Early-onset Jaundice Research Articles

ETIOLOGICAL FACTORS OF NEONATAL HYPERBILIRUBINEMIA IN TRIBAL COMMUNITY OF MEGHALAYA, INDIA - A CROSS-SECTIONAL STUDY

Objective: To identify the etiological factors of neonatal hyperbilirubinemia in tribal population of Meghalaya, India. Design: Cross sectional study. Setting: Neonatal intensive care unit under (level II NICU) Department of Paediatrics and Neonatology of Nazareth Hospital, Meghalaya, India. Participants: Neonates of Khasi, Jaintia and Garo tribes with neonatal jaundice admitted in NICU of Nazareth Hospital, Meghalaya, India. Main Outcome Measures: Demographic variables of the study population, Mean TSB values of various etiological factors, Effect of various etiological factors in early onset neonatal jaundice, Nature and duration of interventions needed for the neonates studied. Results: In 58.9% of the 409 neonates studied, no cause could be assigned for the development of jaundice. Of the remaining, 19.8% was attributed to low birth weight whereas 19% had ABO incompatibility and 10.8% were premature. 9.3% had sepsis, 8.5% had G6PD deciency while 3.2% were born to mothers with diabetes mellitus. Rh incompatibility was the causative factor in 1.7%. In 1.7%, pre-lacteal feed was associated with jaundice. In 62.3% of cases delayed cord clamping was found to be associated. Conclusions: Total serum bilirubin tends to be higher in female neonates, of term gestation, with birth weight 2500 g or above and with ABO incompatibility. Delayed initiation of breast feeding, those with positive history of neonatal jaundice in older siblings and those with proven neonatal sepsis were also found to have higher levels of bilirubin. Neonates who were given pre-lacteals and those born to diabetic mothers show lower mean total serum bilirubin levels. Most neonates who developed jaundice within 24 hours of life (early onset jaundice) had ABO incompatibility.

Cystic biliary anomaly in a newborn with features of choledochal cyst and cystic biliary atresia

Abstract Cystic biliary atresia (CBA) and choledochal cysts (CDC) can present similarly with early onset jaundice, conjugated hyperbilirubinemia, and radiographic cystic biliary dilatations. We present the case of an infant antenatally diagnosed with a congenital biliary dilatation found to have non-atretic intrahepatic and extrahepatic bile ducts leading to a CDC without distal flow past the cyst into the duodenum. While prior literature has differentiated CDC and CBA as separate entities, our case suggests that these two pathologies may arise on a spectrum of obstructive cholangiopathies. An operative approach assessing the fluoroscopic patency of the intrahepatic and extrahepatic bile ducts and exploration of the anatomy can guide the choice of cyst excision versus hepatic portoenterostomy.

Neonatal Jaundice: The Other Side of the Coin in the Development of Allergy.

The current study aims to assess the association between different characteristics of neonatal jaundice and common types of allergic diseases in childhood (as bronchial asthma, acute urticaria, and allergic rhinitis). A case-control study is conducted on 300 allergic children and 300 healthy children as a control group at Fayoum University Hospital. The study was conducted over a span of 2 years, from May 2016 to May 2018. Bronchial asthma, allergic rhinitis, and acute urticaria diagnoses were based on physician clinical examination using specific guidelines for each. For the data regarding children's demographic and maternal characteristics, a structured questionnaire was used. Regarding neonatal jaundice, data were collected from the patients' hospital records. Children with neonatal jaundice are more likely to develop allergy with 57% higher than neonates without jaundice. Early onset jaundice and treatment by phototherapy have statistically significant association with the development of allergic diseases. Different aspects of neonatal jaundice are associated with the development of common allergic diseases in children.

Cystic biliary atresia or atretic choledochal cyst: A continuum in infantile obstructive cholangiopathy

Introduction: Both cystic biliary atresia and choledochal cyst present as infantile obstructive cholangiopathy. Methods: We detail an infant with congenital biliary dilatation and obstructive cholangiopathy where clinicoradiological features (antenatally imaged subhepatic cyst, early onset jaundice, intrahepatic dilated biliary radicals) suggested a choledochal cyst but operative findings (lack of a distal communication of cyst with duodenum) and histomorphological features (cicatricial collagen and myofibroblastic hyperplasia in the cyst wall; ductal plate malformation, ductular cholestasis and strong expression of CD56 in the liver) were those associated with biliary atresia. Conclusion: The observations support the contention that BA and CC may be interim entities in a continuum of manifestation of the same pathology.

Evaluation of neonatal jaundice in the Makkah region.

The aims of this study were to detect the frequency at which the different types of neonatal jaundice occur in Makkah and to estimate the malondialdehyde (MDA) levels. This study included 239 neonates with neonatal jaundice, 20 anemic neonates and 21 healthy neonates. ABO incompatibility was observed in 31.6% of neonates with indirect hyperbilirubinemia, in 14.3% of those with early onset jaundice, in 9.5% of those with persistent jaundice, in 8.5% of those with physiological jaundice, in 5% of anemic neonates and in 12% of all neonates. glucose-6-phosphate dehydrogenase (G6PD) deficiency was observed in 10.5% of neonates with indirect hyperbilirubinemia, in 3.9% of those with physiological jaundice, in 11.1% of those with direct hyperbilirubinemia, in 12% of those with persistent jaundice, in 10% of anemic neonates and in 6.6% of all neonates. Rh incompatibility and polycythemia were found in 2.6% of neonates with indirect hyperbilirubinemia and in 0.4% of all neonates. In comparison to control group, MDA was significantly higher in all groups except for the anemic group. In conclusion, ABO incompatibility and G6PD deficiency frequently result in neonatal jaundice in Makkah, whereas Rh incompatibility and polycythemia are rare. The MDA level may serve as an indicator of oxidative stress.

Hour-specific nomogram for transcutaneous bilirubin in Japanese neonates

The measurement of transcutaneous bilirubin (TcB) is very important to screen for hyperbilirubinemia in newborns. Until now, however, there has been no hour-specific, percentile-based TcB nomogram during the early neonatal period in Japanese neonates. The aim of this study was to develop a TcB nomogram within 72 h of birth in Japanese neonates. A total of 3152 TcB measurements for 181 healthy Japanese neonates (gestational age ≥36 weeks, birthweight ≥2300 g) were obtained within 72 h of birth. All measurements were performed with a Konica Minolta jaundice meter, the JM-103. A nomogram curve was plotted to show the trend of TcB level over time. The nomogram curves rose almost linearly for all percentiles until 72 h after birth. An hour-specific, percentile-based TcB nomogram during the first 72 h after birth in Japanese neonates was successfully developed. Because Japanese neonates have higher and later peak bilirubin, an original hour-specific 97.5th percentile-based TcB nomogram may be needed to identify early-onset jaundice and manage neonatal hyperbilirubinemia.

Early onset jaundice in the newborn: understanding the ongoing care of mother and baby

Neonatal hyperbilirubinaemia or jaundice is a relatively common condition in newborn babies presenting with changes to eythrocyte metabolism after day 3 of life. Early onset jaundice is less common and arises on day 1 from a pathological process. This paper outlines a case study of a baby presenting with this condition due to ABO blood group incompatibility who was admitted from the postnatal ward to the neonatal unit (NNU). The article will focus on the period after initial interventions on admission to the NNU and the ongoing care issues thereafter. Both clinical and psychoemotional care issues for the baby and family are raised. It is important that midwives understand what care is delivered during the neonatal unit stay so that they can empathise and assist with family coping strategies following the separation of the baby from the parents at an often emotionally charged time.

Neonatal jaundice and human milk

Breastfeeding is linked both to a greater jaundice frequency and intensity in the first postnatal days (“breastfeeding jaundice”) and to visible jaundice persisting beyond the first two weeks of life (“breast milk jaundice”), but the appearance of skin jaundice is not a reason for interrupting breastfeeding which can and should continue without any interruption in most cases. There have been numerous contributions to the literature, which have rescaled the direct role of breast milk, both in early jaundice and in the more severe cases of late jaundice. In fact, the reviewed guidelines for detection and management of hyperbilirubinemia underline, how prevention of badly managed breastfeeding and early support for the couple mother-child are effective prevention measures against severe early-onset jaundice; furthermore, the breastfeeding interruption is no longer recommended as a diagnostic procedure to identify breast milk jaundice because of its low specificity and the risk to disregarding the detection of a potentially dangerous disease.

A case of fetal leukemia with intracranial hemorrhage and early-onset jaundice

We report a case of a neonate who was diagnosed as having congenital leukemia after presenting with an intracranial hemorrhage. The chief symptom was early-onset jaundice due to the hemorrhage. The intracranial hemorrhage and post-hemorrhage hydrocephalus advanced. In addition, the leukemia worsened leading to death at 14 days old. The possibility of leukemia, although rare, should be considered as a cause of intracranial hemorrhage in term babies.

Globe Talk: the Cartographic Logic of Late Capitalism

In the bright dawn of globalization talk - sometime in the early '90s - the dean of radical geography was asked what he thought of it all. 'Globaloney' was the terse response, suggesting early-onset jaundice with the new buzzword on the lips of graduating MBAs, think-tank pundits, and financial journalists everywhere. Nearly two decades on, the niagara of hype has slackened and the word even carries a shopworn aura ('past its sell-by date', one can almost hear the feature editors intone). Yet the processes it names, or misnames, are not over. The conditions that gave 'globalization' its currency are surely still at work in the new millennium. The term itself was hatched and took wing in business schools and the echo-chambers of the licensed press; it was intended both to describe and to promote the dismantling of barriers to the movement of capital and the loss of local and national sovereignties to the interests of transnational firms. All this was helped along by developments in telecommunications and silicon capitalism. The geopolitical context was the collapse in 1989 of the Soviet empire ('the end of history'). The propagandists of both blocs had told the same lie, that the USSR was communist. But whatever the Soviet Union was or was not, the barriers to Western capital in search of markets, raw materials and cheap labour had been real enough. Once the 'wall' came down, the old West/East division began to dissolve quickly, since it had been predicated for most of the twentieth century on the political geography of the capitalist-communist bloc system. It has given way to North/South terminology, reflecting the new - but in reality old - configuration of a Northern capitalist core (to use the metaphor of world-systems theory) and a Southern periphery. The obvious limitations of these hemispheric spatial terms led, in the first case, to the coining of tiers mondej 'third world' for countries 'non-aligned' with the two blocs, and more recently to the attachment of 'global' to 'South' to capture the fact that capitalism's uneven development creates conditions typically associated with the South inside the Northern heartlands. We are greatly in Geoff Eley's debt for his survey, and for the heroic attempt to take stock of what is by now a vast and daunting literature, though a lot of it is frankly hogwash. Above all, the effort to historicize is to be welcomed, since the assassination of memory and the flattening of historical depth are among the chief effects of spectacle, an effect already widely noted with respect to 'postmodernity', globalization's slightly older sibling.

Pathogenesis and outcome of biliary atresia: current concepts.

Neonatal cholestatic disorders are a group of hepatobiliary diseases occurring within the first 3 months of life. Bile flow is impaired, and patients have conjugated hyperbilirubinemia, acholic stools, and hepatomegaly. Overall, 1 in 2,500 live births is affected with a neonatal cholestatic disorder (1). The two most common causes of neonatal cholestasis are biliary atresia and idiopathic neonatal hepatitis, accounting for up to 50% to 70% of cases. Other causes include a variety of neonatal infections (viral, toxoplasmosis, syphilis, bacterial), metabolic and genetic diseases, progressive familial intrahepatic cholestatic disorders (PFIC), paucity of interlobular bile duct disorders (e.g., Alagille syndrome), choledochal cyst, ischemia–reperfusion injury, association with parenteral nutrition administration, and other conditions (Table 1). Despite clinical improvement after the portoenterostomy procedure, approximately 70% to 80% of children with biliary atresia will eventually require liver transplantation; thus, biliary atresia alone accounts for almost 50% of all liver transplants performed in children (1). It should be noted that $77 million is spent each year in the United States on liver transplantation for children and the ensuing hospitalizations (2). This sum of money covers 0.2% of total health care expenditures related to children, even though these children represent 0.0006% of the total pediatric population. Importantly, this disproportionate expenditure for liver transplantation in children could be cut in half if improved therapies for biliary atresia were developed that could abrogate or further delay the need for liver transplantation. Remarkably, little is known about the etiopathogenesis of biliary atresia; consequently, there has been slow progress in developing improved therapies or preventative strategies during the past decade. The purpose of this review is to summarize recent advances in the diagnosis and management of biliary atresia, examine the clinical outcome, describe the evolving theories of the etiology and pathogenesis of this disorder, and highlight gaps in our current knowledge.