Intensive Phototherapy Research Articles

Variations in antenatal management and outcomes in haemolytic disease of the fetus and newborn: an international, retrospective, observational cohort study

Advances in haemolytic disease of the fetus and newborn have led to numerous treatment options. We report practice variations in the management and outcomes of haemolytic disease of the fetus and newborn in at-risk pregnancies. In this international, retrospective, observational cohort study, data from cases with moderate or severe haemolytic disease of the fetus and newborn were retrieved from 31 centres in 22 countries. Eligible participants had pregnancies with haemolytic disease of the fetus that led to fetal death at 16 + 0 weeks or later, those treated antenatally with intrauterine transfusion or intravenous immunoglobulins, or neonates without antenatal treatment who were treated with intensive phototherapy, exchange transfusion, or red blood cell transfusions. All patients had confirmed maternal alloantibodies and an antigen-positive fetus incompatible with the maternal alloantibody. Patients with ABO-incompatibility only were excluded. We assessed serological diagnostics and referrals, antenatal treatment and timing, complications, delivery route, and gestational age at birth. Outcomes were analysed in all eligible participants who had complete data available. 2443 pregnancies with haemolytic disease of the fetus and newborn treated between Jan 1, 2006, and July 1, 2021, were shared by the centres and analysed between Dec 1, 2021, and March 1, 2023. 23 pregnancies were excluded due to missing information and we included 2420 for further analysis. 1764 (72·9%) of 2420 pregnancies were affected by D-antibodies. 95 (3·9%) of 2420 pregnancies resulted in fetal death. Of the 2325 liveborn neonates, 1349 (58·1%) received any form of antenatal treatment and 976 (41·9%) were only treated postnatally. Median gestational age at referral was 20·4 weeks (IQR 14·9-28·0) and ranged between medians of 10·0 and 26·3 weeks between centres. Severe hydrops at first intrauterine transfusion was present in 185 (14·5%) of 1276 pregnancies, with proportions ranging between 0 and 42% between centres. A median of two intrauterine transfusions (IQR 1-4) were done per pregnancy. The fetal access sites used in intrauterine transfusions varied widely between centres. Non-lethal complications in intrauterine transfusions by transfusion site occurred at a lower rate in intrahepatic approaches (2·0%, 95% CI 1·1-3·3) than in placental insertion (6·9%, 5·8-8·0) and free loop (13·3%, 8·9-18·9). The use and indication for intravenous immunoglobulin administration varied widely. Neonates with intrauterine transfusion were born at a median gestational age of 35·6 weeks (IQR 34·0-36·7), ranging between medians of 33·2 and 37·3 weeks between centres, while neonates without antenatal treatment were born at a median gestational age of 37·3 (IQR 36·3-38·1), ranging between medians of 34·9 and 38·9 weeks between centres. We found considerable variation in antenatal management and outcomes in haemolytic disease of the fetus and newborn between sites in different countries. Our study shows the capacity of the field to gather valuable data on a rare disease and to optimise care. None.

Heliotherapy for neonates with severe-to-hazardous hyperbilirubinemia: a randomized controlled, non-inferiority trial

Filtered-sunlight phototherapy (FSPT) that blocks ultraviolet light and reduces infrared radiation is safe and non-inferior to intensive electric phototherapy (IEPT) for treating mild-to-severe neonatal hyperbilirubinemia. In this randomized non-inferiority trial, the safety, efficacy, exchange transfusion (ET), and mortality rates of FSPT versus IEPT among Nigerian neonates with severe-to-hazardous hyperbilirubinemia were investigated. Safety was defined as the absence of hyperthermia, hypothermia, dehydration, or sunburn; efficacy by the proportion of assessable treatment days during which total serum or plasma bilirubin (TSB) increased by < 0.2 mg/dL/hr for newborns aged ≤ 72 h-old or decreased for newborns > 72 h-old. A treatment day was deemed assessable if a neonate received phototherapy for ≥ 4 h, and non-inferiority was inferred for differences within a 10% margin. We enrolled 192 newborns (admission TSB ≤ 62 mg/dL), assigned to FSPT (n = 98) or IEPT (n = 94). FSPT was effective on 94.2% of the assessable treatment days compared with 97.1% for IEPT. The mean difference in efficacy between FSPT and IEPT was -2.9%, 95% CI: -7.6, 1.9). 2.6% of newborns who received FSPT developed controlled hyperthermia, and no baby met the criteria for withdrawal for safety reasons. Overall, 50.6% (39/77) of newborns who received FSPT and 53.7% (51/95) of newborns who received IEPT had ET (p = 0.89) and 7 in each group (9.1% vs 7.4%; p = 0.86) died. In conclusion, FSPT is safe and non-inferior to IEPT for treating neonates with severe-to-hazardous hyperbilirubinemia, it is not associated with significantly higher rates of ET and mortality and should be considered where practicable when IEPT cannot be assured. Clinical Trials.gov Number: NCT02612727 (24/11/2015).

Neonatal Jaundice Risk Factors and Multidirectional Intensive Phototherapy Management at Azadi Teaching Hospital in Kirkuk City

Background: A common illness in infants, neonatal jaundice is caused by high bilirubin levels in the first few days of life, which results in yellowing of the skin and eyes. Aim: This study aims to explore neonatal jaundice risk factors and assess the efficacy of multidirectional intensive phototherapy management at Azadi Teaching Hospital in Kirkuk City. Patients and Methods: In this retrospective cross-sectional study spanning from April 1st, 2021, to October 1st, 2021, a total of 497 newborns were examined. Jaundiced neonates underwent intensive phototherapy utilizing the Bilisphere 360 system, which featured a chamber with 16 cylindrical, blue TL 20W/52 fluorescent tubes. The newborns were positioned on a gauze hammock suspended at the chamber's center, illuminated on all sides. Results: A study found that neonatal jaundice affects 50.70% of studied neonates, primarily in the 16-21-day age group, with males accounting for 57.95% of the sample. 94.84% of neonates experience jaundice due to ABO blood group incompatibility and 88.10% due to Rh incompatibility. Additionally, 77.78% of term deliveries are associated with jaundice. Infants with jaundice have higher Thyroid Stimulating Hormone (TSB) and Thyroid Stimulating Hormone (TSH) levels and a younger mean age compared to non-jaundiced infants. Bilisphere 360 proves significantly more effective in the critical 12 to 48 hours after admission, with a mean total bilirubin of 10.71 ± 1.01 mg/dl compared to 14.65 ± 1.71 mg/dl for Neonatal Exchange Transfusions (P-Value: 0.001). Factors like blood group incompatibility, labor duration, and birth weight influence TSB levels in jaundiced neonates. The Bilisphere 360 method is found to be more effective in managing neonatal jaundice than Neonatal Exchange Transfusions in reducing total bilirubin levels.

Hematological abnormality and associated factors in newborns with hyperbilirubinemia before and after phototherapy at University of Gondar Comprehensive Specialized Hospital

This study aimed to assess the magnitude of hematological toxicity and associated factors in newborns with hyperbilirubinemia. A cross-sectional study was conducted from April to December 2023. A total of 247 newborns were included. The data were collected using questionnaires and a data extraction sheet. Four 4 ml of blood was collected. A Sysmex KX-21 analyzer was used for blood analysis, and a Mindray BS-240 analyzer was used for bilirubin measurement. The data were entered into Epi-data and analyzed by SPSS. The logistic regression was used. The P value was set at 0.05. Before phototherapy, the hematological toxicities, such as anemia, leucopenia, and thrombocytopenia, were 45.7%, 22.2%, and 6.1%, respectively, whereas after phototherapy, anemia and thrombocytopenia, significantly increased, but the leucopenia, significantly decreased. The risk of developing anemia increased, 3.5, 2.7, and 2.1-fold among newborns with bilirubin > 18 mg/dl, with Rh blood group incompatibility, and treated with intensive phototherapy, respectively. Both low birth weight and intensive phototherapy increased the incidence of thrombocytopenia by 2 and 3.4-fold, respectively. Hematological toxicity was found to be a severe public health issue in newborns. Thus, strict follow-up and early detection of toxicity by considering aggravation factors are necessary.

Neonatal jaundice is associated with increased risks of congenital anomalies of the kidney and urinary tract and concomitant urinary tract infection

The link between neonatal jaundice and urinary tract infection (UTI) remains debated, with congenital kidney and urinary tract anomalies (CAKUT) potentially playing a role. This population-based study aimed to analyze the correlations between neonatal jaundice, CAKUT, and concomitant UTI. The study cohort consisted of 2,078,122 live births from 2004 to 2014. We linked several population-based datasets in Taiwan to identify infants with unexplained neonatal jaundice and their mothers. The primary outcome was the rate of CAKUT occurring within 3 years after delivery, and the presence of concomitant UTI during neonatal jaundice hospitalization. Infants with neonatal jaundice had a significantly higher risk of CAKUT (adjusted odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.11–1.39) during early childhood. Among the subtypes of CAKUT, obstructive uropathy, vesicoureteral reflux and other CAKUT were associated with an increased risk of neonatal jaundice. Infants who underwent intensive phototherapy, had a late diagnosis (> 14 days of postnatal age) or underwent a prolonged duration of phototherapy (> 3 days) exhibited a higher risk of concomitant UTI compared to other infants with jaundice. Our findings indicate a notable association between neonatal jaundice and increased risks of UTIs in the context of CAKUT. This study underscore the importance of vigilant monitoring and timely interventions for neonates presenting with jaundice, while acknowledging the complexity and variability in the progression of CAKUT and its potential connection to UTIs.

Hemolytic Anemia Due to Glucose-6-Phospate Dehydrogenase Deficiency in Neonate

Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme in erythrocytes that functions to maintain glycolysis, form an erythrocyte membrane, and protect hemoglobin from oxidative denaturation. Clinical manifestations of anemia and severe jaundice are risk factors for acute hyperbilirubinemia encephalopathy, which can progress to kernicterus. G6PD deficiency is X-linked. The incidence is most common in males with an incidence in Indonesia of 1-14%. A 3-day-old male baby appeared yellowish and had a history of being pale since 1 day of age. There was a history of phototherapy and packed red blood cell transfusion from a previous hospital. The baby was born via caesarean section, term baby, with a birth weight of 2700 grams. The Physical examination revealed Kramer V, tachypnea, but no hepatosplenomegaly. A previous laboratory examination at AM Hospital showed total bilirubin of 23.3 mg/dL, indirect bilirubin 23 mg/dL, and pre-transfusion hemoglobin 9.8 g/dL. Chest X-rays revealed grade I–II hyaline membrane disease. Meanwhile, the laboratory test results at the Dr Wahidin Sudirohusodo Hospital showed a total bilirubin of 38.5 mg/dL, indirect bilirubin 37.17 mg/dL, reticulocytes 9.95%, hemoglobin 11.8 g/dL, CRP 5.2 mg/L, Procalcitonin 0.5 ng/mL, and a negative Coombs test. The peripheral blood smear showed fragmented cells of erythrocytes. The G6PD level was 17.2 U/dL (reference value &gt;20.5 U/dL). The patient received low-flow oxygenation, antibiotics, and 72 hours of intensive phototherapy. On the 7th day of treatment, the condition improved, and the baby was discharged. Therefore, Rapid diagnosis and treatment of G6PD deficiency are important to prevent other potential complication such as acute hyperbilirubinemia encephalopathy.

Forgoing Exchange Transfusion in Neonatal Hyperbilirubinemia: A Single-Center Retrospective Cohort Study.

Unconjugated hyperbilirubinemia is part of the everyday life of the neonatal period as it reflects the adaptation of the metabolism of bilirubin. The neonatal hyperbilirubinemia usually resolves spontaneously, but it can also be the cause of an acute or chronic encephalopathy known as kernicterus. Regardless of the cause, the goal of therapy is to prevent this neurotoxicity while not causing undue harm. Phototherapy and, if it is unsuccessful, exchange transfusion (ECT)remain the primary treatment modalities used to keep the maximal total serum bilirubin (TSB) below pathologic levels. This is a descriptive retrospective cohort study of 69 live neonates hospitalized in the Department of Neonatology and Neonatal Resuscitation of Mohammed VI University Hospital with unconjugated hyperbilirubinemia requiring ECT and treated with intensive phototherapy instead, spanning five years from March 2016 to March 2021. We aim to demonstrate the effectiveness of phototherapy in achieving prolonged reduction of bilirubin levels and the prevention of neurological complications and to compare our results with those in the literature. The use of intensive phototherapy in the treatment of neonatal unconjugated hyperbilirubinemia is very effective in lowering total serum bilirubin when its level is in the range of exchange transfusion, and it has succeeded in preventing the neurological complications of severe hyperbilirubinemia. Through this study, it can be seen that phototherapy is an efficacious, simpler, and less hazardous alternative to exchange transfusion in achieving a sustained reduction of bilirubin levels and preventing neurological complications.

Full-Term Baby with Cerebellar Hemorrhage Referred for Severe Jaundice Occurring within the First 3 Days of Life

Cerebellar hemorrhage in full-term infants is a rare condition recently recognized in high-risk newborns requiring intensive care with the availability of advanced neuroimaging techniques. Several aspects such as the incidence, pathophysiology, clinical features, and prognosis of cerebellar hemorrhage in full-term infants remain unknown. We present a case of cerebellar hemorrhage with subdural hemorrhage in a patient hospitalized for jaundice after birth without a history of traumatic delivery, such as breech presentation, prolonged labor or forceps delivery. A full-term female infant weighing 3,100 g at birth, with no complications during delivery, developed jaundice within 48 hours of birth and was admitted for intensive phototherapy in the first 3 days of life with a transcutaneous total bilirubin level of 18.1 mg/dL. Magnetic resonance imaging revealed cerebellar brain lesions with a subdural hemorrhage. At the age of 3 months, the infant exhibited leg rigidity and was referred for rehabilitation. The patient showed signs of improvement during treatment and was generally catching up well with her peers at the age of 9 months. Long-term follow-ups are required to evaluate the consequences on cognitive development, behavior, and motor performance subsequently in life.

A rare presentation of severe alloimmune hemolytic disease of newborn pertaining to minor blood group ‘c’ incompatibility: a case report and review of literature

Hyperbilirubinemia is one of the most widely seen causes of neonatal morbidity. Haemolytic disease of fetus and newborn is caused by maternal alloantibodies to the fetal RBCs. It is responsible for incompatibility between maternal and fetal blood groups, which results in destruction of fetal red blood cells causing hyperbilirubinemia. ABO and Rh incompatibility are the most common causes of severe indirect hyperbilirubinemia. Besides ABO and Rh isoimmunization, minor blood group incompatibilities such as anti-Kell, anti-C, anti-c, anti-E, anti MNS, Duffy, KIDD, P, Lutheran and Lewis have also been identified as causes of severe neonatal jaundice with an incidence of 385/1,00,000 live births in South-East Asia. We, hereby report a rare case of a full term 2.2 kg newborn presented with severe anemia with reticulocytosis and neonatal hyperbilirubinemia at second hour of life. In view of strongly positive DCT and no Rh negative or ABO setting, minor blood group incompatibility screening test was performed in the mother which revealed presence of multiple alloantibodies; however, the red cell phenotyping confirmed the presence of anti-c antibodies in maternal sera responsible for neonatal alloimmune haemolytic anemia. The baby was offered intensive phototherapy with intravenous immunoglobulin.

Neonatal Hemolytic Disease Caused by Anti-e and Anti-C Antibodies Treated with Intensive Phototherapy: A Case Report

ABO and Rh incompatibility are the leading causes of hemolytic disease of the fetus and newborn (HFDN). Due to the high antigenicity of the D antigen, hemolysis and symptoms progress rapidly. However, minor blood group incompatibility manifests varying clinical symptoms, from asymptomatic cases to neonatal jaundice and fetal hydrops. This study presents a case of HFDN in which anti-C and anti-e antibodies were identified and treated with intensive phototherapy. A full-term infant weighing 3,100 g at birth, with no complications during delivery, presented with jaundice and was admitted for intensive phototherapy. Antibody testing detected anti-C and anti-e antibodies in the neonate and the mother. The patient responded well to phototherapy, and intravenous immunoglobulin was administered. The total bilirubin levels decreased, and the infant was discharged after 5 days. At the age of 12 months, the infant exhibited normal neurodevelopment. In conclusion, neonates with HFDN, due to rare minor blood incompatibility, specifically anti-C and anti-e antibodies, can mitigate hyperbilirubinemia using phototherapy. Future research should also consider the severity of the minor blood group incompatibility.

Immunoglobulin G Levels in Neonates After Receiving Phototherapy

Background: Most cases of newborn hyperbilirubinemia are physiologic; however, excessive unconjugated bilirubin is a potential neurotoxin. Phototherapy treats moderate to severe hyperbilirubinemia. If phototherapy increases immunoglobulin G (IgG) clearance, there is a chance of humoral immune disorders. Objectives: The purpose of the study was to investigate the effect of phototherapy on the level of IgG in neonates. Methods: This study investigated 40 full-term newborns with hyperbilirubinemia. Blood samples were taken before and 72 hours after phototherapy. The IgG level was measured by calorimetry tests. Results: Phototherapy resulted in a decrease in IgG levels. The IgG level significantly decreased from 833.135 to 720.185 mg/dL. Before phototherapy, 12.5% of the population had low IgG levels; however, 32.5% had low IgG levels after the treatment. Conclusions: According to the results of the study, intensive phototherapy caused a reduction in IgG levels. Since there was no significant decrease in IgG levels in neonates who received conventional phototherapy, it can be concluded that this treatment is safe in terms of IgG levels.

Acute encephalopathy bilirubin in the first week of life: A case of G6PD-deficient neonate

Background. Acute bilirubin encephalopathy is an acute neurological manifestation due to indirect bilirubin deposits in the basal ganglia and brainstem nuclei. In several developed countries, the incidence reaches 0.6-2.5 cases/100,000 births, while a recent study in 8 hospitals in Indonesia showed an incidence rate of 2%. In this paper, we describe an acute bilirubin encephalopathy in a neonate with G6PD deficiency. Case Presentation. A 5-day-old male neonate was admitted to the ER with recurrent generalized tonic seizures which started 6 hours prior to admission. Post seizure, the neonate cried then fell asleep. He had seemed less active and did not want to breastfeed for the last 12 hours. The neonate was born at full term (3160 grams) by a spontaneous vaginal delivery in the hospital, APGAR score 7/9, mother blood type AB+. He was exclusively breastfed with adequate intake. Physically examined, the neonate was lethargic with flat anterior fontanelle, Kramer V jaundice, fever, hypertonia, decreased sucking reflex, physiologic reflexes +2/+2, Babinski +/+, without cranial nerve paresis. Laboratory results of total bilirubin 44.79 mg/dL (indirect 43.04 mg/dL; direct 1.75 mg/dL), Hb 14.2 g/dL, WBC 15,000/μL, reticulocytes 124,500/μL, negative Coombs’s test, blood type A+, peripheral blood morphology within normal limits. The neonate was planned for exchange transfusion, intensive (triple) phototherapy was performed while waiting for the exchange transfusion. Bilirubin levels fell significantly within 12 hours after phototherapy initiation. Phototherapy was continued, the neonate was discharged on the seventh day of hospitalization in good condition. During treatment, etiology tracking was performed towards G6PD (G6PD level: 6.6 U/dL). Conclusion. Acute bilirubin encephalopathy is a rare morbidity found in newborns. ABE that occurs in the first week of life, prompt further investigations other than physiologic jaundice. Most frequent etiologies are ABO incompatibility, G6PD deficiency, sepsis and hereditary spherocytosis. In this case, we found G6PD as the cause of acute bilirubin encephalopathy in the first week of life.

Utility of Direct Coomb’s test in a Tertiary Care Nursery

Objective: To document the causes and clinical significance of direct Coomb’s test distal convoluted tubule in neonatal Jaundice at a tertiary care setup.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of the Study: Fatima Memorial Hospital, Lahore Pakistan, from Nov 2019 to Oct 2020.&#x0D; Methodology: All babies born to “O” or Rh-negative blood group mothers were included. In addition, data including demographics, mother’s blood group, baby’s blood group, direct Coomb’s test results, bilirubin values, and need for treatment was recorded.&#x0D; Results: The study included 989 neonates. Of all, 489(49.4%) were male, the mean birth weight was 2.80±0.75 kg, and the mean gestation was 36±4.3 weeks. ABO mismatch was present in 452(45.7%) cases and Rh mismatch in 123(12.4%). Of all, 58(5.9%) had positive direct Coomb’s test. Amongst the positive direct Coomb’s test patients, 44(75.8%) babies needed treatment, of which 40(90.9%) received phototherapy, and 4(6.8%) needed Intensive phototherapy (360 degrees). No baby needed an exchange transfusion.&#x0D; Conclusion: In most cases, positive direct Coomb’s test was due to ABO blood group incompatibility. In addition, early phototherapy can control bilirubin rise in most cases, so few would need aggressive or intensive treatment.Keywords: ABO mismatch, Direct Coomb’s test, Neonatal jaundice, Rh mismatch.

Implementation of neonatal phototherapy with the BiliCocoon Bag® device in the maternity ward and impact on mother–infant separation

BackgroundFree bilirubin jaundice is a frequent pathology in the neonatal period. The major complication is neurological toxicity, the most severe form of which is kernicterus. Overall, 5%–10% of jaundiced neonates require treatment. The first-line treatment is phototherapy, with intensive phototherapy being the gold standard. Other equipment is also available, including the BiliCocoon Bag®. It is a safe and controlled therapy that can be performed in the mother's room in the maternity ward, thereby avoiding separation and allowing for breast- or bottle-feeding during treatment. It is easy to install and does not require protective glasses, thus no scope or hospitalization. In our maternity ward, all neonates requiring intensive phototherapy are hospitalized in the neonatology ward. ObjectiveThe objective of our study was to evaluate the number of avoided hospitalizations in neonatology for free bilirubin jaundice since the introduction, according to a strict protocol, of the BiliCocoon Bag® device. Material and MethodThis was a single-center retrospective cohort study using data of newborns usually collected as part of standard care. Children born in our maternity ward during an 18-month period (August 1, 2020 to January 31, 2022) were included. Causes of jaundice, age at the beginning and mode of treatment, number of sessions for each device, and length of stay were compared. Results are presented as number and percentage with median (25th–75th) or mean (extremes) values for categorical and continuous variables, respectively. A t-test was used to compare the means of the independent groups. ResultsA total of 316 newborns were included. Physiological jaundice was the main cause of jaundice. The median age for the first phototherapy treatment was 54.5 h (30–68). The 316 neonates needed 438 phototherapy sessions: 235 (74%) neonates required only one phototherapy session, 85 (36%) of them were treated with the BiliCocoon Bag®. For the 81 children who needed two or more phototherapy sessions, 19 children (23.5%) were treated by tunnel phototherapy and then the BiliCocoon Bag®, and eight children (10%) by BiliCocoon Bag® alone. The BiliCocoon Bag® enabled a relative reduction in the hospitalization rate of 38% and avoided hospitalization for approximately one third of the newborns treated. The BiliCocoon Bag® failure rate was 3.6% and the average length of stay was comparable between the two types of treatment. ConclusionFollowing a strict protocol of use, the BiliCocoon Bag® is a reliable method and a good alternative to intensive phototherapy for newborns in the maternity ward, as it avoids hospitalization and mother–infant separation.

Associations between neonatal jaundice and autism spectrum disorder or attention deficit hyperactivity disorder: Nationwide population based cohort study

Neonatal jaundice might result brain insults. Both autistic spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are developmental disorders, which might result from early brain injury at neonatal period. We aimed to explore the association between neonatal jaundice treated with phototherapy and the ASD or ADHD. This retrospective nationwide population cohort study was based on a nationally representative database of Taiwan, and neonates born from 2004 to 2010 were enrolled. All eligible infants were divided into 4 groups, without jaundice, jaundice with no treatment, jaundice with simple phototherapy only and jaundice with intensive phototherapy or blood exchange transfusion (BET). Each infant was follow-up until the date of incident primary outcomes, death, or 7-year-old, whichever occurred first. Primary outcomes were ASD, ADHD. Using cox proportional hazard model to analyze their associations. In total, 118,222 infants with neonatal jaundice were enrolled, including diagnosed only (7260), simple phototherapy (82,990), intensive phototherapy or BET (27,972 infants). The cumulative incidences of ASD in each group was 0.57%, 0.81%, 0.77%, and 0.83%, respectively. The cumulative incidences of ADHD in each group was 2.83%, 4.04%, 3.52% and 3.48%, respectively. Jaundice groups were significantly associated with ASD, ADHD, or either one, even after all other extraneous maternal and neonatal variables were adjusted. After stratification, the associations were still existed in subgroup with birth weights ≥2500grams and in male subgroup. Neonatal jaundice correlated with the ASD and ADHD. The associations were significant in infants of both sexes and with birth weights larger than 2500grams.

Evaluate of newborn with jaundice at central teaching hospital of pediatrics in Baghdad : descriptive study

Background: - Neonatal jaundice is a frequent condition at newborns, particularly in the first few days after delivery, and it has to be treated well to prevent complications that might have significant, long-lasting complications.&#x0D; Objective: - To assess the outcome of newborn jaundice at the central teaching Hospital of pediatrics in Baghdad using different modality of treatments.&#x0D; Patients and Methods: - A retrospective study is done depending on the medical data of infants have jaundice who were admitted to the neonate units of the central teaching hospital within the period of a year, from May 1st 2020 to May 1st 2021. Blood grouping and total serum bilirubin measurements were taken in each case. Phototherapy, strong phototherapy, and exchange transfusion were utilized to treat the newborn jaundice, depending on its severity.&#x0D; Results: Total neonates admitted from 1st may2020 to1st may 2021 in neonate unit were 2508 and 855 [34%] have jaundice. the male: female rati0 is [1.6:1], males 516[60.3%], females 339[39.6%]. The Physiol0gical jaundice is the often-frequent cause 285[33.3%] patients. The Prematurity seen in 171[20%] patient and the ABO incompatibility seen in 128[1.3%] and the Rh incompatibility 17[2%] patient, the sepsis found in 16[2%] case and the other causes of hyperbilirubinemia seen in 238[27.8%] patient. the Phototherapy is the most frequent kind of management used in 513[55%] and intensive phototherapy is applied for 342[40.3%] patients and just 59[7%] of patients treated with exchange transfusion particularly patients with ABO incompatibility 25 [42%] also Rh incompatibility 34 [57.6%] Good decline in TSB level and not require the exchange transfusion is 812 [95%] of patients. Majority of infants 849 [99.55%] discharge with clinical improvement and only 17 [0.3%] of infant’s patients develops kernicterus and 8 patients is dying [0.1%]&#x0D; Conclusion: Moderate to severe hyperbilirubinemia is still often treated with phototherapy. Intensive phototherapy is beneficial in lowering T.S.B levels, minimizing the need for exchange transfusions, and shortening hospital stays in patients with newborn hyperbilirubinemia.

Anti-M Alloimmunization following Term Stillbirth: A Case Report and Review of the Literature

AbstractAlloimmunization due to anti-M antibodies are rare since they present as naturally occurring immunoglobulin M antibodies, which do not cross the placenta. Very rarely, these may convert to immunoglobulin G antibodies and cause hemolytic disease of the fetus and newborn. We present the case of a fifth gravida, with previous two miscarriages and an unexplained stillbirth, booked with us for the 8 weeks. At booking, she was found to have anti-M antibodies with titers of 1:2, which was stable throughout pregnancy. At 35 weeks, there was evidence of severe fetal anemia and features of hydrops on the ultrasound scan, requiring delivery. Neonatal direct Coombs test was positive. Baby had a hemoglobin of 8.8 mg/dL and a reticulocyte count of 5.5% at birth, requiring two units of blood transfusion. He also required 6 days of intensive phototherapy. Alloimmunization due to anti-M antibodies should be suspected in women with previous bad obstetric history. The maternal antibody titers may not be a true reflection of the severity of fetal affection, and hence not reliable for monitoring in pregnancy

Neonatal jaundice: magnitude of the problem in Cairo University's neonatal intensive Care unit as a referral center.

Neonatal jaundice is one of the most common physiologic problems requiring medical attention in newborns. It is benign in most cases; however, high levels of bilirubin are neurotoxic and can lead to serious brain damage. This study aimed at assessment of magnitude of neonatal jaundice in cases of neonatal hyperbilirubinemia admitted into neonatal intensive care unit (NICU), Cairo University Pediatric Hospital and to detect possible etiologies, management and outcome. The present work is a retrospective study, included 789 neonates suffered from hyperbilirubinemia over a two-year period. Intensive phototherapy and exchange transfusion were used together in 6 cases. Two hundreds and twenty-two cases (28.1%) had exchange transfusion once, 44 cases had it twice, 6 cases had it 3 times and one case had it 4 times. Number of exchange transfusion significantly affects mortality among cases (P= 0.02). Neonatal hyperbilirubinemia is an existing problem in our NICU. Intensive phototherapy is an excellent substitute for exchange transfusion. Respiratory distress and sepsis are significantly higher among dead cases. Screening for risk factors is needed to avoid critical hyperbilirubenemia.

Evaluation of Intravenous Immunoglobulin Administration for Hyperbilirubinemia in Newborn Infants with Hemolytic Disease

The primary objective of this research was to evaluate the use of intravenous immunoglobulin (IVIG) in infants with hemolytic disease, to assess compliance with the American Academy of Pediatrics (AAP) guideline recommendations, and to review the data on which the guidelines were based. This retrospective study evaluated all infants in the NICU (neonatal intensive care unit) who received IVIG between January 2018 and December 2020 (n = 71). Total serum bilirubin (TSB) levels surrounding the time of IVIG administration, rate of rise of bilirubin, and direct antiglobulin test (DAT) status were evaluated to determine the appropriateness of IVIG use based on the 2004 AAP recommendations that was current at the time of the study. Fifty-nine infants received IVIG for hyperbilirubinemia. Of them, 80% had an ABO mismatch, 19% had Rh mismatch, and 71% were DAT-positive. Phototherapy was started at an average of 7 h of age, and the first IVIG dose was administered at an average of 13 h of life; nearly 25% received a second IVIG dose. One infant (1.6%) met all three AAP guideline criteria of being DAT-positive, bilirubin within 3 of exchange level, and rising bilirubin despite intensive phototherapy. Twenty-five (42%) babies were DAT positive and met one of the other two criteria. Only 12% (n = 7) had a bilirubin within 3 of exchange level. Most infants who received IVIG for hyperbilirubinemia did not meet the AAP criteria, prompting us to develop an institution-specific IVIG clinical practice guideline. The 2022 AAP guideline was published after our study was completed, but it confirmed our belief that IVIG usage should be more restricted and the criteria more explicit.

Role of IVIg in Severe Neonatal Jaundice due to Isoimmunization A Retrospective Cohort Study

Aim To see the efficacy of intravenous immunoglobulin (IVIg) in reducing the need for exchange transfusion (ET) in neonates with isoimmune hemolytic disease with serum bilirubin at or above exchange level. Methods Retrospective cohort study conducted in neonatal intensive care unit of a tertiary care center from March 2015 to February 2020 included neonates with gestational age ≥35 weeks with positive Direct Coombs Test with serum bilirubin at or above exchange level according to American Academy of Pediatrics charts with no bilirubin encephalopathy at presentation. Study subjects were followed till discharge. Results ET was prevented in 8/41 (19.5%) cases who received IVIg initially vs. 2/51 cases (3.92%) who didn’t ( P = .02, relative risk: 1.98 with 95% confidence interval [1.32-2.98] with number needed to treat: 2.51). Total duration of phototherapy was significantly lesser in those receiving IVIg ( P &lt; .0001). Conclusion Targeted use of IVIg in isoimmune hemolytic disease of newborn with serum bilirubin rising despite intensive phototherapy or within 2 to 3 mg/dL of the exchange level is more likely to benefit than harm and remain prudent.