Average Bilirubin Level Research Articles

The impact of asphyxia on the development of hyperbilirubinemia in newborns: An observational study

Asphyxia is still a major cause of morbidity and mortality in newborns in both developing and developed countries. The prevalence of asphyxia in provincial referral hospitals in Indonesia is 41.94%. The purpose of this study was to determine the correlation between the first minute Apgar score and bilirubin levels in newborns at Margono Soekarjo Hospital, Purwokerto. The type of research used is analytic observational with a cross sectional approach. The population in this study were newborns who were cared for in the perinatal room at Margono Soekarjo Hospital Purwokerto in 2021-2022 with a total of 3824 babies. The sample size was 156. Data analysis used the Pearson Product Moment test. The results showed that the lowest Apgar score was 1 and the highest Apgar score was 8, the average Apgar score was 5. The lowest bilirubin level was 0.1 mg/dL and the highest bilirubin level was 24.16 mg/dL, the average bilirubin level was 10.68 mg /dL. There is a significant correlation between Apgar scores and bilirubin levels in newborns at Margono Soekarjo Hospital, Purwokerto, with a weak correlation (-0.231). Conclusion: The greater the Apgar score, the lower the bilirubin level.

Hepatitis A in Adults: Experience from a Moroccan Hospital Center

Background: In children, hepatitis A virus infection is usually symptom-free and provides long-term immunity. However, in changing socio-economic environments, certain adults encounter infection risks, exposing them to symptomatic illness and complications. This study aims to outline the profile of adult hepatitis A patients. Methods: We conducted a retrospective study from 2017 to 2023, involving all patients aged over 14 years who presented with acute hepatitis and tested positive for anti-HAV antibodies. Demographic, laboratory and clinical data were analyzed. Results: The analysis involved 109 cases (mean age 21 +/- 6 years, 57.8% males). All patients were symptomatic. Among them, 71.6% presented with a pseudo-flu-like syndrome, 89% with jaundice, 50.5% with fever and 30.2% with gastrointestinal symptoms. Thirty patients were hospitalized (26.6%), among them one subfulminant was recorded. Clinically, hepatomegaly was found in 8 patients (7.3%). One patient had presented with a skin rash. Serum alanine aminotransferases levels were more than 50 times the normal range in 47.7% of cases, with an average bilirubin level of 89 mg/l. Severe acute hepatitis was observed in 26.6% of patients. Conclusion: Our findings revealed that over 25% of adult patients experienced severe acute hepatitis, with one patient progressing to acute liver failure. These results underline the importance of raising awareness of hygiene practices and prompt a study of the overall seroprevalence of hepatitis in the adult population in order to improve viral hepatitis prevention and control strategies in the country.

Field Massage Therapy terhadap Stabilitas Fisiologis dan Kadar Bilirubin Bayi dengan Hiperbilirubinemia

This study aims to determine the effect of field massage therapy on the physiological stability and bilirubin levels of babies with hyperbilirubinemia. The method used is quantitative with a one-group post-test research design. The study's results showed that the average bilirubin level of babies after the intervention was given was 10.6 mg/dL. The statistical analysis found that the p-value was 0.000, which means there was an influence from the therapy provided. This research concluded that there were differences in the impact on physiological stability and bilirubin levels before and after being given field massage therapy. Keywords: Field Massage Therapy, Hyperbilirubinemia, Neonates

Autoimmune Hemolytic Anemia in Patients of Non Hodgkin’s Lymphoma

The study was conducted to determine the frequency of autoimmune haemolytic anaemia in non-Hodgkin’s lymphomas. A cross sectional study on 100 patients of Non-Hodgkin Lymphoma was conducted in Pathology department, KEMU, Lahore. The mean age among the patients was 50.14 ±17.053 years. The mean haemoglobin was 10.73g/dl ± 2.74 . Out of 100, 88 patients had Coomb’s Test negative and 12 patients had a positive result. Those having a positive coomb’s test showed a higher retic count i.e., 5.05 ± 2.37. The average bilirubin levels in all NHL patients were 0.901 0.995 mg/dL, with a substantially higher mean of 2.15 1.19 mg/dL among patients who tested positive for Coomb's. The LDH levels of those immensely high 764.5 ± 441.Post stratification chi square testing showed no significant relationship was found between autoimmune hemolytic anemia among NHL patients. Age and gender have no significant effect. However, disease stage can be a risk factor. Therefore, it is emphasized that all patients of NHL, regardless of age and gender, must be thoroughly investigated.

Study of serum bilirubin as a diagnostic method to predict acute perforated appendicitis

Background: Acute appendicitis is the commonest cause of ‘acute surgical abdomen’. Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. The aim of the study was to whether hyperbilirubinemia might be used as a diagnostic tool to predict perforated appendicitis.Methods: This study comprised patients who presented with the condition of appendicitis and abnormal liver function tests on admission and had a laparoscopic or open appendectomy. The age information, duration of symptoms, temperature, white blood cell counts, bilirubin levels, and histology data were gathered. Peritoneal fluid was cultured and examined for sensitivity.Results: The average bilirubin level of all participating patients was 0.92 mg/dl (range, 0.1-4.3 mg/dl). The mean bilirubin levels were higher for patients with simple appendicitis compared to those with a non-inflamed appendix (0.7 mg/dl and 0.4 mg/dl, p<0.001). Hyperbilirubinaemia was reported to have a specificity of 89% and a positive predictive value of 90.02% for acute appendicitis. Patients with appendiceal perforation, however, had a mean bilirubin level of 1.7 mg/dl and were more likely to have hyperbilirubinaemia (p<0.001). The specificity of hyperbilirubinaemia for perforation or gangrene was 73%.Conclusions: Patients with hyperbilirubinemia with appendicitis condition should be screened for a greater risk of appendiceal perforation than those with normal bilirubin levels.

Efficacy of albumin dialysis as a bridge to transplantation in children with end-stage liver disease

Liver transplantation is the only effective treatment modality for end-stage liver disease. However, donor organs are not always available. In some cases, the gravity of the patient’s condition makes transplantation impossible. In this regard, the use of artificial liver support systems helps in preparing a patient for transplant surgery. Objective: to conduct a retrospective study aimed at evaluating the efficiency of fractionated plasma separation and adsorption system. Materials and methods. From January 2019 to May 2020, 139 pediatric liver transplants were. We analyzed the data of 5 pediatric patients (2 girls and 3 boys, aged 12 to 17 years) who received fractionated plasma separation and adsorption (FPSA) sessions as a bridge to transplantation. The main clinical indication for FPSA was severe hepatic encephalopathy (grade 3 according to the West Haven Criteria), which was observed at 350–872 μmol/L (average 597 ± 98 μmol/L) serum bilirubin level. The FPSA sessions were conducted on a Prometheus device using AV-600 hemofilters as dialyzers (Fresenius Medical Care, Germany). Results. Depending on the extent of bilirubinemia in patients, it took from one (in one case) to three (in one case) daily FPSA sessions to restore clear consciousness, appetite and physical activity. Average bilirubin levels after treatment cycles decreased from 597 ± 98 to 236 ± 73 μmol/L. All patients successfully underwent liver transplant surgery within two to five days, two patients received a liver fragment from a living related donor. Conclusion. The FPSA system stabilizes the condition of potential recipients with acute liver failure. Further research is required to develop optimal regimens for albumin dialysis.

Frequency of Breastfeeding, Bilirubin Levels, and Re-admission for Jaundice in Neonates

OBJECTIVES: This study aimed to explore and compare bilirubin levels and readmission for jaundice in neonates who have different frequency of breastfeeding (BFF) during the first two weeks of life. MATERIAL AND METHODS: One-hundred mothers and full-term neonates recruited from a University Hospital, Bangkok, Thailand. The transcutaneous bilirubin (TcB) levels of neonates were recorded at 24, 48, and 72 hours after birth. The breastfeeding frequency (BFF) was recorded every day for a total of 14 consecutive days. The re-admission rates for jaundice were obtained by telephone call enquiry on day 6, 9, 12, and 14 after birth. For analysis, the samples were assigned to two groups according to their mean BFF during the first two weeks of life. The low-BFF group was breastfed < 8 times/day, and the high-BFF group was breastfed ≥ 8 times/day. RESULT: The average bilirubin levels of neonates in the low-BFF group and the high-BFF group were 6.74 ± 1.76 mg/dl and 5.31 ± 1.76 mg/dl at 24 hours, 10.95 ± 2.44 mg/dl and 8.19 ± 2.40 mg/dl at 48 hours, and 13.34 ± 2.03 mg/dl and 10.60 ± 2.48 mg/dl at 72 hours, respectively. The bilirubin levels and re-admission rates for jaundice of neonates in the low-BFF group were higher than the high-BFF group with statistical significance (p < 0.001 and p < 0.01, respectively). CONCLUSION: High-BFF at least eight times/day may help prevent inadequate breastfeeding jaundice in neonates.

PENUNDAAN PENJEPITAN TALI PUSAT TERHADAP KADAR BILIRUBIN BAYI BARU LAHIR

Delayed cord clamping can have an effect on the hematological value of the newborn. The advantages of cord clamping delays include preventing anemia, increasing hematocrit levels, reducing postpartum incidence, optimizing oxygen transfusion to the baby, improving maternal and infant closeness and promoting infant brain growth. The disadvantage of cord clamping delays is the occurrence of hyperbilirubin and policitemia in newborns. The purpose of this study was to identify the levels of bilirubin newborns. The research method used True Experimental Design in 3 (three) treatment groups; treatment of umbilical delayed cord clamping (DCC) for 2 minutes after birth; delay cord clamping (DCC) for 3-7 minutes /until stop pulsating; and delayed cord clamping (DCC) up to 2 hours. The results showed that the highest average bilirubin levels were found in the 2 minute DCC treatment group with mean value (4.04)

Thrombocytosis and Hepatocellular Carcinoma

Thrombocytopenia has been reported to be both a risk factor for hepatocellular carcinoma (HCC) development as well as a prognostic factor. Many HCCs also occur in presence of normal platelets. To examine a cohort of HCC patients with associated thrombocytosis. Records were examined of a cohort of 634 biopsy-proven and randomly presenting HCC patients without thrombocytopenia. In the total cohort, 52 patients were identified with thrombocytosis (platelet levels >400 × 10(9)/L) and compared with 582 patients with normal platelet values. The average tumor sizes were 13.1 versus 8.8 cm (p < 0.0001), and their total average bilirubin levels were 0.9 versus 1.5 (p = 0.02), comparing thrombocytosis patients versus normal platelet count HCC patients. These differences were even more pronounced in patients with HCC sizes >5 cm. Thrombocytosis patients were younger and had less cirrhosis, but similar percent with hepatitis B or C or alcohol consumption. Thrombocytosis in association with HCC occurs in patients with larger tumor sizes and better liver function.

Prospective Randomized Controlled Study Comparing Low-Cost LED and Conventional Phototherapy for Treatment of Neonatal Hyperbilirubinemia

Our objective was to carry out a prospective, randomized, single-blind study to evaluate whether light emitting diode (LED) phototherapy using a low-cost set of lights is as effective as conventional phototherapy in treating hyperbilirubinemia in neonates. The study included 45 pre-term neonates requiring phototherapy as per American Academy of Pediatrics guidelines; participants were randomized to receive phototherapy using LED-based lights, conventional fluorescent blue lights or conventional halogen lights. There were no statistically significant differences in the average bilirubin levels at the onset, at the maximum and at the end of treatment, nor in the duration of phototherapy treatment and the rate of decrease in bilirubin levels in the neonates receiving conventional fluorescent blue light, conventional halogen light and LED phototherapy. (Differences were considered significant at p < 0.05). The average rate of decrease of bilirubin levels was 0.047 ± 0.037 mg dl(-1) h(-1), 0.055 ± 0.056 mg dl(-1) h(-1) and 0.057 ± 0.045 mg dl(-1) h(-1) in the groups receiving conventional fluorescent blue light, conventional halogen light and LED phototherapy, respectively. The average duration of phototherapy treatment in the three groups was 108.8 ± 85.9 h, 92.8 ± 38.1 h, 110.4 ± 42.6 h, respectively. In this pilot study, LED phototherapy using a simple, low-cost set of lights was as effective as conventional phototherapy in the treatment of neonatal hyperbilirubinemia. LED phototherapy lights that deliver 30-40 µW cm(-2 )nm(-1) can be assembled in small quantities for <US$ 100 each using off-the-shelf parts; such lights may enable phototherapy to be safely and reliably delivered in low-resource settings.

The Bilirubin-Increasing Drug Atazanavir Improves Endothelial Function in Patients With Type 2 Diabetes Mellitus

In type 2 diabetes mellitus (T2DM), oxidative stress gives rise to endothelial dysfunction. Bilirubin, a powerful endogenous antioxidant, significantly attenuates endothelial dysfunction in preclinical experiments. The Gilbert syndrome is accompanied by a mild and lifelong hyperbilirubinemia and associated with only one third of the usual cardiovascular mortality risk. The hyperbilirubinemia caused by atazanavir treatment closely resembles the Gilbert syndrome. We thus hypothesized that treatment with atazanavir would ameliorate oxidative stress and vascular inflammation and improve endothelial function in T2DM. In a double-blind, placebo-controlled crossover design, we induced a moderate hyperbilirubinemia by a 3-day atazanavir treatment in 16 subjects experiencing T2DM. On the fourth day, endothelial function was assessed by venous occlusion plethysmography. Endothelium-dependent and endothelium-independent vasodilation were assessed by intraarterial infusion of acetylcholine and nitroglycerin, respectively. Atazanavir treatment induced an increase in average bilirubin levels from 7 μmol/L (0.4 mg/dL) to 64 μmol/L (3.8 mg/dL). A significant improvement in plasma antioxidant capacity (P<0.001) and endothelium-dependent vasodilation (P=0.036) and a decrease in plasma von Willebrand factor (P=0.052) were observed. Experimental hyperbilirubinemia is associated with a significant improvement of endothelial function in T2DM.

UGT1A1 promoter polymorphisms and the development of hyperbilirubinemia and gallbladder disease in children with sickle cell anemia

Genetic modifiers contribute to phenotypic variability in patients with sickle cell anemia (SCA). The influence of the bilirubin UDP-glucuronosyltransferase (UGT) 1A1 (TA)(n)TAA promoter polymorphism on bilirubin levels and gallbladder disease in SCA was examined using prospectively collected data from the Cooperative Study of Sickle Cell Disease. A total of 324 children with HbSS (median age 6.9 years) had UGT1A1 genotyping; 243 (75%) had common (TA)(6) or (TA)(7) alleles, whereas 81 (25.0%) had variant (TA)(5) or (TA)(8) alleles. The UGT1A1 genotype significantly influenced average bilirubin levels for the common alleles: 6/6 genotype = 2.36 +/- 1.13 mg/dL, 6/7 genotype = 2.90 +/- 1.54 mg/dL, and 7/7 genotype = 4.24 +/- 2.11 mg/dL (P < 0.0001). Thirty-nine percent of children with the 7/7 genotype had documented gallbladder disease, compared with 18.2% with the 6/7 genotype and only 9.9% with the wildtype 6/6 UGT1A1 genotype (P = 0.001). To analyze the (TA)(5) and (TA)(8) variant alleles, three groups were generated, showing increasing bilirubin levels with increasing TA repeats and age. Group 3 (genotypes 6/8, 7/7, and 7/8) had a significantly greater rate of bilirubin change than Groups 1 (genotypes 5/6, 5/7, and 6/6) or 2 (genotype 6/7). These results validate previous smaller studies and confirm that the UGT1A1 promoter polymorphism exerts a powerful influence on bilirubin levels and the development of gallbladder disease in children with SCA. UGT1A1 genotyping should be considered as a screening tool for predicting children most likely to develop gallbladder disease at a young age.

Gilbert Syndrome and the Development of Antiretroviral Therapy–Associated Hyperbilirubinemia

Unconjugated hyperbilirubinemia results from Gilbert syndrome and from antiretroviral therapy (ART) containing protease inhibitors. An understanding of the interaction between genetic predisposition and ART may help to identify individuals at highest risk for developing jaundice. We quantified the contribution of UGT1A1*28 and ART to hyperbilirubinemia by longitudinally modeling 1386 total bilirubin levels in 96 human immunodeficiency virus (HIV)-infected individuals during a median of 6 years. The estimated average bilirubin level was 8.8 micromol/L (0.51 mg/dL). Atazanavir increased bilirubin levels by 15 mu mol/L (0.87 mg/dL), and indinavir increased bilirubin levels by 8 micromol/L (0.46 mg/dL). Ritonavir, lopinavir, saquinavir, and nelfinavir had no or minimal effect on bilirubin levels. Homozygous UGT1A1*28 increased bilirubin levels by 5.2 micromol/L (0.3 mg/dL). As a consequence, 67% of individuals homozygous for UGT1A1*28 and receiving atazanavir or indinavir had > or =2 episodes of hyperbilirubinemia in the jaundice range (>43 micromol/L [>2.5 mg/dL]), versus 7% of those with the common allele and not receiving either of those protease inhibitors (P<.001). Efavirenz resulted in decreased bilirubin levels, which is consistent with the induction of UDP-glucuronosyltransferase 1A1. Genotyping for UGT1A1*28 before initiation of ART would identify HIV-infected individuals at risk for hyperbilirubinemia and decrease episodes of jaundice.

Severe hyperbilirubinaemia in a Chinese girl with type I Crigler–Najjar syndrome: First case ever reported in Mainland China

Jaundice is common in ethnic Chinese infants, but to our knowledge Crigler-Najjar syndrome (CN syndrome) type I has never been reported in China. A Chinese girl with severe jaundice was recently diagnosed to have CN syndrome type I by analyzing the bilirubin-uridinediphospho (UDP)-glucuronosyltransferase gene (UGT1A1). The patient was homozygous for a nonsense mutation that replaced glutamine (CAG, amino acid 239) with stop codon (TAG) at nucleotide number 715 (715C-->T) in exon 1. No mutation was found in exons 2-5. Her parents were heterozygous for the same mutant. The patient had an average bilirubin level of 300-500 mumol/L and a peak of 701 mumol/L. Daily phototherapy for 15 h was required to keep the bilirubin levels within 280-320 mumol/L. The unconjugated hyperbilirubinaemia apparently resulted from homozygous nonsense mutation of UGT1A1, which could completely abolish the UGT activity towards bilirubin (hepatic glucuronidation) and result in CN syndrome type I. Identification of the genetic defect is very useful for gene therapy, especially for DNA/RNA chimera therapy, and can be used as an antenatal screening test to identify the affected offsprings.

Serum Bilirubin Levels with Antiepileptic Drugs

The incidence of reduced bilirubin levels in 168 outpatients with epilepsy, compared with levels in 69 controls, has been investigated. Highly significant (p less than 0.001) reductions in average bilirubin levels were noted for carbamazepine (CBZ), phenytoin (PHT), phenobarbital (PB), and multiple drug groups. A marginally significant (p less than 0.05) reduction in bilirubin levels occurred in patients treated with valproate (VPA) which, unlike the other drugs, has not been shown to induce hepatic enzymes.

Vitamin E to Premature Infants

SummaryLower average bilirubin levels, higher hemoglobin and more normal serum alkaline phosphatase values were found in 67 premature infants who received 100 mg a‐tocopherol intramuscularly at birth, than in a control group. The results are discussed, and the routine administration of ‐vitamin E to premature infants is suggested.