Decrease In Bilirubin Levels Research Articles

The Effect of Abdominal Massage on Bilirubin Levels in Term Infants Receiving Phototherapy: A Randomized Controlled Trial.

The incidence of neonatal hyperbilirubinemia in Europe and the United States is estimated to be 3.2 and 4.4 per 10,000 live births, respectively. Abdominal massage for hyperbilirubinemia is considered a safe complementary treatment for infants that may increase number of defecations and decrease bilirubin levels. This study was designed as a randomized controlled trial to determine the effect of abdominal massage on bilirubin levels in term infants receiving phototherapy. The sample consisted of 43 term newborns (intervention group: 23; control group: 20) who received phototherapy in a university hospital between June 2019 and February 2021. Information and observation forms were used for data collection. The intervention group received 6 abdominal massages over 2 days, performed 3 times a day, 6 hours apart, and lasting 5 minutes each. Transcutaneous bilirubin levels and heart rate were significantly lower in the intervention group than in the control group at 48 hours (P = .015 and P = .033, respectively). Number of defecations was higher in the intervention group at 24 hours (P = .007) but there was no significant difference at 48 hours. The decrease in serum bilirubin between 24 and 48 hours was significantly greater in the intervention group (P = .005). Abdominal massage was effective in reducing bilirubin levels and may increase the number of defecations. Providing massage training to the parents of infants who are discharged early could be a protective approach to prevent the rise in bilirubin levels.

The Effect of Tunnel versus Conventional Phototherapy on the T Lymphocytes in Full Term Neonates with Hyperbilirubinemia

Background Neonatal jaundice is one of the most common conditions. Phototherapy has been accepted as the standard treatment for neonatal jaundice and the decline in the number of exchange transfusions in recent years is, at least in part, likely a direct reflection of the effectiveness of phototherapy at treating hyperbilirubinemia. However, this treatment modality also has some complications. One possible harmful consequence is potential immunotoxic effects by affection of lymphocytes subtypes which can affect the immune system functions in infants. Aim of the Work current study was performed to compare the effect of both conventional and tunnel phototherapy on lymphocytes subsets in term neonates (≥37weeks) with unconjugated hyperbilirubinemia. Patients and Methods The present study was conducted on 60 term neonates (≥37weeks) 40 of them with unconjugated hyperbilirubinemia admitted to NICUs in Ain-Shams University hospital during the period from January 2019 to July 2019. They were randomly assigned to 3 groups: 20 patients were exposed to conventional phototherapy and 20 patients were exposed to tunnel phototherapy and the other 20 healthy full term were assigned as control group. Total serum bilirubin (TSB), direct serum bilirubin (DSB), CBC, CD4 and CD8 percentages and absolute count were measured before and 48 h after phototherapy in the phototherapy groups. Baseline lab was done in the control group at once. Results significant decrease in total and direct bilirubin post-phototherapy in both phototherapy groups proved that tunnel phototherapy is as effective as conventional phototherapy as both provided rapid decrease in bilirubin levels. As regards the effect of phototherapy on lymphocytic count, we found that lymphocytic count significantly decreased post-phototherapy in both phototherapy groups. As regards the effect of phototherapy on CD4+ and CD8+ percentages, we found that CD4+ % significantly decreased postphototherapy in conventional phototherapy group. Moreover, when we measured CD4+ and CD8+ absolute counts, we found that CD4+ and CD8+ absolute counts significantly decreased post-phototherapy in both phototherapy groups. In the view of the effect of phototherapy on CD4/CD8 ratio, we found that the ratio significantly increased in tunnel phototherapy group. Conclusion Conventional and tunnel phototherapy which are used in the treatment of neonatal hyperbilirubinemia, affects the function of the immune system in newborns via alterations in CD4+ and CD8+ absolute counts.

Gene Therapy in Patients with the Crigler–Najjar Syndrome

BackgroundPatients with the Crigler–Najjar syndrome lack the enzyme uridine diphosphoglucuronate glucuronosyltransferase 1A1 (UGT1A1), the absence of which leads to severe unconjugated hyperbilirubinemia that can cause irreversible neurologic injury and death. Prolonged, daily phototherapy partially controls the jaundice, but the only definitive cure is liver transplantation.MethodsWe report the results of the dose-escalation portion of a phase 1–2 study evaluating the safety and efficacy of a single intravenous infusion of an adeno-associated virus serotype 8 vector encoding UGT1A1 in patients with the Crigler–Najjar syndrome that was being treated with phototherapy. Five patients received a single infusion of the gene construct (GNT0003): two received 2×1012 vector genomes (vg) per kilogram of body weight, and three received 5×1012 vg per kilogram. The primary end points were measures of safety and efficacy; efficacy was defined as a serum bilirubin level of 300 μmol per liter or lower measured at 17 weeks, 1 week after discontinuation of phototherapy.ResultsNo serious adverse events were reported. The most common adverse events were headache and alterations in liver-enzyme levels. Alanine aminotransferase increased to levels above the upper limit of the normal range in four patients, a finding potentially related to an immune response against the infused vector; these patients were treated with a course of glucocorticoids. By week 16, serum bilirubin levels in patients who received the lower dose of GNT0003 exceeded 300 μmol per liter. The patients who received the higher dose had bilirubin levels below 300 μmol per liter in the absence of phototherapy at the end of follow-up (mean [±SD] baseline bilirubin level, 351±56 μmol per liter; mean level at the final follow-up visit [week 78 in two patients and week 80 in the other], 149±33 μmol per liter).ConclusionsNo serious adverse events were reported in patients treated with the gene-therapy vector GNT0003 in this small study. Patients who received the higher dose had a decrease in bilirubin levels and were not receiving phototherapy at least 78 weeks after vector administration. (Funded by Genethon and others; ClinicalTrials.gov number, NCT03466463.)

Phototherapy Effects on Zinc Level of Neonates With Hyperbilirubinemia: A Systematic Review and Meta-analysis

Background: Phototherapy is the most common treatment of neonatal jaundice that affects the zinc level as well as the bilirubin level. Objectives: The purpose of this study is to investigate the effect of phototherapy on the zinc level of infants with jaundice by a systematic review and meta-analysis. Methods: In this systematic review and meta-analysis a comprehensive literature search of the databases, including Cochrane Library, Web of Science, PubMed, Scopus, and Google Scholar web browser was conducted using standard keywords. Data analysis of this meta-analysis was performed using STATA software, version 14 and P<0.05 was considered a significant level for tests. Results: In the five studies reviewed in this article with a sample size of 398 individuals, phototherapy increased the level of zinc [Standardized mean difference (SMD): 0.88 (95% CI: 0.38, 1.38), P<0.001] and decreased bilirubin level [SMD: -7.67 (95% CI: -9.11, -6.23), P<0.001] in infants with jaundice. The effect of phototherapy was on the zinc level of these groups: infants with a birth weight of 3000 to 3300 grams (gr) [SMD: 1.07 (95% CI: 0.42, 1.71), P<0.001] and 3301 to 3600 gr [SMD: 0.40 (95% CI: -0.32, 1.12), P=0.028], three-day-old infants [SMD: 1.05 (95% CI: 0.35, 1.74), P<0.001], four-day-old [SMD: 0.76 (95% CI: 0.26, 1.32)], and 5-day-old ones [SMD: 0.23 (95% CI: -0.01, 0.48)]. In addition, phototherapy affected on zinc level of those whose gestational age (GA) was 37 [SMD: 1.12 (95% CI: 0.06, 2.17), P<0.001] and 38 [SMD: 0.61 (95% CI: 0.15, 1.06), P=0.001] weeks. Conclusions: Phototherapy by reducing the level of bilirubin increases the level of zinc in infants with jaundice. So, the standardized mean difference of “phototherapy effects on the zinc level of infants with jaundice” decreases with increasing infants’ weight, increasing infants’ age, and increasing gestational age.

The Effect of Clofibrate and Phototherapy on Prolonged Jaundice due to Breast Milk in Full-Term Neonates.

Jaundice is one of the most common problems during infancy. It is believed that breast milk jaundice is one of the reasons for the persistence of jaundice after 14 days of prolonged jaundice. This study evaluates the effect of Clofibrate and phototherapy on prolonged jaundice originating from breast milk in term and healthy neonates. This double-blind clinical trial study was performed on 100 randomly divided neonates in the neonatal ward of Besat Hospital. In addition to phototherapy, the case group received a single dose of edible Clofibrate (50 mg/kg) dissolved in 2 CCs of distilled water. The control group received the same amount of distilled water as the phototherapy group. After treatment, bilirubin change rate, duration of hospitalization, and any association with gender, gestational age, hemoglobin, blood type, and Rh of neonates were determined and compared throughout the 2 groups. Data analysis showed that the bilirubin reduction rate was statistically significantly higher in the case group than in the control group (P < .05). The mean duration of hospitalization and phototherapy in the case group was significantly lower than in the control group (P = .005). The bilirubin reduction rate was not affected significantly by gestational age, blood type, or Rh. This study's results demonstrated that Clofibrate effectively decreased bilirubin levels and shortened the duration of phototherapy and hospitalization in infants with probable breast milk jaundice. IRCT2012092910933N1.

The effect of massage on the bilirubin level in term infants receiving phototherapy

BackgroundMassage has positive physiological effects on infants. Infant massage increases the excretion of waste products such as bilirubin from the body by accelerating the flow of the blood, lymph, and tissue fluids. PurposeThe aim of the study is to investigate the effect of infant massage on hyperbilirubinemia in newborns receiving phototherapy. MethodsThe study population consisted of infants admitted to the neonatal intensive care unit of a public hospital in Istanbul between October 2021 and January 2022 with a need for phototherapy. Sixty-one newborns who met the study criteria were randomized and divided into two as the experimental (n=30) and control (n=31) groups. All infants were followed up for 3 days, and phototherapy was applied twice a day. In addition to phototherapy, infant massage was applied to the experimental group for 10 min just before the phototherapy. The bilirubin level was measured 2 h after the end of phototherapy for both groups. Moreover, diapers were changed 8 times a day, every 3 h, in both groups. ResultsThe groups were homogeneous in terms of descriptive data, and no significant difference was observed between the groups (p>0.05). When bilirubin levels were compared, there was a significant decrease in bilirubin levels in the experimental group starting from the third day (p =.000). The frequency of defecation on the second and third days increased significantly in the experimental group (p =.000). ConclusionInfant massage can increase the frequency of defecation and help decrease bilirubin levels in newborns diagnosed with hyperbilirubinemia.

Genetic polymorphism of ADAM17 and decreased bilirubin levels are associated with allergic march in the Korean population

BackgroundThe “allergic march” refers to changes in the frequency and intensity of allergic diseases with age. Classically, the allergic march begins with atopic dermatitis in infancy and leads to asthma and rhinitis as it continues. There are many factors that induce the allergic march; however, TNF-α may play an important role in inducing inflammation. Therefore, the therapeutic potential of TNF alpha-targeting agents is being considered for allergic march treatment.MethodsWe performed a correlation study to determine whether genetic polymorphisms of ADAM17 and clinical serum values between allergic and normal groups affect disease development by using the cohort data of the Korean genome epidemiologic research project. Gene association study was performed using PLINK version 1.07 (http://pngu.mgh.harvard.edu/–purcell/plink) and other statistical analysis was performed using PASW Statistics (version 18.0, SPSS Inc. Chicago, IL, USA).ResultsADAM17 (also called TNF-α converting enzyme or TACE) showed a statistically significant association with the allergic march. The 13 and 8 SNPs in ADAM17 were significantly associated with asthma and allergies, respectively. Among them, on average, SNP of rs6432011 showed the greatest statistical correlation with asthma (P = 0.00041, OR = 1.95, 95% CI 1.35–2.82) and allergies (P = 0.02918, OR = 1.35, 95% CI 1.03–1.78). The effect of SNPs in ADAM17 on transcription factor binding was confirmed using RegulomeDB. The six SNPs are located in the genomic expression quantitative trait loci (eQTL) region and can affect transcription factor binding and gene expression. In clinical serum analysis, bilirubin levels were significantly decreased in the allergic group. The multivariate logistic regression analysis revealed that the low-bilirubin groups indicated a 3.22-fold increase in the prevalence of asthma compared with the high-bilirubin group.ConclusionsThe ADAM17 gene and low bilirubin levels are associated with the allergic march in the Korean population, which can provide new guidelines for managing this disease progression phenomena.

Comparing the efficacy and complications of Endoscopic Biliary Drainage (EBD) and Percutaneous Transhepatic Biliary Drainage (PTBD) in patients with perihilar cholangiocarcinoma.

Hilar cholangiocarcinoma (HCCA) is a rare malignancy in patients with biliary disease. If jaundice and obstruction before surgery are left untreated, then they can cause side effects such as cholangitis, delayed tumor treatment, decreased quality of life, and increased mortality. Surgery is the main treatment for HCCA. Therefore, this study was performed to compare the efficacy and complications of percutaneous transhepatic biliary drainage (PTBD) and endoscopic biliary drainage (EBD). This cohort study was conducted on 20 patients with biliary obstruction who had been selected by simple random sampling and divided into two groups of EBD and PTBD. Three weeks after surgery, patients were compared in terms of bilirubin levels and postoperative complications. Data were analyzed by descriptive statistics (table, mean, and standard deviation) and inferential statistics (independent t-test, Chi-square test, and Fisher's test). Independent t-test did not show a significant difference between the two groups in terms of bilirubin level (P = 0.77). However, despite a decrease in bilirubin level in both groups, independent t-test showed that this difference was not significant (P = 0.08). Fisher's exact test showed a significant difference between the two groups in terms of postoperative complications (P = 0.02). Using both drainage methods before surgery reduced bilirubin levels in patients, but EBD method had fewer side effects than PTBD method. The EBD method was performed under the direct supervision of a gastroenterologist. In performing this procedure, specialist physicians should have more supervision.

Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure

BackgroundPrevalence of multiple organ failure (MOF) in critically ill patients is increasing and associated mortality remains high. Extracorporeal organ support is a cornerstone in the management of MOF. We report data of an advanced hemodialysis system based on albumin dialysis (ADVOS multi device) that can regulate acid–base balance in addition to the established properties of renal replacement therapy and albumin dialysis systems in critically ill patients with MOF.Methods34 critically ill patients with MOF received 102 ADVOS treatment sessions in the Department of Intensive Care Medicine of the University Medical Center Hamburg-Eppendorf. Markers of metabolic detoxification and acid–base regulation were collected and blood gas analyses were performed. A subgroup analyses were performed in patients with severe acidemia (pH < 7.2).ResultsMedian number of treatment sessions was 2 (range 1–9) per patient. Median duration of treatment was 17.5 (IQR 11–23) hours per session. Treatment with the ADVOS multi-albumin dialysis device caused a significant decrease in bilirubin levels, serum creatinine, BUN and ammonia levels. The relative elimination rate of bilirubin was concentration dependent. Furthermore, a significant improvement in blood pH, HCO3− and PaCO2, was achieved during ADVOS treatment including six patients that suffered from severe metabolic acidosis refractory to continuous renal replacement therapy. Delta pH, HCO3− and PaCO2 were significantly affected by the ADVOS blood flow rate and pH settings. This improvement in the clinical course during ADVOS treatments allowed a reduction in norepinephrine during ADVOS therapy. Treatments were well tolerated. Mortality rates were 50% and 62% for 28 and 90 days, respectively.ConclusionsIn this case series in patients with MOF, ADVOS was able to eliminate water-soluble and albumin-bound substances. Furthermore, the device corrected severe metabolic and respiratory acid–base disequilibrium. No major adverse events associated with the ADVOS treatments were observed.

Effects of Body Massage on Response to Phototherapy in Neonatal Hyperbilirubinemia: A Randomized Clinical Trial

Background: Massage therapy has been commonly practiced as a traditional complementary therapy in neonates. This study was designed to evaluate the effects of massage on decreasing bilirubin levels in infants undergoing phototherapy. Materials and Methods A total of 60 term icteric infants without known risk factors who were admitted to the neonatal intensive care unit of Ghaem Hospital, Mashhad, Iran from 2016 to 2018 were involved in this preliminary clinical trial. The infant participants were randomly divided into the massage + phototherapy (intervention group, n=30) who received massage therapy (with field technique) thrice daily (every 8 hours) for 30 minutes each, and phototherapy alone (control group, n=30) who received phototherapy and routine care. Serum bilirubin samples were obtained at different time points in both groups. Results: The mean feeding time in the intervention and control groups were 22.5 and 21.4 min, respectively. The mean birth weights in the intervention and control groups were 3052 and 3187 gr, respectively. No significant differences were found between the two groups in age, sex, Apgar score, maternal profile, and previous history of jaundice (P>0.05). Rates of bilirubin loss were 0.81±0.19 mg/dl/h and 0.59±0.18 mg/dl/h in the intervention and control groups, respectively (P=0.043), in the first 8 hours of admission which dropped to 0.46±0.16 and 0.37±0.22, respectively (P=0.958), in the first 30 hours of admission. Conclusion Based on the results, massage is suggested as a complementary method for phototherapy, especially in the first eight hours of treatment during toxic high bilirubin levels and at the peak risk of kernicterus.

Co-administration of erythropoietin and iron complex improves late-phase liver regeneration

Erythropoietin and iron have individually shown beneficial effects on early-phase liver regeneration following partial hepatectomy (PHx); however, there are limited data on the combined effect on late-phase liver regeneration after PHx. Here we examined combined effects of recombinant human erythropoietin (rhEPO, 3,000 IU/kg) and iron isomaltoside (IIM, 40 mg/kg) on late-phase liver regeneration following PHx and investigated the possible underlying mechanism. Rats administrated with rhEPO showed significantly higher liver mass restoration, interleukin-6 (IL-6, a hepatocyte mitogen) levels, and Ki-67-positive hepatocytes on day 7 after PHx than saline-treated controls. These beneficial effects were further enhanced on days 7 and 14 by co-treatment with IIM. This combination also significantly improved liver function indices, such as increased albumin production and decreased bilirubin levels, but did not alter serum levels of toxic parameters, such as aspartate transaminase and alanine transaminase. This study demonstrates that the combination of rhEPO and IIM synergistically improves late-phase liver regeneration and function after PHx, probably by promoting IL-6-mediated hepatocyte proliferation without adverse effects. Thus, this combination treatment can be a potential therapeutic strategy for patients undergoing resection for hepatic malignancies.

Effectiveness and safety of two phototherapy devices for the humanised management of neonatal jaundice

IntroductionNeonatal jaundice is common, especially in premature infants. Compliance treatment protocols with standard serum bilirubin curves force the clinician to separate the child from the mother after birth for phototherapy. The objective of this study is to evaluate the effectiveness and safety of two innovative devices for phototherapy including a LED light mesh: one sleeping bag and one blanket compared to conventional hospital or ambulatory phototherapy. MethodsTwo randomised clinical trials were conducted: one with newborns >2000 g at birth in the Neonatal Care Unit and the other with premature infants followed-up in an outpatient Kangaroo Mother Care (KMC) programme. The gold standard for bilirubin measurement was serum bilirubin, and ambulatory controls were performed with the Bilicheck®. Parents and health personnel completed a questionnaire on comfort and perceptions. ResultsIn the study using the bag, a linear regression was performed for the decrease in bilirubin in mg/dL/h, controlling by early jaundice (<36 h) and the device type. The results were similar between the two devices. For the blanket trial in the KMC programme, the decrease in bilirubin levels with the new device was significantly greater. No differences in temperatures, duration of phototherapy, re-admission, mortality, or side effects for both trials were found. Parents and staff satisfaction with the two devices was identical for the two trials. ConclusionThese two small studies add a "grain of sand" to humanisation of newborn care, avoiding the mother-and-child separation for both the intra-hospital high-risk hyperbilirubinaemia, as well as for the lower-risk hyperbilirubinaemia in an outpatient clinic.

Left versus right-sided percutaneous transhepatic biliary drainage in relief of malignant obstruction

Background: Biliary tree obstruction and consequent jaundice occur in 70%–90% of these patients and have important consequences mainly for the patient's quality of life, morbidity, and overall mortality. Percutaneous transhepatic biliary drainage (PTBD) is an excellent palliative procedure to drain the bile ducts in malignant obstruction. We compared left- and right-sided approach in relief of malignant obstruction. The most common causes of malignant biliary obstruction (MBO) include pancreatic adenocarcinoma, hilar cholangiocarcinoma, ampullary/duodenal adenocarcinoma, gallbladder adenocarcinoma, lymphoma, and compressive metastatic peri-portal lymph node Materials and Methods: This study was a prospective, hospital-based study performed for 2 years from 2016 to 2018. PTBD was performed either through right in 16 patients or left approach in 15 patients. Two approaches were compared in terms of clinical and technological success, changes in laboratory data, internalization and survival. Results: (1) Rate of technological success was 100%. (2) There was a significant reduction in bilirubin, alanine transaminase (ALT), and alkaline phosphatase (ALP) levels after the procedure in both the approaches, but the decrease was more in the right-sided approach. Only the decrease in bilirubin levels was statistically significant. The decrease in albumin was attributed to the progression of the disease. (3) Clinical success was seen in 93.33% and 93.75% in left- and right-sided approach. (4) Internalization was done in 86.67% patients in the left-lobe approach, while as in right-lobe approach, it was done in 93.75% patients. Conclusion: PTBD causes a significant reduction in the bilirubin level, irrespective of the amount of liver drained or the type of drainage (external/internal). In our study, the reduction in bilirubin, ALT and ALP was more in the right-lobe approach. However, only reductions in levels of bilirubin were statistically significant.

ПОВЫШЕНИЕ АДАПТИВНЫХ ВОЗМОЖНОСТЕЙ ОРГАНИЗМА МОЛОДНЯКА КРУПНОГО РОГАТОГО СКОТА С ПРИМЕНЕНИЕМ КОМПЛЕКСА БИОЛОГИЧЕСКИ АКТИВНЫХ ВЕЩЕСТВ

A multifunctional feed additive has been developed in the form of an additional nutrition complex, which contains a probiotic of cellulose-amyl-proteolytic action, shungite mineral, which has adsorbing and antioxidant properties, a “protected” choline of lipotropic-hepatoprotective action, and flaxseed cake in known proportions. The studies were carried out under the conditions of the Federal State Unitary Enterprise “Klenovo-Chegodaevo” on two groups of calves of early postnatal ontogenesis of black-motley holsteinized breed (n = 8). Animals of the experimental group from a month of age received CAF of 40 g / 100 g of live weight. To study metabolic processes in the body (n = 8), at the end of a three-month experiment, blood samples were taken from the jugular vein and biochemical and hematological parameters were determined. The positive effect of the additive on the course of nitrogen metabolism was revealed, with an increase in the concentration of total protein in the blood serum by 5,3% (P<0,05), as well as albumin by 7,3% (P<0,05), with an increase in A / G coefficient, against the background of a decrease in urea concentration by 7,0% (P <0,001). The use of CAF contributed to an increase in the energy supply of the animal organism, as evidenced by an increase in creatinine by 8,2% (P<0,05), glucose concentration by 19.8% (P <0.05), and a higher level of alkaline phosphatase (by 20,5%) (P<0,05). Evidence of an improvement in carbohydrate-fat metabolism is an increase in phospholipids by 45,2% (P<0,001), HDL by 14,0% (P<0,01), with a decrease in bilirubin levels by 23,8%. A higher level of metabolic processes in the body with an improvement in the functional activity of the liver may be indicated by an increase in the activity of creatine kinase by 28,8% (P<0,01), lactate dehydrogenase (LDH) by 10,0% (P<0,05), and cholinesterase by 15,1%, gammaglutamyltranspeptidase (GGT) by 3,9%. The use of CDPs contributed to an increase in hemoglobin in the blood by 9.8% (P<0,05), red blood cells by 7,0%, hematocrit by 10.0%, with a decrease in the level of leukocytes by 13,1%. The absolute increase in live weight of calves over 90 days of experiment was 66,88 ± 2,66 kg in the control group, 77,87 ± 3,04 kg in the experimental group, and average daily gain in live weight was 743,11 ± 29,56, and 865, respectively , 22 ± 33,78 grams (P<0,05), with a difference of 16,4%, with a more pronounced effect of the CAF during the period of a complete transition to nutrition with vegetable feed.

Hepatoprotective activity of Etlingera elatior (Jack) R.M. Smith extract against ccl4 -induced hepatic toxicity in male wistar rats

The objective of this study is to investigate the phytochemical constituents of Wualae fruit extract and its cell-protecting activity towards CCl4-induced hepatotoxicity. Phytochemical screening performed in this study was alkaloid, flavonoid, saponin, tannin, and terpenoid. Extract was also characterized to specify the quality. The cell-protecting of extract was performed to Wistar male rats to measure their total bilirubin, direct bilirubin, indirect bilirubin, SGOT, SGPT, and ALP levels post-treated with Wualae fruit extract at dose 200, 300, and 400 mg/kgBw for 7 d, and induced with CCl4 the next day. Histopathology of intestine and liver organ was also performed. Our study found that extract contains alkaloids, flavonoids, tannins, and terpenoids. We found extract decreases levels of total bilirubin, direct bilirubin, indirect bilirubin, SGOT, SGPT, and ALP at dose of 200, 300, and 400mg/kgBw (p<0.05), although histopathological results demonstrated that dose of 400mg/kgBw showed some necrosis at villi and steatosis at liver. In conclusion, Wualae fruit extract has protective effect toward CCl4- induced hepatotoxicity at dose 200 and 300mg/kgBw and able to decreases bilirubin, SGOT, SGPT, and ALP levels. Flavonoid contains in extract is suspected plays role in its cell-protecting effect.

Crigler najjar syndrome: A systematic outline

Crigler-Najjar Syndrome (CNS) is a rare genetic condition characterized by non-hemolytic unconjugated hyperbilirubinemia. It is caused by mutations in the UGT1A1 gene which codes for the enzyme uridine diphosphate glucoronosyl transferase-1, required for the conjugation and further elimination of bilirubin from the body. Affected individuals are usually asymptomatic apart from the jaundice and investigations reveal isolated indirect hyperbilirubinemia. It can be conveniently diagnosed by evaluating the response to phenobarbital in terms of decrease in bilirubin levels. Genetic testing of the UGT1A1 gene for mutations is the investigative clincher. The hallmark outcome of Crigler-Najjar syndrome is a determined yellowing of the skin, mucous membranes and the sclera of eye. There are two patterns of this disorder: Crigler-Najjar syndrome type I, characterized by a nearly complete lack of enzyme activity and severe symptoms; and Crigler-Najjar syndrome type II, characterized by inadequate enzyme activity and milder symptoms. Both forms are inherited as autosomal recessive characters and are caused by faults or mutations of the UGT1A1 gene. Treatment is engaged toward dropping the level of unconjugated bilirubin in the blood. Early treatment is vibrant in Crigler-Najjar syndrome type I to prevent the development of encephalopathy during the first few months of life. Because Crigler-Najjar syndrome type II is milder and responds to phenobarbital, treatment is different. The purpose of the current review article is to emphasize on causes, types, clinical symptoms, autosomal pattern, complications, management and future direction for treatment of Crigler-Najjar syndrome. Keywords: Hyperbilirubinemia, Phenobarbitone, UGT1A1 gene, Bilirubin, Jaundice, Mutations

The characteristic of neonatal hyperbilirubinemia before and after phototherapy at Sanglah Hospital, Denpasar, Bali in 2017

Background: Hyperbilirubinemia is the most clinical problem in newborn babies. Hyperbilirubinemia occurs 60% in aterm babies and 80% in premature babies. This study aims to know the incidence of hyperbilirubinemia, characteristics of hyperbilirubinemia and effect of phototherapies to bilirubin levels.Methods: A cross-sectional retrospective study was conducted using medical records among 94 neonates with hyperbilirubinemia who treated with phototherapies at Sanglah hospital during 2017. Data regarding gender, gestational weeks, type of delivery, size for gestational age, the onset of hyperbilirubinemia, etiology, birth weight, maternal gravid status, and bilirubin levels were collected and analyzed using SPSS version 20 software descriptively.Results: From 94 neonatal hyperbilirubinemia that meet the inclusion criteria, 51 (54.3%)  males and 43 (45.7%) females based on gender. Mean gestational ages were 36.35±2.921 weeks. The major etiology of neonatal hyperbilirubinemia were breastfeeding jaundice 33 (25.8%), Prematurity 23 (18.7%), ABO incompatibility 13 (10.6%), Breast milk jaundice 11 (8.9%), gastrointestinal malformation 6 (4.9%), G6PD deficiency 5 (4.1%), and sepsis 3 (2.4%). The mean total bilirubin prior to phototherapy was 15.6±4.11 mg/dL whereas the indirect bilirubin was 14.56± 3.55 mg/dL. The duration of phototherapy in this study was 2.8±0.65 days.Conclusions: The incidence of neonatal hyperbilirubinemia during 2017 at Sanglah Hospital were predominantly caused by breastfeeding jaundice, prematurity, and ABO incompatibility. There were decreased bilirubin levels following phototherapies.

Efficacy and Safety of Steroid Therapy for Posttransplant Hyperbilirubinemia Caused by Early Allograft Dysfunction: A Randomized Controlled Trial.

BackgroundHyperbilirubinemia is a common event that occurs after liver transplantation. Hyperbilirubinemia is usually caused by early allograft dysfunction. Glucocorticoid is widely used for immunosuppression, but few studies have analyzed the effects of steroid therapy on posttransplantation hyperbilirubinemia. The aim of this study was to assess whether glucocorticoid was beneficial in treating hyperbilirubinemia caused by early allograft dysfunction.Material/MethodsPatients with postoperative hyperbilirubinemia (those with conditions such as biliary complications and rejections were excluded) were randomly assigned, in a 2: 1 ratio, to the steroid and control groups. Patients in the steroid group were treated with glucocorticoid combined with ursodeoxycholic acid, whereas patients in the control group were only treated with ursodeoxycholic acid. The primary endpoint was decrease in bilirubin and the secondary endpoint was safety.ResultsFrom 1st June 2016 to 30th April 2018, 40 patients were enrolled into the steroid group, and 20 were enrolled into the control group. Donor, recipient, and operative data were similar between the 2 groups. The decrease in bilirubin levels in the steroid group was significantly greater than that in the control group on the first day after the intervention was finished (9.25±1.30 mg/dL vs. 3.11±1.45 mg/dL, p=0.005), and after 2 weeks (15.01±1.20 mg/dL vs. 8.88±1.98 mg/dL, p=0.007). The steroid group did not have a higher complication rate but it did have a shorter postoperative hospital stay than in the control group.ConclusionsLow-dose steroid therapy was effective and safe for treating hyperbilirubinemia caused by early graft dysfunction, and it improved liver function.

Effect of Intravenous Immunoglobulin in Reducing Bilirubin Levels in Hemolytic Disease of Newborn

Background: hemolytic disease of the newborn is an autoimmune haemolytic disease and caused by antibodies produced due to Rh and ABO incompatibilities. Neonatal jaundice is a common clinical problem encountered during the neonatal period. To avoid the associated neurological complications; exchange transfusion and phototherapy have been traditionally used. Aim of the work: was to assess the efficacy of intravenous immunoglobulins in neonates with Rh and/or ABO incompatibility in reducing the duration of phototherapy and the need for exchange transfusion and hospital stay. Subjects and Methods: in this clinical intervention study 40 patients diagnosed with hemolytic disease of newborn were grouped into group A and B. All neonates were treated with standard protocol for phototherapy and exchange transfusion. Group A patients received only phototherapy. Group B patients received intravenous immunoglobulins in a dose of 0.5 gm/kg of body weight single dose and phototherapy. Exchange transfusion was given to the patients of both groups if the bilirubin rose by 0.5 mg/dl per hour. Results: there was a significant decrease of bilirubin level in group B [that received phototherapy plus Intravenous Immunoglobulin (IVIG)] than group A [that received phototherapy only]. Hospital stay and duration of phototherapy decreased in group B than group A. Number of cases exchanged blood in group A was higher than cases of group B. Conclusion: addition of intravenous immunoglobulins for treatment of hemolytic disease of newborn significantly reduces bilirubin levels, duration of phototherapy, need for exchange transfusion and hospital stay.

Effect of Intravenous Immunoglobulin in Reducing Bilirubin Levels in Hemolytic Disease of Newborn

Background: hemolytic disease of the newborn is an autoimmune haemolytic disease and caused by antibodies produced due to Rh and ABO incompatibilities. Neonatal jaundice is a common clinical problem encountered during the neonatal period. To avoid the associated neurological complications; exchange transfusion and phototherapy have been traditionally used. Aim of the work: was to assess the efficacy of intravenous immunoglobulins in neonates with Rh and/or ABO incompatibility in reducing the duration of phototherapy and the need for exchange transfusion and hospital stay. Subjects and Methods: in this clinical intervention study 40 patients diagnosed with hemolytic disease of newborn were grouped into group A and B. All neonates were treated with standard protocol for phototherapy and exchange transfusion. Group A patients received only phototherapy. Group B patients received intravenous immunoglobulins in a dose of 0.5 gm/kg of body weight single dose and phototherapy. Exchange transfusion was given to the patients of both groups if the bilirubin rose by 0.5 mg/dl per hour. Results: there was a significant decrease of bilirubin level in group B [that received phototherapy plus Intravenous Immunoglobulin (IVIG)] than group A [that received phototherapy only]. Hospital stay and duration of phototherapy decreased in group B than group A. Number of cases exchanged blood in group A was higher than cases of group B. Conclusion: addition of intravenous immunoglobulins for treatment of hemolytic disease of newborn significantly reduces bilirubin levels, duration of phototherapy, need for exchange transfusion and hospital stay.