Hyperbilirubinemia In Term Neonates Research Articles

A prospective observational study to evaluate the association of various maternal risk factors with increasing incidence of term neonatal jaundice

<p><strong><em>Background: </em></strong><em>In our setting majority of the mothers were discharged on postnatal day 3.but over the past few years the NICU admissions also increased prolonging the hospital stay of mothers leading to increase in the hospital acquired infections for both mother and baby. This study was developed in this context. <strong></strong></em></p><p><strong><em>Objectives:</em></strong><em> The present study was performed with the purpose of establishing the incidence of neonatal jaundice in term neonates and the role of the various maternal factors being responsible for exaggerated physiological hyperbilirubinemia in term neonates. <strong></strong></em></p><p><strong><em>Methods: </em></strong><em>Using the NICE gestational age-based phototherapy chart, this study analysed serum bilirubin of the term newborns on their day 2 of life. Total 155 antenatal mothers were taken for study. Associations between maternal risk factors and neonatal jaundice and comparing risk factors in early-term, term, and late-term newborns were assessed using chi-squared or Fisher’s exact tests</em></p><p><strong><em>Results: </em></strong><em>Incidence of neonatal jaundice is 58.1% in this study. Age, BMI, weight gain of the mother had no significant correlation with neonatal jaundice. Blood group incompatibility had a positive corelation (P=.001) Gestational age at the time of delivery determines the neonatal outcome. (P=.001). As gestation advances the neonatal outcomes are better. Hyperbilirubinemia incidence more at 37 -38 weeks when compared to 39 weeks. Maternal comorbidities, amniotic fluid volume changes, mode of delivery didn’t have statistical significance. when new-born factors are considered birth weight, gender growth problems, blood group has no statistical significance whereas dehydration proved to be significant (P=.001). meconium-stained amniotic fluid[P-0.034] were found to be associated with the development of neonatal jaundice.</em></p><p><strong><em>Conclusions: </em></strong><em>The prevalence of jaundice is higher in this study. maternal and foetal blood group incompatibility, gestational age at delivery, meconium-stained amniotic fluid, neonatal dehydration was found to be associated with the development of neonatal jaundice.</em></p>

Evaluation of therapeutic effect of oral Ursodeoxycholic Acid on indirect hyperbilirubinemia in term neonates undergoing phototherapy: A randomized controlled clinical trial

Introduction and aims Phototherapy is the most common treatment modality of neonatal hyperbilirubinemia. We aimed to evaluate the therapeutic effect of oral Ursodeoxycholic Acid (UDCA) on indirect hyperbilirubinemia in term neonates undergoing phototherapy. Materials and methods This randomized controlled clinical trial was performed on 106 full-term neonates with jaundice who were admitted to the neonatal ward of 17 Shahrivar Hospital in Rasht, Iran. The neonates were randomly assigned to two groups of intervention (10 mg/kg UDCA+phototherapy) and control (phototherapy alone). Total serum bilirubin (TSB) was measured at the time of admission, during first 12, 24, and 48 hours after admission and at the time of discharge. The duration of hospitalization and side effects were also assessed in both groups. IBM SPSS Statistics for Windows, version 20 was used to analyze the data. Results Results showed that in the intervention group, 28 (52.8%) of neonates were boys with the mean age of 5.1±1.25 days. While, in the control group 29 (54.7%) of them were boys with the mean age of 5.19±2.26 days. Bilirubin levels in both groups decreased significantly after hospitalization (at 12, 24 and 48 hours) (P <0.001). The mean of bilirubin at 12, 24 and 48 hours in the intervention and control groups were 17.1, 13.2, 10.2 mg / dl and 17.1, 14.2 and 11.3 mg / dl, respectively. At the time of discharge, TSB in the former compared to the latter group was significantly reduced (7.74± 1.39 vs. 8.67±1.35) (P = 0.001). In addition, the duration of hospitalization was considerably shorter in the intervention compared to the control group (P = 0.038) and no side effects were observed. Conclusions Administering UDCA plus phototherapy reduced TSB and length of hospital stay with proper safety and efficacy. Therefore, it seems that this combination can be an appropriate treatment modality in neonatal hyperbilirubinemia.

Umbilical Cord Blood Hemoglobin as a Predictor of Significant Neonatal Hyperbilirubinemia in Term Newborns in a Tertiary Care Centre in North Kerala

Aims: Neonatal hyperbilirubinemia is one of the most common problems during first week of life and is the most common cause of readmission in early neonatal period. The present study aimed to predict the development of significant hyperbilirubinemia in term neonates using cord blood hemoglobin.
 Study Design: Prospective study.
 Place and Duration of Study: Department of Paediatrics, MMCH & RC, Kozhikode, Kerala from March 2021 to July 2022.
 Methodology: The prospective study enrolled 162 appropriate for gestational age term newborns, delivered at MMCH & RC. Cord blood hemoglobin was measured and bilirubin estimation was done at 48-72 hours of life. Hyperbilirubinemia was considered significant if serum bilirubin value was above standard as per American Academy of Pediatrics guidelines. Data was entered in Microsoft Excel and analysed using SPSS 20.0 version. The relationship between cord hemoglobin in predicting significant neonatal hyperbilirubinemia was studied using appropriate statistical tests. Sensitivity and specificity of the variables were defined using ROC curve and Pearson correlation coefficient to determine the correlation between the variables.
 Results: Out of the total 162 neonates enrolled, 86 were boys (53.1%) and 76 were girls (46.9%). The mean cord hemoglobin value was 15.3g/dl. 20 neonates (12.3%) had developed significant hyperbilirubinemia and required phototherapy while none of them needed exchange transfusion. Correlation between cord hemoglobin with serum bilirubin showed weak correlation (r=0.194) but the correlation was statistically significant (p<0.05). On ROC curve analysis, cord hemoglobin cut off value ≥14.9g/dl showed 75% sensitivity and 39.4% specificity to predict significant neonatal hyperbilirubinemia.
 Conclusion: There is significant correlation between umbilical cord blood hemoglobin level and neonatal hyperbilirubinemia. Cord hemoglobin ≥14.9g/dl can predict future development of significant neonatal hyperbilirubinemia. This will be useful in very low resource centres to plan early discharge of newborns without fear of hyperbilirubinemia.

Indirect Neonatal Hyperbilirubinemia and the Role of Fenofibrate as an Adjuvant to Phototherapy.

One of the most prevalent illnesses in neonates that needs care and treatment is neonatal jaundice. Several drugs are used as pharmacological modalities for treating hyperbilirubinemia, like intravenous immunoglobulin, D-penicillamine, metalloporphyrin, phenobarbital, zinc sulfate and clofibrate. Previous studies suggest the usefulness of fenofibrate in the treatment of hyperbilirubinemia. The study aims at assessing the effectiveness of oral fenofibrate in the treatment of indirect neonatal hyperbilirubinemia in full-term neonates. This is a quasi-experimental study that was conducted at Heevi Pediatrics Teaching Hospital in Duhok, which is located in the Kurdistan Region of Iraq. It involved term infants who had jaundice. The neonates who were eligible for the study were randomly assigned to one of two groups: the intervention group or the control group. Both groups were treated with conventional phototherapy. Fenofibrate was administered in a single oral dose of 10 mg/kg to the participants in the intervention group. Throughout the entirety of the treatment, levels of total serum bilirubin were compared and contrasted between the two groups. After 12 h of treatment, a statistically significant difference (p-value = 0.001) was seen in the serum bilirubin levels between the two groups. The difference in serum bilirubin levels became significantly progressively pronounced after 24, 48, and 72 h. The average time of discharge was 63.6 h for the intervention group and 90.9 h for the control group, and this difference was statistically significant (p-value < 0.001). The time it takes to lower high bilirubin levels in neonates may be shortened by combining conventional phototherapy with a single oral dosage of 10 mg/kg fenofibrate. Consequently, these neonates will experience a shorter hospitalization and an accelerated discharge from the hospital.

The cost-effectiveness of home phototherapy for hyperbilirubinemia in neonates: results from a randomized controlled trial

This study aimed to establish the cost-effectiveness of home phototherapy versus hospital phototherapy treating hyperbilirubinemia in neonates more than 36 weeks. Based on clinical results from a randomised controlled trial showing that home phototherapy for hyperbilirubinemia in term neonates is as effective as hospital phototherapy, we performed a cost-minimisation analysis to identify the most cost-effective alternative. We included costs for health care resource use as well as costs for transportation in connection with re-visits. The cost per patient was €337 for home phototherapy compared with €1156 for the hospital alternative indicating average cost savings of €819 (95% confidence interval €613–1025) or 71% per patient. Transportation and outpatient costs were higher in the home treatment group and hospital care costs were higher in the hospital group. Sensitivity analysis shows that results are robust also when allowing for uncertainty. Home phototherapy for neonates more than 36 weeks costs less than in-hospital phototherapy while being equally effective, meaning that home phototherapy is a cost-effective alternative to hospital treatment for infants with neonatal hyperbilirubinemia.Trial registrationNCT03536078. Date of registration: 24/05/2018.

Does Gender Affect Levels of Hyperbilirubinemia in Term Neonates

Introduction: Hyperbilirubinemia is a common &amp; in most1cases, benign problem in1first month of1life which is often1physiologic &amp; intervention is not1usually1necessary. In the first week of life, about 60.0% of term &amp; 80.0% of preterm infants have jaundice. Jaundice could lead to major side effects like kernicterus and permanent impairment.1One of the most frequent disorders requiring medical1attention in babies is neonatal jaundice. It has high levels of unconjugated1bilirubin, which can occasionally lead to kernicterus. Objective: To determine frequency of hyperbilirubinemia among neonates who present with physiological jaundice and compare the mean levels of hyperbilirubinemia among genders. Methodology: A total of 368 consecutive neonates were included. This cross-sectional study1was conducted at Department of Paediatric Medicine, NICH Karachi during June 2020 to December 2020. All pre-term or term neonates of either gender with physiological jaundice, and get admitted to pediatric medicine department were included in this study. While Neonates who did not survive first 48 hours of life, neonates who were not exclusively breast fed as determined by History were excluded from study. Blood samples1were taken from the patients and concentrations of serum total bilirubin, In the centrifuged venous samples, direct &amp; indirect1bilirubin concentrations were determined. Serum total,1direct&amp; indirect bilirubin was recorded for each patient. Data was analyzed using IBM. SPSS 22 on computer. Results: Mean ±SD age of neonates was 10.6±4.2 days. In distribution of gender, 214 (58.2%) were male while 154 (41.8%) were female. Mean ±SD of birth weight was 3.4±1.8 kg. Mean ±SD of birth weight was 3.4±1.8 kg with min to max 1.5 – 4.5 kg. majority 203 (55.2%) of neonates had birth weight was 1.5 – 3.0 kg. pre term delivery was done in 195 (53%) neonates while 173 (46.7%) were documented in term neonates. Hyperbilirubinemia was found in 156 (42.4%) patients. Mean levels of hyperbilirubinemia in male v/s female was noted as (12.3±3.8) and (11.5±3.4) respectively and P value found to be significant i.e. (P=0.038). Proportion of hyperbilirubinemia was significantly high 92 (52.9%) in neonates with age &gt; 9 days (p=0.00). Advanced maternal age (&gt;30 years) was also significantly associated with hyperbilirubinemia 88 (50.9%), (p=0.002; OR=1.9). C-section was significantly associated with hyperbilirubinemia 99 (49.3%), (p=0.003). Practical Implication: This study aims to provide an answer to the question of whether gender affects the level of hyperbilirubinemia in neonates. The rationale behind this is that because both preterm and term neonates are affected by this condition, if it is determined that one gender is more affected and experiences higher levels of bilirubinemia, neonates of that specific gender can be closely monitored and followed up in the future. Conclusion: It is to be concluded that hyperbilirubinemia is a frequent finding among neonates who present with physiological jaundice. Therefore, to correctly diagnose and treat the disease, both parents and professionals should take precautions. Keywords: 1Hyperbilirubinemia, Neonates, Jaundice, Risk Factors, Etiology, Hemolysis

Does Gender Affect Levels of Hyperbilirubinemia in Term Neonates

Introduction: Hyperbilirubinemia is a common &amp; in most1cases, benign problem in1first month of1life which is often1physiologic &amp; intervention is not1usually1necessary. In the first week of life, about 60.0% of term &amp; 80.0% of preterm infants have jaundice. Jaundice could lead to major side effects like kernicterus and permanent impairment.1One of the most frequent disorders requiring medical1attention in babies is neonatal jaundice. It has high levels of unconjugated1bilirubin, which can occasionally lead to kernicterus. Objective: To determine frequency of hyperbilirubinemia among neonates who present with physiological jaundice and compare the mean levels of hyperbilirubinemia among genders. Methodology: A total of 368 consecutive neonates were included. This cross-sectional study1was conducted at Department of Paediatric Medicine, NICH Karachi during June 2020 to December 2020. All pre-term or term neonates of either gender with physiological jaundice, and get admitted to pediatric medicine department were included in this study. While Neonates who did not survive first 48 hours of life, neonates who were not exclusively breast fed as determined by History were excluded from study. Blood samples1were taken from the patients and concentrations of serum total bilirubin, In the centrifuged venous samples, direct &amp; indirect1bilirubin concentrations were determined. Serum total,1direct&amp; indirect bilirubin was recorded for each patient. Data was analyzed using IBM. SPSS 22 on computer. Results: Mean ±SD age of neonates was 10.6±4.2 days. In distribution of gender, 214 (58.2%) were male while 154 (41.8%) were female. Mean ±SD of birth weight was 3.4±1.8 kg. Mean ±SD of birth weight was 3.4±1.8 kg with min to max 1.5 – 4.5 kg. majority 203 (55.2%) of neonates had birth weight was 1.5 – 3.0 kg. pre term delivery was done in 195 (53%) neonates while 173 (46.7%) were documented in term neonates. Hyperbilirubinemia was found in 156 (42.4%) patients. Mean levels of hyperbilirubinemia in male v/s female was noted as (12.3±3.8) and (11.5±3.4) respectively and P value found to be significant i.e. (P=0.038). Proportion of hyperbilirubinemia was significantly high 92 (52.9%) in neonates with age &gt; 9 days (p=0.00). Advanced maternal age (&gt;30 years) was also significantly associated with hyperbilirubinemia 88 (50.9%), (p=0.002; OR=1.9). C-section was significantly associated with hyperbilirubinemia 99 (49.3%), (p=0.003). Practical Implication: This study aims to provide an answer to the question of whether gender affects the level of hyperbilirubinemia in neonates. The rationale behind this is that because both preterm and term neonates are affected by this condition, if it is determined that one gender is more affected and experiences higher levels of bilirubinemia, neonates of that specific gender can be closely monitored and followed up in the future. Conclusion: It is to be concluded that hyperbilirubinemia is a frequent finding among neonates who present with physiological jaundice. Therefore, to correctly diagnose and treat the disease, both parents and professionals should take precautions. Keywords: 1Hyperbilirubinemia, Neonates, Jaundice, Risk Factors, Etiology, Hemolysis

Umbilical Cord Blood Bilirubin, Albumin, Reticulocyte Count, and Nucleated Red Blood Cells to Predict Subsequent Hyperbilirubinemia in Term Neonates: A Prospective Observational Study.

Hyperbilirubinaemia is one of the most important causes of re-admission in the early neonatal period. The socioeconomic factors are one of the most common reasons for early discharge in a developing country like India. This study aims to evaluate and analyze the statistical correlation of umbilical cord blood bilirubin, albumin, nucleated red blood cells (nRBC), and reticulocyte count as early predictors of neonatal hyperbilirubinemia. A prospective observational study was conducted from November 2015 to April 2017 in a tertiary care hospital in North Karnataka, India. Umbilical cord blood was collected at birth for analysis of bilirubin, albumin, reticulocyte count, and nRBC in term neonates. Total serum bilirubin (TSB) levels were estimated using the VITROS BuBc Slide method at 72 hours of life. Data were analyzed using SPSS version 23 (IBM Corp., Armonk, NY). A total of 200 term neonates were enrolled in the study, out of which 123 completed follow-ups. Of the 66 newborns who had cord bilirubin levels ≥1.75 mg/dl, 23 (34.8%) developed hyperbilirubinemia after 72 hours of life, whereas 10 of the 57 newborns (17.5%) whose cord bilirubin levels <1.75 mg/dl developed hyperbilirubinemia after 72 hours of life. Cord blood albumin of ≥3.75 g/dl was seen in 93 neonates, of which 18 (19.4%) developed hyperbilirubinemia after 72 hours of life and 15 (50%) with <3.75 g/dl developed hyperbilirubinemia after 72 hours of life. Cord reticulocyte count ≥4.95% was seen in 54 neonates; 20 (37.03%) developed hyperbilirubinemia, whereas in 69 neonates with <4.95%, 13 (18.84%) developed hyperbilirubinemia after 72 hours of life. Of the 62 neonates who had cord nRBC ≥3.5%, 28 (45.2%) neonates developed hyperbilirubinemia after 72 hours of life, whereas 5 of the 61 neonates (8.19%) with cord nRBC <3.5% developed hyperbilirubinemia after 72 hours of life. Cord blood bilirubin, albumin, reticulocyte counts, and nucleated RBC can be used as predictors of subsequent neonatal hyperbilirubinemia.

Oral fenofibrate for hyperbilirubinemia in term neonates: A single-blind randomized controlled trial

Hyperbilirubinemia is common in the neonatal period; however, delayed diagnosis or inadequate treatment can cause irreparable damage to the neonates. We aimed to evaluate the efficacy of oral fenofibrate for hyperbilirubinemia in term neonates. This single-blind randomized controlled trial included 86 term neonates aged 3-7 days, with birth weight ≥2500 g, admitted to Bandar Abbas Children's Hospital, Bandar Abbas Iran, from July 23, 2019, to July 22, 2020. The fenofibrate group received 10 mg/kg oral fenofibrate and phototherapy, while controls only received phototherapy. Serum total bilirubin was measured at 24 and 48 h and at the time of discharge. Hospital length of stay was also noted. The two study groups were comparable regarding age, gender, gestational age, birth weight, and baseline total serum bilirubin levels. Serum total bilirubin levels at 48 h (P < 0.001) and at discharge (P < 0.001) were significantly lower in the fenofibrate group compared to controls. Although hospital length of stay was lower in the fenofibrate group compared to controls, the difference was not statistically significant (P = 0.612). Fenofibrate was more effective on the reduction of serum bilirubin in neonates aged 3-4.5 days starting at the 24th hour. Moreover, it was more effective in female neonates compared to males starting at the 48th hour. A single dose of oral fenofibrate reduced total serum bilirubin in term neonates with hyperbilirubinemia without any side effects; however, this effect was more prominent after 48 h.

Role of Cord Blood Alkaline Phosphatase as a Predictor for Hyperbilirubinemia in Full-term Neonates

Role of Cord Blood Alkaline Phosphatase as a Predictor for Hyperbilirubinemia in Full-term Neonates

Prospective study to determine weight loss as predictor for neonatal hyperbilirubinemia in term neonates

Background: Neonatal hyperbilirubinemia is a common clinical problem encountered during the neonatal period, especially in the first week of life. Significant hyperbilirubinemia is associated with a greater weight loss after 72 hours of life. Poor caloric intake seems to have a greater effect on the regulation of serum bilirubin. Aim of the study: To determine if weight loss can be a predictor for neonatal hyperbilirubenemia in term neonates. Material and Methods: This was a prospective study done in department of Paediatrics, MediCiti Institute of Medical Sciences, Medchal, Telangana for a duration of one year from March 2019 to February 2020. Results: 63.6% (35/55) showed weight loss more than 7% and 36.6% showed weight loss less than 7%. Inadequate breast feeding was seen in 81.8% (45/55) cases and 18.1% showed adequate breast feeding. Conclusion: In our study birth weight loss after 72 hours of birth can be a predictor factor for neonatal hyperbilirubinemia, and may also serve as a helpful clinical factor to prevent significant hyperbilirubinemia 72 hours after birth. Keywords: Neonatal hyperbilirubinemia, Birth weight loss, Serum bilirubin.

Serum 25-Hydroxyvitamin-D Level in Full-term Neonates with Indirect Hyperbilirubinemia at a Level Requiring Phototherapy

Background: Low antioxidant system may contribute to the severity of neonatal hyperbilirubinemia. Aim of the work: This study was performed to clarify the relationship between serum 25-hydroxyvitamin-D (25[OH] D) and the hyperbilirubinemia in full-term neonates. Methods: This is a cross sectional case control study performed with the aim of determining whether there is an association between serum indirect bilirubin and serum vitamin D levels in newborns with jaundice at a level necessitating phototherapy. The study was carried on 60 full term newborns admitted to the Neonatal Intensive Care Unit of Minia University Hospital, from April 2017 to December 2017. They were classified into 2 groups, Group I: (cases): Newborns with postnatal ages of 3-10 days and gestational ages of 37-40 weeks, with a bilirubin level above the pre-set threshold for phototherapy as recommended by the American Academy of Pediatrics (AAP). Group II :( controls) 30 matched apparently normal healthy newborns were enrolled in the study as a control group. The study included the mothers of case group. All laboratory investigations were done in clinical pathology department, Minia University hospital. Results: Serum Vitamin D levels were significantly lower in patients than controls (p < 0.01). There was a strong negative correlation between neonatal total serum bilirubin level and neonatal serum vitamin D in cases group. In addition, we observed that there was a highly statistically significant positive correlation between serum vitamin D level of neonates and their maternal serum level was present. Conclusions: Indirect hyperbilirubinemia in full-term neonates is associated with decreased serum levels of (25[OH] D)

Home phototherapy for hyperbilirubinemia in term neonates\u2014an unblinded multicentre randomized controlled trial

The aim of this study was to assess whether home phototherapy was feasible and safe in a cohort of otherwise healthy term-born neonates who fulfilled the criteria for in-hospital phototherapy. This was a randomized controlled trial in which term newborns with a total serum bilirubin of 18–24 mg/dL (300–400 μmol) were randomized to either home phototherapy or conventional in-hospital phototherapy. The primary outcome measurements were safety and efficacy, length of stay and the number of failed treatments. The secondary outcomes were the number of blood samples and weight gain during treatment. One hundred forty-seven patients were recruited, 69 patients randomized to conventional phototherapy and 78 to home phototherapy. The results showed that no patients needed blood exchange and only 4% of the patients allocated to home phototherapy were admitted to the hospital. The duration of phototherapy, length of stay, amount of blood tests and weight change showed no statically significant differences.Conclusion: Home phototherapy could be a safe alternative to inpatient phototherapy for otherwise healthy newborns with hyperbilirubinemia if daily checkups and 24/7 telephone support can be provided. The parents should be informed to contact the hospital immediately if they fail to perform the treatment at home.Trial registration: Clinicaltrials.gov NCT03536078What is Known:• Phototherapy in the hospital is a safe and effective treatment without major side effects.• Fibre optic equipment has made the choice of home phototherapy possible.What is New:• This is the first randomized controlled trial comparing home phototherapy with hospital phototherapy.• Results indicate that home phototherapy could be considered as a safe and feasible alternative when performed according to instructions given, to hospital treatment for otherwise healthy term newborns.

Role of Cord Blood Carboxyhemoglobin in Detecting Significant Hyperbilirubinemia in Term Neonates with ABO Alloimmunization.

This study aimed to assess whether cord blood carboxyhemoglobin (COHb) levels in jaundiced term neonates with and without a positive direct Coombs test (DCT) and in healthy controls could be used as a predictor of severe hyperbilirubinemia. The percentage of cord blood COHb should be higher among neonates with Coombs-positive ABO hemolytic disease than among those with Coombs-negative ABO incompatibility and higher than that of ABO-compatible control neonates. This cross-sectional descriptive study of 198 term neonates comprised three subgroups: group I featured 68 DCT-positive ABO-incompatible neonates (ABO + DCT), group II featured 60 DCT-negative ABO-incompatible neonates with hyperbilirubinemia (ABO-DCT), and group III featured 70 healthy controls. COHb was determined by an OSM3 hemoximeter. Group I differed from groups II and III for cord blood bilirubin, cord blood hemoglobin, and cord blood hematocrit. Groups I and II had higher mean total serum bilirubin (TSB) levels than group III, while there was no difference in the mean TSB levels between groups I and II. There was no significant difference between the COHb group means for groups I, II, and III (p = 0.98). The area under the receiver operating characteristic curve calculated for group I/group III and group II/group III were found to be 0.62 and 0.54, respectively. COHb levels did not prove to be superior to the DCT for predicting the risk of developing severe hyperbilirubinemia in term neonates. · COHb levels do not predict the risk of developing severe hyperbilirubinemia in term neonates.. · COHb levels may predict that ABO incompatibility in early life.. · COHb levels did not prove to be superior to the direct coombs test..

The risk of hyperbilirubinemia in term neonates after placental transfusion - a randomized-blinded controlled trial.

We aimed to demonstrate non-inferiority of delayed cord clamping (DCC) and cord milking (CM) in comparison to early cord clamping (ECC) in the incidence of hyperbilirubinemia requiring phototherapy. 467 of maternal-foetal dyads were screened for eligibility. 389 term infants, of breastfeeding, non-smoking mothers were randomized to receive ECC ( < 40 s), DCC (1-2 min) or CM (4 times towards the neonate). The primary outcome was defined as hyperbilirubinemia requiring phototherapy. 307 patients were included in the analysis. CM did not increase the risk of phototherapy RR 11.27 95% CI (0.80; 2.04). Similar results were achieved when comparing DCC and ECC, RR 1.29 95% CI (0.82; 2.05). This was also true for CM vs DCC, RR 0.99 95% CI (0.64; 1.52). The prevalence of total serum bilirubin (TSB) at 24-48 hours was 10.8 mg/dL; 10.33 mg/dL and 11.39 in ECC, CM and DCC group respectively. Transcutaneous bilirubin (TcB) levels at 24-48 h were 7.58 mg/dL, 7.89 mg/dL and 7.60 mg/dL in the ECC, CM and DCC respectively. None of the neonates met exchange transfusion criteria or symptomatic polycythaemia. Our study suggests that placental transfusion is not associated with hyperbilirubinemia requiring phototherapy or exchange transfusion.

"Effect of zinc supplementation on serum bilirubin level in term neonates undergoing phototherapy"

Background: Neonatal jaundice is considered a major health problem in neonates owing to bilirubin deposition. Recently, zinc demonstrated a high efficiency in reduction of low bilirubin level when administrated in association with phototherapy. Aim of the work: To assess efficiency and safety of oral zinc as a therapy in treatment of indirect hyperbilirubinemia in term neonates during phototherapy. Patients and Methods:A total of 100 term neonates with indirect hyperbilirubinemia were divided into two equal groups: Intervention Group (n=50) received oral zinc sulphate preparation, in a dose of 5 mg twice daily in combination with phototherapy. Control group (n=50) received phototherapy without oral zinc supplementation. In both groups, the total serum bilirubin levels were measured at admission, 12 hours, 24 hours and at discharge. Results: Treatment of full-term neonates with hyperbilirubinemia by oral zinc sulfate at a dose of 5 mg given twice-daily induce a significant reduction of total serum bilirubin [TSB] after 12 hours, 24 hours and at discharge when compared to the control group. The duration of phototherapy in intervention group was markedly decreased with statistically significant difference in comparison to the control group. However, there was no significant differences between groups regarding adverse effects of phototherapy and zinc therapy. Conclusion: Oral zinc could play a major role in the management of neonatal jaundice when administrated at dose of ten mg/day as it can decrease the neonatal TSB with subsequent reduction of phototherapy duration.

Genetic Factors and Delayed TSB Monitoring and Treatment as Risk Factors Associated with Severe Hyperbilirubinemia in Term Neonates Admitted for Phototherapy.

This study aimed to determine whether maternal-fetal blood group isoimmunization, breastfeeding, birth trauma, age when first total serum bilirubin (TSB) was measured, age of admission, and genetic predispositions to hemolysis [due to genetic variants of glucose-6-phosphate dehydrogenase (G6PD) enzyme], and reduced hepatic uptake and/or conjugation of serum bilirubin [due to genetic variants of solute carrier organic anion transporter protein family member 1B1 (SLCO1B1) and uridine diphosphate glucuronosyltransferase family 1 member A1 (UGT1A1)] were significant risk factors associated with severe neonatal hyperbilirubinemia (SNH, TSB ≥ 342µmol/l) in jaundiced term neonates admitted for phototherapy. The inclusion criteria were normal term neonates (gestation ≥ 37 weeks). Parents/care-givers were interviewed to obtain data on demography, clinical problems, feeding practice and age when first TSB was measured. Polymerase chain reaction-restriction fragment length polymorphism method was used to detect common G6PD, UGT1A1 and SLCO1B1 variants on each neonate's dry blood specimens. Of 1121 jaundiced neonates recruited, 232 had SNH. Logistic regression analysis showed that age (in days) when first TSB was measured [adjusted odds ratio (aOR) = 1.395; 95% confidence interval (CI) 1.094-1.779], age (in days) of admission (aOR = 1.127; 95% CI 1.007-1.260) and genetic mutant UGT1A1 promoter A(TA)7TAA (aOR = 4.900; 95% CI 3.103-7.739), UGT1A1 c.686C>A (aOR = 6.095; 95% CI 1.549-23.985), SLCO1B1 c.388G>A (aOR = 1.807; 95% CI 1.242-2.629) and G6PD variants and/or abnormal G6PD screening test (aOR = 2.077; 95% CI 1.025-4.209) were significantly associated with SNH. Genetic predisposition, and delayed measuring first TSB and commencing phototherapy increased risk of SNH.

Efficacy of oral agar in management of indirect hyperbilirubinemia in full-term neonates

Aim This prospective randomized case control study aimed to investigate effect of oral agar administration in reducing total serum bilirubin (TSB) levels in full-term neonates with jaundice in comparison with control. Materials and methods One hundred sixty full-term neonates were enrolled with TSB 10–19 mg/dl at first week of age from Assiut University Children’s Hospital. Neonates were divided according to TSB into outpatient group (n = 100) (TSB 10–15 mg/dl) and admitted group (n = 60) (TSB > 15–19 mg/dl). Outpatients group were subdivided into agar group received oral agar and control group received placebo. Admitted group were subdivided into agar group received oral agar plus phototherapy combination and control group received phototherapy alone. Neonates in the agar supplementation received oral agar 600 mg/kg/day dissolved in 10 ml distilled water twice daily till TSB decreased to 7 mg/dl. Daily weight, stool frequency and side effects of treatment were observed for each group. TSB was determined pretreatment then serially every 48 h until TSB level reaching ≤7 mg/dl. Results Agar fed was effective in lowering TSB in neonates with TSB 10–15 mg/dl. TSB percentage changes were not significantly lower in agar-fed newborn with TSB >15–19 mg/dl compared with control groups after 24 h and 7 days. Age fed shortened the time required to decrease TSB and increased stooling frequency. Conclusions Oral agar supplemented feeding at 600 mg/kg/day is safe for full-term neonates and useful in decreasing TSB and phototherapy duration. The efficacy of phototherapy in decreasing TSB level in neonatal hyperbilirubinemia can be augmented with oral agar usage.

Umbilical cord albumin and serum bilirubin as predictive factors for hyperbilirubinemia in term neonates

Background: Hyperbilirubinemia is one of the common causes of neonatal admission. As clinical evaluation may cause a delay in identification and subsequent initiation of medical therapy, there is a need for the sensitive and inexpensive predictive marker for hyperbilirubinemia in neonates. Measurement of cord albumin and its correlation with the serum bilirubin is one of the noninvasive predictive markers for Hyperbilirubinemia. The present study carried out to know the significance of umbilical cord albumin level as a predictor of neonatal hyperbilirubinemia.Methods: It is a hospital-based prospective cohort study, total 100 healthy term new-borns admitted in the Neonatal Intensive Care Unit, were included in the study as per study protocol over a period of one year. The blood sample was collected from umbilical cord blood for the analysis of bilirubin and albumin, and post 72 hours of life venous blood obtained for estimation of serum bilirubin and albumin along with direct and indirect Coombs test.Results: In this study most of the patients were in the gestational age of 37-38 weeks (71%) followed by 38-40 weeks (27%) and only 1% are &gt;40 weeks. A positive correlation was observed between cord blood bilirubin, serum bilirubin, serum albumin, and cord blood albumin levels. Cord blood albumin was a better marker for neonatal hyperbilirubinemia with a sensitivity of 83%, and a specificity of 48%; as compared to cord blood bilirubin with a sensitivity and specificity of 73% and 39% respectively.Conclusions: From this study, cord blood albumin level was demonstrated as a good predictive marker for neonatal hyperbilirubinemia with a sensitivity of 83.1%. and specificity 48.8%. Hence, cord blood albumin may be used as a non-invasive predictor for neonatal hyperbilirubinemia.

Correlation between Prolonged Hyperbilirubinemia and Serum Zinc Level in Term Neonates

Background: Prolonged hyperbilirubinemia is defined as jaundice persisting more than two and three weeks of life in term and preterm neonates, respectively. In total, 15-40% of jaundiced neonates became prolonged. The most common causes of prolonged hyperbilirubinemia are breastfeeding, infection, hypothyroidism, and continued hemolysis. Given the fact that no study was conducted on the association between the serums zinc level and prolonged hyperbilirubinemia, this study aimed to compare the healthy neonates with newborns suffering from prolonged hyperbilirubinemia in terms of serum zinc level.Methods: This cross-sectional analytical descriptive study with a control group included all neonates who had a history of hospital admission and phototherapy due to hyperbilirubinemia at Amirkola Children’s Hospital, Babol, Iran. After discharge, on the 14th day of birth, all neonates followed up at the outpatient clinic. The serum bilirubin was checked and the neonates were assigned into the case (with prolonged hyperbilirubinemia) and control (without prolonged hyperbilirubinemia) groups. Both groups were matched regarding confounding factors. Serum zinc level was measured using the colorimetric method and the two groups were compared in this regard.Results: In total, 60 neonates in the case (n=30) and control (n=30) groups were investigated in this study. The serum zinc levels in the case and control groups were 83.7±35.35 and 92.73±38.13 μg/dl, respectively. There was no significant difference between the two groups in terms of the serum zinc level (P=0.34).Conclusion: There is no statistically significant correlation between the serum zinc level and prolonged hyperbilirubinemia in term neonates who had been treated with phototherapy.