fototerapia. O observado näo diferiu de dados da literatura, mostrando somente a alta freqüência de icterícia e a diversidade de conduta frente ao mesmo nível de bilirrubina e à mesma idade gestacional.

Incidencia de ictericia en recién nacidos del Hospital Luis Manuel Morillo King de La Vega, marzo-diciembre 1994 / Incidence of newborn icterus at the \"Luis Morillo King\" Hospital of La Vega, March-December 1994

El recién nacido ictérico, representa hoy por hoy un reto para nuestros Gineco-obstetras, médicos generales y de manera muy particular para nuestros perinatólogos. El objetivo del presente estudio fue conocer el grado de incidencia que ocupa la ictericia del recién nacido en la población perteneciente al Hospital Luis Manuel Morillo King; La Vega, República Dominicana durante el período marzo-diciembre 1994. Durante el período de nuestra investigación fueron asistidas en nuestro centro un total de 2518 recién nacidos niños de los cuales 74 casos (2.9) presentaron ictericia. (79.7//) resultaron ser a término; 15 de ellos recién nacidos prematuros. (2.7//) de las madres habían sido sometidas a transfusión sanguínea por lo menos en una ocasión. Se ha demostrado que la oxitocina usada de manera prolongada como inductor y/o conductor de la labor de parto se ha relacionado con la ictericia. En nuestro estudio se utilizó oxitocina en 8 de las madres cuyos recién nacidos presentaron ictericia 10.8// del total