Hyperbilirubinemia In Newborns Research Articles

Prediction of Rebound Hyperbilirubinemia

Research Article| November 01 2019 Prediction of Rebound Hyperbilirubinemia AAP Grand Rounds (2019) 42 (5): 51. https://doi.org/10.1542/gr.42-5-51 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Prediction of Rebound Hyperbilirubinemia. AAP Grand Rounds November 2019; 42 (5): 51. https://doi.org/10.1542/gr.42-5-51 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP News Search Advanced Search Topics: hyperbilirubinemia, phototherapy Source: Chang PW, Newman TB. A simpler prediction rule for rebound hyperbilirubinemia. Pediatrics. 2019; 144(1):pii: e20183712; doi: https://doi.org/10.1542/peds.2018-3712Google Scholar Investigators from Seattle Children’s Hospital and the University of California, San Francisco, conducted a retrospective analysis to develop a 2-variable clinical prediction rule to quantify the risk of rebound hyperbilirubinemia in newborns who undergo phototherapy. The prediction rule included a newborn’s gestational age and the difference between the AAP-recommended threshold total serum bilirubin (TSB) level at the time that phototherapy was initiated and the TSB level at the time that phototherapy was discontinued (TSB difference).1 To develop the prediction rule, the authors abstracted medical record data in newborns born at ≥35 weeks’ gestation at Kaiser Permanente Northern California hospitals between 2012 and 2014 who underwent inpatient phototherapy. The study sample was randomly divided into a derivation sample to develop the... 2019 You do not currently have access to this content.

Cord blood bilirubin, albumin, and bilirubin /albumin ratio for predicting subsequent neonatal hyperbilirubinemia

Background Early discharge of healthy term newborns after delivery has become a common practice, because of medical and social reasons, as well as economic constraints. Thus, the recognition, follow-up, and early treatment of jaundice has become more difficult as a result of early discharge from the hospital. Since the dreaded complication of neonatal hyperbilirubinemia is kernicterus, an investigation which can predict the future onset of neonatal pathological jaundice is needed.
 Objective To investigate the predictability of neonatal hyperbilirubinemia by using cord blood bilirubin, albumin and bilirubin/albumin ratio.
 Methods This study was conducted on 300 healthy newborns. Umbilical cord blood was used to measure albumin and bilirubin. All infants were regularly followed up to 5th day of life. Neonates were divided into two groups: group A was consisted of neonates who developed jaundice which was in physiological range, while group B was consisted of neonates who developed neonatal hyperbilirubinemia (requiring phototherapy or other modality of treatment). Babies suspected to have bilirubin level which cross physiological limit on any day after birth were subjected to serum bilirubin measurement. Infants whose serum bilirubin level measurement revealed bilirubin levels crossing physiological values were sent to nursery for phototherapy.
 Results The incidence of neonatal hyperbilirubinemia was 11%. Statistically significant correlations between cord blood bilirubin, albumin, and bilirubin/albumin ratio to the development of neonatal hyperbilirubinemia were observed. On ROC analysis, cut-off points to predict significant hyperbilirubinemia in newborn were cord blood bilirubin >3 mg/dL (sensitivity 60.61%, specificity 97.63%), albumin <2.4 mg/dL (sensitivity 78.79%, specificity 98.13%), cord blood bilirubin/albumin ratio >0.98 (sensitivity 78.79%, specificity 95.51%).
 Conclusion Cord blood total bilirubin, albumin. and bilirubin/albumin ratio are excellent parameters to predict the occurrence of neonatal hyperbilirubinemia. However, cord blood albumin is better compared to cord blood bilirubin and bilirubin/albumin ratio.

Severe hyperbilirubinemia in newborns, risk factors and neurological outcomes

Hyperbilirubinemia is highly prevalent in newborns, with risk of neurological invol vement with bilirubinemia higher than 20 to 25 mg/dl. This progression is preventable with early de tection and treatment. To describe the incidence and associated factors in hospitalized pa tients with hyperbilirubinemia higher than 20 mg/dl, and the follow-up of symptomatic cases during hospitalization. Retrospective study of patients with severe hyperbilirubine mia, between 2013 and 2016. Risk factors were evaluated, stratifying by bilirubin level, admission age, and gestational age. The data were compared with Fisher's exact test, chi-square test, and relative risk (RR) in an Excel database, with an alpha error of p <0.05. The data were obtained from the electronic discharge summary and the medical record of secondary level follow-up. During the studied period, out of 25,288 live newborns (NB), 593 were hospitalized due to hyperbilirubinemia higher than 20 mg/dl, one per each 42 live NB; and 59 with bilirubinemia higher than 25 mg/dl, one per each 428 live NB. Hyperbilirubinemia was more frequent in males, with RR 1.22 (95% CI 1.04-1.44), and in late preterm newborns, with RR 2.39 (95% CI 1.96-2.93) compared with term NB. In those admitted with more than four days, the main associated factor was excessive weight loss, whereas in the first three days was classic group incompatibility. Three of ten cases with acute encephalopathy persisted with neurological involvement, which means 11.8 per 100,000 live births. The main risk factors for developing severe hyperbilirubinemia were prematurity, excessive weight loss, classic group incompatibility, and male sex. These findings allow to focus attention on risk groups and decrease the probability of neurological damage.

Evaluation of critical cord blood bilirubin level as a predictor of significant hyperbilirubinemia in term newborns

Evaluation of critical cord blood bilirubin level as a predictor of significant hyperbilirubinemia in term newborns

Rates of Extreme Neonatal Hyperbilirubinemia and Kernicterus in Children and Adherence to National Guidelines for Screening, Diagnosis, and Treatment in Sweden

Neonatal hyperbilirubinemia can cause lifelong neurodevelopmental impairment (kernicterus) even in high-resource settings. A better understanding of the incidence and processes leading to kernicterus may help in the design of preventive measures. To determine incidence rates of hazardous hyperbilirubinemia and kernicterus among near-term to term newborns and to evaluate health care professional adherence to best practices. This population-based nationwide cohort study used prospectively collected data on the highest serum bilirubin level for all infants born alive at 35 weeks' gestation or longer and admitted to neonatal care at all 46 delivery and 37 neonatal units in Sweden from 2008 to 2016. Medical records for newborns with hazardous hyperbilirubinemia were evaluated for best neonatal practices and for a diagnosis of kernicterus up to 2 years of age. Data analyses were performed between September 2017 and February 2018. Extreme (serum bilirubin levels, 25.0-29.9 mg/dL [425-509 μmol/L]) and hazardous (serum bilirubin levels, ≥30.0 mg/dL [≥510 μmol/L]) neonatal hyperbilirubinemia. The primary outcome was kernicterus, defined as hazardous neonatal hyperbilirubinemia followed by cerebral palsy, sensorineural hearing loss, gaze paralysis, or neurodevelopmental retardation. Secondary outcomes were health care professional adherence to national guidelines using a predefined protocol with 10 key performance indicators for diagnosis and treatment as well as assessment of whether bilirubin-associated brain damage might have been avoidable. Among 992 378 live-born infants (958 051 term births and 34 327 near-term births), 494 (320 boys; mean [SD] birth weight, 3505 [527] g) developed extreme hyperbilirubinemia (50 per 100 000 infants), 6.8 per 100 000 infants developed hazardous hyperbilirubinemia, and 1.3 per 100 000 infants developed kernicterus. Among 13 children developing kernicterus, brain injury was assessed as potentially avoidable for 11 children based on the presence of 1 or several of the following possible causes: untimely or lack of predischarge bilirubin screening (n = 6), misinterpretation of bilirubin values (n = 2), untimely or delayed initiation of treatment with intensive phototherapy (n = 1), untimely or no treatment with exchange transfusion (n = 6), or lack of repeated exchange transfusions despite indication (n = 1). Hazardous hyperbilirubinemia in near-term or term newborns still occurs in Sweden and was associated with disabling brain damage in 13 per million births. For most of these cases, health care professional noncompliance with best practices was identified, suggesting that a substantial proportion of these cases might have been avoided.

The effects of antenatal corticosteroid exposure on the rate of hyperbilirubinemia in term newborns.

Objective:Neonatal hyperbilirubinemia is a short-lasting benign condition that affects approximately 60% of infants born at term infants. This study aimed to evaluate the effects of antenatal corticosteroid (ACS) exposure on the rate of hyperbilirubinemia in term newborns.Methods:This retrospective study was conducted at the Health Sciences University Kayseri Education and Research Hospital, Turkey from June 2017 to June 2018. A total of 6254 pregnant participants aged between 18 and 35 years with a singleton pregnancy were included in the study. The study group included 354 women with low-risk pregnancies (no perinatal risk except threatened preterm labor) who received ACS treatment and were hospitalized because of the threat of preterm labor before the 34th gestational week but delivered after 37 weeks of gestation. The control group was composed of 5900 women with low-risk pregnancies who did not receive ACS treatment throughout their pregnancy and delivered after 37 weeks of gestation.Results:Maternal age, mean body mass index, gestational week at delivery, nulliparity, previous cesarean history, sex of the baby, fetal weight, labor induction, vaginal delivery, and five minutes. Apgar score were similar in both groups. The neonatal hyperbilirubinemia rate was 20/354 (5.6%) in the ACS treatment group and 564/5900 (9.6%) in the control group.Conclusions:The neonatal hyperbilirubinemia was significantly decreased in term-born babies exposed to ACS before 34 weeks.

Alkaline phosphatase and haptoglobin as predictor of neonatal jaundice

Background: The term kernicterus refers to the clinical features of bilirubin encephalopathy. Its risk is increased in term babies with very high bilirubin levels. Kernicterus is also known to occur at lower levels of bilirubin in term babies who have risk factors and in preterm babies. Objective: The aim of the present study was to investigate whether serum alkaline phosphatse & haptoglobin (Hp) level could be used for the early diagnosis and prediction of hyperbilirubinemia in newborns. Methodology: The study is a prospective clinical study design, which was carried out in Pediatric Department, Faculty of Medicine, Aswan University Hospital. The study included 100 newborns with gestational age more than 35wk delivered in obstetric department. Results: Our study showed no statistically significant difference between jaundiced and non- jaundiced cases regarding the mode of delivery, maternal gravidity and parity. As regards previous sibiling affected, we found a significant relation between clinically appearing jaundice and previous sibling affected with neonatal hyperbillirubinemia, which may reflect genetic susceptibility for hyperbillirubinemia. No significant relationship between gestational age and clinically appearing jaundice. When assessing the relationship between clinically appearing jaundice and birth weight, our results revealed no significant relationship. Conclusion: The cord blood alkaline phosphatase level is not only a useful predictor for severe neonatal jaundice but also can predict the early onset of neonatal hyperbilirubinemia and expected methods of treatment in healthy newborns more than 35 weeks gestational age.

Alkaline phosphatase and haptoglobin as predictor of neonatal jaundice

Background: The term kernicterus refers to the clinical features of bilirubin encephalopathy. Its risk is increased in term babies with very high bilirubin levels. Kernicterus is also known to occur at lower levels of bilirubin in term babies who have risk factors and in preterm babies. Objective: The aim of the present study was to investigate whether serum alkaline phosphatse & haptoglobin (Hp) level could be used for the early diagnosis and prediction of hyperbilirubinemia in newborns. Methodology: The study is a prospective clinical study design, which was carried out in Pediatric Department, Faculty of Medicine, Aswan University Hospital. The study included 100 newborns with gestational age more than 35wk delivered in obstetric department. Results: Our study showed no statistically significant difference between jaundiced and non- jaundiced cases regarding the mode of delivery, maternal gravidity and parity. As regards previous sibiling affected, we found a significant relation between clinically appearing jaundice and previous sibling affected with neonatal hyperbillirubinemia, which may reflect genetic susceptibility for hyperbillirubinemia. No significant relationship between gestational age and clinically appearing jaundice. When assessing the relationship between clinically appearing jaundice and birth weight, our results revealed no significant relationship. Conclusion: The cord blood alkaline phosphatase level is not only a useful predictor for severe neonatal jaundice but also can predict the early onset of neonatal hyperbilirubinemia and expected methods of treatment in healthy newborns more than 35 weeks gestational age.

Reproducibility of BiliCare™ Transcutaneus Bilirrubin Meter in Mexican Newborns.

Background Newborn hyperbilirubinemia is considered a worldwide health problem that demands medical evaluation. Noninvasive transcutaneous bilirubin (TcB) has been used as a screening method with different devices but there has not been any evaluation of reproducibility of the same brand devices. The BiliCare™ system is evaluated to demonstrate consistency between measurements with four different devices. Methods 336 TcB measurements were obtained with four BiliCare™ devices in 21 Mexican icteric newborns with a mean postnatal age of 44.1 hours of life and 38 weeks of gestation (33–41). Two measurements were taken in the same ear alternatively at the scaphoid fossa with each device. TcB values were compared between devices. Validity was compared with total serum bilirubin (TB). Results intraclass correlation coefficient demonstrates a minimum limit in the study of 0.945 and maximum of 0.988 with the same device. Correlations with serum and between devices gave results above 0.932. Conclusions BiliCare™ transcutaneous bilirubin measurement instrument has very good intra- and interdevice reproducibility; also correlation of TcS with serum bilirubin gave statistically the same results.

Direct hyperbilirubinemia in newborns with gastroschisis.

Patients with gastroschisis and prolonged total (or partial) parenteral nutrition (PN) commonly develop direct hyperbilirubinemia (DH). To quantify the prevalence and severity of DH in newborns with gastroschisis and characterize the diagnostic work-up for DH in this patient population. Retrospective chart review of patients born with gastroschisis between 2005 and 2015 for the first 6 months of life. 29 patients were identified with gastroschisis. Mean gestational age and birthweight were 36.4 (± 1.8) weeks and 2.5 (± 0.6) kg. 41% were treated with primary reduction versus staged closure. Peak total and direct bilirubin (DB) levels were 10.17 ± 6.21mg/dL and 5.58 ± 3.94mg/dL, respectively. 23 patients (79.3%) were diagnosed with DH and 78.2% underwent additional work-up for hyperbilirubinemia consisting of imaging and laboratory studies, none of which revealed a cause for DH other than the presumed PN-associated cholestasis. In all patients, DB began to decline within 1-10 days of initiation of enteral feeds. DH is common in patients with gastroschisis and is unlikely to be associated with pathology aside from PN. Additional work-up may lead to unnecessary resource utilization. Case series with no comparison group, Level IV.

Transcutaneous bilirubin nomogram for Taiwanese newborns – A single center study

Hour-specific bilirubin nomogram has been recommended to predict postdischarge hyperbilirubinemia in newborns. However, it may not be applicable in Taiwan due to ethnic differences. The aim of this study was to construct a 12-h specific transcutaneous bilirubin (TCB) nomogram in newborns for clinical reference. We prospectively enrolled full term or late preterm neonates born in a tertiary care hospital between October 2013 and July 2014. The exclusion criteria included chromosome anomaly, glucose-6-phosphate dehydrogenase deficiency, and receiving phototherapy within 60h after birth. TCB measurements were performed by a single technician using the Bilichek device, and measured every 12h until neonates were discharged. Patient data including sex, delivery mode, gestational age, body weight with daily change, and feeding pattern were collected for analysis. A TCB nomogram was constructed with 40th, 75th, and 95th percentile lines. A total of 498 newborns were enrolled, and the characteristics between the hyperbilirubinemia and nonhyperbilirubinemia groups were not different. The mean TCB curve revealed that the peak TCB level was 14.2±2.9mg/dL at 100.6±3.6h of age. The peak 95th percentile TCB level was 19.4mg/dL at 121.9±5h of age. Mean TCB levels increased at a rate of 0.01-0.21mg/dL/h initially, followed by a decrease after 96-108h of age. Twenty newborns (4%) were diagnosed with hyperbilirubinemia. Regarding TCB distribution, 11 of 60 (18%) had peak TCB levels above the 95th percentile, 5 of 151 (3%) had TCB levels between the 75th and 95th percentile, 4 of 200 (2%) had levels between the 40th and 75th percentiles, and none had a level below the 40th percentile. A 12-h specific TCB nomogram could be a useful reference for workup for hyperbilirubinemia, particularly when it is above the 95th percentile line.

Hyperbilirubinemia in preterm infants in Japan: New treatment criteria.

In 1992, Kobe University proposed treatment criteria for hyperbilirubinemia in newborns using total serum bilirubin and serum unbound bilirubin reference values. In the last decade, chronic bilirubin encephalopathy has been found to develop in preterm infants in Japan because it can now be clinically diagnosed based on an abnormal signal of the globus pallidus on T2-weighted magnetic resonance imaging and abnormal auditory brainstem response with or without apparent hearing loss, along with physical findings of kinetic disorders with athetosis. We therefore revised the Kobe University treatment criteria for preterm hyperbilirubinemic infants in 2017. The three revised points are as follows: (i) newborns are classified under gestational age at birth or corrected gestational age, not birthweight; (ii) three treatment options were created: standard phototherapy, intensive phototherapy, and albumin therapy and/or exchange blood transfusion; and (iii) initiation of standard phototherapy, intensive phototherapy, and albumin therapy and/or exchange blood transfusion is decided based on the total serum bilirubin and serum unbound bilirubin reference values for gestational weeks at birth at <7days of age, and on the reference values for corrected gestational age at ≥7days of age. Studies are needed to establish whether chronic bilirubin encephalopathy can be prevented using the 2017 revised Kobe University treatment criteria for preterm infants in Japan.

Clinical evaluation of severe neonatal Hyperbilirubinaemia in a resource-limited setting: a 4-year longitudinal study in south-East Nigeria

BackgroundNeonatal hyperbilirubinaemia is one of the commonest causes of hospital visit in the neonatal period. When severe, it is a leading cause of irreversible neurological and musculoskeletal disability. Prompt recognition and timely interventions are imperative for a drastic reduction in complications associated with severe hyperbilirubinaemia in newborns.MethodsWe report a 4-year descriptive and longitudinal study to determine the causes, clinical presentations and long-term outcomes in newborns admitted for severe neonatal jaundice. Methods: Newborns admitted and managed for severe neonatal jaundice at the Enugu State University Teaching Hospital during a 4-year period were enrolled and followed up for 2 years.ResultsA total of 1920 newborns were admitted during the study period and 48 were managed for severe hyperbilirubinaemia giving an in-hospital incidence rate of 25 (95% CI 18–32) per 1000 admitted newborns. The mean age of onset was 3.4 ± 0.5 days (range 1–8 days) and hospital presentation from time of first notice was 4.3 ± 0.4 days (range 1–9 days). The total and unconjugated admission serum bilirubin ranged from 7.1 to 71.1 (mean 26 ± 2.5 mg/dl) and 4.2 to 46.3 mg/dl (mean 18.3 ± 9.2) respectively. Earliest sign of severe hyperbilirubinaemia in newborns were: refusal to suck (15.2%) and depressed primitive reflexes (24.5%) while the commonest signs included high pitch cry (11.9%), convulsion and stiffness (6.9%) and vomiting (6.3%) in addition to the former signs. The major causes of severe hyperbilirubinaemia were idiopathic (33.3%), sepsis (35.3%), ABO incompatibility (17.6%) and glucose-6-phosphate dehydrogenase (G6PD) deficiency (11.8%). Long-term sequelae on follow-up included delayed developmental milestone attainment, postural deformities, visual and seizure disorders.ConclusionsThere is urgent need for continued education for mothers, families and healthcare workers on the danger newborns with jaundice could face if not brought early to the hospital for timely diagnosis and management.

Benefit of Clofibrate on indirect hyperbilirubinemia in newborn

Background: hyperbilirubinemia develop in all newborns and resolves within the first several weeks after birth. Clofibrate is planned for management of indirect hyperbilirubinemia Aim: to evaluate Benefit of Clofibrate on indirect hyperbilirubinemia in newborn. Patients and Methods: this is a case- control study of 100 neonates on clofibrate and 100 neonates control groups, both with jaundice enrolled in fifty sex months from June 2008- March 2013 in the Tikrit hospital and personal doctor's office ,Clofibrate group received clofibrate 100mg/kg.Evaluation of TSB reduction at different intervals regarding admission day,after 12-hr, 24-hr and4-day compare with control Results:The12-hr,24-hr,4-days reduction in TSB of clofibrate group were higher19.74±1.72mg/dl , 15.49±1.16mg/dl, 10.4±1.7mg/dL than in control group 17.11 ± 2.02 mg/dL, 16.09± 1.96mg/dL, 13.6±1.52mg/dL respectively with overall significant (P = .031944) The diminished need for phototherapy (P = 0.0198) and hospitalization time (P = 0.025) in clofibrate group were significantly important compare with control group Conclusion: Clofibrate (100mg) solitary dose used in neonates safely because decreasing bilirubin additionally reduce phototherapy , hospitalization time in neonates appeared within 24 hr and full action of clofibrate appeared between 24hr up to 96 hr.

The effect of phototherapy on sister chromatid exchange with different light density in newborn hyperbilirubinemia.

Concerns of possible genotoxic effects of hyperbilirubinemia and phototherapy were raised from experimental and observational studies in neonates. The purpose of this study was to assess the effect of hyperbilirubinemia and phototherapy with three different methods on DNA damage by investigating sister chromatid exchange frequency. Patients whose gestational ages were >37 weeks and bilirubin levels above phototherapy limits were enrolled into three groups and each group was planned to receive 25 babies. Group 1 received enhanced light-emitting diode phototherapy, group 2 had light-emitting diode phototherapy, and group 3 received conventional phototherapy. Infants with hyperbilirubinemia but did not require phototherapy comprised the control group, which was subdivided into two groups regarding bilirubin levels (<or>10mg/dL). Blood samples were collected before and after phototherapy for sister chromatid exchange frequency and samples were examined by a biologist who was blinded to the study groups. The mean pre-treatment sister chromatid exchange frequency was 1.41±0.34/cell, post-treatment 2.65±0.68/cell, and 1.61±0.61/cell for the control group (p<0.05). A statistically significant increase in sister chromatid exchange frequency after phototherapy was observed in all three intervention groups (p values: 0.01, 0.01, and 0.008, respectively). When the treatment groups were compared with each other in terms of irradiance, no significant difference was found (p=0.08). Phototherapy causes an increase in the frequency of sister chromatid exchange regardless of the irradiance. Phototherapy could have some genotoxic adverse effects on chromosomes; however, further investigations are warranted to enlighten as to whether these effects are permanent or clinically important.

Early predictors of significant hyper bilirubinemia in ABO incompatible newborns

ABO incompatibility have been singularly reported to be strong risk factors in the development of significant hyper bilirubinemia in newborns but usually a combination of these are seen to co-exist in the clinical scenarios commonly witnessed in day to day practice.

Heme oxygenase-1 genetic variants and the conundrum of hyperbilirubinemia in African-American newborns.

African-American (AA) infants are known to have, overall, lower bilirubin levels than infants of other ethnicities during their birth hospitalization. However, they are known to have a higher incidence of severe hyperbilirubinemia and are over represented in the US Kernicterus Registry. Heme oxygenase-1 (HO) is the rate limiting enzyme in heme metabolism leading to the equimolar production of bilirubin, carbon monoxide (CO) and free iron (Fe). Short (S) (GT)n repeats (<25) in the promoter region of the gene encoding the inducible HO-1 isozyme augment its expression, while long (L) repeats (>33) lead to an attenuation, modulating the production of bilirubin and CO. The impact of HO-1 promoter polymorphisms on bilirubin levels has not been well studied in (AA) infants. The objectives of this study were to compare the distribution of (GT)n repeat lengths in the HO-1 promoter region in a cohort of AA infants to those found in other ethnicities and to evaluate the contribution of this polymorphism to the degree of hyperbilirubinemia and the level of COHbc in this cohort. We prospectively studied a cohort of term AA infants with O+ mothers. Per hospital routine, infants' blood type, Rh status, direct antiglobulin test (DAT), and total bilirubin (TB) levels were checked prior to discharge. After parental consent, blood was collected for DNA extraction and carboxyhemoglobin (COHbc) measurements at the same time as the infants' newborn screen. An infant's TB percentile risk based on the Bhutani nomogram was used to determine need for phototherapy or follow-up. (GT)n repeat length in the HO-1 promoter was determined for each allele using PCR after DNA extraction from dried bloodspots. Size of allele lengths were typed as short (S, <25), medium (M, 25-33) or long (L, >33). One hundred eighty infants were studied for a total of 360 separate alleles. 12.2% (44/360) of alleles were S which was significantly less than all other ethnicities reviewed. Carboxyhemoglobin (COHbc) levels and bilirubin percentiles were higher among infants who had at least one S allele when compared to those who had at least one L allele in the cohort as a whole: COHbc 0.92 ± 0.35 vs. 0.85 ± 0.37; p = 0.28 and Bilirubin percentile 48.6 ± 34.0 vs. 44.9 ± 31.6; p = 0.51. This relationship remained when only those infants who were DAT neg were examined: COHbc 0.81 ± 0.26 vs. 0.74 ± 0.21; p = 0.11 and Bilirubin percentile 43.6 ± 29.9 vs. 37.5 ± 28.7; p = 0.28. The presence of L alleles of this variant is significantly greater among infants who are either African or of African descent. There was a trend toward lower COHbc levels among infants with at least one L allele as opposed to at least one S allele, although this did not have a statistically significant impact on TB risk percentile.

Frequency of Gestational Diabetes Mellitus in Pregnant Women Referred to Alavi Hospital in Ardabil, 2017

Background: Gestational Diabetes Mellitus (GDM) is the most common complications of pregnancy that spreading throughout the world and in the past 20 years has increased in range from 10% to 100% among racial groups. GDM cause to maternal and fetal side effects, and in the absence of treatment, it can cause macrosomia, respiratory distress, hypoglycemia, hypocalcemia, and hyperbilirubinemia in newborns. Purpose: The aim of this study was to investigate the frequency of GDM in pregnant women in Ardabil, Iran. Method: This retrospective cross-sectional study was conducted on 4485 pregnant women referred to Alavi hospital in Ardabil from April 2017 to December 2017. Data were extracted from hospital records and analyzed by statistical methods in SPSS version 16. Results: Of all Pregnant women, 256 (5.7%) had GDM. 91.7% of women with GDM had cesarean delivery which of them 75.5% were from urban and 73.2% were in the first parity. The mean age of women with cesarean delivery was 26.96 ± 6.38 years and normal delivery was 27.33 ± 6.44 years. Of women with GDM, 53% had primary education and most of them had no history of abortion and family history of diabetes. Conclusion:Considering the increased frequency of GDM in this study in compare with previous studies, the higher rate of cesarean section among young women with diabetes, doing more studies are essential in future.

Effects of phototherapy on outer hair cell function in infants with hyperbilirubinemia

Introduction: Hyperbilirubinemia in newborns has been hypothesized to cause damage to inner ear, thus leading to sensorineural hearing loss. Phototherapy is treatment protocol in most of the hospitals for newborns with high bilirubin levels. The present study aimed to determine the effects of phototherapy on outer hair cell (OHC) function of cochlea. Methods: Twenty-two neonates with hyperbilirubinemia undergoing phototherapy and 22 neonates without any high-risk registers were included in the study. Distortion product otoacoustic emission (DPOAE) was administered before and after phototherapy. Auditory brainstem response (ABR) evaluation was done during the postphototherapy recording. Results: Results showed that DP amplitude and signal-to-noise ratio improved significantly after phototherapy. ABR evaluation revealed; 19 neonates had significantly prolonged wave V latency compared to normal, whereas no peaks were identified among three neonates. Most of the infantile hyperbilirubinemia are found to be harmless until and unless treatment is not initiated at the earliest, but still it is found that short-term increase in bilirubin level can induce temporary changes in OAEs and ABR measures. ABR needs to be repeated over a period of time for these three neonates to rule out auditory dyssynchrony (AD). Conclusion: The results indicate that phototherapy has temporary effects on OHC function and can improve as the bilirubin levels reduce. Follow-up testing over a period of time helps in discriminating the sensory pathology and AD.

Role of cord blood bilirubin and albumin levels as predictors of subsequent hyperbilirubinemia in newborns

Introduction: Neonatal hyperbilirubinemia is one of the most common problems in term and preterm babies. Development of hyperbilirubinemia in neonates is fretful for the parents and a concern for the pediatrician too. Healthy babies born through normal vaginal delivery who are getting discharged early are being readmitted for the treatment of hyperbilirubinemia. Aim sand Objectives: The present study is done to determine the correlation of cord blood bilirubin, albumin and neonatal hyperbilirubinemia in identifying newborn babies at risk of developing significant hyperbilirubinemia and to establish the cutoff values of cord blood bilirubin and cord blood albumin levels to identify such high-risk neonates. Materials and Methods: In present study, 303 term neonates who are delivered in ASRAM, Eluru from January 2012-January 2013, were included after parental consent. Cord blood bilirubin, Blood grouping and typing, Cord blood albumin and serum bilirubin levels were done in all babies. Results: The incidence of significant hyperbilirubinemia in this study was 23.7%. Cord serum unconjugated bilirubin level ≥2.0 mg/dl and total cordserum bilirubin level ≥ 2.5mg/dl as high risk indicator towards predicting neonatal hyperbilirubinemia in first week of life. 58.53% babies had cord serum albumin level &lt; 2.8gm/dl. Conclusion: Cord serum unconjugated bilirubin level ≥2mg/dl and total cord serum bilirubin level ≥2.5mg/dl, cord blood albumin &lt;2.8g/dl is a high-risk indicator towards predicting neonatal hyperbilirubinemia in the first week of life.