Neonatal Jaundice Research Articles

The Association Between Asphyxia and Neonatal Pathological Jaundice Incidence in Umbu Rara Meha Hospital East Sumba Regency

Jaundice causes 70% morbidity and 10% infant mortality worldwide, approximately 1.1 million newborns are affected by jaundice every year. The purpose of this study was to analysis the association between asphyxia and the incidence of neonatal pathological jaundice at Umbu Rara Meha Hospital, East Sumba Regency. The research used a quantitative method with case and control approach using secondary collection data medical records from January to October 2023. The sample ratio was 1:1, the case group sample is 75 babies with jaundice and the control group sample is 75 babies who were born in the hospital. The sampling taken by consecutive sampling. The analysis used the Chi-square test. The data analysis showed there was an association between asphyxia and neonatal pathological jaundice incidence with p=0.001. The data result showed there was an association between asphyxia and neonatal pathological jaundice incidence at Umbu Rara Meha Hospital, East Sumba Regency.

Evaluation of alanine aminotransferase/aspartate aminotransferase ratio and high-density lipoprotein for predicting neonatal adverse outcomes associated with intrahepatic cholestasis of pregnancy.

To determine the association between lipid metabolism and intrahepatic cholestasis of pregnancy (ICP), and explore the value of maternal alanine aminotransferase/aspartate aminotransferase (ALT/AST) and high-density lipoprotein (HDL) in predicting adverse neonatal outcomes in women with ICP. A total of 147 pregnant women with ICP admitted to The Fourth Hospital of Shijiazhuang and 120 normal pregnant women in the same period were selected in this study. The Mann-Whitney U test and Chi-square tests were used to compare the differences in clinical data. Multivariate logistic regression was used to analyze the relationship between ALT/AST and the occurrence of adverse pregnancy outcomes in patients with ICP. The combined predictive value of ALT/AST and HDL was determined by receiver operating characteristic (ROC) curve analysis. Among 147 women with ICP, 122 women had total bile acid (TBA) levels of 10-39.9 µmol/L, and 25 had TBA ≥ 40 µmol/L. There was significantly lower gestational age in patients with severe ICP than in those with mild and control groups (all p<0.05), and the weight of newborns in the maternal ICP group was significantly lower than in the control group (p<0.05). Increasing TBA levels was associated with higher AST, ALT, ALT/AST, and lower HDL level (all p<0.05). Meanwhile, higher levels of ALT/AST was positively associated with neonatal hyperbilirubinemia [adjusted odds ratio (AOR) = 4.019, 95% CI [1.757-9.194, p=0.001] and cardiac injury [AOR = 3.500, 95% CI [1.535-7.987], p=0.003]. HDL was a significant protective factor for neonatal hyperbilirubinemia and cardiac injury [AOR = 0.315, 95% CI [0.126-0.788], p=0.014; AOR = 0.134 (0.039-0.461), p=0.001]. The area under the ROC curve (AUC) for prediction of neonatal hyperbilirubinemia by ALT/AST combined with HDL was 0.668 [95% CI [56.3-77.3%], p = 0.002], and the sensitivity and specificity were 47.1% and 84.0%, respectively. To predict neonatal cardiac injury, the AUC value was 0.668 [95% CI [56.4-77.1%], p = 0.002], with sensitivity and specificity were 41.2% and 87.1%, respectively. The levels of higher ALT/AST and lower HDL were significantly associated with the risk of ICP-related adverse neonatal outcomes. Moreover, ALT/AST combined with HDL has moderate clinical value in predicting the adverse outcomes of neonatal hyperbilirubinemia and cardiac injury.

Clinical overview of phototherapy for neonatal hyperbilirubinaemia.

The most efficient emission spectrum of light for phototherapy is blue-green light emission diode light with peak emission at 478 nm. In the irradiance interval of phototherapy, the relationship between efficacy and irradiance is almost linear, and it is negatively related to the haemoglobin. The action sites of phototherapy are the extravascular compartment and cutaneous blood. The most immature neonates treated aggressively had not only a lower frequency of neurodevelopmental impairment than conservatively treated, but also greater mortality. Intermittent and continuous phototherapy are assumed to be equally efficient. Home-based fibreoptic phototherapy is effective and safe. Important progress is still occurring in phototherapy.

The value of synthetic MRI in detecting the brain changes and hearing impairment of children with sensorineural hearing loss.

Sensorineural hearing loss (SNHL) can arise from a diverse range of congenital and acquired factors. Detecting it early is pivotal for nurturing speech, language, and cognitive development in children with SNHL. In our study, we utilized synthetic magnetic resonance imaging (SyMRI) to assess alterations in both gray and white matter within the brains of children affected by SNHL. The study encompassed both children diagnosed with SNHL and a control group of children with normal hearing {1.5-month-olds (n = 52) and 3-month-olds (n = 78)}. Participants were categorized based on their auditory brainstem response (ABR) threshold, delineated into normal, mild, moderate, and severe subgroups.Clinical parameters were included and assessed the correlation with SNHL. Quantitative analysis of brain morphology was conducted using SyMRI scans, yielding data on brain segmentation and relaxation time.Through both univariate and multivariate analyses, independent factors predictive of SNHL were identified. The efficacy of the prediction model was evaluated using receiver operating characteristic (ROC) curves, with visualization facilitated through the utilization of a nomogram. It's important to note that due to the constraints of our research, we worked with a relatively small sample size. Neonatal hyperbilirubinemia (NH) and children with inner ear malformation (IEM) were associated with the onset of SNHL both at 1.5 and 3-month groups. At 3-month group, the moderate and severe subgroups exhibited elevated quantitative T1 values in the inferior colliculus (IC), lateral lemniscus (LL), and middle cerebellar peduncle (MCP) compared to the normal group. Additionally, WMV, WMF, MYF, and MYV were significantly reduced relative to the normal group. Additionally, SNHL-children with IEM had high T1 values in IC, and LL and reduced WMV, WMF, MYV and MYF values as compared with SNHL-children without IEM at 3-month group. LL-T1 and WMF were independent risk factors associated with SNHL. Consequently, a prediction model was devised based on LL-T1 and WMF. ROC for training set, validation set and external set were 0.865, 0.806, and 0.736, respectively. The integration of T1 quantitative values and brain volume segmentation offers a valuable tool for tracking brain development in children affected by SNHL and assessing the progression of the condition's severity.

Neonatal jaundice incidence, risk factors and outcomes in referral-level facilities in Nigeria.

To determine the incidence, risk factors and outcomes of babies with neonatal jaundice in a network of referral-level hospitals in Nigeria. A cross-sectional analysis of perinatal data collected over a 1-year period. Fifty-four referral-level hospitals (48 public and 6 private) across the six geopolitical zones of Nigeria. A total of 77 026 babies born at or admitted to the participating facilities (67 697 hospital live births; plus 9329 out-born babies), with information on jaundice between 1 September 2019 and 31 August 2020. Data were extracted and analysed to calculate incidence and sociodemographic and clinical risk factors for neonatal jaundice. Incidence and risk factors of neonatal jaundice in the 54-referral hospitals in Nigeria. Of 77 026 babies born in or admitted to the participating facilities, 3228 had jaundice (41.92 per 1000 live births). Of the 67 697 hospital live births, 845 babies had jaundice (12.48 per 1000 live births). The risk factors associated with neonatal jaundice were no formal education (adjusted odds ratio [aOR] 1.68, 95% CI 1.11-2.52) or post-secondary education (aOR 1.17, 95% CI 0.99-1.38), previous caesarean section (aOR 1.68, 95% CI 1.40-2.03), booked antenatal care at <13 weeks or 13-26 weeks of gestation (aOR 1.58, 95% CI 1.20-2.08; aOR 1.15, 95% CI 0.93-1.42, respectively), preterm birth (aOR 1.43, 95% CI 1.14-1.78) and labour more than 18 hours (aOR 2.14, 95% CI 1.74-2.63). Hospital-level and regional-level strategies are needed to address newborn jaundice, which include a focus on management and discharge counselling on signs of jaundice.

Risk of childhood cancer in infants treated with phototherapy for neonatal jaundice

Risk of childhood cancer in infants treated with phototherapy for neonatal jaundice

Comparative Analysis of Classification of Neonatal Bilirubin by Using Various Machine Learning Approaches.

Background Neonatal jaundice poses significant risks to newborn health, necessitating early detection and management. Machine learning (ML) offers promising avenues for improving classification and monitoring, potentially revolutionizing neonatal care. Materials and methods A comparative analysis was conducted using various ML algorithms to classify neonatal bilirubin levels. Data were collected from neonatal images, and algorithms were trained and tested using standard methodologies. Performance metrics, including accuracy, precision, and recall, were evaluated to assess algorithm effectiveness. Results The Nu-Support Vector Classification (NuSVC) model emerged as the most effective, achieving a testing accuracy of 62.50%, with precision and recall rates of 61.90% and 56.52%, respectively. While variability existed among algorithms, these results highlight NuSVC's potential for clinical application in neonatal jaundice screening. Conclusion ML holds promise for improving neonatal jaundice detection and management. The findings suggest that the NuSVC algorithm can enhance screening accuracy, potentially mitigating risks associated with untreated neonatal jaundice. Future research should focus on refining models for broader clinical applicability and integrating ML into decision support systems to improve neonatal care globally.

Preventive effect of prenatal maternal oral probiotic supplementation on neonatal jaundice (POPS Study): A protocol for the randomised double-blind placebo-controlled clinical trial

IntroductionNeonatal jaundice is a common and life-threatening health problem in neonates due to overaccumulation of circulating unconjugated bilirubin. Gut flora has a potential influence on bilirubin metabolism. The infant gut...

Outcomes and Morbidities in Low-Birth-Weight Neonates: A Retrospective Study From Western India.

Low birth weight (LBW) increases infant morbidity and mortality and is a major public health concern, especially in resource-constrained settings. The purpose of this retrospective study was to assess the outcomes and morbidities related to LBW neonates referred to a neonatal intensive care unit (NICU) in Western India. The present study examined the medical records of newborns weighing less than 2 kg at birth who were admitted to the NICU between September 15, 2016, and September 15, 2017. Data on long-term outcomes, clinical manifestations, morbidities, mortality, and demographic variables were gathered and analyzed. Descriptive statistics were used to present continuous variables as mean and standard deviation (SD), while categorical variables were presented as frequencies and percentages. Bivariate and multivariate logistic regression analyses were carried out to find the association between gestational age and major morbidities among LBW babies. Of 4710 births, 327 (6.9%) were LBW. The leading morbidities of LBW babies were respiratory distress syndrome (RDS) 153 (46.8%), neonatal jaundice 92 (28%), and septicemia 81 (25%), contributing to 58 (17.7%) deaths. Lower gestational age was associated with significantly higher adjusted odds of RDS (<28 weeks: reference; 28-32 weeks: adjusted odds ratio (AOR) 0.07, 95% confidence interval (CI) 0.01-0.33; ≥37 weeks: AOR 0.001, 95% CI 0.00005-0.02) and RDS-related mortality (28-32 weeks: AOR 0.26, 95% CI 0.06-1.13; ≥37 weeks: AOR 0.07, 95% CI 0.01-0.43). Among 250 successfully discharged cases, at 12 months, 18 (13.7%) had a weight below the 3rd percentile, and 9 (6.8%) failed the neurodevelopmental screening. LBW infants in this setting experience significant morbidities, mortality, and long-term growth and developmental effects. To alleviate the burden associated with LBW, improved neonatal care facilities, infection control protocols, and focused interventions are essential.

Alpha-1-Antitrypsin Deficiency in Children-Unmet Needs Concerning the Liver Manifestation.

This study aimed to analyse the clinical course of 45 children with severe alpha-1-antitrypsin deficiency (AATD) registered in our clinic to detect possible predictors of poor outcomes. The clinical and biological data of 45 patients with homozygous or compound heterozygous AATD were analysed. The data were collected retrospectively going back to 2005 and prospectively from May 2020 until October 2021. It was based on questionnaires, laboratory values, sonography, and biopsy findings. Liver disease was classified into four grades depending on the grade of liver disease: mild or no liver disease, moderate disease, severe disease, and liver transplantation. Thirty-nine patients (86.7%) had a Pi*ZZ and five (11.1%) a Pi*SZ genotype. One patient showed a new, not-yet-described compound heterozygous genotype (Pi*Z + Asp95Asn). A total of 66.7% of the cohort showed mild or no liver disease, 20% moderate, and 13.3% severe. AATD was diagnosed in most cases because of liver abnormalities, such as the elevation of transaminases (42.2%). A total of 29.4% of the patients with neonatal icterus prolongatus developed severe liver disease, and 25.7% were born small for their gestational age (SGA). Diseases of the atopic type were reported in 47.4% of the cases. The presence of neonatal icterus prolongatus in the first weeks of life was significantly more likely in severe courses of liver disease (r = 0.371, p = 0.012). A tendency toward atopic comorbidity in AAT-deficient children needs to be further evaluated.

Association of gestational hepatitis B virus infection and antiviral therapy with pregnancy outcomes: A retrospective study.

To explore the relationships between gestational hepatitis B virus (HBV) infection, antiviral therapy, and pregnancy outcomes. We retrospectively selected hepatitis B surface antigen (HBsAg)-positive pregnant women hospitalized for delivery at Fujian Medical University Affiliated Hospital from October 1, 2016 to October 1, 2020. The control group included randomly selected healthy pregnant women hospitalized for delivery during the same time. Overall, 1115 participants were enrolled and grouped into control (n = 380) and HBsAg-positive groups (n = 735), which were further divided into groups I (n = 407; low viral load), II (n = 207; high viral load without antiviral therapy), and III (n = 121; high viral load with antiviral therapy). Pregnant women with HBV were positively correlated with the incidence of intrahepatic cholestasis of pregnancy (ICP) (adjusted odds ratio [aOR] 5.1, 95% confidence interval [CI] 2.62-9.92, P < 0.001), neonatal jaundice (aOR 10.56, 95% CI 4.49-24.83, P < 0.001), and neonatal asphyxia (aOR 5.03, 95% CI 1.46-17.27, P = 0.01). Aspartate aminotransferase (AST) greater than the upper limit of normal (ULN) was an independent risk factor for increased ICP incidence (aOR 3.49, 95% CI 1.26-9.67, P = 0.019). Antiviral therapy considerably reduced HBV DNA and improved liver function. High viral load and antiviral therapy did not correlate significantly with adverse pregnancy outcomes (P < 0.05). Pregnant women with HBV have significantly elevated incidence of ICP, neonatal jaundice, and neonatal asphyxia not significantly correlated with viral load. AST greater than ULN independently increases the risk of ICP. Antiviral therapy effectively reduces viral replication and improves liver function without increasing the risk of adverse outcomes.

Neonatal morbidity in the 2011 JAKIDS Jamaican birth cohort

ABSTRACT This study reports the spectrum of discharge diagnoses in a national cohort of newborns admitted during a 3-month period to hospitals across Jamaica. The data were analyzed using measures of central tendency and risk assessed using odds ratio. Data on 1607 admissions were used to describe the spectrum of morbidity in hospitalized infants. Eight hundred and seven (50%) male and 754 (48%) female neonates were admitted. There was a 15% (240) readmission rate during the neonatal period. Infants of diabetic mothers were almost three times as likely to be admitted as infants whose mothers were not diabetic OR 2.89 (CI 1.96 − 4.13). Infants of women who were hypertensive were 1.5 times more likely to be admitted than infants of non-hypertensive women OR 1.56 (CI 1.56–1.9). The odds ratio for admission of an infant born to a woman delivered by caesarean section was 2.1 (CI: 1.67–2.38). Premature infants constituted 50% of admissions. The most prevalent discharge diagnosis included presumed sepsis, respiratory distress and neonatal jaundice in both preterm and term neonates. In the extreme preterm infant respiratory distress syndrome was the most predominant discharge diagnosis. Multiple gestation was a significant risk for admission OR 2.7 (CI 1.8 to 3.9). Prematurity, multiple gestation, macrosomia, maternal diabetes, maternal hypertension and low 5 minute Apgar score < 7 were all found to be independent predictors of neonatal admission in a logistic regression model (p < 0.001). The recognition of the discharge morbidity is useful for future health planning for the most vulnerable in our population.

Multicenter evaluation of the diagnostic efficacy of jaundice color card for neonatal hyperbilirubinemia

Objective: To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice. Methods: Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate's parents used the JCard to measure jaundice at the neonate's cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson's correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis. Results: Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation (r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0 μmol/L. The TcB value of 205.2 μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions: JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Correlation between gestational age and incidence of hyperbilirubinemia in neonates

The incidence of hyperbilirubinemia in neonates is a significant concern worldwide, with potential implications for morbidity and mortality. This study aims to investigate the correlation between gestational age and the occurrence of hyperbilirubinemia in neonates. Secondary data were collected from the Neonatal Intensive Care Unit of Buleleng Regional Hospital from October 2022 to March 2024. The study employed an observational-analytical design with a cross-sectional approach. Pearson correlation analysis examined the relationship between bilirubin levels and gestational age. The results revealed a negative linear correlation between neonatal bilirubin levels and gestational age, indicating a higher risk of elevated bilirubin levels in preterm neonates. The majority of neonates included in the study were preterm (72.3%), with 98.3% experiencing hyperbilirubinemia. This study contributes valuable insights into the relationship between gestational age and hyperbilirubinemia in neonates, particularly in resource-limited settings. Early identification of at-risk neonates and appropriate interventions are crucial for preventing complications associated with hyperbilirubinemia.

Management of Neonatal Hyperbilirubinemia: Shedding Light on the American Academy of Pediatrics 2022 Clinical Practice Guideline Revision.

Neonatal hyperbilirubinemia is one of the most common conditions managed by pediatricians. Although many infants are affected, most will experience complete resolution without complication. Acute bilirubin encephalopathy and kernicterus are rare yet debilitating sequelae of severe hyperbilirubinemia that can be avoided through careful monitoring and treatment with phototherapy. Appropriate management of neonatal hyperbilirubinemia must balance the risks of these severe conditions with the effects of overtreatment. Released in 2022, the American Academy of Pediatrics revised the clinical practice guideline for the management of hyperbilirubinemia, which aims to provide that balance through updates to the previous guideline. This article will provide the reader with (1) an evidence-based harm and benefit analysis of the guideline, (2) an overview of key changes and clarifications made in the new guideline, and (3) a practical summary of guideline updates. [Pediatr Ann. 2024;53(6):e208-e216.].

Effect of Awareness Program on Newly Mothers' Knowledge and Practices Regarding Neonatal Jaundice

Effect of Awareness Program on Newly Mothers' Knowledge and Practices Regarding Neonatal Jaundice

A Retrospective Cohort Study on Treponema pallidum Infection: Clinical Trends and Treatment Outcomes for Congenital Syphilis in Guangxi, China (2013-2023).

Syphilis, a prevalent sexually transmitted infection, poses severe risks, especially during pregnancy. This study aimed to elucidate the trends and impacts of syphilis in Guangxi, China, focusing on prevalence, clinical manifestations, and treatment outcomes in pregnant women and newborns. The objectives included understanding the demographic characteristics of affected pregnant women, analysing the clinical manifestations in newborns, and assessing the effectiveness of the treatment protocol. Conducted in adherence to ethical guidelines, a retrospective cohort study from January 2013 to December 2023 included 54,048 pregnant women tested for T. pallidum. Diagnosis involved a comprehensive approach, utilizing tests like the Toluidine Red Unheated Serum Test (TRUST) and the Treponema pallidum Particle Agglutination (TPPA) assay. Infant diagnosis and clinical manifestations were evaluated through a decade-long follow-up. Treatment protocols, including Benzathine penicillin, were implemented. Statistical analyses were conducted using SAS version 9.4. Among 54,048 pregnant women, 0.10% were syphilis positive, correlating with a rise in hospitalizations. Newborns exhibited varied clinical manifestations, with neonatal pneumonia and jaundice being prevalent. The treatment protocol, especially with Benzathine penicillin, achieved a remarkable 100% cure success rate. The study noted a significant reduction in mother-to-child transmission. Syphilis in mothers and babies was diagnosed at different clinical stages, including primary, secondary, latent, and tertiary. This study underscores the escalating impact of syphilis on pregnant women and newborns in Guangxi, China. The findings highlight the necessity for robust preventive measures, early diagnosis, and effective treatment strategies. The observed 100% cure success rate with Benzathine penicillin emphasizes the importance of strict treatment protocols in mitigating the adverse effects of congenital syphilis and reducing its transmission.

Exchange Transfusion Trends and Risk Factors for Extreme Neonatal Hyperbilirubinemia over 10 Years in Shiraz, Iran.

Exchange transfusion (ET) is an effective treatment for acute bilirubin encephalopathy and extreme neonatal hyperbilirubinemia (ENH). It can reduce mortality and morbidity. This study aimed to investigate the trends and risk factors of ENH requiring ET in hospitalized neonates in Iran. A retrospective analysis of medical records of neonates who underwent ET due to ENH was conducted from 2011 to 2021, in Shiraz, Iran. Clinical records were used to gather demographic and laboratory data. The quantitative data were expressed as mean±SD, and qualitative data was presented as frequency and percentage. P<0.05 was considered statistically significant. During the study, 377 ETs were performed for 329 patients. The annual rate of ET decreased by 71.2% during the study period. The most common risk factor of ENH was glucose-6-phosphate dehydrogenase (G6PD) deficiency (35%), followed by prematurity (13.06%), ABO hemolytic disease (7.6%), sepsis (6.4%), Rh hemolytic disease (6.08%), and minor blood group incompatibility (3.34%). In 28.52% of the cases, the cause of ENH was not identified. 17 (5.1%) neonates had acute bilirubin encephalopathy, of whom 6 (35.29%) had G6PD deficiency, 6 (35.29%) had ABO incompatibility, and 2 (11.76%) had Rh incompatibility. Although the rate of ET occurrence has decreased, it seems necessary to consider different risk factors and appropriate guidelines for early identification and management of neonates at risk of ENH should be developed. The findings of the study highlighted the important risk factors of ENH in southern Iran, allowing for the development of appropriate prevention strategies.

Morbidity and immediate outcome of Small for Gestational Age infants born at term gestation

Background: Small-for-gestational-age (SGA) is defined as birth weight below the tenth percentile according to a specific gestational age and sex reference. SGA babies are either due to symmetric or asymmetric intrauterine growth restriction.Objectives: The study aims to evaluate the immediate outcome of the full term SGA neonates requiring neonatal intensive care unit (NICU) admission. Methods: It was prospective cross-sectional study conducted between February 2018 and January 2019 in NICU of Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke. Babies were evaluated daily for short term outcome till they were discharged from hospital.Results: A total of 50 term SGA babies were included in the study. Most of the SGA babies needing admission to NICU were severe intrauterine growth restriction (IUGR). Among 50 cases 22 were male and 22 were female. Meconium-stained liquor was present in 20% during birth. Eighty two percent cried immediately, 4% cried after stimulation, 12% needed bag and mask ventilation and 2% were intubated at birth. The short term morbidities during NICU stay were birth asphyxia (14%), apnoea (8%), jaundice (30%), bleeding (2%), meconium aspiration syndrome (10%), neonatal sepsis (44%), transient tachypnoea of newborn (12%), hypoglycemia (6%). Four of the SGA babies expired due to severe sepsis. Asymmetrical intrauterine growth retardation (IUGR) babies were in 44% and symmetrical IUGR were in 56%. There was no significant difference in outcome of symmetrical and asymmetrical babies. Their final outcome was 92% discharged and 8% death.Conclusions: Most of the SGA babies needing admission to NICU were severe IUGR. The most common morbidities seen was Neonatal sepsis followed by neonatal jaundice. The result of this study could be important to recognize the anticipated problems and areas requiring attention to improve quality of neonatal care of SGA babies in order to manage the problems associated with them.

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.