Icteric Neonates Research Articles

The effect of intravenous fluid therapy in icteric neonates during phototherapy: A randomized clinical trial -

Jaundice is the most prevalent neonatal clinical complication. One of the causes of this disease is the insufficiency of mother's milk to feed the neonate. Therefore, fluid therapy is considered as one of the useful intervention to alleviate jaundice. This study was designed to examine the effect of intravenous fluid therapy on icteric neonates who are also treated by phototherapy. A clinical research was conducted on 100 icteric neonates hospitalized in the hospitals of the city of Kashan during the year 2014. They were randomly assigned into two equal groups of intervention and control groups. The case group was treated by photo plus fluid therapy whereas the control group was treated by the phototherapy only. The bilirubin level of neonates was measured at admission, 6, 12 and 24 hours after the start of the treatment in both groups. The rebound bilirubin level was measured 12 hours after the termination of the phototherapy. The results of analysis indicated that there was no significant difference in the bilirubin decrease between the photo plus fluid therapy and the phototherapy-only group after 6, 12 and 24 hours of treatment (p>0.05). However, when the bilirubin level of the treated group was very high there was a significant difference between the bilirubin decrease of the photo plus fluid therapy and the phototherapy group alone after 6, 12 and 24 hours of treatment (p<0.05). The level of bilirubin rebound in the photo plus fluid therapy was more than the control group and needed-phototherapy again; therefore, the time for the phototherapy in the photo plus fluid therapy was longer than the control group. Despite the fact that using fluid therapy in the group with very high level of bilirubin causes decrease of bilirubin level, it leads to the increase of bilirubin rebound and the need to use phototherapy again. Therefore, this treatment is useful for the cases of severe jaundice that require blood transfusion even though it results in longer periods of phototherapy and the length of hospitalization.

Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia and Neurotoxicity in Neonates from Hilly Terrain of India.

Background and Aim:Neonatal hyperbilirubinemia continues to be the most common cause of hospital admissions and readmissions in the neonatal population worldwide and this pattern continues despite attempts to identify neonates at risk of pathological hyperbilirubinemia. Therefore, this study aimed to study the risk factors for severe hyperbilirubinemia in neonates.Materials and Methods:An observational prospective study was undertaken for 1 year in neonates with hyperbilirubinemia requiring double volume exchange transfusion in neonatology unit of a tertiary rural health care hospital.Results:Risk factors included ABO incompatibility in 14 (28.5%), Rh incompatibility in 14 (28%). Other risk factors for hyperbilirubinemia were, jaundice in elder sibling, oxytocin use, birth asphyxia, hypothyroidism, ABO along with Rh incompatibility, Glucose-6 phosphate Dehydrogenase deficiency, cephalhematoma, and sepsis in neonates. Ten (20%) neonates were neurologically abnormal with signs of encephalopathy. Significant association of risk factors with neurotoxicity were also found. All neurologically abnormal neonates were small for date and none was appropriate for date (P = 0.05). There were no neurologically abnormal neonates with A+ and O− mothers (P = 0.04).Conclusion:The high rate of exchange transfusion warrants aggressive management of neonatal hyperbilirubinemia by health-care providers by adequate dissemination of information, strict following of hour-based normograms, performing total serum bilirubin assessment in all icteric neonates, and stratification into risk groups thereafter.

The effect of intravenous fluid therapy in icteric neonates during phototherapy: A randomized clinical trial

The effect of intravenous fluid therapy in icteric neonates during phototherapy: A randomized clinical trial

Evaluation of the Predictive Value of Umbilical Cord Serum Bilirubin Level for the Development of Subsequent Hyperbilirubinemia in Term and Late-Preterm Neonates

Background: Considering the increasing rates of early hospital discharge and kernicterus in healthy full term newborns, timely identification of neonates at risk of severe hyperbilirubinemia is of great significance. The aim of this study was to investigate the predictive value of umbilical cord serum (UCS) bilirubin level for subsequent hyperbilirubinemia. Moreover, we compared the predictive value of UCS bilirubin with that of risk factor assessment and predischarge bilirubin level. Methods: In this prospective, cohort study, 450 healthy neonates born at the gestational age of ³ 35 weeks were included. UCS bilirubin concentration, direct Coombs test results, and blood group were determined in the newborns. Total serum bilirubin level was re-assessed before hospital discharge. The subjects were followed-up for 1-4 days after discharge and the total serum bilirubin level was measured in neonates with clinical jaundice. Results of the assessment of risk factors for hyperbilirubinemia were recorded. Results: In total, 319 newborns were followed-up within the study period. The mean UCS bilirubin level in non-icteric and icteric neonates was 2.35 and 2.49 mg/dl, respectively. No significant relationship was found between UCS bilirubin level and development of hyperbilirubinemia (P=0.30), whereas a significant correlation was detected between predischarge bilirubin level and development of jaundice (P=0.009). Gestational age, birth weight, history of jaundice in siblings, and mode of delivery were the clinical risk factors which showed a significant correlation with postnatal hyperbilirubinemia. Conclusion: Based on the findings, UCS bilirubin level could not predict subsequent hyperbilirubinemia. Therefore, the best predictive marker for neonatal jaundice is the assessment of clinical risk factors and predischarge bilirubin level.

Glucose-6-Phosphate Dehydrogenase Deficiency and Neonatal Hyperbilirubinemia

Background: Jaundice is affecting over 60-80 percent of neonates in the first week of life. Glucose-6-phosphate dehydrogenase (G6PD) deficiency, which is an important cause of pathologic hyperbilirubinemia, can lead to hemolytic anemia, jaundice and kernicterus. The present study was performed to determine the prevalence of G6PD deficiency among icteric neonates in Shirvan, Iran. Methods: This descriptive, analytical study was performed by evaluating the medical records of neonates with jaundice, admitted to the neonatal ward of Imam Khomeini Hospital of Shirvan in 2012-2013. All neonates, who were evaluated in terms of G6PD, were included in this study. Data including the clinical signs and symptoms, laboratory test results and maternal history during pregnancy were recorded in the questionnaires. The patients were divided into two groups: with and without G6PD deficiency. The recorded data were compared between the two groups, using t-test and Chi-square test. P-value less than 0.05 was considered statistically significant. Results: Among 452 admitted neonates, 16 (3.5%) presented with G6PD deficiency. There was no significant difference between the two groups in terms of birth weight, weight on admission, Coombs’ test results, hematocrit level, length of hospital stay and total bilirubin level. However, there was a significant difference between the two groups regarding reticulocyte count. Conclusion: Based on the findings, establishment of an early G6PD screening program, which can prevent further complications in neonates, seems essential, particularly in countries such as Iran where G6PD deficiency is highly prevalent.

Hyperbilirubinemia and phototherapy in newborns: Effects on cardiac autonomic control

BackgroundNeonatal jaundice and its phototherapeutic treatment can lead to several side effects involving activation of autonomic control mechanisms. AimThe aims of this study are to investigate the autonomic nervous system changes in icteric neonates using heart rate variability (HRV) and to assess the effect of phototherapy on short-term heart rate dynamics as an indicator of autonomic nervous control of cardiovascular system. MethodsHRV recordings from 20 icteric full-term neonates before, during and after phototherapy and from 20 healthy controls were analyzed. In addition to traditional time and frequency domain measures, heart rate complexity parameters including normalized complexity index (NCI), normalized unpredictability index (NUPI), pattern classification indices (0V%, 1V%, 2LV%, 2UV%) and irreversibility index (P%) on four time scales were evaluated. All measures were derived from data segments of 1000 RR intervals. ResultsThe analysis revealed higher values of 1V%, 2LV%, and lower P% in neonates with hyperbilirubinemia compared to controls. While HRV magnitude did not change, mean heart rate increased during and after the phototherapy. Nonlinear analysis showed a decrease of complexity, unpredictability and pattern classification measures 2LV% and 2UV%. In contrast, 0V% and irreversibility index P% were increased during and at least 30min after phototherapy. ConclusionThe results suggest a shifted autonomic balance in icteric neonates compared to the controls and its further alterations during phototherapy. As the nonlinear HRV parameters are independent of the linear methods, they can provide new information about the cardiac regulatory mechanisms and their changes in neonates.

PS-201a Hyperbilirubinemia And Phototherapy In Newborns Affect Cardiovascular Autonomic Control

<h3>Background</h3> Neonatal jaundice and its phototherapeutic treatment can lead to side effects involving activation of autonomic control mechanisms. <h3>Aim</h3> To investigate the autonomic nervous system changes in icteric neonates using heart rate variability (HRV) and to assess the effect of phototherapy on HRV as an indicator of autonomic nervous control of cardiovascular system. <h3>Methods</h3> HRV recordings of 20 icteric full-term neonates before, during and after the phototherapy and of 20 healthy controls were analysed. Besides traditional time and frequency domain measures, HRV complexity parameters including normalised complexity index (NCI), normalised unpredictability index (NUPI), pattern classification (0V%, 1V%, 2LV%, 2UV%) and multiscale irreversibility indices (P%, G%, E) were evaluated. All measures were derived from data segments of 1000 RR intervals. <h3>Results</h3> The analysis revealed higher values of 1V% and 2LV%, lower P% and reduced percentage of irreversible HRV recordings in the group of neonates with hyperbilirubinemia. While mean heart rate was increased during and after the phototherapy, HRV magnitude was not changed. Nonlinear analysis showed a decrease of complexity, unpredictability and pattern classification measures 2LV% and 2UV%. In contrast, 0V%, P% and the percentage of irreversible recordings were increased during and after the phototherapy. <h3>Conclusion</h3> The results suggest a shifted autonomic balance in icteric neonates compared to the controls and its further alterations during phototherapy. As the nonlinear HRV parameters are independent of the linear methods, they can provide new information about the cardiac regulatory mechanisms and their changes in neonates. Supported by grants VEGA N. 1/0223/12, 1/0059/13 and APVV-0235–12.

Comparing the effect of clofibrate and phenobarbital on the newborns with hyperbilirubinemia.

The aim of treating hyperbilirubinemia is preventing the serum bilirubin to reach neurotoxic levels, which is done by phototherapy or blood transfusion. However, pharmacological treatments still remain vague. Therefore the effects of adding either clofibrate or phenobarbital on treatment outcomes was evaluated in icteric non-hemolitic newborns. Ninety neonates were divided in three groups. Two groups were prescribed 100 mg/kg clofibrate or 5 mg/kg phenobarbital orally as single dose on arrival, in addition to phototherapy. The control group only received phototherapy. Serum bilirubin was evaluated at the reception and 12, 24, 48 and 72 hours after beginning of drug therapy. Total bilirubin levels decreased in treated groups compared with the control group in all samples taken (12, 24, 48 and 72 hours). Clofibrate effect in decreasing bilirubin level was more prominent (14 % and 32 % after 12 and 72 h respectively). In addition duration of hospitalization and length of phototherapy decreased in clofibrate and phenobarbital groups compared with control group (1.5, 2 days respectively, vs. 2.6 days). Therefore using clofibrate and phenobarbital in icteric neonates are supportive not only by decreasing the serum bilirubin level, but also by lessening the duration of hospitalization and phototherapy. Thus in addition to cost benefits for the patient these drugs can reduce the risks of transfusion, and clofibrate seems more promising in this regard.

Neonatal Hyperbilirubinemia in infants with G6PD c.563C &gt; T Variant

BackgroundThere is a strong correlation between glucose-6-phosphate dehydrogenase (G6PD) deficiency and neonatal hyperbilirubinemia with a rare but potential threat of devastating acute bilirubin encephalopathy. G6PD deficiency was observed in 4–14% of hospitalized icteric neonates in Pakistan. G6PD c.563C > T is the most frequently reported variant in this population. The present study was aimed at evaluating the time to onset of hyperbilirubinemia and the postnatal bilirubin trajectory in infants having G6PD c.563C > T.MethodsThis was a case–control study conducted at The Aga Khan University, Pakistan during the year 2008. We studied 216 icteric male neonates who were re-admitted for phototherapy during the study period. No selection was exercised. Medical records showed that 32 were G6PD deficient while 184 were G6PD normal. Each infant was studied for birth weight, gestational age, age at the time of presentation, presence of cephalhematoma, sepsis and neurological signs, peak bilirubin level, age at peak bilirubin level, days of hospitalization, whether phototherapy or exchange blood transfusion was initiated, and the outcome. During hospital stay, each baby was tested for complete blood count, reticulocyte count, ABO and Rh blood type, direct antiglobulin test and quantitative G6PD estimation [by kinetic determination of G6PDH]. G6PDgenotype was analyzed in 32 deficient infants through PCR-RFLP analysis and gene sequencing.ResultsG6PD variants c.563C > T and c.131 C > G were observed in 21 (65%) and three (9%) of the 32 G6PD deficient infants, respectively. DNA of eight (25%) newborns remained uncharacterized. In contrast to G6PD normal neonates, infants with c.563C > T variant had significantly lower enzyme activity (mean ± 1SD; 0.3 ± 0.2 U/gHb vs. 14.0 ± 4.5 U/gHb, p < 0.001) experienced higher peak levels of total serum bilirubin (mean ± 1SD; 16.8 ± 5.4 mg/dl vs. 13.8 ± 4.6 mg/dl, p = 0.008) which peaked earlier after birth (mean ± 1SD 2.9 ± 1.6 vs. 4.3 ± 2.3 days, p = 0.007). No statistically significant difference was observed in mean weight, age at presentation, hemoglobin, reticulocyte count, TSH level, hospital stay or in the frequency of initiation of phototherapy or blood exchange between the two groups.ConclusionsWe concluded that infants with G6PD c.563C > T variant developed jaundice earlier than infants with normal G6PD enzyme levels. Compared to G6PD normal infants, G6PD c.563C > T carrying infants had significantly low G6PD activity.

Hemolytic Events in Rh Positive Neonates Born to Rh Negative Mothers

Background One of the most important cause of severe neonatal hyperbilirubinemia is hemolysis including Rh incompatibility. The aim of this study was to assess the rate of hyperbilirubinemia due to hemolysis in Rh positive neonates born to Rh negative mothers. Methods In this retrospective study from March 1998 to February 2003, 60 icteric Rh positive newborns that were born to Rh negative mothers, were studied. The data of patients were gathered from questionnaires sheets. Results The rate of hemolysis due to Rh incompatibility was 18.3%. The mean age of mothers was 31.9 years (SD:4.6). The mean level of hemoglobin in these patients was significantly lower (P=0.009) and serum bilirubin levels higher than nonhemolytic icteric neonates (P=0.007). The mean age of onset of jaundice in hemolytic neonates was 1.55 days (SD: 618) and in nonhemolytic patients 2.08 (SD:1.03) days. Exchange blood transfusion was performed for 23 neonates (38.3%). In 61.7% of cases no history of anti-D immunoglobulin given during pregnancy or at delivery was present. Conclusion Due to poor prenatal care consisting of inadequate provision of anti-D immunoglobulin in Rh negative mothers, sensitization to Rh antigen in our Rh negative mothers was considerably high.

The effect of Ophthalmic Patch on Conjunctiva of Neonates under Phototherapy

Objective Conjunctivitis is a common disease in neonates. Several bacterial and viral infectious agents may cause it. Tear circulation and blinking has protective effects from bacterial colonization in the conjuntival sac. Reduced blinking increases the possibility of bacterial conjunctivitis. We studied the effect of eye patches on bacterial colonization of the conjunctival sac. Methods In 100 icteric neonates who needed phototherapy and occlusive patches for their eyes during the procedure we did conjunctival bacterial culture before and after 48 hrs after occlusive patches. The results of two cultures were analyzed with statistical tests, McNemar, chi- square and, binominal with SPSS V18 software. Results In 100 neonates there were 51 (51%) males 49 (49%) females. The mean birth weight was 2578±736 g. Culture before ophthalmic patches showed 20 (20%) cases with positive conjunctival cultures and 76 cases (76%) with positive culture 48 hrs after use of eye patches. Conclusion Eye patches during phototherapy increase bacterial colonization in the conjunctival sac. We must be aware of this complication during phototherapy.

284 Comparison of Molecular Mutations of G6Pd Gene Between Icteric and Non Icteric Neonates

Objective: Jaundice is a common disorder in neonates and G6PD deficiency could result in kernicterus. The aim of This study was to compare of G6PD mutation in icteric and non icteric neonates. Methods: This case-control study was done in 50 icteric neonates with G6PD deficiency that needed phototherapy or exchange were selected as case group and 50 non icteric neonates with G6PD deficiency that were admitted to NICU and newborn ward with non icteric etiology were selected as control group.. 2 cc peripheral blood samples were collected in EDTA tube after obtaining parent consent.. G6PD deficiency was diagnosed with FST (Floorescent Spot Test) and billirubin was measured with DSA method. In first stept, all samples were evaluated for Mediterranean mutation and then negative samples were tested for Chatham mutation and finally all remaining samples were tested for Cosenza mutation. Findings: In non icteric group 54% were Mediterranean, 18% Chatham, 28% Cosenza negative and in icteric group 56% were Mediterranean, 32% Chatham, 12% Cosenza negative and the distribution of Mediterranean and Chatham mutations were not significantly different between two groups (p>0.05) and distribution of rare mutations (Cosenza negative) was significantly different between icteric and non icteric group (p< 0.05). Exchange transfusion in neonates with chatham mutation was needed significantly less than photothrapy (p< 0.05). Conclusion: Mediterranean mutation was the most frequent mutation in icteric and non icteric neonates of our region. but rare mutations (Cosenza negative) were more prevalent in non icteric group. Need to exchange transfusion was less in chatham mutation.

Late onset jaundice and urinary tract infection in neonates

To determine the prevalence and the associated parameters of urinary tract infection (UTI) in infants with late onset jaundice. This prospective analytic study was conducted among 400 cases, selected by simple sampling from neonates with late onset jaundice admitted in two referral hospitals of Isfahan during a 9-month period. The information including the age, sex and feeding type, as well as the results of physical examination, treatment, radiology studies, etc were recorded. The etiology of jaundice was assessed by laboratory tests. Urine analysis and urine culture were performed for all subjects. XZ and t-test were used for analysis of the data in- SPSS software. Of the 400 icteric neonates, 147 (36.8%) were female and 253 (63.3%) were male; 23 (5.8%) were diagnosed to have UTI, 5 cases (1.3%) had G6PD deficiency, 19 (4.8%) had dysmorphic red blood cell and 3(0.75%) had ABO or RH incompatibility. The relation between the type of feeding, circumcision and UTI was significant (P< 0.05). Of the 23 neonates with UTI,4 cases (17. 39%) were found to have urogenital abnormality. UTI was found in 5.8% of infants with late onset jaundice. The study revealed significant association between breast feeding, circumcision and lower prevalence of UTI in icteric neonates. It is suggested that evaluation for UTI should be considered as a screening test in all cases of neonatal late onset jaundice.

Transcutaneous Bilirubinometery Compared with Serum Level of Bilirubin in Icteric Neonates in Zahedan

Transcutaneous Bilirubinometery Compared with Serum Level of Bilirubin in Icteric Neonates in Zahedan

Glucose-6-phosphate dehydrogenase deficiency in neonates.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited deficiency that may be the cause of neonatal hyperbilirubinemia, as has been found in several countries and among widely different ethnic groups, especially in Mediterranean region. Our aim was to study the prevalence of G6PD deficiency in relation to neonatal jaundice. From March 1998 to April 2001 we studied 705 clinically icteric neonates who were admitted to Al-Zahra and Beheshti hospitals, two teaching hospitals in Isfahan, Iran. Laboratory investigations included determination of direct and indirect serum bilirubin concentrations, blood group typing, direct coomb's test, hemoglobin, blood smear, reticulocyte count and G6PD level. In only 53 (7.5%) of cases G6PD deficiency was diagnosed. In all G6PD deficient neonates no evidence of other factors known to cause hyperbilirubinemia were detected. The sex distribution was 13 (24.5%) females and 40 (75.5%) males in the G6PD deficient group. The mean bilirubin level in G6PD deficient and G6PD normal groups were 22.26 +/- 8.36 and 18.14 +/- 3.85 mg/dl, respectively (p=0.001). Phototherapy was required in G6PD deficient and other icteric neonates with duration of 3.76 +/- 1.93 and 3.13 +/- 2.14 days, respectively (p=0.045). Twenty-seven of the 53 (50.9%) G6PD deficient infants required exchange transfusion. None of them developed kernicterus. Since the prevalence of severe hyperbilirubinemia among our neonates was relatively high and about half of them required exchange transfusion, early detection of this enzymopathy regardless of sex and close surveillance of the affected newborns may be important in reducing the risk of severe hyperbilirubinemia and exchange transfusion.

Skin colour and bilirubin in neonates.

The correlation between the yellow colour of the skin and serum bilirubin concentration, reserve albumin concentration, and pH was investigated in 76 icteric neonates. Significant linear correlation existed between yellow colour of the skin and serum bilirubin concentration, reciprocal of the reserve albumin concentration, and the squared hydrogen ion concentration. Furthermore, the basic yellowness of the skin at birth correlated linearily with the yellow colour of the skin measured when the child became jaundiced. The results support the proposed hypothesis that bilirubin is transferred from plasma to skin through two different mechanisms: (a) leakage of bilirubin-albumin complexes into extravascular spaces and (b) precipitation of bilirubin acid in phospholipid membranes. The latter mechanism suggests that measurement of the yellow colour of the skin may be a better predictor of brain damage than the serum bilirubin concentration and thus be of clinical utility. Measurement of the yellow colour of the skin as a method of obtaining serum bilirubin concentration is unreliable.

Bilirubin displacement by ceftriaxone in neonates: evaluation by determination of ‘free’ bilirubin and erythrocyte-bound bilirubin

Determination of 'free' bilirubin, erythrocyte-bound bilirubin and unconjugated bilirubin was used to test the effects of ceftriaxone on the binding of bilirubin to albumin. This study, performed on blood samples from icteric neonates, showed that the addition of ceftriaxone produced an increase of free bilirubin and erythrocyte-bound bilirubin and a decrease of unconjugated bilirubin. Ceftriaxone displays a significant displacing effect at concentrations obtained during therapeutic use and should be used with caution in high-risk jaundiced infants.

A Cytologic Study on Vaginal Smears in Neonates with Special Reference to Neonates Suffering from Icterus Gravis

Gravely icteric neonates including those having Rh incompatibility, were submitted to an observ- ation of vaginal smears and estimation of hormones in the urine for consecutive postnatal days.This was done in order to compare the resultswith those previously reported in respect to nor- mal mature infants, and at the same time to ex- plore liver functions in neonates suffering fromicterus gravis as well as the involvement of adrenal glands in diseases of the liver.1. Vaginal smears were found to be geneoallyhypochromatic. Estrogen effect observed on the1st and 2 nd postnatal days was not significant, but disappeared somewhat later. An and rogeneffect manifesten itself around the 8 th day andwas slightly observable during the 12 th to 15 thdays. This effect was a little more marked thanin normal infants.2. Regarding hormones in the urine, estriol generally indicated low levels and disappearedslowly. A high 17-OHCS level was reached whentotal bilirubin began to fall from a peak. A high 17-KS level was seen later, i. e., when total bili- rubin returned to normal value.3. These variations in vaginal smears approx- emately corresponded with those in urinary hormone levels.4. The protracted excretion of estriol may bedue to the reduction associated with severe jaundice in the liver's metabolic capacity to createestrogen. The finding that high 17-OHCS and 17KS levels were obtained in concent with or alittle later than the peak of total bilirubin maybe explained by the defensive function of theadrenocortex being mobilized in the event of ict- erus gravis, with the resultant transitory increasein hormonal secretion.5. The finding that 17-OHCS levels varied incloser correspondence with total bilirubin than 17-KS levels may be reasonably understood inview of 17-OHCS being derived from adrenocortical glucocorticoid and hence is considered to bea more sensitive indicator of adrenocortical fun- ctioning than 17-KS.6. In cares of no serious jaundice with Rhincompatibility, vaginal smears approximatelycorresponded with those in normal mature infa- nts. This suggests that hormonal secretion ormetabolism may be affected not by Rh incompa- tibility per se but by icterus gravis.