Neonatal Bilirubin Levels Research Articles

Diagnostics Value of Quantitative Magnetic Resonance Imaging (MRI) in Neonatal Acute Bilirubin Encephalopathy.

Background: This study was designed to investigate the diagnostic value of relative signal intensity of globus pallidus on T1-weighted magnetic resonance imaging (MRI) in neonatal acute bilirubin encephalopathy (ABE). Methods: Participants who were recruited in hospital from April 2019 to May 2020 were grouped into mildly increased total serum bilirubin (TSB) group (n = 30), severely increased TSB group (n = 25), or extremely increased TSB group (n = 10) based on the total serum bilirubin level. Bilirubin-induced neurologic dysfunction scale score was used to determine if participants had acute bilirubin encephalopathy. All neonates underwent conventional brain MRI and the relative signal intensity of globus pallidus was measured on T1-weighted images. The diagnostic value of these 3 indices was assessed by receiver operating characteristic curve analysis. Results: There was a significant correlation between relative signal intensity of globus pallidus and total serum bilirubin level in neonates with hyperbilirubinemia (r = 0.551, P < .001). Relative signal intensity of globus pallidus in the extremely increased TSB group was significantly higher than that in severely increased TSB, mildly increased TSB, and healthy control groups. Relative signal intensity of globus pallidus in the acute bilirubin encephalopathy group was significantly higher than that in the non-acute bilirubin encephalopathy group (P < .01). The area under the receiver operating characteristic curve of the relative signal intensity of globus pallidus was 0.765 (P < .01), with sensitivity of 0.655 and specificity of 0.861. The area under the curve of the total serum bilirubin and visual inspection of globus pallidus signal was 0.621 and 0.579, respectively. The area under the curve of relative signal intensity was significantly greater than that of total serum bilirubin and visual inspection (P = .04 for both). Conclusion: Relative signal intensity of globus pallidus, which is an objective assessment, has the potential to be used as a diagnostic tool for acute bilirubin encephalopathy.

Correlation between transcutaneous bilirubin levels and total serum bilirubin levels in postnatal period in a tertiary care center

Background: Neonatal jaundice is generally a benign condition seen during the postnatal period. The non-invasive methods including transcutaneous bilirubinometry have been developed for assessment of neonatal jaundice, transcutaneous bilirubin TcB) meters noninvasively estimate the bilirubin levels by measuring light transmission through the skin of neonates this value is then to be plotted against a chart in order to look for hyperbilirubinemia. Aim was to determine the efficacy of measuring the transcutaneous bilirubin as a screening tool for clinically significant hyperbilirubinemia. Methods: Study was a cross sectional study conducted under pediatric department of SMBT IMS and RC at tertiary care center after taking the approval from the ethical committee. Total of 110 neonates that appear to be clinically suffering from neonatal jaundice were considered for study after consent from respective parent/ guardian. Neonatal TCB levels and serum bilirubin levels were done. If bilirubin levels lie in phototherapy range, then baby was shifted to NICU and phototherapy treatment was given, and once levels came within normal range after the phototherapy treatment, again serum bilirubin levels were measured in order to compare pre-and post-treatment levels. Results: Present study showed male preponderance. 64 were male and 46 were female. Majority 61% were full term normal delivery and 39% were LSCS. Mean TCB level was 8.5±2.8. Statistical significance was seen for TCB and sever hyperbilirubinemia. Conclusions: Present study concluded that hyperbilirubinemia is commonly seen among males. Newborn delivered had hyperbilirubinemia. Statistical significance was seen between TCB level and severity of the disease. Thus, neonatal TCB levels can be used as a screening test for detecting hyperbilirubinemia in neonates. As TCB is a noninvasive and cost effective it can be used widely as predictor of the disease.

Bilirubin Levels in Neonates ≥35 Weeks of Gestation Receiving Delayed Cord Clamping for an Extended Time—An Observational Study

To describe bilirubin levels in neonates ≥350/7 gestational weeks, receiving delayed cord clamping (CC), in relation to the updated Bhutani nomogram. This was a retrospective, observational study based on data from medical records and local data sheets. Singleton neonates, born vaginally at a gestational age ≥350/7, and with a registered time to CC and at least one registered bilirubin, were included. We excluded neonates with positive direct antiglobulin test or hemolytic disorders. Adjusted analyses were performed using ANOVA and linear or logistic regression. We analyzed 558 neonates, mean gestational age (SD) 39.9 (1.3) weeks. CC was performed at a median (IQR) time of 6 (5-8) minutes. The dataset contained 1330 bilirubin measurements. Median (IQR) age at bilirubin measurement was 37 (22-54) hours. Bilirubin percentiles in neonates with CC time ≥2minutes were similar, or lower, compared with the Bhutani nomogram between 12 and 72hours, but with greater 95th percentile at later hours of age. Phototherapy was initiated in 13 (2.3 %) of the neonates. We found no association between time to CC and hyperbilirubinemia (β=-0.05, P=.07). Need for phototherapy was marginally greater in neonates with shorter time to CC. Bilirubin levels were not correlated to time to CC. Our findings indicate that CC beyond 2minutes can be performed without additional monitoring for jaundice.

Correlation of Serum Zinc Level with Hyperbilirubinemia in NeonatesA Case-Control Study

Introduction: Neonatal jaundice is the common cause of hospitalisation in the first month of life. Factors that affect the severity of neonatal jaundice includes maternal, pre-natal, and neonatal factors as well as environmental factors. Zinc (Zn) is one of the factors that affect the severity of neonatal jaundice as it prevents the lipid depolarization of the cell membranes. Hypozincemia may alter the erythrocyte membrane resulting in deficient synthesis of enzymes which play a key role in bilirubin metabolism. Aim: To correlate the serum Zinc level with bilirubin level in neonates with hyperbilirubinemia and also to compare with healthy controls. Materials and Methods: This case-control study was done in Clinical Biochemistry Laboratory of Father Muller Medical College and Hospital, Mangalore, Karnataka, India, from April 2018 to June 2018. Total 60 subjects were included in the study, which was divided into two groups: Neonates with clinically diagnosed hyperbilirubinemia (Group I) and normal healthy neonates as controls (Group II). Serum levels of zinc, total bilirubin, conjugated and unconjugated bilirubin were compared among groups. Correlation among the biochemical parameters was analysed by Karl Pearson’s Correlation Analysis. Results: In present study, 30 subjects were males and 30 females with mean age of 4.90±1.06 days among Group I and 2.50±1.61 days among Group II. This study observed significantly decreased mean levels of serum Zinc (171.24±19.82 μg/dL) in Group I patients when compared to mean levels of serum Zinc (189.23±17.90 μg/ dL) in Group II controls. There was statistically significant positive correlation among serum levels of Zinc and total bilirubin in Group I patients (p&lt;0.05) when compared to Group II. Conclusion: There was statistically significant positive correlation was found among serum levels of Zinc and total bilirubin in cases when compared to healthy controls. Current results showed, zinc may have a protective effect in the incidence of neonatal jaundice.

Effect of Phototherapy on Transcutaneous vs Total Serum Bilirubin Level in Preterm Neonates- A Prospective Cohort Study

Introduction: Neonatal jaundice is one of the most common problems encountered in the first week after birth. Neonates who develop significant hyperbilirubinemia require phototherapy. Delay in the diagnosis and management of jaundice may lead to neonatal morbidity and mortality. Total Serum Bilirubin (TSB) estimation is considered the gold standard method. However, this invasive procedure causes pain, anxiety, and may lead to infection and iatrogenic anaemia, especially in preterm neonates. Transcutaneous Bilirubin (TcB) estimation, which measures bilirubin through the skin, has been proposed as an alternative screening method for hyperbilirubinemia in term and near-term neonates. Aim: To compare TcB to TSB in preterm neonates of 30-34 6/7 weeks gestational age before, during, and after phototherapy. Materials and Methods: This hospital-based prospective cohort study was conducted at SDMCMS&amp;H, Dharwad, Karnataka, India, between December 2019 and November 2020. A total of 100 preterm neonates between 30 to 34 6/7 weeks of gestation with clinically suspected jaundice were enrolled in the study. TSB was measured in the laboratory using the Diazo Method, while TcB was measured using the Drager jaundice meter JM 103. TcB and TSB were measured and compared in preterm neonates with clinically suspected jaundice before phototherapy, during phototherapy (8 to 12 hours after initiation), and after 12- 18 hours of discontinuation of phototherapy. The collected data was analysed statistically using the mean, standard deviation, dependent t-test, Karl Pearson’s correlation coefficient, and scatter plots. Results: This study enrolled 100 neonates diagnosed with neonatal jaundice, of which 57 were males and 43 were females, resulting in a male-to-female ratio of 1:1.3. Phototherapy was administered to neonates with TSB values, with 79% of the babies between 30-32 weeks and 21% between 32-34 weeks. In the present study, TcB and TSB were compared before, during, and after phototherapy, and the results were analysed, showing statistical significance. The mean TcB levels were 12.05, 9.66, and 7.23 before, during, and after phototherapy, respectively. The mean TSB levels were 11.28, 10.16, and 7.65 before, during, and after phototherapy, respectively. Based on Karl Pearson’s correlation coefficient, a positive correlation was found between TcB and TSB before (r=0.8319, p-value &lt;0.001), during (r=0.6069, p &lt;0.001), and after phototherapy (r=0.8154, p&lt;0.001). Conclusion: TcB values are comparable to TSB values and can be adopted as the standard method to measure bilirubin levels in preterm babies in a clinical setting.

Association of Antenatal Corticosteroid use with Hypoglycaemia and Hyperbilirubinemia in Preterm Neonates Admitted in a Tertiary Hospital of Kolkata: A Longitudinal Study

AbstractBackground: Timely use of antenatal corticosteroids in a mother of preterm labour decreases the rates ofperinatal death, respiratory distress syndrome, intra-ventricular hemorrhage, necrotizing enterocolitis inthe new borns. However it is reported to have a causative role in neonatal hypoglycemia and hyperbilirubinemia.So the present study attempts to determine the association between the use of antenatal corticosteroids withhypoglycaemiaand hyperbilirubinemia in newborns with less than 35 weeks of gestational age.Methods: A prospective observational study was conducted during a time period of 24 months from January 2020to December 2021 in a tertiary care hospital of Kolkata on 99 preterm neonates of less than 35 weeks of gestationalage. Antenatal history of corticosteroid use, neonatal glucose level and bilirubin level were measured amongothers. Data were analyzed using MS-EXCEL.Results: Majority of neonates’ mothers (71.7%) had received antenatal corticosteroids. Only 4.0% of the cases hadhypoglycaemia at birth. But there was no cases of hypoglycaemia at 12 hour and 24 hour after birth. In 58.6% ofthe cases bilirubin level was in the phototherapy range and double surface photo therapy was required. In 14.1%of the cases double volume exchange transfusion was required.Conclusion: Antenatal corticosteroid administration is not associated with neonatal hypoglycaemia but it issignificantly related to neonatal hyperbilirubinemia.

Handheld diffuse reflectance spectroscopy system for noninvasive quantification of neonatal bilirubin and hemoglobin concentrations: a pilot study.

The prevalence rate of neonatal jaundice can reach 80%, of which 5% may develop dangerous hemolytic jaundice. The blood test for obtaining bilirubin and hemoglobin concentration is the gold standard for diagnosing hemolytic jaundice; however, frequently drawing blood from jaundice neonates for the screening purpose is not practical. We have developed a handheld diffuse reflectance spectroscopy system to noninvasively determine the bilirubin and hemoglobin levels in neonates. Our study showed that the correlation coefficients were 0.95 and 0.80 for bilirubin and hemoglobin between the results from the blood tests and our handheld system, respectively. This handheld system could be an effective tool for screening hemolytic jaundice.

Relationship Of Gestational Age With Hyper Bilirubin Incidence In 3 Days Neonates At Dustira Cimahi Hospital

One of the most typical clinical manifestations of the infant is hyperbilirubinemia. Jaundice sends more than 85% of term newborns back to the hospital within the first week of life. 60% of term newborns and 80% of preterm (less term) infants have hyperbilirubinemia. If hyper bilirubin is not appropriately treated, it can damage brain cells, cause seizures, and progress to kernicterus, even causing death. Even if the newborn gets kernicterus and recovers and can be passed, the baby can grow but not develop optimally and can even cause long-term effects such as mental impairment. This type of research is analytical research. This study was an observational study that related two variables: namely, the relationship between gestational age and the incidence of hyperbilirubinemia in neonates aged three days. The type of approach in this research is cross-sectional. Sampling was done using a purposive sampling technique with as many as 286 samples. The median gestational age for neonates with hyperbilirubinemia at Dustira Cimahi Hospital in 2021 was 36 weeks, still considered preterm, with a minimum gestational age of 30 weeks and a maximum of 43 weeks. The median bilirubin level in neonates with hyperbilirubinemia at Dustira Cimahi Hospital in 2021 was 10 mg/dL which was still classified as physiological hyper bilirubin, with a minimum level of 5.52 mg/dL and a maximum level of 16.03 mg/dL. There was a significant relationship between gestational age and the incidence of hyperbilirubinemia in neonates aged 3 days at Dustira Cimahi Hospital in 2021 with moderate strength and negative correlation direction.

Frequency of Neonatal Hyperbilirubinemia in Maternal Hyperglycemia

Objective: To evaluate the occurrence of newborn hyperbilirubinemia among women who were diagnosed as maternal hyperglycemia. Subject and Method: The present cross-sectional study was conducted in the OBS and Gynecology department of PNS Shifa Karachi. The study was done over the time period of six months. All pregnant women who visit antenatal clinics at PNS Shifa Hospital with a gestational age of 24 and 32 weeks undergoing a 75 gm 2 h glucose tolerance test and fulfilling criteria of IFG, IGT, or GIGT were included. After delivery, a 2 ml blood sample was drawn from each newborn and sent to the hospital diagnostic laboratory to evaluate the neonatal bilirubin level and serum bilirubin &gt;300µmol/L after 96 hrs was considered as neonatal hyperbilirubinemia. All of the data was obtained using a study proforma. For the analysis of the data, SPSS software version 20 was utilized. Results: A total of 157 hyperglycemic mothers were studied; their average age was 28.20±4.67years and gestational ag was 37.11±3.22 weeks. Out of all, most of the women 100(63.7%) were multiparous. Caesarean section was done in 98(62.4%) cases. New born Neonatal hyperbilirubinemia was noted in 10.2% of the cases. The frequency of the neonatal hyperbilirubinemia was higher in the age groups of 19–30 years and &gt;30 years, while findings were non-significant statistically according to maternal age and gestational age (p = &gt;0.05). Conclusion: The study's findings showed that 10.2% of women with diabetes were found to have newborns with hyperbilirubinemia. It was proven to be statistically insignificant based on maternal age and gestational age. Keywords: Maternal, hyperglycemia, hyperbilirubinemia

Increased Total Serum Bilirubin Level Post-Ibuprofen Use Is Inversely Correlated with Neonates' Body Weight.

Backgrounds: Drugs with the ability to displace bilirubin from albumin-binding sites subsequently leading to an increased bilirubin level may cause hyperbilirubinemia in neonates. Ibuprofen is commonly used to treat patent ductus arteriosus (PDA) in neonates, yet the use of ibuprofen has drawn mixed conclusions. We performed a retrospective study to determine how ibuprofen use influences the total serum bilirubin (TSB) level in neonates of differing birth weight (BW). Materials and methods: Neonates (including premature infants) born at Chang Gung Memorial Hospital, Taiwan during January 2004 to July 2020 were entered into this study. We recorded the phototherapy duration, including the initial day and end day, and determined the average influence of one-day phototherapy on TSB level. The highest monitored TSB level post-ibuprofen use minus the one measured prior to ibuprofen use was considered the TSB change following ibuprofen administration in this study, and the above-mentioned influence of daily phototherapy on the TSB level was used to correlate the results. Neonates with any of the following conditions were excluded: those who received ceftriaxone, those with intraventricular hemorrhage, and those infected with TORCH. Results: The average daily influence of phototherapy on the TSB level of neonates was −0.20 (−0.57~0.05) mg/dL, −0.28 (−0.84~0.13) mg/dL, −0.75 (−1.77~0.10) mg/dL, and −1.60 (−2.70~−0.50) mg/dL in neonates with BWs of <1 kg, 1–1.49 kg, 1.5–2.49 kg, and ≥2.5 kg, respectively, indicating that neonates with a BW ≥ 1.5 kg experienced a greater reduction in TSB level following phototherapy as compared with those with a BW < 1.5 kg. The average TSB increase following ibuprofen use in neonates was 3.38 ± 2.77 mg/dL, 2.04 ± 2.53 mg/dL, and 1.34 ± 2.24 mg/dL in neonates with BWs of <1 kg, 1–1.49 kg, and ≥1.5 kg, respectively, i.e., an elevated TSB change with a decreased neonate BW was noted post-ibuprofen use (p = 0.026, one-way analysis of variance (ANOVA)). Conclusions: As ibuprofen use is correlated with an apparent increase in TSB level in neonates with a lower BW, especially in those with a BW < 1 kg, iv acetaminophen can be an appropriate alternative to ibuprofen for ELBW neonates for the treatment of PDA if they are experiencing severe unconjugated hyperbilirubinemia.

Differential effects of delayed cord clamping on bilirubin levels in normal and diabetic pregnancies

Delayed cord clamping increased the risk of jaundice in newborns born to diabetic mothers, but had no effect in newborns from mothers with normal pregnancies. DCC may be a risk factor for increased bilirubin in infants of diabetic mothers. ClinicalTrials.gov: NCT04369313; date of registration: April 27, 2020 (retrospectively registered). • Delayed cord clamping had significant benefits for newborns by increasing neonatal hemoglobin levels and reducing the risk of neonatal anemia, etc. • Delayed cord clamping may lead to neonatal hyperemia, erythrocytosis, and hyperbilirubinemia, which increases the risk of neonatal jaundice. • Our trial focused on the differential effects of delayed cord clamping on jaundice in full-term newborns between diabetic pregnancies and normal pregnancies. And newborns of diabetic mothers who received delayed cord clamping had a significantly increased risk of jaundice compared to newborns with normal pregnancy. • Delayed cord clamping may be a risk factor for increased bilirubin levels in neonates of diabetic mothers.

A study to assess the efficacy of phototherapy with low cost white curtains versus routine phototherapy among newborns admitted with neonatal jaundice in NICU of GGSMC &amp;amp; H, Faridkot, Punjab

Aim of the study: The study was intended to assess the efficacy of phototherapy with low cost white curtains versus routine phototherapy on reducing serum bilirubin level in newborns.Material and Methods: A quantitative research approach and experimental research design was used to conduct the present study. The total 70 patients (above 32 weeks of gestational age) were selected who were admitted in Neonatal Intensive Care Unit on the basis of Inclusion and exclusion criteria and randomly allocated into experimental and conventional group through computerized block design method. Socio-demography data sheet was used to collect baseline information and Lab investigation was used to collect the data. Results: The present study results revealed that pre intervention mean± SD of total serum bilirubin level in phototherapy with low cost white curtain (experimental group) was 15.457±1.145 and was 15.263±1.602 in routine photo therapy (conventional group) respectively. Post intervention mean± SD of total serum bilirubin level in photo therapy with low cost white curtain (experimental group) was 10.351±1.55 and was 11.389±1.39 in routine phototherapy (conventional group) respectively. Paired t test and individual t test was applied for statistical analysis. Results reveals that t value in experimental group was 14.759 at df 34 with p value 0.001 and 22.435 at DF 34 with p value 0.001 in experimental and conventional group which is found to be significant at p=0.005. It proved that there is significant difference in baseline mean of reduction in total serum bilirubin level in neonates who were on phototherapy with low cost white curtains.Conclusions: On the basis of the findings of the study, it was concluded that Phototherapy with low cost white curtains is more effective in reducing the total serum bilirubin level in neonates having jaundice than routine phototherapy.

Correlation between Alkaline Phosphatase and Neonatal Jaundice.

Background: Hyperbilirubinemia is one of the most common neonatal disorders and one of the risk factors of neurological complications. So this study was conducted to evaluate the correlation between alkaline phosphatase (ALP) and pathological jaundice. Methods: A case-control was performed on term neonates with and without pathological jaundice who were referred to the Hazrat-e-Ali Asghar Hospital in 2017. In both groups, cases (neonates with pathological jaundice, n=153) and control (neonates with and without pathological jaundice, n=153) levels of alkaline-phosphatase and serum total bilirubin were evaluated with biochemical tests. Moreover, other data were also recorded from their history and clinical examinations. In addition, the severity of jaundice, duration of hospitalization, type of required treatment, and probable complications after the treatment were considered in follow-up. Data were collected by checklist and entered to SPSS v.20. ALP level and its relationship with serum total bilirubin compared between two groups. Results: Mean level of ALP was 411.3 ± 134.2 U/L in the case group and 338 ± 131.4 U/L in the control group. Serum total bilirubin level was 11.9 mg/dl in the case group and 6.2 mg/dl in the control group. ALP levels in the case group were significantly more than the control group (p=0.001). There was no correlation between ALP and serum total bilirubin level in neonates in the case group (p=0.532). There was no statistically significant relationship between alkaline phosphatase level and gender of neonates, but the relationship of ALP level with types of delivery was statistically significant (p=0.002). There was not a significant relationship between ALP level with hospitalization duration (p=0.371). Conclusion: The result of this study showed that there is no correlation between ALP levels and pathological jaundice in patients, although this issue needs to be approved by the other studies.

The Effect of Field Massage on Bilirubin Levels in Neonates with Hyperbilirubinemia

Hyperbilirubinemia is one of the most common clinical phenomena. It is found in 80% of premature infants and 60% of term infants in the first week of life. Most hyperbilirubinemia does not require special therapy, but because of the potential toxic effects, all neonates should be monitored to detect the possibility of severe hyperbilirubinemia. Based on data from the Directorate of Family Health, in 2019, out of 29,322 under-5 deaths, 69% of deaths occurred in the neonatal period. One of the causes of mortality in neonates is bilirubin encephalopathy/kernicterus. Bilirubin encephalopathy is the most severe complication of neonatal jaundice. In addition to encephalopathy, other risks include sequelae in the form of cerebral palsy, high-pitched deafness, paralysis and dental dysplasia, which greatly affect the quality of life. Several studies have been conducted to find alternative supporting therapies that can be used to effectively reduce bilirubin levels in addition to providing phototherapy, one of which is the provision of field massages. Field massage is thought to increase the excretion of bilirubin in infants during phototherapy. The purpose of this literature review was to determine the effect of field massage on reducing bilirubin levels in neonates with hyperbilirubinemia. This was a traditional narrative literature review which grouped similar extracted data according to the results measured to answer the objectives. According to the results, giving field massages two times a day for three days for 15 minutes each time was able to significantly reduce bilirubin levels.&#x0D; Keywords: field massage, hyperbilirubinemia, neonates

Effects of vitamin E on neonatal hyperbilirubinemia in preterm newborns

Neonatal jaundice indicates the presence of pigment in the skin and sclera. Vitamin E is an important component of the cellular antioxidant defense system. Here in the present study, we aimed to evaluate and investigate these therapeutic effects. This is a randomized clinical trial performed on 100 premature neonates. Group 1 received 10 units of Vitamin E daily for 5 days. The other group received placebo. Amount of bilirubin was measured at the time of 0, 24, 48, 72, and 96 h after birth. Mean bilirubin in Vitamin E group was increasing until the 2nd day and then got a decreasing trend. In the control group, the increasing trend of bilirubin was going on till the 3rd day. Mean bilirubin increased significantly during the follow-up in both Vitamin E and control groups (χ2 [df] = 20.23 (1), P < 0.001). Although both groups showed an increasing trend in mean bilirubin, on the last day of follow-up, the average amount of increase was lower in Vitamin E group (5.06 ± 2.25 vs. 6.23 ± 3.98). Also in the 3rd and 4th days, mean bilirubin was lower in Vitamin E group. This study supports the usage of oral Vitamin E therapies on reducing the bilirubin levels in neonates. We also showed that this reduced trend occurs after day 3 of life, but in the follow-ups, neonates who were treated with Vitamin E had lower bilirubin levels compared to the placebo group.

Roles of Probiotics in Reduction of Neonatal Jaundice in Term Newborns.

the primary objective was to examine the effect of Bifidobacterium on decreasing the bilirubin level in term neonates delivered by Caesarean Section (CS). A total of 153 healthy term neonates delivered by CS were included in this study and were divided into the non-probiotic group (n=99) and probiotic group (n=54) based on the history of probiotics administration. There were no infants who underwent phototherapy. A total of 20 doses of probiotics were given orally from the first day of life. The transcutaneous bilirubin (TcB) levels were measured every day for the first 5 days of life. Data of each infant and mother were gathered from medical records. The bilirubin level per day (day-1 to day-5) in the non-probiotic group was no different from the probiotic group. Differences in bilirubin level between day-5 and day-1, and also between day-5 and day-2 were not different between the two groups. There was a significant (p = 0.03) body weight gain in the probiotic groups with a mean of 36.09 ± 8.23 gram/day. No obvious adverse reactions were seen in both the non-probiotic group and probiotic group. Our findings suggest no significant effects of probiotics on lowering bilirubin levels in the first five days of life. Also, probiotics have a positive effect on body weight gain in healthy term infants, and it is safe to be given to newborns.

Association between serum 25-hydroxy Vitamin D and bilirubin levels in term neonates with hyperbilirubinemia: A cross-sectional, observational study

Introduction: Neonatal jaundice is a common cause of hospital admission among neonates in the 1st week of life. The condition results from an imbalance between oxidative stress and antioxidant mechanisms. Considering the fact that the metabolism of both bilirubin and 25-hydroxy Vitamin D occurs in the liver and 25-hydroxy Vitamin D being a potent antioxidant, we hypothesized that there exists an association between 25-hydroxy Vitamin D and serum bilirubin levels. Methods: A total of 174 neonates were enrolled in the study and were further subclassified into 4 groups: Group A (no clinical jaundice), Group B (clinical jaundice with the value of serum bilirubin <10 mg/dl), Group C (clinical jaundice with the value of serum bilirubin >10 mg/dl but not in phototherapy range), and Group D (clinical jaundice with serum bilirubin value requiring initiation of phototherapy). 25-hydroxy Vitamin D and serum bilirubin levels along with parathyroid hormone, calcium, phosphorus, and alkaline phosphatase levels were estimated. Results: The mean 25-hydroxy Vitamin D levels were highest in Group A and lowest in Group D (21.92 ± 20.85 vs. 14.38 ± 8.52, P = 0.020) and vice versa for serum bilirubin levels (15.08 ± 0.93 vs. 4.28 ± 0.97, P < 0.001). There was a nonsignificant negative correlation between serum 25-hydroxy Vitamin D and bilirubin levels (correlation coefficient: −0.113 [−0.257–0.0364], P = 0.138). Conclusion: The present study suggests a lack of association between serum 25-hydroxy Vitamin D and bilirubin levels. However, the results need to be confirmed by further prospective studies to conclude that 25-hydroxy Vitamin D has no role in the pathogenesis of neonatal hyperbilirubinemia.

Role of Short Duration Double Phototherapy in The Treatment of Unconjugated Hyperbilirubinemia

Objective: To determine the role of short duration double phototherapy in the treatment of unconjugated hyperbilirubinemia. Materials and Methods: This prospective cases series study was conducted at pediatric department of CMH hospital at Malir Karachi. All the neonates diagnosed with unconjugated hyperbilirubinemia admitted to the neonatal ward were included. All the cases underwent short duration double phototherapy. Babies were observed for side-effects of phototherapy, like skin reaction and dehydration. Serum bilirubin was checked by bilirubinometre after 6 hourly of the treatment. Al the data was collected via study proforma. Data was analyzed by using SPSS version 20 Results: Total 74 neonates were studied, most of the neonates presented within 48-72 hours after birth. Majority of the term babies as 59.5% had history of 37-40 weeks of gestation and 28.4% had gestational age history &gt;40 weeks. Out of all, males’ babies were 58.1% and female babies were 41.9%. Neonatal bilirubin level was significantly decreased from bassline 18.35+0.97 after 6 hours of double phototherapy as 14.66+1.18 with mean difference of 3.68+1.37 (p-value 0.001). Conclusion: Short duration double phototherapy found to be the effective, reliable and safe for skin reaction in the treatment of unconjugated hyperbilirubinemia. Key words: Hyperbilirubinemia, double phototherapy, six hours Â

Maternal Exposure to Air Pollution Is Associated with Neonatal Jaundice: A Retrospective Cohort Study

To evaluate the association between maternal ambient pollutant exposure and neonatal jaundice in multiple pollutant species and examine sex differences. Epidemiologic study: Records of 13 297 newborns (6153 male, 7144 female) born in Taichung, Taiwan were obtained from a national database. Average concentrations of prenatal air pollutants 3months prior to birth were divided into low, middle, and high levels. Neonatal jaundice phototherapy rates between mothers who suffered varying air pollutant levels were compared. Clinical study: Three hundred seventy-six newborns (189 male, 187 female) born and received jaundice treatment with phototherapy in a hospital in Taichung, Taiwan were recruited. The correlation between prenatal exposure to air pollutants 3months prior to birth, newborn's serum bilirubin, and serum hemoglobin were calculated. Epidemiologic study: Male newborns born to mothers exposed to high carbon monoxide (CO), nitric oxide (NO), nitrogen dioxide (NO2), and methane (CH4) levels had higher phototherapy rates. In female newborns, the same was noted for CO and CH4. Clinical study: Male newborns had a positive correlation between CO, ≤2.5μm diameter particles, ≤10μm diameter particles, NO, NO2, nonmethane hydrocarbon, and CH4 exposure 3months prior to birth and serum bilirubin levels. Female newborns had a positive correlation for CH4. A positive correlation between CO, ≤2.5μm diameter particles, ≤10μm diameter particles, NO2, nonmethane hydrocarbon, CH4 exposure, and serum hemoglobin levels was noted in male newborns. Maternal exposure to air pollutants may increase neonatal jaundice treatment rates for phototherapy and higher neonatal serum total bilirubin level. Higher hemoglobin levels because of higher pollutant exposures may explain our findings. The association was more obvious in male newborns.

Causes of Neonatal Jaundice Requiring Exchange Transfusion

Background: Neonatal jaundice is highly prevalent in Asia and has serious complications, such as kernicterus. Therefore, it is very important to identify the risk factors of jaundice requiring exchange transfusion since it can be helpful in the prevention of the disease and early diagnosis of its complications. Objectives: The present study aimed to identify the causes of neonatal jaundice requiring blood exchange. Methods: The present cross-sectional study was performed on 251 term and preterm neonates. The studied newborns were 2-14 days old (born at ≥ 35 weeks of gestation) with jaundice and bilirubin of more than 17 mg/dL and received exchange transfusion during 2011 - 2020 in Ghaem teaching hospital, Mashhad, Iran. The required data of the study variables, such as hyperbilirubinemia risk factors, laboratory tests, the documented history of the mothers and neonates, and physical examination results, were collected through a questionnaire and the medical records of the patients. Finally, the collected data were analyzed in SPSS software (version 20). Results: Based on the results, the mean value of the total serum bilirubin level in neonates who received exchange transfusion was 27.53 ± 10.05 mg/dL. The blood types of about 40% of mothers and their neonates were O and A/B, respectively. Moreover, 11.4% of mothers were Rh-negative; however, their neonates were Rh-positive. The results also revealed that the causes of exchange transfusion were unknown, ABO incompatibility, Rh incompatibility, glucose-6-phosphate dehydrogenase deficiency (G6PDD), and sepsis in 52.7 %, 24%, 7.1%, 5.3%, and 5.3% of the neonates, respectively. Conclusions: The findings of this study suggest that after unknown causes, the most common causes of exchange transfusion were ABO incompatibility, Rh incompatibility, G6PDD, and sepsis. Therefore, since most of these causes can be recognized, it is recommended to perform related tests and take related measures in the Midwifery Department of the hospital to prevent the occurrence and exacerbation of jaundice. Moreover, it is recommended to perform an early follow-up after the discharge.