Hyperbilirubinemia In Infants Research Articles

Hyperbilirubinemia in Infants of Diabetic Mothers

Large for gestational age (LGA) infants of insulin-dependent diabetic mothers (IDM), appropriate for gestational age (AGA) IDM, and infants of nondiabetic mothers were compared for the incidence of neonatal hyperbilirubinemia and related etiologic factors. At 60 hours of age, LGA IDM had significantly higher serum bilirubin concentrations (12.3 +/- 2.1 mg/100 ml) than AGA IDM (7.6 +/- 3.9 mg/100 ml) or control infants (7.8 +/- 2.8 mg/100 ml) (P < .001). Peak serum bilirubin concentrations were also significantly higher in LGA IDM (14.4 +/- 2.1 mg/100 ml) than in AGA IDM (8.4 +/- 3.7 mg/100ml) or control infants (8.6 +/- 3.3 mg/100 ml) (P < .001). Mean percent of carboxyhemoglobin was used as an indicator of hemolysis and showed a significant elevation in LGA IDM (1.51 +/- 0.19) when compared to AGA IDM (1.10 +/- 0.27) and control infants (1.19 +/- 0.33) (P < .05). No significant differences were found among the three groups with respect to mode of delivery, frequency of pitocin administration, 5-minute Apgar scores, incidence of isoimmunization, incidence of enclosed hemorrhage, hemoglobin concentration, bilirubin concentrations at 12 hours, and percent of weight loss. Our data suggest that only LGA IDM are at increased risk for hyperbilirubinemia and that increased heme turnover is a significant factor in the pathogenesis.

Conjugated hyperbilirubinemia in infants with erythroblastosis fetalis.

In an attempt to identify the incidence of conjugated hyperbilirubinemia in infants with erythroblastosis fetalis the records of 67 infants were reviewed. Twenty-two infants were found to have direct bilirubin concentrations greater than 1.0 mg./dl. Among 11 infants who underwent intrauterine exchange transfusion, nine (82%) had conjugated hyperbilirubinemia. Of the remaining 56 infants without the procedure, only 13 (23%) showed evidence of this complication. To predict infants at risk of developing conjugated hyperbilirubinemia, the ratio of hematocrit and total bilirubin concentration in cord blood (H/B ratio) was examined.

SERUM INHIBITORY ACTIVITY TO GLUCURONYL TRANSFERASE IN PYLORIC STENOSIS

The unconjugated hyperbilirubinemia noted in infants with pyloric stenosis (PS) Is believed secondary to a reduction in hepatic bilirubin UDP-glucuronyl transferase (GT) activity. In order to determine if a circulating inhibitor to GT is present and related to the reduced activity and the jaundice, 60 infants with PS were studied immediately prior to surgery. Bilirubins were determined in all infants and 42 sera, 43 gastric aspirate specimens and 29 urine samples were assayed for a possible inhibitor of GT. The mean total serum bilirubin concentration was 1.6mg/dl and the unconjugated fraction was 1.2mg/dl with 35 patients having values in excess of 1.1mg/dl. The 72 urine and gastric aspirate specimens revealed no inhibitory activity while 28 of the 42 sera demonstrated significant (> 20%) inhibitory activity with a mean of 39% inhibition of GT using a standardized in vitro assay. 12 age matched healthy infants served as controls and demonstrated no serum inhibitory activity. Of the 28 infants with significant serum inhibition only 10 had elevated serum bilirubin concentrations while 14 patients had hyperbilirubinemia without serum inhibitory activity present. These data confirm the frequent appearance of jaundice, establish the presence of significant serum inhibitory activity against GT but show no relationship between a circulating inhibitor of GT and hyper-bilirubinemia in infants with PS.

NEWS AND ANNOUNCEMENTS

Postgraduate Course On Biliary Tract Disease: A postgraduate course, Biliary Tract Disease, sponsored by the American Gastroenterological Association, will be held July 26-28, 1973, in Aspen, Colorado. Treatment of cholestasis and hyperbilirubinemia in infants is among the topics to be presented. For information write to John A. Benson, Jr., M.D., University of Oregon Medical School, Portland, Oregon 97201. Program On School Health: A program on child health, behavior, and learning will be held August 6-9, 1973, at the Department of Pediatrics, School of Medicine, State University of New York at Buffalo.

PHOTOTHERAPY OF SEVERE UNCONJUGATED HYPERBILIRUBINEMIA: FORMATION AND REMOVAL OF LABELED BILIRUBIN DERIVATIVES

Formation and disposition of the photodegradation products of bilirubin was studied in two infants with severe unconjugated hyperbilirubinemia (Crigler-Najjar syndrome) who responded to phototherapy with a marked and sustained fall of serum bilirubin. During exposure to light, tracer amounts of 14C-bilirubin were infused at constant rates for periods of 10 and 24 hours. Radioactivity in bilirubin and in its photoderivatives was determined in serially collected samples of plasma, urine, and bile. Direct evidence was obtained that light converts bilirubin in vivo to more polar, predominantly diazonegative, and presumably less toxic derivatives which are rapidly excreted in bile and urine without detectable retention in the plasma. These findings provide experimental support for the use of phototherapy in the management of hyperbilirubinemia in infants.

HYPERBILIRUBINEMIA IN INFANTS OF DIABETIC MOTHERS.

HYPERBILIRUBINEMIA IN INFANTS OF DIABETIC MOTHERS.

THE RELATION OF VITAMIN K TO HYPERBILIRUBINEMIA

The concentration of bilirubin in the serum in a group of 119 premature and full-term infants was studied after the administration of water-soluble vitamin K and vitamin K1. It appeared that large doses of water-soluble vitamin K produced a higher concentration of bilirubin than was found in the control infants. Vitamin K1 administered intravenously did not have a hyperbilirubinemic effect. The mean concentration of bilirubin on the fifth day for infants given 25 mg of vitamin K1 orally approximated that of the untreated control group. However, the regression line of body weight versus concentration of bilirubin for this group showed a tendency towards hyperbilirubinemia in infants of less than 2500 gm (5 lb).