Traditional beliefs in the management and prevention of neonatal jaundice in Ado-Ekiti, Nigeria.

AIM: Traditional beliefs about neonatal jaundice persist in Sub-Saharan Africa, and because those beliefs might worsen the outcomes of the disease by delaying care or by treating it at home with unproven remedies; our study sought to identify the traditional beliefs of antenatal mothers regarding the management and prevention of neonatal jaundice in rural areas of Ekiti State, Southwestern Nigeria. METHODS: The study employed a descriptive cross-sectional design. A total of 190 women who attended two primary health care centers in Ekiti State were recruited for the study from April 1 to May 31, 2017, by convenience sampling through the antenatal clinic register. Data was collected by the use of an adapted self-administered, structured questionnaire. RESULTS: Of the women selected, 56% had at least one child before.36% of all the respondents would use pawpaw extract to treat neonatal jaundice, 30% would use sunlight, 26% would use antibiotics, 16% would use over the counter drugs, and 5% would use phototherapy. With regards of preventive measures, 48% indicated that neonatal jaundice can be prevented by breast feeding, 11% by drinking herbal concoctions by both mother and baby, 26% by giving glucose water to the baby and 12% of respondents by avoidance of cold water when pregnant. CONCLUSION: Our study showed that traditional beliefs regarding the management and prevention of neonatal jaundice are prevalent in Ado Ekiti, Nigeria.

Therapeutic efficacy and safety of Yinzhihuang granules with phototherapy in neonatal pathologic jaundice: An updated systematic review and meta-analysis.

BACKGROUND: Yinzhihuang granule, consisting of extracts of Artemisia capillaris Thunb., Gardenia jasminoides Ellis, Lonicera japonica Thunb., and Scutellaria baicalensis Georgi is a well-known traditional Chinese patent medicine for patients with liver injury in China. However, the effects and safety of its use for pathologic jaundice in newborns require further systematic evaluation. PURPOSE: To systematically evaluate the efficacy and safety of Yinzhihuang granules for the treatment of neonatal pathologic jaundice and to provide clinical evidence. METHODS: Chinese databases (China Network Knowledge Infrastructure, Wan Fang Database, and VIP Database) and English databases (PubMed, EmBase, and the Cochrane Library) were thoroughly investigated through screening randomized controlled trials on Yinzhihuang granules for neonatal pathologic jaundice from the establishment of all databases to November 18, 2021. A meta-analysis was performed for selected data using STATA software. TSA software was used for trial sequential analyses of the total effective rate and adverse reactions. RESULTS: A total of 19 trials and 2,221 newborns with pathologic jaundice were included in this study. Outcome measures of clinical efficacy in the experimental group were higher than in controls, including total bilirubin (WMD = -30.34, 95% CI = -35.44 to -25.23, p < 0.001), direct bilirubin (WMD = -15.03, 95% CI = -23.54 to -6.52, p < 0.001), indirect bilirubin (WMD = -11.22, 95% CI = -17.50 to -4.95, p < 0.001), recovery time (WMD = -2.96, 95% CI = -3.92 to -2.00, p < 0.001), hospitalization time (WMD = -3.83, 95% CI = -4.89 to -2.76, p < 0.001), and liver function indices. There were statistically significant differences between the two groups. Likewise, the incidence of adverse reactions, including diarrhea, erythra, and fever decreased remarkably in the trial group (RR = 0.44, 95% CI =  0.33 to 0.59, p < 0.001). Publication bias did not exist. We verified the efficacy and safety of Yinzhihuang granules with phototherapy for pathologic jaundice in newborns according using TSA analysis. CONCLUSION: Yinzhihuang granules with phototherapy for neonatal pathologic jaundice are more effective than phototherapy alone. The incidence of ADRs does not increase with the application of Yinzhihuang granules. Due to the heterogeneity across the included studies, additional multicenter clinical trials with follow-ups are needed to confirm our findings.

Neonatal Eye Shielding during Phototherapy: What Protects the Eye Better?

BACKGROUND: Phototherapy remains an important component of the management of unconjugated neonatal jaundice, a major cause of newborn morbidity. During phototherapy the toxic unconjugated form of bilirubin is converted to nontoxic form through action of light delivered by phototherapy. An important possible complication of phototherapy is retinal damage and therefore eye protective measures are taken during therapy to prevent this from occurring. Devices currently in use for phototherapy are capable of providing intensive phototherapy with the attendant increased risk of eye injury. The materials used in providing eye protection are varied among care providers. A dearth of information exists on shielding provided by the commonly used eye protectors during phototherapy, more so during intensive phototherapy. OBJECTIVE: To evaluate the shielding provided by the different eye protectors commonly used in our setting under intensive phototherapy. MATERIALS AND METHOD: Five materials in use for eye shielding were obtained. Using an institutional built light emitting diode phototherapy device, intensive phototherapy was provided and the irradiance at varying distances of 35 cm, 25 cm, 15 cm and 10 cm was measured using an Olympic bili meterTM Natus. At the distance of each measured irradiance the different eye protective materials were then placed one after the other over the surface of the measuring sensor of the meter and the irradiance measurement was recorded. Two measurements were taken for each material at each distance and the average irradiance measurement was then recorded for each of the materials tested at that distance. RESULTS: Five eye shielding materials in use were identified: black cotton fabric, white cotton fabric, black cotton fabric with foam, white cotton fabric with foam and gauze. The black cotton fabric with or without foam at the phototherapy device irradiances of 30, 46.3, 58.7 and 75.4 µw/m2/nm recorded 0 irradiance. CONCLUSION: Black cotton fabric with or without foam pad provided the most shielding under intensive phototherapy.

El contacto piel a piel como promotor de la lactancia materna, y su posible relación con la disminución de la hiperbilirrubinemia / Skin-to-skin contact as a promoter of breastfeeding, and its possible relationship with the reduction of hyperbilirubinemia

INTRODUCCIÓN: El contacto piel a piel (CPP) postparto es una práctica de atención de salud fuertemente aconsejada por la OMS, por los beneficios a largo y a corto plazo que conlleva tanto para la salud de la madre como para la del recién nacido. OBJETIVO: Realizar una búsqueda bibliográfica con el objetivo de determinar los beneficios que tiene la CPP durante el periodo del postparto inmediato sobre la lactancia materna (LM) y la ictericia neonatal (IN). RESULTADOS: Los resultados muestran que el CPP aumenta diversos indicadores de éxito de lactancia materna, dentro de los cuales destacan: aumento en la efectividad de la primera lactancia, mayor probabilidad de mantener la LM a 4 meses, aumento del periodo de LM en promedio, mayor probabilidad de LM exclusiva a 6 meses. No se encontraron mayores beneficios al iniciar el CPP antes de los 10 minutos, ni al prolongarlo más de 60 minutos. Además, el CPP indirectamente disminuye la probabilidad de presentar IN, debido a que aumenta la frecuencia de LM, indicador que se asocia de manera indirecta a los niveles de bilirrubina en el recién nacido. CONCLUSIÓN: La revisión de la literatura especializada nos permite concluir que el contacto temprano entre la madre y su hijo en sala de partos, piel a piel, tiene efectos significativamente positivos en la lactancia materna y puede llegar a representar un factor protector de la hiperbilirrubinemia no conjugada en el RN.

Postpartum skin-to-skin contact (SSC) is a health care practice strongly advised by the WHO because of the long- and short-term benefits for both maternal and newborn health. This update summarizes the main findings supporting the recommendation to perform SSC during the immediate postpartum period, specifically the benefits on breastfeeding (BF) and neonatal jaundice (NI). The results show that SSC increases several indicators of breastfeeding success, including: increased effectiveness of the first breastfeeding, greater probability of maintaining BF at 4 months, increased BF period on average, greater probability of exclusive BF at 6 months. No greater benefits were found when initiating SSC before 10 minutes, nor when prolonging it for more than 60 minutes. In addition, SSC indirectly decreases the probability of presenting NI, because it increases the frequency of BF, an indicator that is indirectly associated with bilirubin levels in the newborn. CONCLUSION: A review of the specialized literature allows us to conclude that postpartum skin-to-skin contact (SSC) has significantly positive effects on breastfeeding and may represent benefits in bilirubin levels in the newborn.

Sunlight for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates.

BACKGROUND: Acute bilirubin encephalopathy (ABE) and the other serious complications of severe hyperbilirubinemia in the neonate occur far more frequently in low- and middle-income countries (LMIC). This is due to several factors that place babies in LMIC at greater risk for hyperbilirubinemia, including increased prevalence of hematologic disorders leading to hemolysis, increased sepsis, less prenatal or postnatal care, and a lack of resources to treat jaundiced babies. Hospitals and clinics face frequent shortages of functioning phototherapy machines and inconsistent access to electricity to run the machines. Sunlight has the potential to treat hyperbilirubinemia: it contains the wavelengths of light that are produced by phototherapy machines. However, it contains harmful ultraviolet light and infrared radiation, and prolonged exposure has the potential to lead to sunburn, skin damage, and hyperthermia or hypothermia. OBJECTIVES: To evaluate the efficacy of sunlight administered alone or with filtering or amplifying devices for the prevention and treatment of clinical jaundice or laboratory-diagnosed hyperbilirubinemia in term and late preterm neonates. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 5), MEDLINE, Embase, and CINAHL on 2 May 2019. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials (RCTs), quasi-RCTs, and cluster RCTs. We updated the searches on 1 June 2020. SELECTION CRITERIA: We included RCTs, quasi-RCTs, and cluster RCTs. We excluded crossover RCTs. Included studies must have evaluated sunlight (with or without filters or amplification) for the prevention and treatment of hyperbilirubinemia or jaundice in term or late preterm neonates. Neonates must have been enrolled in the study by one-week postnatal age. DATA COLLECTION AND ANALYSIS: We used standard methodologic procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Our primary outcomes were: use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, chronic bilirubin encephalopathy, and death. MAIN RESULTS: We included three RCTs (1103 infants). All three studies had small sample sizes, were unblinded, and were at high risk of bias. We planned to undertake four comparisons, but only found studies reporting on two. Sunlight with or without filters or amplification compared to no treatment for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates One study of twice-daily sunlight exposure (30 to 60 minutes) compared to no treatment reported the incidence of jaundice may be reduced (risk ratio [RR] 0.61, 95% confidence interval [CI] 0.45 to 0.82; risk difference [RD] -0.14, 95% CI -0.22 to -0.06; number needed to treat for an additional beneficial outcome [NNTB] 7, 95% CI 5 to 17; 1 study, 482 infants; very low-certainty evidence) and the number of days that an infant was jaundiced may be reduced (mean difference [MD] -2.20 days, 95% CI -2.60 to -1.80; 1 study, 482 infants; very low-certainty evidence). There were no data on safety or potential harmful effects of the intervention. The study did not assess use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, and long-term consequences of hyperbilirubinemia. The study showed that sunlight therapy may reduce rehospitalization rates within seven days of discharge for treatment for hyperbilirubinemia, but the evidence was very uncertain (RR 0.55, 95% CI 0.27 to 1.11; RD -0.04, -0.08 to 0.01; 1 study, 482 infants; very low-certainty evidence). Sunlight with or without filters or amplification compared to other sources of phototherapy for the treatment of hyperbilirubinemia in infants with confirmed hyperbilirubinemia Two studies (621 infants) compared the effect of filtered-sunlight exposure to other sources of phototherapy in infants with confirmed hyperbilirubinemia. Filtered-sunlight phototherapy (FSPT) and conventional or intensive electric phototherapy led to a similar number of days of effective treatment (broadly defined as a minimal increase of total serum bilirubin in infants less than 72 hours old and a decrease in total serum bilirubin in infants more than 72 hours old on any day that at least four to five hours of sunlight therapy was available). There may be little or no difference in treatment failure requiring exchange transfusion (typical RR 1.00, 95% CI 0.06 to 15.73; typical RD 0.00, 95% CI -0.01 to 0.01; 2 studies, 621 infants; low-certainty evidence). One study reported ABE, and no infants developed this outcome (RR not estimable; RD 0.00, 95% CI -0.02 to 0.02; 1 study, 174 infants; low-certainty evidence). One study reported death as a reason for study withdrawal; no infants were withdrawn due to death (RR not estimable; typical RD 0.00, 95% CI -0.01 to 0.01; 1 study, 447 infants; low-certainty evidence). Neither study assessed long-term outcomes. Possible harms: both studies showed a probable increased risk for hyperthermia (body temperature greater than 37.5 °C) with FSPT (typical RR 4.39, 95% CI 2.98 to 6.47; typical RD 0.30, 95% CI 0.23 to 0.36; number needed to treat for an additional harmful outcome [NNTH] 3, 95% CI 2 to 4; 2 studies, 621 infants; moderate-certainty evidence). There was probably no difference in hypothermia (body temperature less than 35.5 °C) (typical RR 1.06, 95% CI 0.55 to 2.03; typical RD 0.00, 95% CI -0.03 to 0.04; 2 studies, 621 infants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Sunlight may be an effective adjunct to conventional phototherapy in LMIC settings, may allow for rotational use of limited phototherapy machines, and may be preferable to families as it can allow for increased bonding. Filtration of sunlight to block harmful ultraviolet light and frequent temperature checks for babies under sunlight may be warranted for safety. Sunlight may be effective in preventing hyperbilirubinemia in some cases, but these studies have not demonstrated that sunlight alone is effective for the treatment of hyperbilirubinemia given its sporadic availability and the low or very low certainty of the evidence in these studies.

The effect of vitamin C supplementation in the last month of pregnancy on neonatal bilirubin levels; A double-blind randomized clinical trial.

OBJECTIVES: Jaundice is a typical condition in the neonatal period, particularly in the Asian continent. Drowsiness and disruption of breastfeeding, behavioral and neurological disorders, hearing loss and mental retardation are the results of impairment in controlling it. The increase in oxidant substances can stimulate the heme oxygenase enzyme and increase the conversion of heme to bilirubin. In some studies, vitamin C levels in the blood of infants with hyperbilirubinemia were lower than in healthy infants. DESIGN: In this double-blind clinical trial study, 144 healthy pregnant women aged 20-40 years who were in 34th weeks of gestation were randomly divided into intervention, and control groups and until the end of pregnancy, they took a 500 mg tablet of vitamin C or placebo (Preparation of starch) daily. Demographic information, dietary intake, and physical activity level of the participants were also evaluated. The total blood bilirubin level was measured on the fifth day after birth using a sample of the neonatal heel. Statistical analysis was performed using SPSS software version 22. In this study P-value < 0. 05 was considered significant. RESULTS: Of the 144 participants, 128 of them completed the intervention. There was no significant difference between the two groups at the level of vitamin C intake through diet, and anthropometric indices, but the total bilirubin level in the neonates of the two groups was statistically different (P = 0.02). CONCLUSION: Vitamin C supplementation in the last month of pregnancy had a significant effect on neonatal bilirubin level and decreased it significantly.

Timing of umbilical cord clamping and neonatal jaundice in singleton term pregnancy.

BACKGROUND: Delayed cord clamping was not adopted widely in China because of the potential effect of neonatal hyperbilirubinemia, jaundice and polycythemia, and the optimal cord clamping time remained controversial. AIM: To assess the effect of delayed cord clamping versus early cord clamping on neonatal jaundice for term infants. STUDY DESIGN: This retrospective study included 1981 mother-infant pairs, who were assigned to early cord clamping groups (n = 1005) and delayed cord clamping group (n = 949). The delayed cord clamping included three subgroups (30-60 s, 61-90 s, 91-120 s). The main outcomes were transcutaneous bilirubin levels at 0 to 4 days of age, the rate of jaundice requiring phototherapy, the neonatal hematological status at 1 to 3 days after birth. RESULTS: Compared with the early cord clamping group, the neonatal transcutaneous bilirubin level did not differ and the neonatal hematological status (hemoglobin and hematocrit levels) were improved in combined and three subgroups of delayed cord clamping group. Increasing the duration of cord clamping from 90 s to 120 s did not result in further increases in hemoglobin and hematocrit levels but led to a trend towards a higher risk of neonatal jaundice requiring phototherapy and neonatal polycythemia. CONCLUSIONS: Delayed cord clamping for <90 s in healthy term infants may not only improve the early hematological status of newborns but also avoid excessive neonatal jaundice requiring phototherapy.

Screening and treatment to reduce severe hyperbilirubinaemia in infants in primary care (STARSHIP): a factorial stepped-wedge cluster randomised controlled trial protocol.

INTRODUCTION: Jaundice caused by hyperbilirubinaemia is a physiological phenomenon in the neonatal period. However, severe hyperbilirubinaemia, when left untreated, may cause kernicterus, a severe condition resulting in lifelong neurological disabilities. Although commonly applied, visual inspection is ineffective in identifying severe hyperbilirubinaemia. We aim to investigate whether among babies cared for in primary care: (1) transcutaneous bilirubin (TcB) screening can help reduce severe hyperbilirubinaemia and (2) primary care-based (versus hospital-based) phototherapy can help reduce hospital admissions. METHODS AND ANALYSIS: A factorial stepped-wedge cluster randomised controlled trial will be conducted in seven Dutch primary care birth centres (PCBC). Neonates born after 35 weeks of gestation and cared for at a participating PCBC for at least 2 days within the first week of life are eligible, provided they have not received phototherapy before. According to the stepped-wedge design, following a phase of 'usual care' (visual assessment and selective total serum bilirubin (TSB) quantification), either daily TcB measurement or, if indicated, phototherapy in the PCBC will be implemented (phase II). In phase III, both interventions will be evaluated in each PCBC. We aim to include 5500 neonates over 3 years.Primary outcomes are assessed at 14 days of life: (1) the proportion of neonates having experienced severe hyperbilirubinaemia (for the TcB screening intervention), defined as a TSB above the mean of the phototherapy and the exchange transfusion threshold and (2) the proportion of neonates having required hospital admission for hyperbilirubinaemia treatment (for the phototherapy intervention in primary care). ETHICS AND DISSEMINATION: This study has been approved by the Medical Research Ethics Committee of the Erasmus MC Rotterdam, the Netherlands (MEC-2017-473). Written parental informed consent will be obtained. Results from this study will be published in peer-reviewed journals and presented at (inter)national meetings. TRIAL REGISTRATION NUMBER: NTR7187.

Transcutaneous bilirubin levels of newborn infants performed abdominal massage: A randomized controlled trial.

PURPOSE: This study was designed as a randomized controlled trial to determine the effect of abdominal massage on bilirubin levels of newborn infants. DESIGN AND METHODS: The sample group consisted of 90 newborn infants (experimental group: 44; control group: 46) who were followed in a university hospital after birth between March and August 2017. The data were collected using an Information Form, Observation Form, and Transcutaneous Bilirubin Level Meter. Bilirubin levels were measured 1 hr after the first breastfeeding in both groups. The abdominal massage was performed for 5 min in each session, was continued in three sessions per day; was completed in totally six sessions for 2 days in infants in the experimental group. The second bilirubin measurements were repeated at the 48th hour after the birth and bilirubin levels were compared in two groups. The Student t test was used to evaluate the normally distributed data and the Mann-Whitney U test was used to carry out statistics in nonnormal distribution of quantitative data. RESULTS: The bilirubin levels of the groups (experimental group: 1.06 ± 0.92; control group: 1.01 ± 0.98) were statistically similar before abdominal massage, t(88) = 0.25, p = 0.803. The difference of the bilirubin levels was compared in the groups before and after abdominal massage. The increase of bilirubin levels in the experimental group (1.96 ± 1.69 mg/dl) was statistically significantly lower compared with the control group (2.80 ± 2.30 mg/dl), t(88) = -1.974, p = 0.048. PRACTICE IMPLICATIONS: Abdominal massage is effective to reduce bilirubin levels of newborn infants.

Preventive effect of purgative manna on neonatal jaundice: A double blind randomized controlled clinical trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Cotoneaster nummularioides Pojark manna (Shir-e-Khesht) is popular in Persian medicine. Different effects of some Cotoneaster species manna include antibacterial, antioxidant, anticancer, and hepatoprotective effects, as well as bilirubin serum levels reduction. Cotoneaster species manna is used in many parts of Iran as a laxative and accelerates the passage of meconium. Neonatal jaundice has relatively costly and sometimes invasive therapeutic interventions, which its prevention from becoming severe cases can be a priority in neonatal medicine. AIM OF THE STUDY: The aim of this study was to evaluate the effectiveness of an herbal product (Purgative Manna, native to Iran and Asian countries) in preventing severe cases of jaundice and reducing total bilirubin levels in neonates. MATERIALS AND METHODS: This randomized double-blind controlled clinical trial included full-term babies. Four hundred and forty-five (445) eligible neonates were assigned to two groups using the block balanced randomization method; 222 neonates received the Purgative Manna product as drops, and 223 neonates received placebo drops. The neonates received a dose of 5 drops per kilogram of neonatal weight (divided into three doses per day) for three days. The treatment period was three days, and a 24-h (three times) examination was performed to measure the initial outcome of the trial (i.e., the total serum bilirubin level). The secondary outcomes of this trial were the need for hospitalization due to jaundice and/or phototherapy from 4 to 14 days after birth, the frequency of defecation within 24 h, and the triple complications of diarrhoea, dehydration symptoms, and abdominal colic. RESULTS: In this study, 220 neonates in the Purgative Manna product group and 222 neonates in the placebo group completed their interventions within the predicted period of the study. At the end of study, the total bilirubin level in the Purgative Manna treated group was significantly lower than that of the placebo group. The difference between the mean total bilirubin levels of the two groups was approximately 2.1 mg/dl on the third day after treatment, with an effect size of 0.79 (95% CI: 0.06-0.98). The relative risk for reducing the need for hospitalization or phototherapy in the group treated with Purgative Manna drops was 0.26, compared with the placebo group. The risk of occurrence of severe jaundice or phototherapy in the Purgative Manna group was 75% lower than that of the placebo group. The median frequency of defecation in the intervention group at three time intervals in the first, second and third days after treatment was 1-2 times more than that of the comparison group (p < 0.001). CONCLUSIONS: Meanwhile, considering the fact that one in every eight neonates who used the product avoided having a severe and high-risk case of jaundice or the need for phototherapy intervention (even through an exchange transfusion), the use of Purgative Manna drops can be recommended; however, further study is necessary.

Neonatal Jaundice: awareness, perception and preventive practices in expectant mothers.

BACKGROUND: Neonatal jaundice (NNJ) is a preventable cause of neonatal morbidity and mortality. Improving mothers' knowledge will help with early recognition of NNJ, prompt and appropriate intervention. This study highlights the knowledge, attitude and practice regarding neonatal jaundice among expectant mothers attending the antenatal clinics of Korle-Bu Teaching Hospital and Mamprobi Polyclinic in Accra. METHODS: This was a cross-sectional study involving 175 expectant mothers. Interviewer based questionnaire was used to obtain data on knowledge, attitude and practice concerning NNJ. The study was conducted between 1st and 17th November 2013 at two antenatal clinics in Accra. RESULTS: Out of the 175 respondents, 135 (77.1%) had heard about NNJ but only 37 (27.4%) of them heard it from the hospital. Among those who had heard about NNJ, 98 (72.6%) knew at least one symptom of NNJ; 125 (92.6%) did not know the causes of jaundice or had the wrong information and there was no significant association with their level of education (X2 =6.757, p=0.15). Only 7(5.2%) knew one or more correct forms of treatment of NNJ; 67(49.6%) knew one or more danger signs and 86(63.5%) knew one or more complications. CONCLUSION: Majority of expectant mothers attending antenatal clinics at a Teaching Hospital and a Polyclinic in Accra, Ghana are aware of NNJ but have poor knowledge about the causes, danger signs and treatment of NNJ, irrespective of their level of education or their parity. FUNDING: None declared.

Filtered sunlight, solar powered phototherapy and other strategies for managing neonatal jaundice in low-resource settings.

Challenges in treating severe neonatal jaundice in low and middle-income country settings still exist at many levels. These include: a lack of awareness of causes and prevention by families, communities and even sometimes health care professionals; insufficient, ineffective, high quality affordable diagnostic and therapeutic options; limited availability of rehabilitation provision for kernicterus. Collectively these challenges lead to an unacceptably high global morbidity and mortality from severe neonatal jaundice. In the past decade, there has been an explosion of innovations addressing some of these issues and these are increasingly available for scale up. Scientists, healthcare providers, and communities are joining hands to explore educational tools, low cost screening and diagnostic options including at point-of-care and treatment modalities including filtered sunlight and solar powered phototherapy. For the first time, the possibility of eliminating the tragedy of preventable morbidity and mortality from severe NNJ is on the horizon, for all.

Evidências no uso de fototerapia convencional em neonatos com icterícia / Evidence on the use of phototherapy in neonates with jaundice

Este artigo apresenta uma revisão sistemática do uso de fototerapia convencional na redução da bilirrubina indireta emrecém-nascidos com icterícia patológica. Teve por objetivo analisar as condutas de fototerapia convencional descritas em ensaiosclínicos controlados aleatórios para o tratamento de icterícia em neonatos. A amostra foi composta por 9 artigos publicados em8 periódicos internacionais, todos em inglês, em 2008 e 2009. Constatou-se a existência de recomendação do uso de lâmpadasfluorescentes brancas e azuis associadas.

This paper presents a systematic review on the use of conventional phototherapy for reducing indirect bilirubinin newborn infants with pathological jaundice. It aimed to analyze the conducts of conventional phototherapy described inrandomized controlled clinical trials for the treatment of jaundice in newborn infants. The sample consisted of 9 papers publishedin 8 international journals, all in English, in 2008 and 2009. The existence of a recommendation to use combined white and bluefluorescent lamps was found.

En este artículo se presenta una revisión sistemática del uso de la fototerapia convencional en la reducción de labilirrubina indirecta en recién nacidos con ictericia patológica. El objetivo fue analizar las conductas de fototerapia convencionaldescritas en ensayos clínicos controlados aleatorios para el tratamiento de ictericia en recién nacidos. La muestra fue compuesta por9 artículos publicados en 8 revistas internacionales, todos en inglés, en 2008 y 2009. Se constató la existencia de recomendacióndel uso de lámparas fluorescentes blancas y azules asociadas.

A Survey of Practice and Knowledge of Refugee and Migrant Pregnant Mothers Surrounding Neonatal Jaundice on the Thailand-Myanmar Border.

BACKGROUND: In populations with a high prevalence of glucose-6-phosphate dehydrogenase deficiency, practices that can induce haemolysis need to be identified to raise awareness of preventable risks. The aim of this survey was to determine the proportion of prospective mothers using haemolytic agents and their knowledge and practice surrounding neonatal jaundice. METHODS: Pregnant mothers were invited to participate in a cross-sectional survey conducted at Shoklo Malaria Research Unit on the Thailand-Myanmar border. RESULTS: From 12 April 2015 to 12 June 2015, 522 pregnant women completed the survey. Mothball use in the household was reported by 41.4% (216 of 522) of prospective mothers and menthol containing products on baby skin by 46.7% (244 of 522). CONCLUSION: Just over 40% of the households reported use of naphthalene-containing mothballs. Future health promotion activities that focus on reducing naphthalene mothball and menthol-containing products use have the potential to reduce rates of severe neonatal jaundice in this population.

The Association of Breastfeeding Practices with Neonatal Jaundice.

Background: Neonatal jaundice is a common problem in newborns. Inadequate breastfeeding jaundice is an important consideration for the neonatal jaundice. Early breastfeeding initiation and good breastfeeding practices may help to prevent neonatal jaundice. Objective: To find the association of breastfeeding practices, the time to initiate breastfeeding, the breastfeeding frequency, breast milk volume, and appropriate latching with neonatal jaundice at the early postpartum. Material and Method: The subjects were postpartum women and newborns who had normal deliveries without complications at the HRH Princess Maha Chakri Sirindhorn Medical Center in the Nakhon Nayok province between July 2013 and June 2014. During postpartum period, the time of the first neonatal suckling, the breastfeeding frequency per day, the breastfeeding duration for each instance, the breast milk volume, and appropriate latching were assessed. The newborns had routine microbilirubin evaluation done at 48 hours postpartum. The data of newborn with neonatal jaundice was collected, analyzed, and compared with no jaundice newborn. The demographic data and breastfeeding factors were analyzed by Chi-square, t-test, and the Fisher's exact test. Results: The data of 176 newborns (neonatal jaundice 88 cases and no jaundice newborn 88 cases) and mothers were analyzed. It had shown that the mean time for the initiation of breastfeeding was 1.57±0.6 hours in the no jaundice newborn group and 5.56±3.1 hours in the neonatal jaundice group. The percentages of 'breastfeeding frequency less than eight times per day' in the neonatal jaundice and no jaundice newborn groups were 92.0% and 1.1% at day 1 postpartum, and 42.0% and 0.0% at day 2 postpartum, respectively. The percentages of 'breastfeeding duration less than 10 minutes' per feeding in the neonatal jaundice group were 35.2% and 13.6% at day 1 and day 2 postpartum. No one in the no jaundice newborn group had breastfeeding durations of less than 10 minutes for each feeding. The percentages of mothers in the neonatal jaundice and no jaundice newborn groups having no milk were 84.1% and 1.1% at day 1, and 4.5% and 0.0% at day 2 postpartum, respectively. The percentages of 'latch scores greater than 8' in the neonatal jaundice and no jaundice newborn groups were at 15.9% and 50.0% at day 1, and 31.8% and 95.5% at day 2 postpartum. There were statistically significant differences in the breastfeeding parameters. Conclusion: The factors of the time of the initiation of breastfeeding, breastfeeding frequency, duration, breast milk volume, and appropriate latching are associated with neonatal jaundice at the second day postpartum.

The benefits of optimal cord clamping.

Optimal cord clamping is known and now widely recognised as having positive consequences for the neonate in the short- and medium-term. This review of some of the key literature published over the last five years on the effects of both ECC and OCC provides an insight into the evidence on this topic. The aim of this article is to summarise the key papers on the topic of the effect of timing of cord clamping, including some of those included in the Cochrane Review as well as the majority that have been published since, to provide an up-to-date overview.

Comparison of neonatal outcomes in women with gestational diabetes with moderate hyperglycaemia on metformin or glibenclamide--a randomised controlled trial.

BACKGROUND: Two oral hypoglycaemic agents, metformin and glibenclamide, have been compared with insulin in separate large randomised controlled trials and have been found to be as effective as insulin in gestational diabetes. However, very few trials have compared metformin with glibenclamide. MATERIALS AND METHODS: Of 159 South Indian women with fasting glucose ≥5.5 mmol/l and ≤7.2 mmol/l and/or 2-h post-prandial value ≥6.7 mmol/l and ≤13.9 mmol/l after medical nutritional therapy consented to be randomised to receive either glibenclamide or metformin. 80 women received glibenclamide and 79 received metformin. Neonatal outcomes were assessed by neonatologists who were unaware that the mother was part of a study and were recorded by assessors blinded to the medication the mother was given. The primary outcome was a composite of neonatal outcomes namely macrosomia, hypoglycaemia, need for phototherapy, respiratory distress, stillbirth or neonatal death and birth trauma. Secondary outcomes were birthweight, maternal glycaemic control, pregnancy induced hypertension, preterm birth, need for induction of labour, mode of delivery and complications of delivery. RESULTS: Baseline characteristics were similar but for the higher fasting triglyceride levels in women on metformin. The primary outcome was seen in 35% of the glibenclamide group and 18.9% of the metformin group [95% CI 16.1 (2.5, 29.7); P = 0.02]. The difference in outcome related to a higher rate of neonatal hypoglycaemia in the glibenclamide group (12.5%) versus none in the metformin group [95% CI 12.5(5.3, 19.7); P = 0.001]. Secondary outcomes in both groups were similar. CONCLUSION: In a south Indian population with gestational diabetes, metformin was associated with better neonatal outcomes than glibenclamide.

Strategies for neonatal hyperbilirubinemia: a literature review.

"Common" neonatal jaundice can lead to dangerous levels of hyperbilirubinemia, causing neurological damage and even death. This article outlines evidence-based assessment techniques, management guidelines, and treatments for neonatal hyperbilirubinemia, addressing complexities that have arisen with new technologies and research results. We also explicate the role of the nurse in both prevention and care of patients and families who are affected by hyperbilirubinemia and jaundice.