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1.
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
3.
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
4.
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
5.
JAMA Netw Open ; 2(3): e190858, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901042

RESUMO

Importance: Neonatal hyperbilirubinemia can cause lifelong neurodevelopmental impairment (kernicterus) even in high-resource settings. A better understanding of the incidence and processes leading to kernicterus may help in the design of preventive measures. Objectives: To determine incidence rates of hazardous hyperbilirubinemia and kernicterus among near-term to term newborns and to evaluate health care professional adherence to best practices. Design, Setting, and Participants: This population-based nationwide cohort study used prospectively collected data on the highest serum bilirubin level for all infants born alive at 35 weeks' gestation or longer and admitted to neonatal care at all 46 delivery and 37 neonatal units in Sweden from 2008 to 2016. Medical records for newborns with hazardous hyperbilirubinemia were evaluated for best neonatal practices and for a diagnosis of kernicterus up to 2 years of age. Data analyses were performed between September 2017 and February 2018. Exposures: Extreme (serum bilirubin levels, 25.0-29.9 mg/dL [425-509 µmol/L]) and hazardous (serum bilirubin levels, ≥30.0 mg/dL [≥510 µmol/L]) neonatal hyperbilirubinemia. Main Outcomes and Measures: The primary outcome was kernicterus, defined as hazardous neonatal hyperbilirubinemia followed by cerebral palsy, sensorineural hearing loss, gaze paralysis, or neurodevelopmental retardation. Secondary outcomes were health care professional adherence to national guidelines using a predefined protocol with 10 key performance indicators for diagnosis and treatment as well as assessment of whether bilirubin-associated brain damage might have been avoidable. Results: Among 992 378 live-born infants (958 051 term births and 34 327 near-term births), 494 (320 boys; mean [SD] birth weight, 3505 [527] g) developed extreme hyperbilirubinemia (50 per 100 000 infants), 6.8 per 100 000 infants developed hazardous hyperbilirubinemia, and 1.3 per 100 000 infants developed kernicterus. Among 13 children developing kernicterus, brain injury was assessed as potentially avoidable for 11 children based on the presence of 1 or several of the following possible causes: untimely or lack of predischarge bilirubin screening (n = 6), misinterpretation of bilirubin values (n = 2), untimely or delayed initiation of treatment with intensive phototherapy (n = 1), untimely or no treatment with exchange transfusion (n = 6), or lack of repeated exchange transfusions despite indication (n = 1). Conclusions and Relevance: Hazardous hyperbilirubinemia in near-term or term newborns still occurs in Sweden and was associated with disabling brain damage in 13 per million births. For most of these cases, health care professional noncompliance with best practices was identified, suggesting that a substantial proportion of these cases might have been avoided.


Assuntos
Hiperbilirrubinemia Neonatal , Kernicterus , Feminino , Fidelidade a Diretrizes , Humanos , Hiperbilirrubinemia Neonatal/diagnóstico , Hiperbilirrubinemia Neonatal/epidemiologia , Hiperbilirrubinemia Neonatal/terapia , Recém-Nascido , Kernicterus/diagnóstico , Kernicterus/epidemiologia , Kernicterus/terapia , Masculino , Estudos Prospectivos , Suécia
6.
J Matern Fetal Neonatal Med ; 32(16): 2721-2726, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29504491

RESUMO

BACKGROUND: Hyperbilirubinemia occurs in over 80% of newborns and severe bilirubin toxicity can lead to neurological dysfunction and death, especially in preterm infants. Currently, the risk of bilirubin toxicity is assessed by measuring the levels of total serum bilirubin (TSB), which are used to direct treatments including immunoglobulin administration, phototherapy, and exchange transfusion. However, free, unbound bilirubin levels (Bf) predict the risk of bilirubin neurotoxicity more accurately than TSB. OBJECTIVE: To examine Bf levels in preterm infants and determine the frequency with which they exceed reported neurotoxic thresholds. METHODS: One hundred thirty preterm infants (BW 500-2000 g; GA 23-34 weeks) were enrolled and Bf levels measured during the first week of life by the fluorescent Bf sensor BL22P1B11-Rh. TSB and plasma albumin were measured by standard techniques. Bilirubin-albumin dissociation constants (Kd) were calculated based on Bf and plasma albumin. RESULTS: Five hundred eighty samples were measured during the first week of life, with an overall mean Bf of 13.6 ± 9.0 nM. A substantial number of measurements exceeded potential toxic thresholds levels as reported in the literature. The correlation between Bf and TSB was statistically significant (r2 0.17), but this weak relationship was lost at high Bf levels. Infants <28-week gestations had more hearing screening failures than infants ≥28-week gestation. CONCLUSIONS: Unbound (free) bilirubin values are extremely variable during the first week of life in preterm infants. A significant proportion of these values exceeded reported neurotoxic thresholds.


Assuntos
Bilirrubina/sangue , Hiperbilirrubinemia Neonatal/sangue , Albumina Sérica/metabolismo , Feminino , Idade Gestacional , Perda Auditiva/epidemiologia , Testes Auditivos/estatística & dados numéricos , Humanos , Hiperbilirrubinemia Neonatal/epidemiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Valor Preditivo dos Testes
7.
World J Pediatr ; 15(1): 42-48, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30406356

RESUMO

BACKGROUND: Acute bilirubin encephalopathy (ABE) still represents a significant cause of morbidity and mortality throughout the world, especially in developing countries. We aimed to determine the prevalence of ABE based on the Johnson bilirubin-induced neurologic dysfunction (BIND) score and to describe the discharge outcomes. METHODS: We prospectively studied all newborns ≥ 35 weeks with ABE by evaluating signs of mental sensorium, muscle tone, and cry patterns over 1 year. RESULTS: 12% (81 out of 674) of the newborns admitted for neonatal hyperbilirubinemia had a BIND score > 1. Their admission age was 6 ± 4.1 days; total serum bilirubin (TSB) was 31.2 ± 10 mg/dL (range 17.5-75.2). Of these newborns, 40.7% and 21% had evidence of haemolysis and sepsis, respectively. Overall mortality was 9.9%; 58% of the newborns showed signs of mild-to-moderate BIND at discharge, while 32.1% survived with an apparently normal outcome. Admission BIND score was significantly correlated with admission TSB (r = 0.476, P < 0.001). Similarly, BIND score at discharge was correlated with admission TSB (r = 0.442, P < 0.001) and admission BIND score (r = 0.888, P < 0.001). The regression model showed that admission TSB (P < 0.001) and maternal illiteracy (P = 0.034) were predictors of the BIND score at admission, while admission BIND score was the best indicator of the discharge score (P < 0.001). CONCLUSIONS: ABE is still a major problem in our community. Admission TSB and maternal illiteracy are good predictors of bilirubin encephalopathy at admission and discharge.


Assuntos
Hiperbilirrubinemia Neonatal/epidemiologia , Unidades de Terapia Intensiva Neonatal , Kernicterus/epidemiologia , Bilirrubina/sangue , Egito/epidemiologia , Feminino , Hemólise , Mortalidade Hospitalar , Humanos , Recém-Nascido , Alfabetização , Masculino , Mães , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/etiologia , Estudos Prospectivos , Sepse/epidemiologia , Índice de Gravidade de Doença , Centros de Atenção Terciária
8.
BMC Pregnancy Childbirth ; 18(1): 488, 2018 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-30541506

RESUMO

BACKGROUND: Annually in the US, over 100,000 pregnant women with overt type 2 diabetes give birth. Strict maternal glycemic control is the key to optimizing infant outcomes. Medical treatment of type 2 diabetes in pregnancy is generally restricted to insulin, as data on the safety and efficacy of oral hypoglycemic agents in pregnancy are limited. However, over one-third of infants born to women with type 2 diabetes experience an adverse outcome, such as premature delivery, large-for-gestational age, hypoglycemia, hyperbilirubinemia, or birth trauma, suggesting that current treatment regimens fall short of optimizing outcomes. Metformin is the pharmacologic treatment of choice for type 2 diabetes outside of pregnancy. Metformin is favored over insulin because it results in less weight gain, fewer hypoglycemic episodes, and is administered orally rather than injected. However, metformin is not typically used for treatment of type 2 diabetes complicating pregnancy, mainly because no large clinical studies have been conducted to examine its use in this context. METHODS/DESIGN: This is a randomized double-blind multi-center clinical trial of insulin plus metformin versus insulin plus placebo for the treatment of type 2 diabetes complicating pregnancy. A total of 1200 women with type 2 diabetes will be randomized between 10 weeks 0 days' and 20 weeks 6 days' gestation and followed until 30 days after delivery. Neonate outcomes will be followed until 30 days of age. The primary aim is to compare the effect of insulin and metformin versus insulin and placebo on composite adverse neonatal outcomes, comprising perinatal mortality, preterm delivery, neonatal hypoglycemia, hyperbilirubinemia, large-for-gestational age small for gestational age, low birth weight, and/or birth trauma. Key secondary aims are to compare treatment groups for neonatal fat mass and rate of maternal hypoglycemia. Additional aims are to assess the side effects and safety of insulin and metformin among pregnant women with overt type 2 diabetes and to compare gestational weight gain among women treated with metformin plus insulin versus insulin alone. DISCUSSION: Successful completion of this study will result in high-quality, contemporary evidence for management of overt type 2 diabetes complicating pregnancy to improve neonatal outcomes. TRIAL REGISTRATION: NCT02932475 (05/17/2016).


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Macrossomia Fetal/epidemiologia , Hipoglicemia/epidemiologia , Hipoglicemiantes/uso terapêutico , Doenças do Recém-Nascido/epidemiologia , Insulina/uso terapêutico , Metformina/uso terapêutico , Gravidez em Diabéticas/tratamento farmacológico , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Traumatismos do Nascimento/epidemiologia , Gerenciamento Clínico , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Hiperbilirrubinemia Neonatal/epidemiologia , Hipoglicemia/induzido quimicamente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Pessoa de Meia-Idade , Mortalidade Perinatal , Gravidez , Adulto Jovem
9.
Lancet Child Adolesc Health ; 2(8): 610-620, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30119720

RESUMO

Hyperbilirubinaemia, presenting as jaundice, is a ubiquitous and frequently benign condition in newborn babies but is a leading cause of hospitalisation in the first week of life. In some infants jaundice can become severe, progressing to acute bilirubin encephalopathy and kernicterus with a substantial risk of neonatal mortality and long-term neurodevelopmental impairments. Severe hyperbilirubinaemia and its sequelae continue to occur in industrialised countries with functioning medical systems and a disproportionately high burden also persists in low-income and middle-income countries due primarily to delays in delivering effective treatments that are routinely available in high-income countries. In this Review we summarise up-to-date evidence on the epidemiology of neonatal jaundice including its global burden based on estimates of its prevalence, and both fatal and non-fatal health outcomes. We also discuss the management of severe hyperbilirubinaemia including the prevention of kernicterus, and highlight future directions for research.


Assuntos
Hiperbilirrubinemia Neonatal , Efeitos Psicossociais da Doença , Previsões , Saúde Global , Humanos , Hiperbilirrubinemia Neonatal/diagnóstico , Hiperbilirrubinemia Neonatal/epidemiologia , Hiperbilirrubinemia Neonatal/terapia , Recém-Nascido , Fatores de Risco
10.
BMC Pediatr ; 18(1): 190, 2018 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-29895274

RESUMO

BACKGROUND: Indirect neonatal hyperbilirubinemia (INH) is a common neonatal disorder worldwide which can remain benign if prompt management is available. However there is a higher morbidity and mortality risk in settings with limited access to diagnosis and care. The manuscript describes the characteristics of neonates with INH, the burden of severe INH and identifies factors associated with severity in a resource-constrained setting. METHODS: We conducted a retrospective evaluation of anonymized records of neonates hospitalized on the Thai-Myanmar border. INH was defined according to the National Institute for Health and Care Excellence guidelines as 'moderate' if at least one serum bilirubin (SBR) value exceeded the phototherapy threshold and as 'severe' if above the exchange transfusion threshold. RESULTS: Out of 2980 records reviewed, 1580 (53%) had INH within the first 14 days of life. INH was moderate in 87% (1368/1580) and severe in 13% (212/1580). From 2009 to 2011, the proportion of severe INH decreased from 37 to 15% and the mortality dropped from 10% (8/82) to 2% (7/449) coinciding with the implementation of standardized guidelines and light-emitting diode (LED) phototherapy. Severe INH was associated with: prematurity (< 32 weeks, Adjusted Odds Ratio (AOR) 3.3; 95% CI 1.6-6.6 and 32 to 37 weeks, AOR 2.2; 95% CI 1.6-3.1), Glucose-6-phosphate dehydrogenase deficiency (G6PD) (AOR 2.3; 95% CI 1.6-3.3), potential ABO incompatibility (AOR 1.5; 95% CI 1.0-2.2) and late presentation (AOR 1.8; 95% CI 1.3-2.6). The risk of developing severe INH and INH-related mortality significantly increased with each additional risk factor. CONCLUSION: INH is an important cause of neonatal hospitalization on the Thai-Myanmar border. Risk factors for severity were similar to previous reports from Asia. Implementing standardized guidelines and appropriate treatment was successful in reducing mortality and severity. Accessing to basic neonatal care including SBR testing, LED phototherapy and G6PD screening can contribute to improve neonatal outcomes.


Assuntos
Hiperbilirrubinemia Neonatal/epidemiologia , Sistema do Grupo Sanguíneo ABO , Incompatibilidade de Grupos Sanguíneos/complicações , Deficiência de Glucosefosfato Desidrogenase/complicações , Hospitalização , Humanos , Hiperbilirrubinemia Neonatal/complicações , Hiperbilirrubinemia Neonatal/mortalidade , Hiperbilirrubinemia Neonatal/terapia , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/mortalidade , Doenças do Prematuro/terapia , Mianmar/epidemiologia , Fototerapia , Estudos Retrospectivos , Fatores de Risco , Tailândia/epidemiologia
11.
Neonatology ; 114(3): 223-225, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29940590

RESUMO

BACKGROUND: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common enzyme deficiency affecting more than 300 million individuals worldwide. Extreme neonatal hyperbilirubinemia, with its severe sequelae of bilirubin neurotoxicity and the potential of death, is the most devastating manifestation of G6PD deficiency. In a recent review of Favism, Luzzatto and Arese state that the pathophysiology of jaundice in G6PD-deficient neonates is different from that of favism, as there is little evidence of hemolysis in these infants. OBJECTIVES: To explore the role of hemolysis in neonatal hyperbilirubinemia associated with G6PD deficiency. METHODS: Previously published works including studies of endogenous production of carbon monoxide (CO), an index of heme catabolism, in hyperbilirubinemic G6PD-deficient neonates were reviewed to determine the role of hemolysis in this condition. RESULTS: Three studies demonstrated that endogenous CO production is elevated in G6PD-deficient neonates with extreme hyperbilirubinemia. CONCLUSIONS: Hemolysis is an important pathogenetic factor in G6PD deficiency-associated neonatal hyperbilirubinemia.


Assuntos
Bilirrubina/sangue , Deficiência de Glucosefosfato Desidrogenase/complicações , Hiperbilirrubinemia Neonatal/complicações , Eritrócitos/enzimologia , Favismo , Deficiência de Glucosefosfato Desidrogenase/enzimologia , Hemólise , Humanos , Hiperbilirrubinemia Neonatal/epidemiologia , Recém-Nascido
12.
Neonatology ; 114(3): 235-241, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29940600

RESUMO

BACKGROUND: Preventing the development of allergic skin disease in children is the best way to treat the disease. OBJECTIVES: Ultraviolet (UV)-free blue light phototherapy has been reported to treat atopic eczema. We evaluated the effect of neonatal phototherapy on allergic skin disease in children. METHODS: We randomly recruited 117,041 children from an insurance research database. Those with neonatal jaundice and receiving neonatal phototherapy were classified as the icteric-phototherapy group (n = 4,744), those with neonatal jaundice and not receiving phototherapy were classified as the icteric-non-phototherapy group (n = 5,003), and those without jaundice were classified as the non-icteric group (n = 107,294). We reviewed claims from birth to age 5 years. The prevalence of atopic dermatitis (AD), clinical visit times, and topical prescriptions for allergic skin disease at different ages were compared among groups. RESULTS: AD prevalence was lower in the icteric-phototherapy group than in the icteric-non-phototherapy group. Moreover, clinical visit times for allergic skin disease were lower at age 1-4 years, and topical agent prescription for allergic skin disease were lower at age 1-5 years, in the icteric-phototherapy group than in the icteric-non-phototherapy group. The decreased use of topical agents could reach 64.29%. The 5-year complications of skin disease and cancer in the phototherapy group were not higher. CONCLUSIONS: To our knowledge, this is the first study to report on the effect of UV-free blue light therapy on allergic skin disease in newborns. Blue light therapy in newborns may be a novel method to efficiently prevent allergic skin disease for at least 5 years.


Assuntos
Dermatite Atópica/epidemiologia , Dermatite Atópica/prevenção & controle , Hiperbilirrubinemia Neonatal/epidemiologia , Hiperbilirrubinemia Neonatal/terapia , Fototerapia , Assistência Ambulatorial , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Icterícia Neonatal , Masculino , Análise Multivariada , Análise de Regressão , Fatores de Risco , Taiwan/epidemiologia
13.
BMC Pediatr ; 18(1): 178, 2018 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-29803223

RESUMO

BACKGROUND: Considering the significant prevalence of Neonatal Indirect Hyperbilirubinemia (NIH) and its irreversible neurological complications, identifying the factors involved in the prevalence of neonatal jaundice is essential. The present study was conducted to determine the relationship between serum vitamin D levels and the prevalence of NIH in infants admitted to Qods Hospital of Qazvin in Iran in 2015-16. METHODS: In this case-control study, 30 term infants with NIH (the case group) were compared with 30 healthy, non- icteric, term infants (the control group) in terms of serum levels of 25-hydroxyvitamin D. The results were analyzed and compared between the two groups using t-test and the Chi-square test. RESULTS: The mean and standard deviation of serum 25-hydroxyvitamin D levels were 10.76 ± 8.6 ng/dl in the case group and 14.88 ± 11.38 ng/dl in the control group. There were no significant differences between the two groups (P = 0.11). CONCLUSION: The results suggest the lack of a relationship between vitamin D levels and NIH. However, further prospective studies are needed to conclude that vitamin D has no role in the pathogenesis of NIH.


Assuntos
Hiperbilirrubinemia Neonatal/sangue , Vitamina D/análogos & derivados , Estudos de Casos e Controles , Feminino , Humanos , Hiperbilirrubinemia Neonatal/epidemiologia , Recém-Nascido , Irã (Geográfico)/epidemiologia , Masculino , Prevalência , Vitamina D/sangue
14.
Biomed Res Int ; 2018: 9425843, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29607327

RESUMO

Neonatal hyperbilirubinemia (NH) is a common finding in newborn babies in Indonesia. Common and rare variants of UGT1A1 have been known to contribute to NH etiology. This study aims to identify UGT1A1 genetic variation and haplotype associated with NH in Indonesian population. DNA was isolated from 116 cases and 115 controls and a targeted-deep sequencing approach was performed on the promoter, UTRs, and exonic regions of UGT1A1. Determining association of common variants and haplotype analysis were performed using PLINK and Haploview. Ten and 4 rare variants were identified in cases and controls, respectively. The UGT1A1 rare variants frequency in cases (5.17%) was higher than that in controls (1.7%). Four of those rare variants in cases (p.Ala61Thr, p.His300Arg, p.Lys407Asn, and p.Tyr514Asn) and three in controls (p.Tyr79X, p.Ala346Val, and p.Thr412Ser) are novel variants. The frequencies of p.Gly71Arg, p.Pro229Gln, and TA7 common variants were not significantly different between cases and controls. A haplotype, consisting of 3 major alleles of 3' UTRs common variants (rs8330C>G, rs10929303C>T, and rs1042640C>G), was associated with NH incidence (p = 0.025) in this population. Using targeted-deep sequencing and haplotype analysis, we identified novel UGT1A1 rare variants and disease-associated haplotype in NH in Indonesian population.


Assuntos
Alelos , Variação Genética , Glucuronosiltransferase/genética , Haplótipos , Hiperbilirrubinemia Neonatal/genética , Regiões 3' não Traduzidas , Éxons , Feminino , Humanos , Hiperbilirrubinemia Neonatal/epidemiologia , Indonésia/epidemiologia , Masculino , Regiões Promotoras Genéticas
15.
JBI Database System Rev Implement Rep ; 16(2): 287-290, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29419612

RESUMO

REVIEW QUESTION/OBJECTIVE: The objective of this review is to assess the effectiveness of the universal hyperbilirubinemia screening program on common newborn health outcomes.Specifically, the review will assess: the incidence of severe hyperbilirubinemia/kernicterus/exchange transfusion, rate of readmission due to jaundice, length of hospital stay on birth admission, rate and utilization of phototherapy during birth hospitalization, and jaundice related emergency visits.


Assuntos
Bilirrubina/análise , Hiperbilirrubinemia Neonatal/diagnóstico , Hiperbilirrubinemia Neonatal/epidemiologia , Triagem Neonatal/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Transfusão Total/estatística & dados numéricos , Feminino , Humanos , Hiperbilirrubinemia Neonatal/terapia , Incidência , Recém-Nascido , Icterícia Neonatal/diagnóstico , Icterícia Neonatal/epidemiologia , Icterícia Neonatal/terapia , Kernicterus/diagnóstico , Kernicterus/epidemiologia , Kernicterus/terapia , Tempo de Internação/estatística & dados numéricos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Fototerapia/estatística & dados numéricos , Projetos de Pesquisa , Revisão Sistemática como Assunto
16.
J Perinatol ; 38(5): 517-525, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29410540

RESUMO

OBJECTIVE: ABO hemolytic disease occurs among neonates with blood groups A or B delivered to group O women. Extreme neonatal hyperbilirubinemia due to ABO disease has been reported, but its frequency is not well known. We sought to determine the odds of developing severe ABO hemolytic disease in the 13 years since adopting universal bilirubin screening/management in the Intermountain Healthcare system. STUDY DESIGN: We conducted a retrospective analysis of neonates born between 2004 and 2016, defining "severe hemolytic disease" as; (1) total serum bilirubin (TSB) >25 mg/dL, or (2) hospital readmission for jaundice, or (3) bilirubin encephalopathy. Neonates born to group O (+) mothers were included and considered either; (1) Controls (not at risk for ABO disease because they were group O), (2) Study subjects (at risk for ABO disease because they were group A or B). RESULTS: Of 400,531 live births, 47% were to group O women; 86% of whom were group O (+). Overall, 42,529 (27%) neonates born to group O (+) women had their blood group determined; 29,729 (68%) were O, 10,682 (25%) A, and 3109 (7%) B. Peak TSBs during the first 10 days were higher in group A (11.0 ± 4.2 mg/dL) and B (11.5 ± 4.3) than group O neonates (10.3 ± 4.1). However the relative risks of a TSB ≥25 mg/dL, readmission for jaundice, or kernicterus, were the same in the control vs. study groups. CONCLUSIONS: In our health system, severe hemolytic disease in neonates born to group O (+) woman is not more likely in group A or B neonates than in controls (group O). We recognize that in other practices, particularly those who do not have a universal bilirubin screening/management program, ABO hemolytic disease severity might be different than in our system.


Assuntos
Sistema do Grupo Sanguíneo ABO , Bilirrubina/sangue , Eritroblastose Fetal/epidemiologia , Hiperbilirrubinemia Neonatal/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Hemólise , Humanos , Hiperbilirrubinemia Neonatal/complicações , Recém-Nascido , Kernicterus , Masculino , Estudos Retrospectivos , Utah/epidemiologia
17.
J Obstet Gynaecol Res ; 44(1): 93-101, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28892225

RESUMO

AIM: To assess the feasibility and practicality of expectant management for pregnancies with fetal growth restriction (FGR) at term without evidence of placental dysfunction. METHODS: We reviewed the records of pregnancies with an estimated fetal weight ≤ 1.5 SD below the mean at 37 weeks of gestation. We excluded elective cesarean deliveries and pregnancies that, at 37 weeks, were complicated by oligohydramnios, decreased fetal cerebroplacental ratio, or pregnancy-related hypertensive disorders. Prior to May 2013, we performed routine labor induction for FGR at term; after that time, we used routine expectant management. The rate of delivery by cesarean or instrumental assist and the rate of neonatal morbidity were compared between the groups. RESULTS: The gestational age at delivery and the neonatal birthweight were higher in the expectant management policy group (39+4 vs 38+1 weeks; 2405 vs 2205 g). The cesarean rate (7/77 vs 7/73) and the instrumental delivery rate (5/77 vs 6/73) did not differ. Neonatal hypoglycemia and hyperbilirubinemia were significantly less frequent (10/77 vs 21/73; 7/77 vs 20/73) in the expectant management policy group. Seven patients in the expectant management policy group underwent emergency cesarean delivery; five of these (71%) had required labor induction because of progression to oligohydramnios. CONCLUSIONS: Expectant management policy for FGR at term can reduce neonatal morbidity without increasing maternal risk or the cesarean rate. Caution should be used, however, during labor if oligohydramnios develops during expectant management.


Assuntos
Peso ao Nascer/fisiologia , Cesárea/estatística & dados numéricos , Extração Obstétrica/estatística & dados numéricos , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/terapia , Idade Gestacional , Hipoglicemia/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Trabalho de Parto Induzido/estatística & dados numéricos , Adulto , Feminino , Humanos , Hiperbilirrubinemia Neonatal/epidemiologia , Recém-Nascido , Gravidez
18.
An. pediatr. (2003. Ed. impr.) ; 87(5): 294.e1-294.e8, nov. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-168559

RESUMO

La hiperbilirrubinemia representa la causa más común de reingreso hospitalario en la primera semana de vida. Su detección continúa siendo un desafío, debido especialmente al alta precoz que puede asociarse con un retraso en el diagnóstico. La identificación de los niños con riesgo de desarrollar hiperbilirrubinemia significativa es una de las principales prioridades de la sanidad pública. En este documento, se presenta un enfoque para el manejo de la ictericia del recién nacido, según recomendaciones basadas en la evidencia médica y en la opinión del Comité de Estándares de la Sociedad Española de Neonatología (AU)


Hyperbilirubinaemia is one of the most frequent causes of hospital readmission during the first week of life. Its detection is still a big challenge, mainly due to the early discharge from the hospital that can be associated with a delay of the diagnosis. The identification of those newborns at risk of developing significant hyperbilirubinaemia is one of the main priorities in the public health care system. An approach to the management of newborn jaundice is presented in this article, following the recommendations based on the medical evidence and on the opinion of the Standards Committee of the Spanish Society of Neonatology (AU)


Assuntos
Humanos , Recém-Nascido , Hiperbilirrubinemia Neonatal/epidemiologia , Triagem Neonatal/métodos , Icterícia Neonatal/epidemiologia , Hiperbilirrubinemia Neonatal/prevenção & controle , Doenças do Prematuro/diagnóstico , Fatores de Risco , Padrões de Prática Médica
19.
Rev Neurol ; 65(2): 57-62, 2017 Jul 16.
Artigo em Espanhol | MEDLINE | ID: mdl-28675256

RESUMO

INTRODUCTION: There is a huge disparity in the description of the prevalence and risk factors of periventricular leukomalacia in preterm infants. AIMS: To describe and compare, through a systematic review of the literature, the prevalence of periventricular leukomalacia in preterm infants, as well as to determine the main risk factors associated with its presentation. SUBJECTS AND METHODS: A systematic review was conducted consulting multiple databases of the last 20 years. The search terms were: periventricular leukomalacia, prevalence, risk factors and premature birth. We included all studies that mention or led to the prevalence of periventricular leukomalacia and those that referred to its risk factors. RESULTS: Of the 209 studies identified, we selected 107 studies in which the prevalence of periventricular leukomalacia was mentioned or the risk factors were described. A stratified analysis was performed for the diagnostic technique and gestational age, in addition to a narrative synthesis. Ultrasound detected a prevalence of 14.7% and magnetic resonance of 32.8%. Prevalence in children under 28 weeks was 39.6%; 27.4% in children under 32 weeks and 7.3% in children under 37 weeks. Risk factors include gestational age, intrauterine infection, premature rupture of membranes and chorioamnionitis. CONCLUSIONS: The prevalence of periventricular leukomalacia in preterm infants is heterogeneous, increases according to the degree of prematurity and is better detected by magnetic resonance. There are multiple factors related to its presentation, the main factor is gestational age.


Assuntos
Doenças do Prematuro/epidemiologia , Leucomalácia Periventricular/epidemiologia , Corioamnionite/epidemiologia , Comorbidade , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Idade Gestacional , Humanos , Hiperbilirrubinemia Neonatal/epidemiologia , Recém-Nascido Prematuro , Doenças do Prematuro/etiologia , Leucomalácia Periventricular/etiologia , Imagem por Ressonância Magnética , Síndrome de Aspiração de Mecônio/epidemiologia , Obesidade/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Prevalência , Fatores de Risco , Ultrassonografia Pré-Natal
20.
J Neonatal Perinatal Med ; 10(2): 181-189, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28409762

RESUMO

BACKGROUND: Hyperbilirubinemia is one of the most common causes of neonatal readmission to hospital. AIMS: To assess risk factors for hyperbilirubinemia among neonates readmitted for this condition and the ratio of the mean corpuscular hemoglobin concentration (MCHC) to the mean corpuscular volume (MCV). METHODS: We retrospectively studied the clinical and laboratory findings, management and possible risk factors for hyperbilirubinemia in 301 neonates born at ≥35 weeks gestation and readmitted to hospital owing to hyperbilirubinemia over five years. RESULTS: No risk factors for hyperbilirubinemia were identified in 64 (21.3%) neonates, and one or more risk factors were found in 237 neonates (78.7%). The most prevalent risk factor (41.9%) was G6PD deficiency, which occurred in 11 of the 15 neonates with a serum bilirubin level ≥427 µmol/l. A double-volume exchange blood transfusion was performed in two neonate boys in whom G6PD deficiency was the single risk factor for hyperbilirubinemia. One of them developed kernicterus later. The MCHC/MCV ratio of neonates with idiopathic hyperbilirubinemia, unexplained hemolysis, or other risk factors overlapped. CONCLUSIONS: This study confirmed that in an area where G6PD deficiency is prevalent, it is the most common and most severe risk factor for hyperbilirubinemia. This finding supports routine neonatal screening for G6PD deficiency in such areas. The usefulness of determining the MCHC/MCV ratio in the management of hyperbilirubinemia is uncertain.


Assuntos
Deficiência de Glucosefosfato Desidrogenase/complicações , Deficiência de Glucosefosfato Desidrogenase/epidemiologia , Hiperbilirrubinemia Neonatal/epidemiologia , Hiperbilirrubinemia Neonatal/etiologia , Readmissão do Paciente/estatística & dados numéricos , Transfusão Total/estatística & dados numéricos , Feminino , Deficiência de Glucosefosfato Desidrogenase/terapia , Hospitais , Humanos , Hiperbilirrubinemia Neonatal/terapia , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Triagem Neonatal , Prevalência , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia
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