Diagnosis Of Hyperbilirubinemia Research Articles

Ischemic-Modified Albumin in Neonates with Congenital Heart Defects.

Ischemia-modified albumin (IMA) is a new biochemical marker of ischemia. We aimed to search blood IMA levels in neonates with congenital heart defects. During the study period, patients diagnosed with congenital heart disease and newborns with a diagnosis of hyperbilirubinemia as a control group were included in the study. IMA level was analyzed using the IMA absorbance unit (ABSU) method. In total, 57 newborns with congenital heart disease requiring cardiac operation for the study group and 38 newborns for the control group were included. There was no difference between the two groups in terms of gender, mode of delivery, and weeks of gestation. The average IMA values in the control group were 0.19 ± 0.09 ABSU. The prepostoperative mean IMA values of the patient group were 0.22 ± 0.07 and 0.23 ± 0.07 ABSU, respectively. Comparison of the postoperative IMA with the mean of the control group was statistically significant. Preoperative and postoperative IMA values of patients who have died due to primary heart disease and surgical complications were 0.21 ± 0.07 (0.08-0.32) ABSU and 0.25 ± 0.06 (0.12-0.36) ABSU, respectively. IMA levels were not statistically different between the two groups. Hypoxia and ischemia in congenital heart disease in the newborn period both preoperatively and postoperatively were important in prognosis. IMA was higher in the postoperative group. Many comprehensive studies are important in terms of preventing complications and decreasing mortality and morbidity by commenting on prognosis. · IMA is a new biochemical marker of ischemia.. · In the literature, there are no reports about the relation between congenital heart defects and IM.. · The exposure of CHD patients to hypoxia/asphyxia in the preintra and postoperative periods cause neurologic deficits.

The use of immature granulocyte and other complete blood count parameters in the diagnosis of transient tachypnea of the newborn

BackgroundAlthough Transient tachypnea of the newborn (TTN) is one of the most common causes of respiratory distress in the newborn period, there is no laboratory parameter used to diagnose it. Immatur granulocyte (IG) measurement is accepted as a useful indicator that can be used in early detection of many infectious conditions, especially neonatal sepsis. In this study, it was aimed to determine if IG and other complete blood count (CBC) parameters could be used as laboratory findings supporting TTN diagnosis. Materials and methodsThis study, which was retrospectively planned, was conducted in the neonatal intensive care unit (NICU) a public hospital between January 1, 2019 and January 31, 2021. Randomly selected 50 infants, hospitalized with the diagnosis of TTN, constituted the patient group of the study. 50 infants hospitalized with the diagnosis of hyperbilirubinemia and did not have any additional problems accepted as the control group. IG and other CBC parameters of infants in the patient and control groups were compared in the study. ResultsThere was no significant difference between the patient and control groups in terms of demographic data and types of delivery (p > 0.05). The rate of delivery by elective cesarean section (C/S) was significantly higher than the rate of normal spontaneous vaginal (NSV) delivery in the patient group (p < 0.001). The IG number and percentage, WBC (white blood cell) count, RDW (red cell distribution width), number and percentage of NRBC (nucleated red blood cell), neutrophil and lymphocyte ratio, count and percentage of basophil and PLR (platelet/lymphocyte ratio) of the patient group was significantly higher than the control group (p < 0.05). ConclusionAccording to the findings obtained in the study, it was concluded that IG and other CBC parameters may be used to support clinical and imaging findings to diagnose transient tachypnea of the newborn.

Neonatal hyperbilirubinemia and bilirubin neurotoxicity in hospitalized neonates: analysis of the US Database.

The objective of this study was to assess the prevalence and trends for neonatal hyperbilirubinemia, and the development of bilirubin neurotoxicity in the USA. We used a de-identified national dataset for the years 2002-2017. The study included all newborn inpatients with postnatal age ≤28 days. Cochran-Armitage trend test was used for trend analyses. Regression analyses were performed and adjusted odds ratios (aOR) were reported. The study included 57,989,476 infants; of them 53,259,758 (91.8%) were term infants and 4,725,178 (8.2%) were preterm infants. Bilirubin neurotoxicity decreased over the years in term infants (Z = 0.36, p = 0.03) without change in preterm infants (Z = 42.5, p = 0.12). Black neonates were less likely to be diagnosed with hyperbilirubinemia than White neonates (aOR = 0.77, 95% confidence interval (CI): 0.77-0.78, p < 0.001) and more likely to develop bilirubin neurotoxicity than White neonates (aOR = 3.0.5, 95% CI: 2.13-4.36, p < 0.001). Bilirubin neurotoxicity rate in the overall population was 2.4 per 100,000 live births. Bilirubin neurotoxicity has significantly decreased in term infants and did not change in preterm infants. Despite the less diagnosis of hyperbilirubinemia in Black newborns, they are disproportionately at increased risk of developing bilirubin neurotoxicity when compared to White newborns. In this article, we analyzed the National Inpatient Database. This is the largest study of its kind using data on 57,989,476 neonates. The article has multiple novel findings: (1) it demonstrated that utilization of phototherapy has increased significantly over the years, (2) the rate of kernicterus for neonates decreased in term infants and did not change in preterm babies, (3) kernicterus was mostly encountered in infants without isoimmunization jaundice, and (4) there is a clear racial disparity in neonatal jaundice; although Black newborns have less neonatal jaundice, they are at increased risk of developing kernicterus.

Türkiye, Konya'da bebek dostu bir hastanede indirekt neonatal hiperbilirubinemi ve uzun fototerapi süresi ile ilişkili risk faktörleri

Aim: Indirect neonatal hyperbilirubinemia is a common neonatal disorder worldwide which can remain benign if prompt management is available. However there is a higher morbidity and mortality risk in settings with limited access to diagnosis and care. The aim of this study was to evaluate the etiologies of indirect neonatal hyperbilirubinemia, to determine the effectiveness of phototherapy treatment and to specify the associated risk factors for prolonged phototherapy duration. Materials and Method: Infants with ≥37 weeks of gestation, postnatal age of ≤14 days, and diagnosis of hyperbilirubinemia at admission, defined as serum bilirubin level at or above the phototherapy treatment threshold were included in the study. All the study participants were treated with intermittent phototherapy. The data were retrospectively analized and duration of phototherapy was classified as ≤24 hours (early discharge) and &amp;gt;24 hours (late discharge). Results: A total of 205 newborns were included in the study. The mean birth weight was 3171.12±436.19 g and mean gestational age was 38.87±1.18 (37–39) weeks. Also, ABO incompatibility and cephalic hematoma were found to be the most common etiologies in our series. On the other hand, male gender (p=0.03) and formula as the first prelacteal feeds (p=0.03) were significantly higher in late discharge group. Additionally; male gender, formula as the first prelacteal feed, ABO incompatibility, Rh isoimmunization, cephalic hematoma and sepsis were risk factors for long phototherapy duration of &amp;gt;24 hours. Discussion and Conclusion: Determination of possible risk factors for neonatal jaundice can provide early hospital admissions by informing mothers before discharge after birth.

Neonatal Hyperbilirubinemia, Types, Causes and Treatments: A Review Study

Neonatal hyperbilirubinemia results from a readiness for the bilirubin production in neonates and limited their ability to excrete it. The diagnosis of hyperbilirubinemia based on yellow discoloration of the skin and whiteness of eyes, idle in the child's movement and the lack of lactation. The baby seems sick or is difficult to awaken. Bilirubin is a tetrapyrrole pigment derived from breakdown product of normal heme catabolism in senescent red blood cells. Unconjugated bilirubin normal elevation is named newborn physiologic hyperbilirubinemia, whereas the level of bilirubin of infant normally to be a bit higher after birth, In the same context the placenta in the womb of the mother. Pathologic hyperbilirubinemia is defined as odd of bilirubin from the normal level so intervention required. Many reasons for this type of jaundice

Cystatin-C as Novel Marker of Neonatal Hyperbilirubinemia, in Al-Najaf City, Iraq

Neonatal hyperbilirubinemia results from a readiness for the bilirubin production in neonates and limited their ability to excrete it. The diagnosis of hyperbilirubinemia based on yellow discoloration of the skin and whiteness of eyes, idle in the child's movement and the lack of lactation. The baby seems sick or is difficult to awaken. Serum cystatin-C, is a low molecular protein that belongs to the family of cysteine protease inhibitor, was proposed as an endogenous filtration marker. In this study sixty neonatal patients suffering from hyperbilirubinemia (35 males,25female) were collected from prematurity unit (PU) in Al-Zahra Educational Hospital/Al-Najaf Al-Ashraf during the period from August,2020 to February,2021. A group of 20 randomly (12male, 8female) selected apparently healthy group. After diagnosis of hyperbilirubinemia, the patients were divided into three groups according to age (1-3), (4-7) and (7-9) days. The result reveals that significant increase (p&lt;0.05) in serum cystatin-C in neonatal hyperbilirubinemia as compared with healthy group. The result of study reveals no significant increase(p&lt;0.05) in serum levels of cystatin-C, while the study shows a significant increase (p&lt;0.05) between male and female in serum levels of bilirubin.

Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia in Neonates from Eastern Part of Nepal

&#x0D; &#x0D; &#x0D; &#x0D; Introduction: Neonatal hyperbilirubinemia continues to be the commonest cause of nursery and NICU admissions and readmissions in the neonatal period worldwide. Although most cases are physiological, toxic levels of un-conjugated bilirubin can lead to acute and chronic bilirubin encephalopathy. Hence, this study aimed to study the risk factors for exchange range hyperbilirubinemia in neonates.&#x0D; Methods: This was a hospital-based prospective observational study conducted in a teaching and referral NICU over a period of one year from July 2019 to August 2020. All neonates with diagnosis of hyperbilirubinemia requiring double volume exchange transfusion were included in the study. Risk factors for significant hyperbilirubinemia were analysed with descriptive statistics. P-value of &lt; 0.05 was considered significant wherever applicable.&#x0D; Results: The mean gestational age and birth weight were 38.06 ± 2.13wks and 2611.72 ± 389.39 gm respectively. Fifteen percent of the babies (162) developed hyperbilirubinemia and 28 (17.3%) required double volume exchange transfusion. Among neonates requiring exchange transfusion, 17 were females and 11 were males. Among 28 babies who required DVET, 20 (71.4%) were SGA. ABO incompatibility was present in 14 (50.0%) neonates and Rh incompatibility in 13 (46.4%) neonates. ABO along with Rh incompatibility was present in eight (28.6%) neonates. DCT was positive in six neonates with ABO incompatibility and nine neonates in Rh incompatibility. G6PD deficiency was present in four (14.3%) neonates.&#x0D; Conclusions: The most important risk factors identified were small for gestational age, ABO and Rh incompatibility followed by oxytocin use and sibling treated for jaundice.&#x0D; &#x0D; &#x0D; &#x0D;

Evaluation of cord blood alkaline phosphatase levels as an indicator of neonatal jaundice

Introduction Neonatal jaundice remains an important neonatal issue, and the condition is mostly benign. Jaundice is a complex disease of high bilirubin levels in the body and yellowing of the skin and mucous membranes. Hyperbilirubinemia is associated with encephalopathy and kernicterus, resulting in permanent disability. Because babies are discharged early, detection and diagnosis of hyperbilirubinemia are delayed in some cases. Therefore, early diagnosis of jaundice and timely actions are necessary. Several methods have been used to determine the risk of neonatal hyperbilirubinemia. Alkaline phosphatase (ALP) is an intracellular enzyme found abundantly in red blood cells. It is a hydrolase enzyme and responsible for removing phosphate from many types of molecules. Our aim in this study was to investigate whether cord blood ALP level during the first 6 h of live of newborn could be used for the early diagnosis and prediction of hyperbilirubinemia in newborns. Patients and methods This was a prospective study carried out during the period from June 2018 to December 2018 at El-Mania General Hospital. This study included a total of 60 neonates: 30 full-term infants and 30 preterm infants. A total of 60 babies were evaluated, starting from the sixth hour after birth, and cord blood ALP levels were analyzed. We performed an assessment of the complete medical history (maternal history and neonatal history). Third day of live measured transcutaneous bilirubin of neonate, and seventh day we measured serum bilirubin (total and direct). Results The present study showed that infants with high cord blood ALP levels are at risk of developing significant indirect neonatal hyperbilirubinemia that requires interventions with an accuracy of 82.2%, a sensitivity of 72%, a specificity of 85.71%, a positive predictive value of 83.43%, and a negative predictive value of 75.37%. Conclusion The cord blood ALP level can be used as a predictor of severe neonatal jaundice.

Acute bilirubin encephalopathy and its associated risk factors in a tertiary care hospital, Pakistan.

Objective:To determine the incidence of acute bilirubin encephalopathy (ABE) and its risk factors in neonates presenting with hyperbilirubinemia in a tertiary care children hospital.Methods:This descriptive observational study was conducted from June 2018 to June 2019. A total of 300 infants who were admitted in neonatal ICU with diagnosis of hyperbilirubinemia in The Children’s Hospital & The Institute of Child Health, Multan, Pakistan were included in this period. Incidence of ABE was noted. ABE was divided into two categories on the basis of severity of symptoms; mild ABE and moderate to severe ABE. Total serum bilirubin (TSB) in all neonates was measured in all patients in hospital laboratory using colorimetric method. ABO incompatibility and Rh factor incompatibility was also noted for each neonate.Results:Out of 300 neonates who presented with hyperbilirubinemia, ABE was diagnosed in only 42 (14.0%) neonates (mild ABE in 17 (5.7%) and moderate in 25 (8.3%). Out of 42 neonates of ABE, total serum bilirubin levels were 20-29.9 mg/dL in 24 (40.5%) neonates, and >30 mg/dL in 18 (42.8%) neonates. Pre-term birth was a significant risk factor of ABE; 23.8% in ABE and 10.70% in non-ABE (p-value 0.01). During treatment, 02 (4.76%) neonates expired due to ABE.Conclusion:In present study, ABE was diagnosed in 14.0% neonates who presented with hyperbilirubinemia. We found pre-term delivery as a significant risk factor of ABE.

Effect of Neonatal Phototherapy on Eosinophil Levels in Nonsevere Hyperbilirubinemia.

The purpose of the research was to determine the impact of phototherapy (PT) on eosinophil levels in neonates with nonsevere bilirubin levels (<20 mg/dL) treated with PT. This observational pilot study included term neonates with early neonatal hyperbilirubinemia. Ninety-six term neonates were included in the study. The male-to-female ratio was 1.23. Hyperbilirubinemia was most frequently related to ABO group incompatibility (49%). Fifty-two neonates (54.1%) were born by normal spontaneous delivery. After PT, while total serum bilirubin, hemoglobin, hematocrit, leukocyte, and neutrophil levels were found to be significantly decreased, eosinophil levels were significantly increased (p = 0.01). No significant difference was found regarding lymphocyte and basophil levels after PT. A statistically significant correlation was found between bilirubin and eosinophil levels before PT (r 2 = 0.28, p = 0.03). No correlation between eosinophil levels and treatment age, gender, diagnosis of hyperbilirubinemia, and delivery route before PT was found. After PT, eosinophil levels increased, while other blood cell series were found to be decreased. The correlation between the bilirubin levels and eosinophil was found to be negative (r 2 = - 0.32, p = 0.02) after PT. PT may increase serum eosinophil levels in term neonates with nonsevere hyperbilirubinemia.

ANALYSIS OF HEMOGLOBIN LEVELS AND LEUKOCYTE COUNT IN NEONATES WITH HYPERBILIRUBINEMIA

Hyperbilirubinemia is one of the most common clinical phenomena in neonatal patient. Etiology is generally physiological, only about 10% being pathological. It is important for clinicians to distinguish between physiological and pathological hyperbilirubinemia, because uncontrolled pathological conditions can cause severe complications of kern icterus, one ofthe causes of death in infants.This study was retrospective study by obtaining data of all neonatal patients with diagnosis of hyperbilirubinemia, who undergone hemoglobin and leukocyte count test. The data were classified into two groups: physiological and pathological hyperbilirubinemia. Statistical tests were performed to assess the association of hemoglobin levels and leukocytes count between the two groups. A total of 144 data were collected, 54 physiological and 90 pathological hyperbilirubinemia. In physiological hyperbilirubinemia, hemoglobin levels and leukocyte counts were found to be normal, whereas in pathological anemia and leukocytosis developed and the difference between the two groups was statistically significant (p&lt;0,001). Anemia was found in neonates with pathological hyperbilirubinemia caused by RDN, LBW, sepsis, hemolytic, and hemorrhagic. Leukocytosis was found in pathological hyperbilirubinemia caused by sepsis.There was a significant difference between the incidence of anemia and leukocytosis in physiological and pathological hyperbilirubinemia. It can be concluded that routine blood tests can be used to distinguish whether hyperbilirubinemia experienced by neonatel patient is a physiological or pathological condition, so it can be one of the tests suggested when the neonate is hyperbilirubinemia.

Easy Diagnosis of Jaundice: A Smartphone-Based Nanosensor Bioplatform Using Photoluminescent Bacterial Nanopaper for Point-of-Care Diagnosis of Hyperbilirubinemia.

One of the concerns of parents in the first days of their baby's birth is the baby's risk of jaundice/hyperbilirubinemia. This is because more than 60% of babies are born with jaundice that, if not timely diagnosed and subsequently treated, can lead to serious damage to their health. On the other hand, despite recent progress in sensor technology for clinical applications, the development of easy-to-use, cost-effective, sensitive, specific, and portable diagnostic devices, which use nontoxic and biodegradable materials in their design and fabrication, is still in high demand. Herein we present an easy-to-use, cost-effective, selective, nontoxic, and disposable photoluminescent nanopaper-based assay kit with a smartphone readout for easy diagnosis of neonatal jaundice through visual determination of Bilirubin (BR) in infants' blood samples. The developed BR assay kit comprises highly photoluminescent carbon dot (CD) sensing probes embedded in a bacterial cellulose (BC) nanopaper substrate (CDBN). The photoluminescence (PL) of the developed BR sensor is quenched in the presence of BR as a PL quencher and then selectively recovered upon blue light (λ = 470 nm) exposure, due to conversion of the unconjugated BR to the colorless oxidation products (non-PL quencher) through BR photoisomerization and photooxidation, that subsequently leads to selective PL enhancement of CDBN. The recovered PL intensity of the developed BR assay kit, which was monitored by integrated smartphone camera, was linearly proportional to the concentration of BR in the range of 2-20 mg dL-1. The feasibility of real application of the fabricated smartphone-based BR assay kit was also confirmed via comparing the results of our method with a clinical reference method for determination of BR concentration in infant's blood samples. With the advantages of nontoxicity and the extraordinary physicochemical properties of photoluminescent BC nanopaper as the sensing substrate, along with those of smartphone technology, we believe that our developed smartphone-based BR assay kit, as an easy-to-use, cost-effective (∼0.01 Euro per test), portable and novel sensing bioplatform, can be potentially exploited for sensitive, specific, rapid, and easy BR detection and jaundice diagnosis at the point of care (POC) and in routine clinical laboratories as well.

Evaluating the Diagnostic Value of Skin Bilirubin in Comparison with Plasma Bilirubin to Identify Hyperbilirubinemia in Healthy Babies

Background: An elevated level of bilirubin in the blood is the most common and benign problem among newborns; it is also the most important factor in the evaluation of neonatal jaundice in newborns. If severe indirect hyperbilirubinemia is left untreated, it can be neurotoxic; therefore, doctors cannot overstate the need for the early detection of hyperbilirubinemia. Objectives: We investigated the relationship between the skin and plasma methods of the quality of the BiliChek process as a means of diagnosing hyperbilirubinemia Patients and Methods: This study was performed at Amiralmomenin hospital in Semnan, Iran and examined 64 healthy infants who had gestational ages of 37 weeks and greater and jaundice as their sole cause for hospitalization. Infants hospitalized due to other diseases, such as sepsis, were excluded from the study. First, a blood sample was taken to determine the infants’ serum total bilirubin. Then, the amount of bilirubin was determined with BiliChek placed on three locations: the infants’ foreheads, chests, and left thighs. Results: SD ± mean values of the skin method on each forehead, chest, and thigh were respectively (3.5 ± 13.8, 12.8 ± 3.5 and 9.7 ± 2.6 mg per deciliter); using the plasma method, bilirubin SD ± mean was 14.4 ± 4.0, so that the skin method in all three areas was lower than the plasma method. Variables such as the type of delivery, birth rank, blood type, birth weight, and maternal age are independent of hyperbilirubinemia level, and there is no significant relationship between them. There is only a significant relationship between bilirubin levels and a baby’s age, as there is a significant relationship to birth (P = 0.000). Cut off point for the use of BiliChek in the forehead has been set at 3.13 milligrams per deciliter, and the sensitivity and specificity levels are 83.87% and 92.59%, respectively. As for the chest, it was 3.13 mg dL, with sensitivity and specificity levels of 83.87% and 96.30%, respectively. For the thigh, it was 9.7 mg per dL, with sensitivity and specificity levels of 83.87% and 96.30% respectively. There is no significant difference between the three areas mentioned in the skin method for predicting hyperbilirubinemia. Conclusions: In our study, we determined that BiliChek can be used in the diagnosis of hyperbilirubinemia, but this use is limited and applies only to the cutoff point and for values higher than the cutoff point. BiliChek is used as a means of screening for infants that need blood sampling.

Pre-Discharge Screening Trans-Cutaneous Bilirubinometry in Healthy Newborns in Mahdieh Hospital, Tehran.

Background:Incidence of jaundice is high in newborn infants. Since well appearing newborns are rapidly and routinely discharged from hospital, performing an inexpensive noninvasive pre-discharge screening test for evaluation of jaundice seems to be necessary.Objectives:This study was conducted to compare the accuracy of cutaneous v/s serum bilirubin measurements in this regard.Patients and Methods:This was a prospective cross sectional study conducted in Mahdieh hospital, Tehran. 613 neonates weighing ≥ 1,800 g with gestational age of ≥ 35 weeks were enrolled. A pre discharge transcutaneous bilirubin test (TcB) was performed in all. Serum samples were taken from neonates with TcB ≥ 5 mg/dL in first and > 8 mg/dL in second 24 hours. Decision for treatment or recheck of bilirubin level after discharge was made based on serum bilirubin results.Results:Based on the study protocol, among 613 studied neonates, 491 (80%) revealed high TcB, of them 240 (49%) cases showed TBC ≥ 5 mg/dL in first and 251 (51 %) in second pre-discharge 24 hours. TcB ranged 3.3 - 17.1, mean TcB in first 24 hours was 6.9 ± 1 .7 (mode 6) and in second 24 hours 9.1 ± 2.1 (mode 10). Of 491 neonates with high TcB, capillary serum sample was taken as the second step and 398 neonates revealed high total serum bilirubin (TsB) with the same protocol for TcB. 108 (27.1%) neonates showed TsB ≥ 5 mg/dL in first and 290 (72.9%) in second 24 hours. According to the study results TcB has a 81% positive predictive value (PPV) in diagnosis of hyperbilirubinemia. Correlation coefficient of TcB and TsB in highest rate is equal to 72% (P value < 0.001).Conclusions:TcB is an inexpensive, noninvasive and precise pre-discharge screening test for evaluation of hyperbilirubinemia, with a high PPV. It is highly recommended to be performed routinely due to high incidence of hyperbilirubinemia in neonates.

The Factors Affecting on Newborn Jaundice.

Purpose : Hyperbilirubinemia is a simple problem for newborn babies, but a very widespread one. Jaundice is seen in the first week of life in 60% of mature babies and in 80% of premature babies. In this study, it is aimed to research hyperbilirubinemia etiology and risk factors. Materials and Methods : The medical records of 709 newborns monitored with a diagnosis of hyperbilirubinemia in the Yuzuncu Yil University Medical Faculty Research Hospital Child Health and Diseases Clinic, Turkey, were examined retrospectively Findings : ABO incompatibility was determined in 165 (23.3%) of the newborn, Rh incompatibility was determined in 80 (11.3%) of the newborn and ABO+Rh incompatibility was determined in 13 (0.018%) of the newborn. Direct hyperbilirubinemia was determined in 28 (3.9%) of the newborn. Clinical symptoms and findings regarding kernicterus were found in 66 (9.3%) of the newborn. Blood exchange was made in 121 (17.1%) of them. Conclusions : In neonate important etiologic factors for hyperbilirubinemia are respiratory distress syndrome, transient tachypnea of newborn, low birth weight and urinary system infections. In mother important etiologic factors for hyperbilirubinemia are prevalence of early membrane rupture, hypertension and diabetes mellitus.

Progress in pediatrics in 2013: choices in allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses.

This review will provide new information related to pathophysiology and management of specific diseases that have been addressed by selected articles published in the Italian Journal of Pediatrics in 2013, focusing on allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses in children. Recommendations for interpretation of skin prick test to foods in atopic eczema, management of allergic conjunctivitis, hypertension and breastfeeding in women treated with antiepileptic drugs and healthy breakfast have been reported. Epidemiological studies have given emphasis to high incidence of autoimmune disorders in patients with Turner syndrome, increasing prevalence of celiac disease, frequency of hypertension in adolescents, incidence and risk factor for retinopathy of prematurity. Advances in prevention include elucidation of the role of probiotics in reducing occurrence of allergies and feeding intolerance, and events of foetal life that influence later onset of diseases. Mechanistic studies suggested a role for vitamin D deficiency in asthma and type 1 diabetes and for reactivation of Varicella-Zoster virus in aseptic meningitis. Regarding diagnosis, a new mean for the diagnosis of hyperbilirubinaemia in newborns, a score for recognition of impaired nutritional status and growth and criteria for early Dyke-Davidoff-Masson Syndrome have been suggested. New therapeutic approaches consist of use of etanercept for reducing insulin dose in type 1 diabetes, probiotics in atopic eczema, and melatonin in viral infections.

The impact of jaundice in newborn infants on the length of breastfeeding

To examine the breastfeeding prevalence among infants aged three and six months who were previously hospitalized because of hyperbilirubinemia, and to determine whether jaundice in newborn infants increases the risk of breastfeeding discontinuation. Surveys were mailed to mothers of all eligible infants admitted over a two-and-a-half year period to the paediatric ward of a tertiary care children's hospital with a diagnosis of hyperbilirubinemia. A total of 127 mother-patient pairs were included in the study. Breastfeeding rates at three and six months were compared with those of a city-wide survey (Infant Care Survey) conducted by Ottawa's Public Health Department. Risk factors for early breastfeeding discontinuation were examined. Breastfeeding rates at three and six months were not different between the study group and those reported in the Infant Care Survey (75.5% in the study group versus 71.2% in the Infant Care Survey group, at three months; and 59.1% in the study group versus 50.8% of the Infant Care Survey group, at six months). None of the previously reported risk factors for early weaning had an impact on breastfeeding duration in the study population. Breastfeeding rates following the discharge of infants diagnosed with jaundice were not significantly different from those reported for the general population. Different patient characteristics may have inflated the breastfeeding rates in the study population, as evidenced by a very high education level among the mothers of enrolled patients. Larger prospective studies in diverse populations are needed to determine the rates of early breastfeeding discontinuation in jaundiced infants.