Displacement of bilirubin from albumin in plasma from jaundiced newborns. An in vitro study of purified Chinese herbal constituents and sulfisoxazole.

The aim of the present study was to clarify the in vitro potential of the purified Chinese herbal constituents LZX-A (neferine), QTJ (sinomenine), YHS (tetrahydropalmitine) and SQZG (notoginsenoside R1) to displace the highly bound bilirubin from albumin binding sites in plasma from jaundiced newborn infants. Sulfisoxazole (1.32 mM) was used as a positive control for bilirubin displacement. The displacing potential of the herbal constituents was investigated at assumed therapeutic concentrations and up to 100 times higher. Total (TB) and unbound (UB) bilirubin in plasma were measured by the peroxidase method. Sulfisoxazole increased the UB concentration in plasma by more than 60%. An increased % displacement of bilirubin was found at higher TB levels confirming the presence also of lower affinity binding sites for bilirubin in plasma. None of the purified herbal constituents showed any bilirubin displacing properties and were unaffected by the level of TB in plasma. The combination of sulfisoxazole and the herbal constituents showed no synergistic effect. It is concluded that none of the investigated purified herbal constituents possess any significant potential in vitro to increase the UB concentration in plasma from jaundiced newborn infants.

[Treatment of very-low-birth-weight infants in Norway the last 40 years]. / Behandlingen av svaert for tidlig fødte barn de siste 40 år.

BACKGROUND: Treatment of very-low-birth-weight infants has changed significantly in the last decades. MATERIAL AND METHODS: Medical records were assessed retrospectively with respect to details in diagnostic and treatment characteristics for three cohorts (born in 1970, 1980 or 1989) from Rikshospitalet, Oslo and two from St. Olavs hospital (born in 1997 and 2007), Trondheim. RESULTS: Few infants were given intensive care in 1970, still infants with a gestational age (GA) of 25 weeks survived. From 1980, infants down to GA 23 weeks were treated. Overall survival did not change, but infants lived longer before they died. From 1980 to 1989, survival improved from 73 % to 82 %, and some infants with GA 23 weeks also survived. This improuval was probably related more to prenatal and obstetric care than to postnatal care. Mortality has continued to decrease from 1989 to 2007, and infants weighing > 1000 g now rarely die. More than 80 % of children weighing < 1000 g also survive. As an increased number of extremely premature infants are now treated, overall morbidity in survivors is still around 30 %. INTERPRETATION: Despite improved treatment results for very-low-birth-weight infants, treatment of the smallest among them is still a challenge.

[Costs for treatment of very-low-birth-weight infants]. / Kostnader ved behandling av svaert for tidlig fødte barn.

BACKGROUND: The cost of treating premature infants is increasing due to use of advanced medical technology and rising labour costs. Few Norwegian studies have been published in the field. This study has assessed treatment costs for very-low-birth-weight infants in St. Olavs University Hospital. MATERIAL AND METHODS: Children born in 1997 or 2007 were studied retrospectively. Individual costs (diagnostics and treatment) were estimated from detailed analysis of each patient's daily medical record. General daily costs (salary, equipment etc.) for treatment levels 1 (growth and development), 2 (observation) and 3 (intensive treatment) were estimated from department and hospital budgets. RESULTS: The total mean treatment cost from admission to discharge was 603,238 NOK per patient in 2007, an increase from 475,131 NOK in 1997. As more infants survived without serious complications in 2007, the cost of a surviving healthy infant was actually lower in 2007 (922,599 NOK) than in 1997 (1,135,035 NOK). DRG reimbursements cover the cost for treating children with a birth weight in the range 1000 - 1499 g, but not for those weighing < 1000 g. INTERPRETATION: Very-low-birth-weight infants are probably the most expensive patient group treated in hospitals; the total cost in 2007 was (mean) 900,000 NOK.

Displacement of bilirubin from albumin by ibuprofen in vitro.

Ibuprofen binds to plasma albumin and could interfere with the binding of bilirubin in jaundiced newborn infants. Most clinical studies have not shown increased concentrations of unbound bilirubin (UB) in plasma from infants treated with ibuprofen for a patent ductus arteriosus. However, studies in vitro have not been equally conclusive. Plasma were obtained from routine samples from jaundiced newborn infants and pooled. Total and UB were measured with the peroxidase method after addition of ibuprofen or sulfisoxazole as a known bilirubin displacer. Final ibuprofen concentrations varied from 0.43 to 2.6 mM. Bilirubin concentrations were varied from 176 to 708 microM by adding bilirubin to plasma samples. Ibuprofen caused a linear increase in UB up to +54% at a concentration of 1.8 mM, compared with an increase of 87% by sulfisoxazole (1.32 mM). A double reciprocal plot of molar concentrations of bound versus UB at bilirubin concentrations ranging from 176 to 708 microM showed a competitive displacement of bilirubin by ibuprofen. The data indicate that ibuprofen is a competitive displacer of bilirubin in vitro. Ibuprofen should be used with caution in premature infants with a significant hyperbilirubinemia.

[Environmental toxins in breast milk]. / Miljøgifter i morsmelk.

BACKGROUND: Breast milk is very important to ensure infants a well-composed and safe diet during the first year of life. However, the quality of breast milk seems to be affected by an increasing amount of environmental toxins (particularly so-called Persistent, Bioaccumulative Toxins [PBTs]). Many concerns have been raised about the negative effects this may have on infant health. MATERIAL AND METHODS: The article is a review of literature (mainly review articles) identified through a non-systematic search in PubMed. RESULTS: The concentration of PBTs in breast milk is mainly caused by man's position as the terminal link in the nutritional chain. Many breast-fed infants have a daily intake of such toxins that exceed limits defined for the population in general. Animal studies demonstrate effects on endocrine function and neurotoxicity in the offspring, and a number of human studies seem to point in the same direction. However the "original" optimal composition of breast milk still seems to protect against long-term effects of such toxicity. INTERPRETATION: There is international consensus about the need to monitor breast milk for the presence of PBTs. Such surveillance will be a good indicator of the population's general exposure to these toxins and may also contribute to identifying groups as risk who should not breast-feed their children for a long time.