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1.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(3): 280-284, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-32204767

RESUMO

Hyperbilirubinemia is a prevalent disease in neonates and is also a main reason for hospitalization within the first week after birth, and this disease is mainly caused by the imbalance between production and elimination of bilirubin. Uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1), organic anion transporter polypeptide 2 (OATP2), heme oxygenase 1 (HO-1), and biliverdin reductase A (BLVRA) play crucial roles in the metabolism of bilirubin. More and more studies have revealed the association between the variation of the encoding genes for these enzymes and hyperbilirubinemia. This article reviews the research advances in the association between the gene polymorphisms of bilirubin metabolic enzymes and hyperbilirubinemia.


Assuntos
Hiperbilirrubinemia Neonatal , Polimorfismo Genético , Bilirrubina , Glucuronosiltransferase , Heme Oxigenase-1 , Humanos , Hiperbilirrubinemia , Hiperbilirrubinemia Neonatal/genética , Recém-Nascido , Transportador 1 de Ânion Orgânico Específico do Fígado
2.
Gene ; 736: 144409, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32007587

RESUMO

OBJECTIVE: To identify the association between UGT1A1 Gly71Arg and TATA promoter polymorphisms and neonatal hyperbilirubinemia. METHODS: The studies related to the correlation between UGT1A1 Gly71Arg and TATA promoter polymorphisms and neonatal hyperbilirubinemia were searched systematically in various databases. According to the presence or absence of significant heterogeneity, a random-effect or fixed-effect model was chosen to estimate the overall odds rations (ORs) and 95% confidence intervals (CIs). RESULTS: Totally 21 studies on Gly71Arg polymorphism including 4738 neonates and 13 studies on TATA promoter polymorphism involving 2841 neonates were identified. Significant associations were presented between Gly71Arg polymorphism and neonatal hyperbilirubinemia in Asia [A vs. G, OR(95%CI): 2.327(1.904-2.845), P < 0.001; AA + GA vs. GG, OR(95%CI): 2.253(1.954-2.598), P < 0.001; AA vs. GG + GA, OR(95%CI): 5.166(3.520-7.564), P < 0.001; AA vs. GG, OR(95%CI): 6.458(4.376-9.531), P < 0.001; GA vs. GG, OR(95%CI): 1.920(1.654-2.228), P < 0.001] and Africa [A vs. G, OR(95% CI): 9.750(1.214-78.301), P = 0.032; AA + GA vs. GG, OR(95% CI): 11.000(1.290-93.832), P = 0.028; GA vs. GG, OR(95% CI): 10.000(1.163-85.998), P = 0.036]. TATA promoter polymorphism was associated with an increased risk of neonatal hyperbilirubinemia in Asia [TA7/7 vs. TA6/6 + TA6/7, OR(95%CI): 1.670(1.034-2.696), P = 0.036] and Europe [TA7/7 vs. TA6/6 + TA6/7, OR(95%CI): 2.627(1.722-4.008), P < 0.001]. CONCLUSION: The risk of neonatal hyperbilirubinemia may be increased by the variation of UGT1A1 Gly71Arg in Asia and Africa, as well as the variation of UGT1A1 TATA promoter in Asia and Europe.


Assuntos
Predisposição Genética para Doença/genética , Glucuronosiltransferase/genética , Hiperbilirrubinemia Neonatal/genética , Polimorfismo de Nucleotídeo Único/genética , Regiões Promotoras Genéticas/genética , África , Animais , Ásia , Estudos de Casos e Controles , Europa (Continente) , Humanos
3.
BMC Res Notes ; 12(1): 617, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547861

RESUMO

OBJECTIVE: The study evaluated the efficacy of phototherapy and 20% albumin infusion to reduce total serum bilirubin (TSB) in neonates with severe hyperbilirubinemia. The primary outcome was a reduction of TSB at the end of treatment. The secondary outcomes were the need for exchange transfusion, inpatient mortality, neurological outcomes at discharge, and development outcomes at 12-months follow-up. RESULTS: One hundred and eighteen neonates were randomly assigned to phototherapy and 20% albumin (n = 59) and phototherapy and saline (n = 69). The median age at admission was 5 (interquartile range (IQR) 3-6) days, and the median gestation was 36 (IQR 36-38) weeks. No significant differences were found in the change in TSB (Mann-Whitney U =609, p = 0.98) and rate of change in TSB per hour after treatment (Mann-Whitney U = 540, p = 0.39) between the two groups. There were no significant differences between the two groups in the proportion of participants who required exchange transfusion (χ2 (2) = 0.36, p = 0.546); repeat phototherapy (χ2 (2) = 2.37, p = 0.123); and those who died (χ2 (2) = 0.92, p = 0.337). Trial registration The trial was registered in the International Standardized Randomized Controlled Trial Number (ISRCTN); trial registration number ISRCTN89732754.


Assuntos
Albuminas/uso terapêutico , Hiperbilirrubinemia Neonatal/terapia , Fototerapia/métodos , Solução Salina/administração & dosagem , Bilirrubina/sangue , Transfusão de Componentes Sanguíneos/métodos , Feminino , Hospitalização , Humanos , Hiperbilirrubinemia Neonatal/mortalidade , Hiperbilirrubinemia Neonatal/fisiopatologia , Lactente , Mortalidade Infantil , Recém-Nascido , Quênia , Masculino
5.
Cochrane Database Syst Rev ; 8: CD012731, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31425619

RESUMO

BACKGROUND: Hyperbilirubinaemia occurs in approximately two-thirds of all newborns during the first days of life and is frequently treated with phototherapy. Although generally seen as safe, there is rising concern regarding phototherapy and its potentially damaging effects on DNA and increased side effects particularly for preterm infants. Other methods, such as enteral feeding supplementation with prebiotics, may have an effective use in the management of hyperbilirubinaemia in neonates. OBJECTIVES: To determine whether administration of prebiotics reduces the incidence of hyperbilirubinaemia among term and preterm infants compared with enteral supplementation of milk with distilled water/placebo or no supplementation. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), MEDLINE via PubMed (1966 to 14 June 2018), Embase (1980 to 14 June 2018), and CINAHL (1982 to 14 June 2018). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. SELECTION CRITERIA: We considered all RCTs that studied neonates comparing enteral feeding supplementation with prebiotics versus distilled water/placebo or no supplementation. DATA COLLECTION AND ANALYSIS: Two reviewers screened papers and extracted data from selected papers. We used a fixed-effect method in combining the effects of studies that were sufficiently similar. We then used the GRADE approach to assess the quality of the evidence. MAIN RESULTS: Three small studies evaluating 154 infants were included in this review. One study reported a significant reduction in the risk of hyperbilirubinaemia and rate of treatment with phototherapy associated with enteral supplementation with prebiotics (risk ratio (RR) 0.75, 95% confidence interval (95% CI) 0.58 to 0.97; one study, 50 infants; low-quality evidence). Meta-analyses of two studies showed no significant difference in maximum plasma unconjugated bilirubin levels in infants with prebiotic supplementation (mean difference (MD) 0.14 mg/dL, 95% CI -0.91 to 1.20, I² = 81%, P = 0.79; two studies, 78 infants; low-quality evidence). There was no evidence of a significant difference in duration of phototherapy between the prebiotic and control groups, which was only reported by one study (MD 0.10 days, 95% CI -2.00 to 2.20; one study, 50 infants; low-quality evidence). The meta-analyses of two studies demonstrated a significant reduction in the length of hospital stay (MD -10.57 days, 95% CI -17.81 to -3.33; 2 studies, 78 infants; I² = 0%, P = 0.004; low-quality evidence). Meta-analysis of the three studies showed a significant increase in stool frequency in the prebiotic groups (MD 1.18, 95% CI 0.90 to 1.46, I² = 90%; 3 studies, 154 infants; high-quality evidence). No significant difference in mortality during hospital stay after enteral supplementation with prebiotics was reported (typical RR 0.94, 95% CI 0.14 to 6.19; I² = 6%, P = 0.95; 2 studies; 78 infants; low-quality evidence). There were no reports of the need for exchange transfusion and incidence of acute bilirubin encephalopathy, chronic bilirubin encephalopathy, and major neurodevelopmental disability in the included studies. None of the included studies reported any side effects. AUTHORS' CONCLUSIONS: Current studies are unable to provide reliable evidence about the effectiveness of prebiotics on hyperbilirubinaemia. Additional large, well-designed RCTs should be undertaken in neonates that compare effects of enteral supplementation with prebiotics on neonatal hyperbilirubinaemia with supplementation of milk with any other placebo (particularly distilled water) or no supplementation.


Assuntos
Hiperbilirrubinemia Neonatal/prevenção & controle , Prebióticos/administração & dosagem , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/prevenção & controle , Masculino , Fototerapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(7): 635-639, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31315760

RESUMO

OBJECTIVE: To study the effect of red blood cell (RBC) storage duration on the clinical effect of exchange transfusion (ET) and internal environment in neonates with hyperbilirubinemia. METHODS: A retrospective analysis was performed for the clinical data of 135 neonates with hyperbilirubinemia who received ET between January 2015 and August 2018. According to RBC storage duration, the neonates were divided into short-term storage group (RBCs were stored for ≤7 days) with 56 neonates and long-term storage group (RBCs were stored for >7 days) with 79 neonates. The two groups were compared in terms of serum total bilirubin (TBIL) level and the rate of TBIL reduction at 0 and 12 hours after ET, as well as the duration of continued phototherapy and rate of repeated ET. Routine blood test parameters, electrolytes, blood glucose, and blood gas parameters were measured before ET and at 0 hour after ET. RESULTS: At 0 hour after ET, there were no significant differences in the TBIL level and the rate of TBIL reduction between the two groups (P>0.05). At 12 hours after ET, the long-term storage group had a significantly higher TBIL level and a significantly lower rate of TBIL reduction than the short-term storage group (P<0.01). The long-term storage group had a significantly longer duration of continued phototherapy after ET than the short-term storage group (P<0.05). Compared with the short-term storage group, the long-term storage group had significantly higher incidence rates of ET-related complications, including hyponatremia, hyperkalemia, and metabolic acidosis (P<0.05). CONCLUSIONS: The use of RBCs with a storage duration of >7 days in ET for neonates with hyperbilirubinemia does not affect the immediate effect of ET, but these neonates tend to have a poor outcome after continued phototherapy and high risk of hyponatremia, hyperkalemia, and metabolic acidosis.


Assuntos
Transfusão Total , Hiperbilirrubinemia Neonatal , Bilirrubina , Eritrócitos , Humanos , Hiperbilirrubinemia , Recém-Nascido , Fototerapia , Estudos Retrospectivos
9.
Rev Chil Pediatr ; 90(3): 267-274, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31344186

RESUMO

INTRODUCTION: Hyperbilirubinemia is highly prevalent in newborns, with risk of neurological invol vement with bilirubinemia higher than 20 to 25 mg/dl. This progression is preventable with early de tection and treatment. OBJECTIVE: To describe the incidence and associated factors in hospitalized pa tients with hyperbilirubinemia higher than 20 mg/dl, and the follow-up of symptomatic cases during hospitalization. PATIENTS AND METHOD: Retrospective study of patients with severe hyperbilirubine mia, between 2013 and 2016. Risk factors were evaluated, stratifying by bilirubin level, admission age, and gestational age. The data were compared with Fisher's exact test, chi-square test, and relative risk (RR) in an Excel database, with an alpha error of p <0.05. The data were obtained from the electronic discharge summary and the medical record of secondary level follow-up. RESULTS: During the studied period, out of 25,288 live newborns (NB), 593 were hospitalized due to hyperbilirubinemia higher than 20 mg/dl, one per each 42 live NB; and 59 with bilirubinemia higher than 25 mg/dl, one per each 428 live NB. Hyperbilirubinemia was more frequent in males, with RR 1.22 (95% CI 1.04-1.44), and in late preterm newborns, with RR 2.39 (95% CI 1.96-2.93) compared with term NB. In those admitted with more than four days, the main associated factor was excessive weight loss, whereas in the first three days was classic group incompatibility. Three of ten cases with acute encephalopathy persisted with neurological involvement, which means 11.8 per 100,000 live births. CONCLUSIONS: The main risk factors for developing severe hyperbilirubinemia were prematurity, excessive weight loss, classic group incompatibility, and male sex. These findings allow to focus attention on risk groups and decrease the probability of neurological damage.


Assuntos
Idade Gestacional , Hiperbilirrubinemia Neonatal/epidemiologia , Perda de Peso , Incompatibilidade de Grupos Sanguíneos/epidemiologia , Feminino , Humanos , Hiperbilirrubinemia Neonatal/etiologia , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
10.
J Pak Med Assoc ; 69(6): 767-771, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31189279

RESUMO

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.


Assuntos
Hiperbilirrubinemia Neonatal/terapia , Fototerapia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Paquistão , Fototerapia/instrumentação , Fototerapia/métodos , Fototerapia/estatística & dados numéricos
11.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31196939

RESUMO

OBJECTIVES: We previously reported a clinical prediction rule to estimate the probability of rebound hyperbilirubinemia using gestational age (GA), age at phototherapy initiation, and total serum bilirubin (TSB) relative to the treatment threshold at phototherapy termination. We investigated (1) how a simpler 2-variable model would perform and (2) the absolute rebound risk if phototherapy were stopped at 2 mg/dL below the threshold for treatment initiation. METHODS: Subjects for this retrospective cohort study were infants born 2012-2014 at ≥35 weeks' gestation at 1 of 17 Kaiser Permanente hospitals who underwent inpatient phototherapy before age 14 days. TSB reaching the phototherapy threshold within 72 hours of phototherapy termination was considered rebound. We simplified by using the difference between the TSB level at the time of phototherapy termination and the treatment threshold at the time of phototherapy initiation as 1 predictor, and kept GA as the other predictor. RESULTS: Of the 7048 infants treated with phototherapy, 4.6% had rebound hyperbilirubinemia. The area under the receiver operating characteristic curve was 0.876 (95% confidence interval, 0.854 to 0.899) for the 2-variable model versus 0.881 (95% confidence interval, 0.859 to 0.903) for the 3-variable model. The rebound probability after stopping phototherapy at 2 mg/dL below the starting threshold was 2.5% for infants ≥38 weeks' GA and 10.2% for infants <38 weeks' GA. CONCLUSIONS: Rebound hyperbilirubinemia can be predicted by a simpler 2-variable model consisting of GA and the starting threshold-ending TSB difference. Infants <38 weeks' gestation may need longer phototherapy because of their higher rebound risk.


Assuntos
Hiperbilirrubinemia Neonatal/terapia , Doenças do Prematuro/terapia , Fototerapia/métodos , Feminino , Idade Gestacional , Humanos , Hiperbilirrubinemia Neonatal/diagnóstico , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico , Modelos Logísticos , Masculino , Razão de Chances , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento
12.
Int J Pediatr Otorhinolaryngol ; 123: 146-150, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31103744

RESUMO

OBJECTIVE: To explore the effects of exchange transfusion on auditory neuropathy spectrum disorder (ANSD) in neonates with severe hyperbilirubinemia (SH). METHODS: The clinical data of 2216 SH neonates who met the standard of exchange transfusion and 732 non severe-hyperbilirubinemia (NSH) neonates in the same period who did not require exchange transfusion in the neonatology department of Childrens' Hospital of Chongqing Medical University between January 2010 and December 2015 were retrospectively analyzed. In addition, the SH neonates were further divided into the exchange transfusion group and photography group. Hearing screening was conducted on all neonates using transiently evoked otoacoustic emission (TEOAE) and auto auditory brainstem response (AABR), and neonates who failed the above screening were performed diagnostic hearing test. And then neonates diagnosed with hearing disorder were followed up for 2-5 years. RESULTS: The pass rates of hearing screening were 80.58%, 79.71% and 87.84% in the phototherapy group, exchange transfusion group and NSH group respectively, with a significant difference(P < 0.05). Hearing loss was diagnosed in 10.15%, 12.39% and 8.54% of neonates in the phototherapy group, exchange transfusion group and NSH group. After follow-up, ultimate incidence rates of ANSD were 11.96%, 11.57% and 2.4% respectively in the 3 groups, with a significant difference (P < 0.05). CONCLUSIONS: SH is one of risk factors for ANSD. SH neonates have a lower incidence of ANSD in the exchange transfusion group than in the phototherapy group. Neonates who meet the standards of exchange transfusion adopt this therapy in early stage, which can quickly decrease bilirubin level and ultimately reduce incidence of ANSD.


Assuntos
Transfusão Total , Perda Auditiva Central/epidemiologia , Hiperbilirrubinemia Neonatal/terapia , Audiometria , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Feminino , Perda Auditiva Central/diagnóstico , Testes Auditivos , Humanos , Hiperbilirrubinemia Neonatal/complicações , Incidência , Recém-Nascido , Masculino , Emissões Otoacústicas Espontâneas/fisiologia , Estudos Retrospectivos , Fatores de Risco
14.
Biomed Res Int ; 2019: 6274719, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31111060

RESUMO

Neonatal hyperbilirubinemia is a common problem with potentiality to cause irreversible brain damage. Reduction of serum bilirubin level is essential to minimize such damage. Compact fluorescent tubes, halogen bulbs, fiber optic blankets, and LEDs are commonly used light sources for phototherapy with varying efficacies. This study aimed at evaluating the effect of LED versus conventional phototherapy on (a) rate of reduction in total serum bilirubin levels, (b) effect on urinary lumirubin excretion, and (c) comparing side effects of phototherapies among neonates with hyperbilirubinemia. In this randomized control trial, 166 neonates ≥ 35 weeks of age requiring phototherapy were recruited and further divided into 2 groups [LED (83) and conventional (83)] by using computer generated random numbers. Serial total serum bilirubin levels and random urinary lumirubin levels were collected and side effects of phototherapy were noted. Rate of fall in total serum bilirubin levels (TSB, µmol/L/hour) and random urinary lumirubin levels were computed. Data were collected using a pretested proforma. Analysis was done with Statistical Package for Social Sciences (SPSS) version 11.5. Independent sample "t" test and Chi-square tests were used with p value of <0.05 being significant. Significant difference was documented in mean rate of decrease of TSB (µmol/L/hour) in LED group (5.3 ± 2.91) when compared to conventional group (3.76 ± 2.39) (p <0.001). A significant increase in mean random urinary lumirubin levels (arbitrary units) was observed in LED group (129.01 ± 33.18) when compared to conventional group (114.44 ± 44.84) (p = 0.021). Side effects were minimal and comparable in both groups. This study concludes the rates of decrease in total serum bilirubin levels and increase in urinary lumirubin levels were significant with LED when compared with conventional phototherapy, implying LED to be more efficacious.


Assuntos
Hiperbilirrubinemia Neonatal/terapia , Fototerapia/efeitos adversos , Fototerapia/métodos , Bilirrubina/análogos & derivados , Bilirrubina/urina , Biometria , Lesões Encefálicas/etiologia , Distribuição de Qui-Quadrado , Feminino , Tecnologia de Fibra Óptica , Testes Hematológicos , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Fototerapia/instrumentação , Método Simples-Cego
15.
Int J Lab Hematol ; 41 Suppl 1: 95-101, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31069991

RESUMO

Hereditary hemolytic anemia (HHA) is a group of genetically and phenotypically heterogeneous disorders characterized by premature destruction of red blood cells (RBCs) with clinical manifestations ranging from asymptomatic to marked hemolytic anemia. There are three main categories of HHA: (a) RBC membrane defects; (b) hemoglobinopathies/thalassemias; and (c) RBC enzyme deficiencies. Hyperbilirubinemia is a frequent consequence of hemolytic anemia and can lead to bilirubin-associated neurotoxicity in neonates and to jaundice, and formation of gall stones in adults. Hyperbilirubinemia can also be caused by impaired bilirubin conjugation due to polymorphisms and mutations in genes involved in bilirubin metabolism (eg, UGT1A1). Neonates with HHA and co-inherited variants impairing bilirubin conjugation are at increased risk of bilirubin-associated toxicity. Prior to the advent of next-generation sequencing (NGS), molecular diagnosis of these disorders was limited to targeted single gene Sanger sequencing. However, NGS is making its way into the standard diagnostic workup of complex and multigene disorders like HHA. This review will focus on the molecular updates of HHA with particular focus on the neonatal and pediatric population.


Assuntos
Anemia Hemolítica Congênita , Hiperbilirrubinemia Neonatal , Adulto , Anemia Hemolítica Congênita/sangue , Anemia Hemolítica Congênita/diagnóstico , Anemia Hemolítica Congênita/genética , Membrana Eritrocítica/genética , Membrana Eritrocítica/metabolismo , Feminino , Cálculos Biliares/sangue , Cálculos Biliares/diagnóstico , Cálculos Biliares/genética , Glucuronosiltransferase/genética , Glucuronosiltransferase/metabolismo , Humanos , Hiperbilirrubinemia/sangue , Hiperbilirrubinemia/diagnóstico , Hiperbilirrubinemia/genética , Hiperbilirrubinemia Neonatal/sangue , Hiperbilirrubinemia Neonatal/diagnóstico , Hiperbilirrubinemia Neonatal/genética , Recém-Nascido , Masculino , Mutação , Patologia Molecular
16.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30952779

RESUMO

BACKGROUND: Severe neonatal hyperbilirubinemia (>20 mg/dL) affects ∼1 million infants annually. Improved jaundice screening in low-income countries is needed to prevent bilirubin encephalopathy and mortality. METHODS: The Bili-ruler is an icterometer for the assessment of neonatal jaundice that was designed by using advanced digital color processing. A total of 790 newborns were enrolled in a validation study at Brigham and Women's Hospital (Boston) and Sylhet Osmani Medical College Hospital (Sylhet, Bangladesh). Independent Bili-ruler measurements were made and compared with reference standard transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) concentrations. RESULTS: Bili-ruler scores on the nose were correlated with TcB and TSB levels (r = 0.76 and 0.78, respectively). The Bili-ruler distinguished different clinical thresholds of hyperbilirubinemia, defined by TcB, with high sensitivity and specificity (score ≥3.5: 90.1% [95% confidence interval (CI): 84.8%-95.4%] and 85.9% [95% CI: 83.2%-88.6%], respectively, for TcB ≥13 mg/dL). The Bili-ruler also performed reasonably well compared to TSB (score ≥3.5: sensitivity 84.5% [95% CI: 79.1%-90.3%] and specificity 83.2% [95% CI: 76.1%-90.3%] for TSB ≥11 mg/dL). Areas under the receiver operating characteristic curve for identifying TcB ≥11, ≥13, and ≥15 were 0.92, 0.93, and 0.94, respectively, and 0.90, 0.87, and 0.86 for identifying TSB ≥11, ≥13, and ≥15. Interrater reliability was high; 97% of scores by independent readers fell within 1 score of one another (N = 88). CONCLUSIONS: The Bili-ruler is a low-cost, noninvasive tool with high diagnostic accuracy for neonatal jaundice screening. This device may be used to improve referrals from community or peripheral health centers to higher-level facilities with capacity for bilirubin testing and/or phototherapy.


Assuntos
Recursos em Saúde/economia , Icterícia Neonatal/diagnóstico , Icterícia Neonatal/economia , Triagem Neonatal/economia , Triagem Neonatal/instrumentação , Adulto , Bangladesh/epidemiologia , Boston/epidemiologia , Cor , Feminino , Recursos em Saúde/tendências , Humanos , Hiperbilirrubinemia Neonatal/diagnóstico , Hiperbilirrubinemia Neonatal/economia , Hiperbilirrubinemia Neonatal/epidemiologia , Recém-Nascido , Icterícia/diagnóstico , Icterícia/economia , Icterícia/epidemiologia , Icterícia Neonatal/epidemiologia , Masculino , Triagem Neonatal/tendências , Adulto Jovem
17.
Trop Doct ; 49(3): 201-204, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30943888

RESUMO

Babies with ABO incompatibility are often advised frequent biochemical screening and prolonged hospital stay. Our primary objective of the study was to compare serum bilirubin levels at 48 h and 96 h of age in neonates with and without ABO incompatibility. Our prospective study included neonates with gestation ≥ 34 weeks, with or without ABO incompatibility (92 in each group). A direct Coombs test was performed on cord blood. The mean serum bilirubin and haematocrit levels in both groups at 48 h and 96 h were comparable. The mean reticulocyte count of babies with ABO incompatibility was, however, significantly higher. Late preterm and term neonates with and without ABO incompatibility have similar bilirubin levels and no increased risk of significant hyperbilirubinemia. Prolonged hospitalisation of these neonates appears to be unnecessary.


Assuntos
Sistema do Grupo Sanguíneo ABO/imunologia , Incompatibilidade de Grupos Sanguíneos/imunologia , Hiperbilirrubinemia Neonatal/imunologia , Incompatibilidade de Grupos Sanguíneos/sangue , Incompatibilidade de Grupos Sanguíneos/epidemiologia , Teste de Coombs , Feminino , Sangue Fetal/imunologia , Humanos , Hiperbilirrubinemia Neonatal/sangue , Hiperbilirrubinemia Neonatal/epidemiologia , Recém-Nascido , Masculino , Estudos Prospectivos , Fatores de Risco
18.
BMJ Case Rep ; 12(3)2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30842133

RESUMO

We present twins born to the 31-year-old, multigravida mother, who were referred to our centre at 90 hours of life for severe hyperbilirubinaemia. Twin 1 had already received two double volume exchange transfusions at 55 and 83 hours of life, in view of the persistent rise in bilirubin despite receiving phototherapy. Twin 2 had received phototherapy and 1 packed red blood cell transfusion in view of the fall in haematocrit. Mother's blood group was B positive and that of both twins was O positive. Both the twins were started on intensive phototherapy and their serum bilirubin and haematocrit were evaluated. On investigation, a minor blood incompatibility was found. Double volume exchange transfusion was done for twin 2 at 100 hours of life in view of the rapid rise in serum bilirubin. Both the babies were monitored for their serum bilirubin and treated for sepsis and discharged after 15 days.


Assuntos
Bilirrubina/sangue , Incompatibilidade de Grupos Sanguíneos/diagnóstico , Transfusão Total , Hiperbilirrubinemia Neonatal/terapia , Fototerapia/métodos , Gêmeos , Adulto , Incompatibilidade de Grupos Sanguíneos/fisiopatologia , Incompatibilidade de Grupos Sanguíneos/terapia , Transfusão Total/efeitos adversos , Feminino , Hematócrito , Humanos , Hiperbilirrubinemia Neonatal/sangue , Hiperbilirrubinemia Neonatal/fisiopatologia , Recém-Nascido , Masculino , Resultado do Tratamento
19.
Early Hum Dev ; 131: 41-44, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30831388

RESUMO

BACKGROUND: There is no standardized method for total serum bilirubin (TSB) monitoring during phototherapy for neonatal hyperbilirubinemia and national guidelines give heterogeneous indications. AIM: To assess the hypothesis that TSB values do not exceed exsanguino-transfusion (EXT) threshold during phototherapy and that it is possible to decrease its monitoring frequency in jaundiced infants. STUDY DESIGN: We carried out a prospective observational study in which changes in TSB during phototherapy for non-haemolytic hyperbilirubinemia were recorded in a cohort of late preterm and term infants. TSB values after 6, 12, 18, and 24 h of phototherapy were compared to the EXT threshold matched to infants' gestational and postnatal age according to the specific nomogram of the Italian Society of Neonatology guidelines. RESULTS: We studied 105 infants who started phototherapy at a mean age of 89 ±â€¯37 h when mean TSB was 17.1 ±â€¯2.5 mg/dL. We found that TSB decreased during phototherapy and the difference between mean TSB and EXT threshold progressively increased during phototherapy; TSB exceeded EXT threshold in none of our patients (0%). CONCLUSIONS: Our study demonstrates that differences between mean TSB and EXT threshold increased during phototherapy in late preterm and term infants with non-haemolytic hyperbilirubinemia; in none of our patients TSB exceeded EXT threshold. Our findings support the possibility of safely decreasing TSB monitoring during phototherapy, thus limiting noxious painful stimuli in neonates.


Assuntos
Bilirrubina/sangue , Hiperbilirrubinemia Neonatal/terapia , Fototerapia/métodos , Transfusão Total/métodos , Feminino , Humanos , Hiperbilirrubinemia Neonatal/sangue , Recém-Nascido , Recém-Nascido Prematuro , Icterícia Neonatal/sangue , Icterícia Neonatal/terapia , Masculino , Estudos Prospectivos , Resultado do Tratamento
20.
Pediatr Int ; 61(5): 465-470, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30838731

RESUMO

BACKGROUND: The main photochemical pathway in phototherapy for neonatal hyperbilirubinemia is the production and elimination (in bile or urine) of cyclobilirubin, which is a structural photoisomer of bilirubin, and which is most efficiently produced by green light. Green light-emitting diode (LED) phototherapy, however, has not been evaluated in the clinical setting because it is not recommended in American Academy of Pediatrics guidelines. We therefore compared the efficacy of green LED phototherapy and blue LED phototherapy in patients with neonatal hyperbilirubinemia. METHODS: In this prospective randomized controlled trial, neonates with hyperbilirubinemia were randomly allocated to a green LED or blue LED phototherapy group. Both groups underwent 24 h of phototherapy, and blood was sampled before and after 24 h of phototherapy. Total serum bilirubin (TSB) was measured using enzymatic methods and bilirubin photoisomers were measured on high-performance liquid chromatography. RESULTS: Thirty-four infants were randomized (green, n = 16; blue, n = 18). TSB decreased significantly from 15.3 ± 1.5 to 13.9 ± 1.5 mg/dL in the green LED group (P < 0.01) and from 16.2 ± 1.3 to 14.5 ± 1.7 mg/dL in the blue LED group (P < 0.01) after 24 h of phototherapy. No significant difference was found in TSB reduction after phototherapy between the groups. CONCLUSIONS: Both light sources produced a significant reduction in TSB, indicating clinical effectiveness.


Assuntos
Hiperbilirrubinemia Neonatal/terapia , Fototerapia/métodos , Bilirrubina/sangue , Cor , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Resultado do Tratamento
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