Influence of UGT1A1 Genetic Variants on Free Bilirubin Levels in Japanese Newborns: A Preliminary Study.

BACKGROUND: Free bilirubin (Bf) is a better marker than total serum bilirubin (TSB) for predicting bilirubin encephalopathy (BE). To date, two UGT1A1 genetic variants (rs4148323 and rs3064744) have been associated with neonatal hyperbilirubinemia; however, the direct association between UGT1A1 variants and Bf levels in newborns has not been elucidated. METHODS: We retrospectively analyzed the clinical data of 484 infants, including the genotype data of two UGT1A1 genetic variants. We divided the infants into a high Bf group (Bf ≥ 1.0 µg/dL, n = 77) and a non-high Bf group (Bf < 1.0 µg/dL, n = 407), based on the peak Bf values. Logistic regression analysis was performed to calculate the odds ratios (ORs) for each variant allele compared to wild-type alleles. RESULTS: The frequencies of the A allele in rs4148323 and (TA)7 allele in rs3064744 in the high Bf group (29% and 4%, respectively) were significantly different from those in the non-high Bf group (16% and 12%, respectively). In logistic regression analysis, for rs4148323, the A allele was significantly associated with an increased risk of hyper-free bilirubinemia over the G allele (adjusted OR: 1.80, 95% confidence interval [CI]: 1.19-2.72, p < 0.01). However, for rs3064744, the (TA)7 allele was significantly associated with a decreased risk of hyper-free bilirubinemia over the (TA)6 allele (adjusted OR: 0.42, 95% CI: 0.18-0.95, p = 0.04). CONCLUSIONS: This study is the first to show that the A allele in rs4148323 is a risk factor and that the (TA)7 allele in rs3064744 is a protective factor for developing hyper-free bilirubinemia in Japanese newborns.

High Direct Bilirubin Associated With Levoffoxacin Use in a Neonate.

Limited data exist regarding the use of fluoroquinolones in the neonatal population. Levofloxacin has some utility in this population because it is one of a very limited number of antibiotics with activity against Stenotrophomonas maltophilia. We describe the successful treatment of S maltophilia tracheitis in a premature neonate using levofloxacin 10 mg/kg every 24 hours and the subsequent unexpected sharp rise in the direct bilirubin. This case illustrates a previously unrecognized adverse drug effect associated with levofloxacin use in neonates.

Effect of Synbiotic on the Treatment of Jaundice in Full Term Neonates: A Randomized Clinical Trial.

PURPOSE: Jaundice accounts for most hospital admissions in the neonatal period. Nowadays, in addition to phototherapy, other auxiliary methods are used to reduce jaundice and the length of hospitalization. This study aimed to investigate the effect of probiotics on the treatment of hyper-bilirubinemia in full-term neonates. METHODS: In this randomized clinical trial, 83 full-term neonates, who were admitted to the hospital to receive phototherapy in the first 6 months of 2015, were randomly divided into two groups: synbiotic (SG, n=40) and control (CG, n=43). Both groups received phototherapy but the SG also received 5 drops/day of synbiotics. Serum bilirubin, urine, stool, feeding frequency, and weight were measured daily until hospital discharge. A p-value<0.05 was considered statistically significant. RESULTS: The mean total serum bilirubin in the SG was lower than that in the CG (9.38±2.37 and 11.17±2.60 mg/dL, respectively). The urine and stool frequency in the SG was significantly higher than that in the CG (p<0.05). The duration of hospitalization in the SG was shorter than that in the CG. CONCLUSION: Use of synbiotics as an adjuvant therapy had a significant treatment effect on jaundice in full-term neonates. Further studies including larger samples with long follow-up periods are essential to confirm the benefits of routine use of synbiotics in neonatal patients with jaundice.

Comparison of light-emitting diodelights vs fluorescent light phototherpy for the treatment of unconjugated hyperbilirubinemia in preterm infants - Randomised Control Trial.

OBJECTIVE: To compare the mean treatment duration of phototherapy when done with light-emitting diodelights versus fluorescent lights for the treatment of unconjugated hyperbilirubinaemia in preterm infants. METHODS: The randomised controlled trial was conducted at Allied Hospital, Faisalabad, Pakistan, from September 12, 2015, to March 11, 2016, and comprised patients with unconjugated hyperbilirubinaemia. Detailed history, including demographic information, were noted. The patients were divided into two groups using computergenerated random number tables. Group A received light-emitting diode light phototherapy and group B received fluorescent light phototherapy. Initially complete blood count with peripheral film, retic count, coombs test, blood group, serum bilirubin level (total, direct, indirect) were done. Serum bilirubin was checked by bilirubinometre 6hourly till the end of treatment. Data analysis was done using SPSS 20.. RESULTS: There were 460 patients divided into two equal groups of 230(50%) each. Mean age was 32.34}2.28 weeks in Group A and 32.21}2.11weeks in Group B. In Group A, 116(50.43%) subjects were boys and 114(49.57%) were girls. In Group B, 120(52.17%) were boys and 110(47.83%) were girls. Mean duration of treatment was recorded as 36.83+2.09 hours in Group A and 45.66+2.52 hours in Group B. (p=0.0001). CONCLUSIONS: The mean duration of treatment of phototherapy with light-emitting diodelights lights was significantly shorter compared to fluorescent lights.

Effect of Synbiotic on the Treatment of Jaundice in Full Term Neonates: A Randomized Clinical Trial / 대한소아소화기영양학회지

PURPOSE: Jaundice accounts for most hospital admissions in the neonatal period. Nowadays, in addition to phototherapy, other auxiliary methods are used to reduce jaundice and the length of hospitalization. This study aimed to investigate the effect of probiotics on the treatment of hyper-bilirubinemia in full-term neonates. METHODS: In this randomized clinical trial, 83 full-term neonates, who were admitted to the hospital to receive phototherapy in the first 6 months of 2015, were randomly divided into two groups: synbiotic (SG, n=40) and control (CG, n=43). Both groups received phototherapy but the SG also received 5 drops/day of synbiotics. Serum bilirubin, urine, stool, feeding frequency, and weight were measured daily until hospital discharge. A p-value<0.05 was considered statistically significant. RESULTS: The mean total serum bilirubin in the SG was lower than that in the CG (9.38±2.37 and 11.17±2.60 mg/dL, respectively). The urine and stool frequency in the SG was significantly higher than that in the CG (p<0.05). The duration of hospitalization in the SG was shorter than that in the CG. CONCLUSION: Use of synbiotics as an adjuvant therapy had a significant treatment effect on jaundice in full-term neonates. Further studies including larger samples with long follow-up periods are essential to confirm the benefits of routine use of synbiotics in neonatal patients with jaundice.

Gestational Diabetes: Glycemic Control in the Last Two Weeks Before Delivery Contributes to Newborn Insulinemia.

INTRODUCTION: Fetal hyperinsulinemia in gestational diabetes mellitus (GDM) not only is important during intrauterine life, a time when it can result in macrosomia, but also at delivery, since it can result in neonatal hypoglycemia and hyperbilirubinemia. The question is, how long before delivery does maternal glycemic control contribute to newborn insulinemia in GDM? METHODS: In 72 women with GDM, we calculated Spearman's rank (rs) correlations between umbilical cord blood C-peptide at birth (a biomarker of insulin secretion), and both maternal glycosylated hemoglobin (HbA1c) and mean blood glucose (MBG) recorded in the last two visits prior to delivery. Iterative correlations were done between umbilical cord blood C-peptide at birth, and maternal glucose control, at 0, 1, 2, 3, 4, and 5 weeks before delivery. RESULTS: At an early visit (32.95 ± 1.8 weeks), rs = 0.353 (P = 0.07) between HbA1c and C-peptide, whereas rs = 0.244 (P = 0.186) between MBG and C-peptide. At the latest visit (35.04 ± 1.6 weeks), rs = 0.456 (P = 0.004) between HbA1c versus C-peptide, and rs = 0.359 (P = 0.023) between MBG versus C-peptide. Iterative correlations between MBG and C-peptide became significant at 2 weeks before delivery. CONCLUSION: To further reduce the risk of hypoglycemia and hyperbilirubinemia in infants born to women with GDM, besides applying a strict in-patient glucose control protocol at delivery, it is necessary to improve even more the quality of maternal glucose control during the last 2 weeks prior to delivery.

Evidence of hemolysis in pigs infected with highly virulent African swine fever virus.

AIM: The research was conducted to understand more profoundly the pathogenetic aspects of the acute form of the African swine fever (ASF). MATERIALS AND METHODS: A total of 10 pigs were inoculated with ASF virus (ASFV) (genotype II) in the study of the red blood cells (RBCs), blood and urine biochemistry in the dynamics of disease. RESULTS: The major hematological differences observed in ASFV infected pigs were that the mean corpuscular volume, mean corpuscular hemoglobin, and hematocrits were significantly decreased compared to controls, and the levels of erythropoietin were significantly increased. Also were detected the trends of decrease in RBC count at terminal stages of ASF. Analysis of blood biochemistry revealed that during ASF development, besides bilirubinemia significantly elevated levels of lactate dehydrogenase, and aspartate aminotransferase were detected. Analysis of urine biochemistry revealed the presence of bilirubinuria, proteinuria during ASF development. Proteinuria, especially at late stages of the disease reflects a severe kidney damage possible glomerulonefritis. CONCLUSION: The results of this study indicate the characteristics of developing hemolytic anemia observed in acute ASF (genotype II).

Multiple variants in UGT1A1 gene are factors to develop indirect hyper-bilirubinemia.

Most Taiwanese patients with hyper-bilirubinemia have genetic abnormalities in the uridine diphosphoglucuronate-glucuronosyltransferase 1A1 (UGT1A1) gene beyond the variants in the TATA box upstream of UGT1A1 associated with Gilbert's syndrome. To investigate the role of UGT1A1 in the pathogenesis of indirect hyper-bilirubinemia, we prospectively studied 97 consecutive patients with indirect hyper-bilirubinemia for genotypes of promoter [(TA)6TAA6, (TA)7TAA7] and coding region [nucleotide (nt)-211, nt-686, nt-1,091 and nt-1,456] of UGT1A1. Thirty-six of the patients (45.6%) were found to have Gilbert's syndrome with 7/7 genotype; among them, 14 also carried variants at nt-686. Forty-two patients (43.3%) had the 6/7 genotype; among them, 36 patients were found to have one or more variants in the coding region. Patients with higher serum total bilirubin are associated with higher likelihood of carrying Gilbert's syndrome genotype: 60.0% (P=0.007) patients with serum total bilirubin level ≥2.5 mg/dL carried the Gilbert's syndrome genotype, while only 23.9% of patients with serum total bilirubin level <2.5 mg/dL carry the same genotype (P=0.0006). Forty-one of the 61 non-Gilbert's patients had one homogenous variants or two or more heterozygous variants in UGT1A1. Further studies are necessary to confirm the role of one homo-zygous variant or two or more hetero-zygous variants in UGT1A1 gene as factors for indirect hyper-bilirubinemia.

Mechanism of Ademetionine for Treating Hyper-unconjugated Bilirubinemia in Neonate Rats / 中国药房

OBJECTIVE:To investigate the efficacy and mechanism of ademetionine for treating hyper-unconjugated bilirubinemia in neonate rats.METHODS:The model of hyper-unconjugated bilirubinemia was established in 95 neonate SD rats by subcutaneously injection of phenylhydrazine hydrochloride,then the rats were randomly assigned to model control group(treated with normal saline),therapeutic control group(phenobarbital/nikethamide)and the therapeutic group(s-adenosyl-1-methionine)q.d for 7 days all by intraperitoneal injection.Blood samples were taken at different time for the analysis of the hepatic BUGT activity and serum bilirubin.RESULTS:In therapeutic control group compared with the model control group,the serum unconjugated bilirubin was lower,and the hepatic BUGT activity of therapeutic was higher(P

A Study on the Changes of OFR in G6PD Deficient Neonates with Hyper-bilirubinemia During Phototherapy / 中国医师杂志

0.05). Compared with the healthy neonates, the concentration of blood MDA and ROS was significantly higher, and that of blood HB and SOD was significantly lower in both groups(P

Neurodevelopmental outcome at 1 year in Zimbabwean neonates with extreme hyperbilirubinaemia.

UNLABELLED: The study concentrates on estimating the magnitude of the effect of a single risk factor, maximum total serum bilirubin (TSB) in excess of 400 micromol/l (23.4 mg/dl), on the neurodevelopmental outcome of 50, singleton, Zimbabwean neonates at 1 year of age. At 1 year corrected age the Bayley Scales of Infant Development (BSID) was administered. Two infants died and five were lost to follow up. TSB was neither associated with birth weight nor with gestational age. Of 43 infants with a TSB > 400 micromol/l (23.4 mg/dl),11(26%) scored abnormal on the BSID at 1 year of age and 5 (12%) infants developed the choreoathetoid type of cerebral palsy. CONCLUSION: Infants with bilirubin levels between 400 and 500 micromol/l (23.4 and 29.2 mg/dl) who scored abnormal or suspect on the Bayley Scales of Infant Development were preterm or had haemolytic disease. All term infants without haemolysis and with bilirubin levels between 400 and 500 micromol/l (23.4 mg/dl-29.2 mg/dl) were normal at 1 year of age.

PIP: The effect of maximum total serum bilirubin (TSB) in excess of 400 mcgmol/l (23.4 mg/dl) on neurodevelopmental outcome at 12 months was assessed in a follow-up study of 50 infants admitted to the Special Baby Care Unit of Mpilo Central Hospital in Bulawayo, Zimbabwe. There were 26 preterm infants (52%) in this series. 2 infants died before they reached 12 months of age and 5 were lost to follow-up. TSB levels were not associated with either birth weight or gestational age. Overall, 32 infants (74%) had Bayley Scales of Infant Development scores within the normal range. 11 (26%) of the 43 infants with extreme TSB (above 482 mcgmol/l) had suspect or abnormally low scores on the Bayley Scales and 5 of these infants (12%) developed the choreo-athetoid type of cerebral palsy. The infants with TSB levels of 400-500 mcgmol/l who had suspect or abnormal Bayley scores either had hemolytic disease or were premature. Finally, infants treated with exchange transfusion had higher TSB levels and 67% of transfused newborns demonstrated delayed development at 12 months of age.

Epidemiology of clinical hyperbilirubinaemia in Al Ain, United Arab Emirates.

All infants born at Al Ain Hospital, United Arab Emirates between 1 January and 30 June 1995 who developed clinically relevant hyperbilirubinaemia defined as jaundice requiring investigation and treatment were prospectively studied. Of the 2300 live births, 85 (3.7%) developed hyperbilirubinaemia. Of these, 22 were premature, 22 had ABO haemolytic disease of the newborn, eight had G6PD deficiency (Mediterranean), seven had breast-milk jaundice, five were born to mothers with diabetes mellitus and one had Rh incompatibility. No specific factor was identified in 20 (24%). Significant differences in the distribution of diagnostic categories were found among the major ethnic groups in the population studied. This first study of the epidemiology of clinically relevant hyperbilirubinaemia in this community identified locally relevant risk factors and highlighted areas of health care which, if modified, might reduce the incidence of hyperbilirubinaemia.

PIP: If untreated, severe unconjugated hyperbilirubinemia is neurotoxic. Management of the condition therefore includes preventing serum bilirubin from reaching toxic levels. Identifying infants at risk of developing severe hyperbilirubinemia and early intervention have reduced levels of morbidity and mortality associated with bilirubin encephalopathy. The incidence of neonatal jaundice and the etiological factors associated with hyperbilirubinemia vary by locale. All infants born at Al Ain Hospital, United Arab Emirates, between January 1 and June 30, 1995, who developed clinically relevant hyperbilirubinemia defined as jaundice requiring investigation and treatment were prospectively studied. 85 (3.7%) of the 2300 live births developed hyperbilirubinemia. Of those, 22 were premature, 22 had ABO hemolytic disease of the newborn, 8 had G6PD deficiency (Mediterranean), 7 had breast milk jaundice, 5 were born to mothers with diabetes mellitus, and 1 had Rh incompatibility. No specific factor was identified in 20 (24%) infants. Significant differences in the distribution of diagnostic categories were found among the major ethnic groups in the population studied.

Basic care reduces neonatal hyperbilirubinaemia.

We studied the frequency of jaundice, bilirubin estimations, phototherapy administration and exchange transfusions performed at 5 year intervals (1981, 1986 and 1991) among babies admitted to special care unit and those managed in postnatal ward, showing a decline which was significant except for the number of exchange transfusions performed. The number of term babies with serum bilirubin > 15 mg/dl and preterm babies with serum bilirubin > 10 mg/dl also declined significantly without prophylactic phototherapy or pharmacotherapy.

PIP: An examination of the case records of infants admitted to the Institute of Child Health in Bombay, India, in 1981, 1986, and 1991 reveals a significant decline over time in the numbers of infants with jaundice and those requiring serum bilirubin estimation and phototherapy. Cases of jaundice totalled 341 in 1981, 156 in 1986, and 109 in 1991. Bilirubin estimations were required in 166, 13, and 27 infants, respectively, while phototherapy was administered in 125, 7, and 1 cases, respectively. Nine infants received exchange transfusion in 1981 compared with 2 in 1986 and none in 1991. Also recorded were significant declines in serum bilirubin values exceeding 15 mg/dl in term babies and 10 mg/dl in preterm infants. These changes, which occurred without prophylactic use of phototherapy or pharmacotherapy, are considered to reflect a renewed emphasis on provision of warmth, early institution of breast milk feeds, and improved care in the labor room. Although modest physiologic levels of bilirubin during the neonatal period may not be harmful, the bilirubin concentration at which the risk of brain damage exceeds the risk of treatment remains unclear.

The effect of breast-feeding frequency on serum bilirubin levels.

OBJECTIVE: Our purpose was to evaluate the effect of breast-feeding frequency on serum bilirubin levels in the first 3 days after birth. STUDY DESIGN: Two hundred seventy-five infants were randomly assigned to a frequent or demand breast-feeding schedule. RESULTS: Infants in the frequent group (n = 131) nursed nine (7.5 to 10.5) times per day (median and inner 80%), and the demand group (n = 143) fed 6.5 (5.5 to 8.0) times per day. The serum bilirubin level was measured in all infants between 48 and 80 hours (median 53 hours, inner 80% 48 to 68 hours) and was 7.4 (1.8 to 10.7) mg/dl in the frequent group and 8.0 (2.9 to 11.2) mg/dl in the demand group (p = 0.103). There was no correlation between the frequency of breast-feeding and the serum bilirubin level. CONCLUSION: Within the range of the frequency of nursing observed in this study, we could not demonstrate a significant effect on serum bilirubin levels in the first 3 days after birth.

Serum bilirubin levels in breast-fed vs formula-fed infants during the first 3-5 days of life.

Breast feeding seems to be a cause of neonatal jaundice during the first five days of life; the mechanism of which needs further study. Thai infants appear to exhibit a higher level of "physiological jaundice" bilirubin level than Caucasians.

PIP: Neonatal jaundice remains the most common problem in the well baby nursery. Pediatricians and neonatologists believe that breast-fed infants have a generally increased severity of jaundice during the first week of life. The authors report findings from their study of whether healthy breast-fed Thai infants have significantly higher serum bilirubin levels than those of formula-fed infants in the first 3-5 days of life. Of 190 infants born, 130 were delivered by cesarean section. The authors studied 76 infants fed with formulated milk and 54 fed with breast milk; the study did not include infants who were delivered normally and fed with formulated milk. All mothers with normal delivery insisted upon breast feeding, while discomfort among many mothers who delivered by cesarean section led them to agree to feed their babies with formulated milk. The study found breast feeding to be an apparent cause of neonatal jaundice during the first five days of life, although more study is needed on the phenomenon. Thai infants seem to have more physiological jaundice than Caucasians.

Association between glucose-6-phosphate dehydrogenase deficiency and neonatal jaundice: interaction with multiple risk factors.

This nonconcurrent cohort study was carried out to evaluate the association of neonatal jaundice with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency and its interactions with other risk factors. The G-6-PD enzyme activity of 12,379 neonates was screened by a semi-quantitative fluorometric assay and double-checked by a quantitative method to identify a G-6-PD deficient cohort of 333 neonates. Matched with these on birth date, sex and delivery hospital were a G-6-PD normal cohort of 653 neonates. Neonatal jaundice was defined by a peak serum bilirubin (PSB) level of > or = 15 mg/dl. A significant association between G-6-PD deficiency and neonatal jaundice was observed in male but not female neonates. There was an inverse dose-response relation between G-6-PD activity and neonatal jaundice among male neonates. Both hypoxia/asphyxia and maternal hepatitis B surface antigen (HBsAg) carrier status were associated with an increased risk of neonatal jaundice among G-6-PD deficient but not G-6-PD normal male neonates. Based on multiple regression analyses, an additively synergistic effect on PSB level and severe jaundice (PSB > or = 20 mg/dl) was observed for G-6-PD deficiency and maternal HBsAg carrier status.

PIP: Researchers compared data on 333 newborns with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency at 5 public and 5 private hospitals in Taiwan with data on 653 birth date, sex, and delivery hospital matched newborns to examine the peak serum bilirubin (PSB) level and incidence of neonatal jaundice of both G-6-PD deficient and G-6-PD normal newborns. They also wanted to determine whether an association exists between G-6-PD activity level and incidence of neonatal jaundice and associations between G-6-PD deficiency and other likely risk factors of neonatal jaundice. A significant association between G-6-PD deficiency and neonatal jaundice existed among male neonates but not female neonates. Male neonates had a considerably higher incidence of neonatal jaundice than did female neonates (11.6% vs. 6.2%). There was a significant inverse dose-response relationship between G-6-PD activity and neonatal jaundice among the male neonates (p.01). For example, the relative risk was 1.78 for 20.1-29.9 relative intensity, 2.01 for 15.1-20, 2.61 for 10.1-15, and 4.07 for 10. Maternal hepatitis B surface antigen (HBsAg) carrier status and hypoxia/asphyxia significantly increased the risk for G-6-PD deficiency in male neonates (p.05). The multiple regression analysis indicated a significant effect of G-6-PD deficiency on the PSB level and the incidence rate of severe neonatal jaundice. There was a similar significant interaction between G-6-PD deficiency and maternal HBsAg carrier status.

Relation of peak total serum bilirubin concentrations to neurodevelopmental outcome at 2 years of age in premature African neonates.

As part of a wider survey of the neurodevelopmental outcome of neonates who received intensive care for various morbidities in the Middle-Belt region of Nigeria, the relationship between peak total serum bilirubin (PTSB) concentrations in the neonatal period and neurodevelopmental status at 2 years of age was evaluated in 159 children available for follow-up and assessment. The prevalence of handicaps (minor and major) increased consistently with increase in the PTSB concentration, commencing in the range of 151-200 mumol/l. Major handicaps evolved in association with PTSB concentrations above 201 mumol/l. The handicaps consisted mainly of cerebral palsy and mental retardation. Children with handicaps (minor and major) experienced greater PTSB concentrations than those with a normal neurodevelopmental outcome. The emergence of major handicaps from a mean (SD) moderate peak hyperbilirubinaemia of 241.1 (35.9) mumol/l in the African neonate is worthy of note and cause for concern.

Prevention of mental handicaps in children in primary health care.

Some 5-15% of children aged 3 to 15 years in both developing and developed countries suffer from mental handicaps. There may be as many as 10-30 million severely and about 60-80 million mildly or moderately mentally retarded children in the world. The conditions causing mental handicaps are largely preventable through primary health care measures in developing countries. Birth asphyxia and birth trauma are the leading causes of mental handicaps in developing countries where over 1.2 million newborns die each year from moderate or severe asphyxia and an equal number survive with severe morbidity due to brain damage. The other preventable or manageable conditions are: infections such as tuberculous and pyogenic meningitides and encephalopathies associated with measles and whooping cough; severe malnutrition in infancy; hyperbilirubinaemia in the newborn; iodine deficiency; and iron deficiency anaemia in infancy and early childhood. In addition, recent demographic and socioeconomic changes and an increase in the number of working mothers tend to deprive both infants and young children of stimulation for normal development. To improve this situation, the primary health care approach involving families and communities and instilling the spirit of self-care and self-help is indispensable. Mothers and other family members, traditional birth attendants, community health workers, as well as nurse midwives and physicians should be involved in prevention and intervention activities, for which they should be trained and given knowledge and skills about appropriate technologies such as the risk approach, home-based maternal record, partograph, mobilogram (kick count), home-risk card, icterometer, and mouth-to-mask or bag and mask resuscitation of the newborn. Most of these have been field-tested by WHO and can be used in the home, the health centre or day care centres to detect and prevent the above-mentioned conditions which can cause mental handicap.

PIP: 5-15% of all 3-15 year old children in the world are mentally impaired. In fact, 0.4-1.5% (10-30 million) are severely mentally retarded and an additional 60-80 million children are mildly or moderately mentally retarded. Birth asphyxia and birth trauma account for most cases of mental retardation in developing countries. 1.2 million newborns survive with severe brain damage and an equal number die from moderate or severe birth asphyxia. Other causes of mental retardation can also be prevented or treated such as meningitis or encephalitis associated with measles and pertussis; grave malnutrition during the 1st months of life, especially for infants of low birth weight; hyperbilirubinemia in neonates which occurs frequently in Africa and countries in the Pacific; and iodine deficiency. In addition, iron deficiency may even slow development in infants and young children. Current socioeconomic and demographic changes and a rise in the number of employed mothers may withhold the necessary stimulation for normal development from infants and young children. Primary health care (PHC) interventions can prevent many mental handicaps. For example, PHC involves families and communities who take control of their own care. Besides traditional birth attendants, community health workers, nurse midwives, physicians, and other parents must also participate in prevention efforts. For example, they should be trained in appropriate technologies including the risk approach, home risk card, partograph, mouth to mask or bag and mask resuscitation of the newborn, kick count, and ictometer. WHO has field tested all these techniques. These techniques not only prevent mental handicaps but can also be applied at home, health centers, and day-care centers.

Serum bilirubin levels in newborns of diabetic and hypertensive mothers.

PIP: The aim of this study was to investigate the effect of oxytocin induction and augmentation on neonatal bilirubin levels in newborns of diabetic and hypertensive mothers. All women included in the study were admitted to the obstetrics department at Al Hussein Hospital. They were 18-38 years old, and their gestational ages were 38-41 weeks by date. A total number of 140 newborn infants were divided into 3 groups and studied for bilirubin levels. The first group consisted of 40 infants of diabetic mothers, 20 of whom were given oxytocin for labor induction and 20 of whom received it for labor augmentation. The second group consisted of 40 infants of hypertensive mothers, 20 of whom were given oxytocin for labor induction and 20 of whom received it for labor augmentation. The third group consisted of 60 controls, 20 of whom were given oxytocin for labor induction, 20 of whom received it for labor augmentation, and 20 of whom received no oxytocin. It was found that total and unconjugated bilirubin levels were higher in infants delivered after induction of labor, whether their mothers were diabetic, hypertensive, or neither, than in infants delivered without labor induction. Bilirubin levels were mildly high in infants of diabetic mothers after augmented delivery and then nullified after 24 hours. However, the study suggested that the increased bilirubin levels were related to induced labor rather than the medical problem of the mothers, provided that the newborns were of average weight.^ieng

A comparison of the effects of NORPLANT capsules and NORPLANT-2 rods on clinical chemistry: metabolic changes.

A comparison of the effects of NORPLANT capsules and NORPLANT-2 rods on liver function, lipid and carbohydrate metabolism is presented. The results indicate that the effects of both these long acting progestogen-containing subdermal implant systems are similar and comparable. With respect to liver function, possible hepatocellular dysfunction is indicated as evidenced by a significant rise in serum bilirubin and a significant fall in total protein and globulin. As regards to lipid metabolism, there appears to be no cardiovascular risk in both groups. The effects of NORPLANT on carbohydrate metabolism is not of any clinical significance.

PIP: Medical researchers enrolled 100 women who use the NORPLANT 6 capsule system and 100 women who used the NORPLANT 2 rod system in a clinical trial at the National University Hospital in Singapore to compare the 2 implants' effects on clinical chemistry. The mean bilirubin levels increased 55% during the 1st year for both groups. These levels fell a mere 4.5% in the NORPLANT-2 group. Still, at the end of 2 years, the mean bilirubin levels of both groups were significantly higher than preinsertion levels. Total proteins and globulins fell significantly in both groups during the 2 year study. The mean albumin level rose significantly in the NORPLANT-2 women and the slight risk in NORPLANT-6 women was not significant. Even though these changes in liver function occurred, the mean levels of bilirubin, total protein, globulin, and albumin stayed within the normal clinical range. Further no individual had levels outside the normal range. NORPLANT-6 and NORPLANT-2 had basically similar effects on lipid metabolism. The high density lipoprotein (HDL) cholesterol/total cholesterol ratio was .200 for both groups indicating that the 2 NORPLANT systems did not put women at increased risk of coronary heart disease. In addition, the low density lipoprotein cholesterol/HDL ratio for both groups did not rise higher that the preinsertion level. These results indicated that the 2 systems may actually have a protective effect against cardiovascular conditions in the 1st 2 years. Neither NORPLANT-6 nor NORPLANT-2 significantly changed carbohydrate metabolism. At the end of 1 hour, however, the glucose tolerance levels significantly increased, but fell considerably at 2 hours. In fact, absolute glucose tolerance levels stayed in the normal range. In conclusion, the 2 systems acted essentially the same.