RESUMO
OBJECTIVE: To identify clinical and genetic risk factors for moderate hyperbilirubinemia during the first week of life. STUDY DESIGN: Using univariate and multivariate multiple regression analyses, the RR for clinical factors, the African variant of glucose-6-phosphate dehydrogenase (G6PD) deficiency (G202A/A376G), and (TA)(n) UGT1A1 polymorphisms were established in a cohort of 608 Brazilian newborn infants. Hyperbilirubinemia was monitored until 134.5 ± 49.8 h of life (IQR, 111.0 to 156.7). The dependent variable was total bilirubinemia (TB) ≥12.9 mg per 100 ml estimated by transcutaneous or plasma bilirubin measurements. RESULT: The African variant of G6PD deficiency and (TA)(7)/(TA)(7) and (TA)(7)/(TA)(8) polymorphisms present in 6.1 and 12.0% of newborns, respectively, were not risk factors for moderate hyperbilirubinemia. Coexpression of G6DP deficiency and UGT1A1 polymorphisms occurred in 0.49% of the subjects. Independent clinical predictors for TB≥ 12.9 mg per 100 ml were gestational age <38 weeks and reference curve percentiles >P40th. CONCLUSION: In this study, G6PD deficiency and UGT1A1 gene promoter polymorphisms were not risk factors for moderate hyperbilirubinemia. Genetic factors may vary considerably in importance among different populations.
Assuntos
Comparação Transcultural , Hiperbilirrubinemia Neonatal/diagnóstico , Hiperbilirrubinemia Neonatal/genética , Brasil , Estudos de Coortes , Feminino , Seguimentos , Triagem de Portadores Genéticos , Genótipo , Deficiência de Glucosefosfato Desidrogenase/diagnóstico , Deficiência de Glucosefosfato Desidrogenase/genética , Glucuronosiltransferase/genética , Humanos , Recém-Nascido , Kernicterus/diagnóstico , Kernicterus/genética , Masculino , Triagem Neonatal , Polimorfismo Genético/genética , Estudos Prospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To propose a method to evaluate and maintain the efficiency of equipment commonly used in Brazil in order to obtain uniform results in phototherapy treatments in different services. MATERIAL AND METHODS: The radiometer/photometer used to measure spectral irradiance is locally manufactured and fulfills basic requirements. Measure standardization seeks to be applicable and reproducible to phototherapy devices employed in Brazil. The material necessary for measurements can be easily assembled by the neonatology staff, except for the radiometer. We searched Medline for papers relevant to this review published throughout the last 10 years. RESULTS: Irradiance in phototherapy issues should be referred to as "medium spectral irradiance". We describe how to obtain medium spectral irradiance using fluorescent and halogen phototherapies. COMMENTS: The components of a radiometer/photometer are described. This knowledge is fundamental to understanding sensibility variations and to justifying differences in irradiance when ranges of radiometer recording are a little different. The standardization of this device will certainly simplify the comparison between results in different services. We also analyzed characteristics of different equipment used in phototherapy that might interfere with their irradiance.
RESUMO
OBJECTIVE: To discuss the use of alternative treatment methods in hemolytic disease of newborn to replace common early exchange transfusion. METHODS: Case report of newborn with intensive Rh incompatibility treated with intensive phototherapy, plus phenobarbital instead of traditional early exchange transfusion.RESULTS: The neonatés cord blood showed 9.2 mg/dL of total bilirubin and 39% hematocrit. He was medicated with phenobarbital and intensive phototherapy at once. There was a rapid growing hyperbilirubinemia followed by stabilization for almost 60 hours with little changes, but without levels that justified an exchange transfusion. He became progressively anemic and needed a concentrate transfusion. When he was five days old, he was discharged and returned to follow-up at the 7th week of life when his bone marrow was beginning to recover from anemia.CONCLUSIONS: This case demonstrates that pharmacologic agents and intensive phototherapy can be as useful as advantageous in severe hemolytic disease of newborn. We should always try to use them before adopting more aggressive therapies.