Neonatal Indirect Hyperbilirubinemia Research Articles

Rate of glucose-6-phosphate dehydrogenase deficiency in neonatal indirect hyperbilirubinemia at a private tertiary centre.

To investigate the rate of hospitalized neonates with glucose-6-phosphate dehydrogenase (G6PD) deficiency presented with indirect hyperbilirubinemia at a private tertiary center in Al-Ahsa, Saudi Arabia, over 4 years and to compare the characteristics of G6PD-deficient and normal neonates admitted for indirect hyperbilirubinemia. The retrospective case control study was carried out at Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia. Data were collected from Yassasi Medical System from 2018-2021 and finalized in 2024. The study included 2 groups: G6PD-normal and G6PD-deficient neonates with indirect hyperbilirubinemia not having recognizable triggers of hemolysis. The analysis focused on serum bilirubin levels, direct bilirubin levels, hematocrit levels, hemoglobin levels, reticulocyte percentage, G6PD levels, duration of phototherapy, and the need for exchange transfusion. The study enrolled 3200 neonates with hyperbilirubinemia, of whom 274 met inclusion criteria. A total of 103 (37.6%) neonates were G6PD-deficient, with 77 (74.8%) being male and 26 (25.2%) female. Glucose-6-phosphate dehydrogenase-deficient neonates exhibited significantly higher initial total bilirubin levels and earlier sampling times. There was no significant correlation between G6PD deficiency and hematocrit or hemoglobin levels in hyperbilirubinemic neonates, but 4 neonates required exchange transfusion, demonstrating statistical significance (p=0.009). High rate of G6PD deficiency in neonates with indirect hyperbilirubinemia, requiring close monitoring to prevent exchange transfusions, with no significant differences in hematocrit or hemoglobin levels.

Why Infants with Some Inherited Metabolic Diseases do not Develop Neonatal Indirect Hyperbilirubinemia ? An Overlooked Detail

Why Infants with Some Inherited Metabolic Diseases do not Develop Neonatal Indirect Hyperbilirubinemia ? An Overlooked Detail

Glucose-6-phosphate dehydrogenase deficiency and neonatal indirect hyperbilirubinemia: a retrospective cohort study among 40,305 consecutively born babies

Background and objectiveGlucose-6-phosphate dehydrogenase deficiency (G6PDD) being highly prevalent in the Middle East, the primary objective was to estimate the incidence of neonatal jaundice among G6PD-deficient neonates and to explore its association with various risk factors.MethodsThis retrospective cohort study includes 7 years data of neonates diagnosed with G6PDD between 1st January 2015, and 30 September 2022, from Al Wakra Hospital, HMC Qatar.ResultsAmong the 40,305 total births, 1013 had G6PDD with an incidence of 2.51%. Of all the G6PDD babies, 24.6% (249/1013) received phototherapy and three babies required exchange transfusion. Statistically significant associations were noted between the need for phototherapy and gestational age, gestational age groups, birth weight, and birth weight groups, but logistic regression analysis showed significant association for phototherapy only with the gestational age group.ConclusionUniversal screening and proper follow-up is essential for G6PDD as it plays crucial role in neonatal jaundice.

Frequency of Urinary Tract Infection among Neonates with Persistent Jaundice at Lady Reading Hospital, Peshawar

Jaundice refers to yellow-orange discoloration of the skin and sclera, resulting from an excessive accumulation of bilirubin in the dermis and mucous membranes. Indirect neonatal hyperbilirubinemia is a prevalent and frequent etiology of jaundice, leading to the hospitalization of neonates in healthcare institutions worldwide. Objective: To determine the frequency of urinary tract infection among neonates with prolonged jaundice. Methods: The present study, a cross-sectional design, was carried out at the Department of Pediatrics, Lady Reading Hospital, Peshawar, from June 20th to December 20th, 2022. The study consisted of 87 infants, encompassing both genders, who presented with persistent jaundice. Two samples of clean urine were collected from neonates, with a time interval of many minimums of two hours between each collection. These samples were then sent to the hospital laboratory for diagnosing urinary tract infection. Results: The age range of participant neonates in this study ranged from 14 to 28 days, with a mean age of 20.597±4.50 days. The mean duration of complaint was also 18.20±4.077 days, and the mean weight was 2.855±0.27 Kg. The proportion of male patients was 58.6%, while the proportion of female patients was 41.4%. Among these 11.5% were found to have urinary tract infection. Conclusions: It is concluded that significant number (11.5%) of patients with persistent jaundice has urinary tract infection. It is likely a potential etiological factor contributing to neonatal unexplained prolonged indirect hyperbilirubinemia.

The association of oxidative stress of neonatal hyperbilirubinemia and vitamin E supplementation.

Jaundice in newborns is a sign of skin and sclera pigmentation. Hyperbilirubinemia and these phenomena do, however, have a relationship. According to many clinical studies, elevated blood bilirubin and low vitamin E (VE) levels in newborns are associated. The aim of the study was to investigate the association of oxidative stress of neonatal hyperbilirubinemia in patients who underwent phototherapy with additional vitamin E supplementation (25 mg/kg/day over the course of three days) and patients without additional vitamin E. A set of 100 neonatal indirect hyperbilirubinemia patients was enrolled at neonatal intensive care units (NICUs) of the pediatric departments at Al Azhar University Hospitals during the period from February 2021 to October 2022 after obtaining signed written informed consent of all neonates' parents with an explanation of the aim of study. Significant differences were found between the studied groups regarding serum bilirubin on the third day of admission (p = 0.039). Patients who were treated with vitamin E had lower serum bilirubin on the third day of admission (8.25 ±3.41) than the control group (11.66 ±3.22). Also, among the VE group, serum bilirubin was significantly decreased on the third day of admission (8.25 ±3.41) compared to zero days of admission (14.10 ±4.39) (p = 0.041). Vitamin E supplementation has an important role in treatment of indirect hyperbilirubinemia in neonates. Early administration of vitamin E in preterm neonates resulted in a significant decrease of serum bilirubin and increased total antioxidant capacity. Vitamin E supplementation in full term decreased the duration of phototherapy.

Prevalence of Glucose-6-Phosphate Dehydrogenase Deficiency in Cord Blood and Its Relation to Neonatal Indirect Hyperbilirubinemia in Fayoum Governorate

Prevalence of Glucose-6-Phosphate Dehydrogenase Deficiency in Cord Blood and Its Relation to Neonatal Indirect Hyperbilirubinemia in Fayoum Governorate

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.

Recent Advances in Adjuvant Pharmacotherapy for Neonatal Indirect Hyperbilirubinemia: A Narrative Review

Context: Hyperbilirubinemia is a common cause for diagnostic work-up and therapeutic intervention in neonates and needs a convenient, quick, and safe treatment modality. Phototherapy is the most common treatment for neonatal jaundice; however, complementary treatment is still needed. Despite the identification of the enzymatic pathways of bilirubin catabolism, few pharmacological interventions have been found to be effective in reducing bilirubin, along with traditional phototherapy. This review was conducted to evaluate recent pharmacotherapies as adjuvants to phototherapy for the treatment of neonatal indirect hyperbilirubinemia (IHB). Evidence Acquisition: This study was carried out through a literature search with the keywords of Infant, Newborn, and Indirect Hyperbilirubinemia, combined with Drug Therapy, in PubMed, Scopus, International Statistical Institute, Web of Science, Cochrane, and Embase databases. This study included relevant articles (i.e., randomized controlled trials, observational studies, guidelines, and reviews) written in English and published between 2012 - 2022. Results: This narrative review first assessed the relevant articles to define IHB and its etiology. Then, the efficacy and side effects of recent pharmacologic agents as adjuvants to phototherapy were discussed. Additionally, this study reviewed the efficacy and safety of drugs prescribed to neonates to prevent jaundice. Conclusions: The best drug for adjuvant pharmacotherapy, in addition to phototherapy, for neonatal jaundice has not still been identified. The use of probiotics, prebiotics, synbiotics, and ursodeoxycholic acid (UDCA) in adjuvant to phototherapy has been recently increasing, and beneficial results were observed in most studies. The use of agar, charcoal, fibrate, and phenobarbital had a minor therapeutic role in recent years. There were conflicting results about the efficacy of herbal agents in neonatal jaundice. The use of intravenous immunoglobulin (IVIG), metalloporphyrin, and albumin is also limited to severe or immune-related IHB cases. The prescription of the aforementioned drugs sometimes had different results. Therefore, further research in this regard is necessary.

Management of Indirect Hyperbilirubinemia; Comparison of Complications of Light Emitting Diode (LED) and Fluorescent Phototherapy

Objective: To compare the frequency of complications (hyperthermia, skin eruption, dehydration) of LED phototherapy and fluorescent phototherapy in management of indirect hyperbilirubinemia in neonates Material and methods: This randomized control study was carried out from 1st June 2015 to 31 December 2016 at NNU of The Children`s Hospital Lahore using Non probability consecutive sampling technique after getting informed consent from parents. All basic demographic information of each variable (name, age) was noted and entered on Performa. SPSS-18 was used to interpret the data. Results: In our study the mean age was 1.98±0.83 days. Skin rash complication was observed in 43(13%) cases, dehydration was found in 48(14.5%) cases and hyperthermia was noted in 65(19.70%) patients. Practical Implication: Many setups in Pakistan are still using conventional fluorescent phototherapy machines. LED has lesser side effects as compared to conventional one so by using LED light source we can lessen the adverse effects of phototherapy that will be beneficial to the babies Conclusion: LED light source is effective for phototherapy with significantly lesser complication rate (hyperthermia, skin eruption, and dehydration) compared to fluorescent phototherapy in management of indirect hyperbilirubinemia in neonates. In this study LED phototherapy significantly showed fewer complications as compared to fluorescent phototherapy cases. Keywords: LED, Fluorescent, Hyperthermia, Skin, Rash, Dehydration, Neonates, Hyperbilirubinemia

A retrospective comparison of phototherapy need in O-B versus O-A incompatibility in a single Saudi institution.

ABO incompatibility is a major risk factor for neonatal indirect hyperbilirubinemia (NIH), requiring treatment. It has been shown that there are racial differences in direct antiglobulin test (DAT) positivity and phototherapy need in the O--B versus (vs) O--A incompatibility. The comparison between the O--B and O--A incompatibility is not well studied in Saudi Arabia. We aimed to compare DAT positivity and phototherapy need in O-B vs O-A incompatibility in Saudi Arabia. This retrospective cohort study was conducted in one Saudi hospital. We included a convenience sample of neonates born between 01 January 2013 and 31 December 2021. We included healthy neonates admitted to the nursery care unit only, born at≥38 weeks gestation, and had normal G6PD levels. Neonates that had no G6PD level measurement or lost follow-up post-discharge were excluded. The data span was the first 14 days of life. A total of 611 neonates met our inclusion criteria. Positive DAT was more prevalent in the O-B than the O-A incompatibility [43.5% vs 29.2%, p < 0.001). A greater odd of phototherapy need was observed in the O--B vs O-A incompatibility across various strata. Readmission for NIH, use of 360° exposure phototherapy, or intravenous immunoglobulin administration was more prevalent in the O-B than the O-A incompatibility (13.2% vs 5.0%, p < 0.001). A logistic regression analysis revealed that the O-B incompatibility modified the association between DAT positivity and phototherapy need. The O-B incompatibility had a mediator effect on the relationship between DAT positivity and the need for phototherapy in the study population, which emphasizes that the O-B and O-A are not the same from the NIH point of view.

Ursodeoxycholic acid and phototherapy versus phototherapy and placebo on neonatal indirect hyperbilirubinemia

Introduction: Recently ursodeoxycholic acid was recommended for the treatment of neonatal hyperbilirubinemia in a few studies. Objectives: This study aimed to compare ursodeoxycholic acid and phototherapy versus phototherapy in lowering the level of bilirubin in neonates who was admitted due to hyperbilirubinemia. Patients and Methods: This randomized double-blind study was carried out in the department of neonatology at the children’s medical center of Ahvaz Jundishapur of the University of Medical Sciences. Inclusion criteria were weight 2500-4200 g and exclusive breastfeeding. Gestational age between 38-41 weeks and age between 3-7 days were included. Total bilirubin between 14-20 according to Bhutani nomogram and direct bilirubin was less than 2 mg/dl was included. Exclusion criteria were ABO incompatibility, Rh incompatibility, G6PD (glucose6-phosphate dehydrogenase) deficiency, sepsis, hypothyroidism, liver problem, prematurity and newborn of diabetic mothers. A dose of 5 mg/kg per dose of ursodeoxycholic acid (UDCA) was prescribed for neonates every 12 hours. Placebo is also prescribed for other neonates. Unconjugated bilirubin was measured after 4 hours and every 12 hours till total bilirubin=12 mg/dL. The primary outcome measures were total bilirubin level four hours and every 12 hours after admission till reached 12 mg/dL. The secondary outcome measure was total bilirubin=12 mg/dL at 12-24 hours after admission and diarrhea, vomiting, skin rash or any adverse effect in the neonates who received UDCA. Neonates who underwent phototherapy and UDCA were the case group. Neonates who received phototherapy and placebo were allocated in the control group. Data were analyzed using SPSS version 16.0. Kolmogorov-Smirnov test was conducted to evaluate data distribution. Intention-to-treat analysis was used. Mann-Whitney U test was conducted for data analysis. Results: In the current study, 30 cases and 30 control were included. Discharged neonates were 96% among the UDCA group and 87% among the control group in the 1st 24 hours after admission. Among the UDCA group, 100% were discharged at the 2nd 24 hours of admission and 96% among the control. The duration of phototherapy was shorter in the case group than in the control group, however this difference had no statistical difference. Conclusion: No significant difference between neonates who underwent phototherapy and phototherapy+ UDCA in terms of duration of phototherapy and bilirubin reduction was found. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (identifier: IRCT20181003041225N1; https://en.irct.ir/trial/34272, ethical code; IR.AJUMS.REC.1397.899).

Is Oral Agar Combined with Phototherapy Superior than Phototherapy in Treatment of Neonatal Indirect Hyperbilirubinemia

Background: Neonatal jaundice is the commonest condition encountered during daily practice of neonatologists. Phototherapy remains the main-stay in the treatment. However, its safety and efficacy still questioned. Agar was proposed as an adjuvant therapy to improve the effectiveness and safety profile of bilirubin. However, the evidence is still building up. The current work aimed to address the value of agar as an adjuvant to phototherapy for neonatal hyperbilirubinemia of full-term neonates.&#x0D; Methods: The study was a randomized double-blind comparable clinical trial. Full term neonates with indirect hyperbilirubinemia within their first week of life at the level of phototherapy were included. Patients were randomly assigned into two equal groups. The phototherapy alone group, where newborns received 10 ml of distilled water by bottle every 12 hours. The second group, where neonates received 300 mg/kg of agar orally by bottle every 12 h before feedings in 10 ml of distilled water. The collected data for comparison included patient demographics and serial measurements of total serum bilirubin (TSB). Treatment was stopped when TSB levels falls to 2 mg/dl below the phototherapy initiation threshold.&#x0D; Results: Both groups were comparable regarding patient demographics, mode of delivery and gestation age at delivery. TSB levels showed significant progressive reduction after the first, at the third and the fifth days of therapy among agar and comparable groups. The percentage of reduction in TSB levels was significantly higher in phototherapy-Agar combination group than the other group at third day of therapy (- 38.92 versus - 28.66%, p=0.0001). Finally, the length of hospital stay duration was significantly shortened with agar than the other group (3.34±0.70 vs 3.7 ±0.74, p=0.014).&#x0D; Conclusion: Adding oral agar to phototherapy improves the effectiveness and safety among full-term neonates with indirect hyperbilirubinemia.

Effects of Two Different Doses of Ursodeoxycholic Acid on Indirect Hyperbilirubinemia in Neonates with Glucose-6-phosphate Dehydrogenase Deficiency Treated with Phototherapy: A Randomized Controlled Trial

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the causes of severe hyperbilirubinemia, prolonged jaundice, and bilirubin-induced encephalopathy in neonates. In a randomized controlled trial, we evaluated the effect of oral ursodeoxycholic acid (UDCA) on indirect hyperbilirubinemia in G6PD-deficient neonates requiring phototherapy. Intervention group I (N = 45; received phototherapy and 10 mg/kg/day UDCA), Intervention group II (N = 40; received phototherapy and 20 mg/kg/day UDCA), and a control group (N = 49; received phototherapy and placebo). Levels of total serum bilirubin (TSB) in all 3 groups decreased significantly over time (P = .001) but the level of TSB at different hours after admission and the duration of phototherapy did not differ significantly between the 3 groups. After discharge, the 2 intervention groups had a significantly lower rate of readmission than the control group (P = .001). No significant difference was observed between the 10 and 20 mg/kg/day groups. Further evaluation is recommended, especially in terms of the pharmacokinetics of UDCA in neonates. Trial registration number: IRCT20091201002801N4, prospectively registered on 2019-06-1.

Evaluation of urinary tract infections in neonatal indirect hyperbilirubinemia.

We have evaluated urinary tract infections (UTI) in neonatal indirect hyperbilirubinemia. Urine culture is not routinely requested in patients with indirect hyperbilirubinemia. However, debates continue about the frequency and investigation of UTI in neonatal indirect hyperbilirubinemia patients. The aim of this study was to determine the prevalence of UTI in neonates admitted to the hospital due to pathological indirect hyperbilirubinemia and whether a routine urine culture test is necessary in patients. In this retrospective study, we analyzed data from 1390 patients hospitalized to the Neonatal Unit due to pathological indirect hyperbilirubinemia. One hundred and eleven of these patients with detected bacterial agents in the urine cultures were evaluated. The type of the pathogens grown in urine culture, the number of colonies, and the antibiotic resistance status were evaluated. Among 1390 patients screened, 111 (8%) were found to have UTI, 68 of whom (61.3%) were male. Out of the microorganisms that grew, Escherichia coli was the dominant microorganism with 36.1%, which was followed by Klebsiella species (23.4%), and Enterococcus species (18%), respectively. The prevalence of UTI is high in the neonatal period as in all childhood and especially in patients admitted to the Neonatal Unit due to indirect hyperbilirubinemia. Escherichia coli and Klebsiella species are the most common bacterial agents that grow. Missing the diagnosis of urinary tract infection in neonates may cause renal problems. Therefore, we recommend requesting a urine culture in routine examinations of neonates who are diagnosed with pathological indirect hyperbilirubinemia and admitted to the hospital due to the need for phototherapy.

Role of ursodeoxycholic acid in neonatal indirect hyperbilirubinemia: a systematic review and meta-analysis of randomized controlled trials

BackgroundNeonatal jaundice is a transitional phenomenon affecting three out of five full-term newborns globally. Ursodeoxycholic acid could be beneficial in neonatal jaundice needing phototherapy. MethodsWe searched PubMed, EBSCO, ProQuest, and Cochrane Library up to August 21st, 2021, for articles to be reviewed. Meta-analysis using random-effects model was performed.ResultsEight studies involving 1116 neonates were chosen in this review; however, only five studies were included for meta-analysis. Phototherapy duration was significantly lower in the interventional group with high heterogeneities. Subgroup analysis of the phototherapy duration based on the risk of bias resulted in a shorter duration (mean difference (MD) = –17.82; 95% CI = –20.17 to –15.47; p = < 0.001) with low heterogeneity in the treatment group. Secondary outcome focusing on mean total serum bilirubin showed a lower mean total serum bilirubin in 48 h post-treatment (MD = –0.43; 95% CI = –0.64 to –0.22; p = < 0.0001) with low heterogeneities in Asian countries.”ConclusionsUrsodeoxycholic acid might be considered as a novel adjuvant therapy in neonatal indirect hyperbilirubinemia to shorten the phototherapy duration and lower the mean total serum bilirubin.

Neonatal and Maternal Risk Factors for Indirect Hyperbilirubinemia: A Cross-Sectional Study from Bahrain.

Results Out of 555 records, 404 neonates were included. Among those, 209 (51%) were males and 275 (68.1%) were Bahraini. The median indirect bilirubin level at presentation was 218 (interquartile range, 174-270) μmol/L. ABO incompatibility was the commonest risk factor for neonatal indirect hyperbilirubinemia (n = 152, 37.6%) followed by glucose-6-phosphate dehydrogenase (G6PD) deficiency (n = 130/400, 32.5%). Age (>25 years) was the commonest maternal risk factor (n = 331, 81.9%) followed by cesarean delivery (n = 137, 33.9%). Neonates with ABO incompatibility had a significantly higher mean indirect bilirubin level compared to those with other risk factors (234.9 ± 68.5 versus 225 ± 82.2 mmol/L, respectively) (P = 0.04). Phototherapy use significantly increased along with the rise of bilirubin level (P < 0.0001). Intravenous immunoglobulins (IVIG) and exchange transfusion were used in 44 (10.9%) and 14 (3.5%) patients, respectively. Neonates who received IVIG had significantly higher bilirubin levels than those who did not (P = 0.005). Male newborns (P = 0.008), Bahrainis (P = 0.001), those with reticulocytosis (P = 0.001), and those who received IVIG (P = 0.001) were more prone to have associated risk factors. Conclusion ABO incompatibility, G6PD deficiency, and older maternal age were the commonest neonatal and maternal risk factors for developing neonatal indirect hyperbilirubinemia. Bahraini, male newborns, reticulocytosis, and IVIG use were associated with these factors. Early detection of such factors through screening can aid in immediate management to prevent serious complications of this common condition.

A comparative study between glucose 6-phosphate dehydrogenase deficient and normal term neonates with indirect hyperbilirubinemia in a rural tertiary care hospital of Eastern India

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an important cause of neonatal indirect hyperbilirubinemia or even kernicterus leading to long-term neurological sequelae specially in countries like India where G6PD deficiency is quite prevalent. Aims and Objectives: We have planned this study to know the prevalence of G6PD deficiency among cases of neonatal jaundice and also to evaluate the difference between G6PD deficient and normal neonates with indirect hyperbilirubinemia in terms of laboratory parameters and need of phototherapy or exchange transfusion. Materials and Methods: This observational and cross-sectional study was done for a period of 1 year in the SNCU and NICU of a district Medical College of West Bengal among 200 term neonates presented with indirect hyperbilirubinemia. Birth weight, sex, hemoglobin, G6PD level, serum bilirubin at admission, phototherapy duration, and need for exchange transfusion were recorded along with other necessary parameters. Results: We found G6PD deficiency in 24 neonates (12%) out of 200 cases of neonatal jaundice, 20 of whom were male. There is a statistically significant difference in hemoglobin and serum bilirubin level between two groups. Difference in early presentation of jaundice within 24–48 h (66.7% vs. 34.1%) and need of prolonged phototherapy 72–96 h (45.83% vs. 7.4%) between G6PD deficient and normal group were statistically significant. Difference in requirement of exchange transfusion is not statistically significant. Conclusion: Early screening for G6PD deficiency should be considered in every neonates of G6PD deficient endemic countries so that we can predict the natural course of the jaundice in those G6PD deficient neonate and prevent complication by early initiation of phototherapy or exchange transfusion.

Effect of ursodeoxycholic acid on indirect hyperbilirubinemia (nonhaemolytic and haemolytic) in neonates treated with phototherapy

Background Hyperbilirubinemia is a global problem in neonates. Classic management for indirect neonatal hyperbilirubinemia includes phototherapy and exchange transfusion. Phototherapy shows disadvantages, and exchange transfusion is related to significant morbidity. Aim To assess the added role of ursodeoxycholic acid (UDCA) in reducing unconjugated hyperbilirubinemia in neonates undergoing phototherapy. Patients and methods Our randomized controlled trial was performed on neonates with hyperbilirubinemia who needed phototherapy and were admitted to the neonatal care unit at Tanta University Hospital from May 2017 to March 2019. A total of 120 neonates were randomly divided into four groups: group A (n=30), which included neonates with nonhemolytic indirect hyperbilirubinemia who received UDCA 10 mg/kg/day beside the usual phototherapy; group B (n=30), which included neonates with isoimmune hemolytic indirect hyperbilirubinemia who received UDCA 10 mg/kg/day, besides the usual phototherapy; group C (n=30), which included neonates with nonhemolytic indirect hyperbilirubinemia who received phototherapy only; and group D (n=30), which included neonates with isoimmune hemolytic indirect hyperbilirubinemia who received phototherapy only. The total serum bilirubin (TSB) was determined every 24 h till being less than 10 mg/dl. Results TSB was significantly decreased in group A compared with group C (P&lt;0.05). However, TSB was comparable in groups B and D (P&gt;0.05). Duration of phototherapy was significantly shorter in groups A and B compared with groups C and D (P&lt;0.05). Conclusion UDCA shows a beneficial added role in the treatment of neonatal indirect hyperbilirubinemia, particularly in the nonhemolytic type.

Glucose 6 phosphate dehydrogenase deficiency in unexplained neonatal hyperbilirubinemia – A study in neonatal care unit of a tertiary care hospital.

Background: Glucose 6 phosphate dehydrogenase (G6PD)deficiency causes impaired production of reduced glutathione and in turn exposes red blood cells to damage by oxidative metabolites with resultant hemolysis. Objective: To study the spectrum of neonatal hyperbilirubinemia , to investigate the relevance of G6PD deficiency in unexplained causes of neonatal hyperbilirubinemia and to look for outcome in cases of deficiency of the enzyme. Material &amp; methods: Cross sectional observational study done on 100 neonates. The inclusion criteria was babies born between 37 and 42 completed weeks of gestation with clinically evident jaundice and those of age upto seven days requiring admission in neonatal care unit .Their age, gender, religion, socioeconomic and residential status noted. History elicited from mother following informed consent and babies were examined clinically.Investigations included complete hemogram, total bilirubin with conjugated and unconjugated assay, red blood cell G6PD assay, thyroid profile and coomb’s test Result: The mean age (mean±s.d.) of patients was 4.5100± 1.4460 days. The study population of 100 babies included 69 males and 31 females with a male to female ratio of 2.23:1. G6PD testing showed deficiency in fifteen patients, whereas eighty five showed normal values of G6PD. All patients in the study population showed normal values of T3, T4, TSH and negative direct coomb’s test. G6PD assay showed a mean value of 9.7291± 2.5480. The mean total bilirubin (mean±s.d.) of patients with deficient G6PD was 20.4533 ± 2.2853 mg/dl. G6PD deficient group showed higher serum bilirubin assay compared to non- deficient ones. Conclusion: G6PD deficiency is a common enzyme defect causing severe indirect hyperbilirubinemiain neonates which can result in kernicterus with neurological damage. Early neonatal screening programmes should be implementedin areas where the deficiency is prevalent. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 669-674

Positive Direct Antiglobulin Test: Is It a Risk Factor for Significant Hyperbilirubinemia in Neonates with ABO Incompatibility?

ABO blood group (ABO) incompatibility is a common cause of neonatal indirect hyperbilirubinemia. The direct antiglobulin test (DAT) can identify infants developing hemolytic disease. This study aims to evaluate the significance of DAT positivity among neonates with ABO incompatibility. This retrospective study included 820 neonates with blood group A or B who were born to blood group O mothers. The study group consisted of neonates (n = 79) who had positive DAT, and the control group consisted of infants (n = 741) who had negative DAT. Demographic and clinical data of the neonates regarding jaundice were collected and compared statistically. The bilirubin level at 24 hours of life (study group: 8 ± 2.6 mg/dL, control group: 6 ± 2.2 mg/dL, p < 0.001) and the highest bilirubin level (study group: 12.7 ± 3.6 mg/dL, control group: 10.4 ± 4.2 mg/dL, p < 0.001) were higher in infants with positive DAT. A total of 37 (46.8%) infants in the study group and 83 (11.2%) infants in the control group received phototherapy (PT) in the nursery (p < 0.001). In neonates with positive DAT, direct bilirubin level, duration of hospitalization, and PT in the nursery were higher (p = 0.002, <0.001, and <0.001, respectively), whereas hemoglobin level was lower (p < 0.001). In neonates with ABO incompatibility, a positive DAT is a risk factor for developing significant hyperbilirubinemia. Close follow-up of newborn infants with ABO incompatibility is crucial for early detection and treatment of neonatal jaundice to avoid early and late complications. · The clinical spectrum of ABO incompatibility varies widely.. · The ABO incompatibility with positive DAT are at greater risk for high bilirubin levels.. · Infants with blood group incompatibilities must be monitored closely..