Mean Duration Of Phototherapy Research Articles

Single surface phototherapy with reflecting curtains versus double surface phototherapy in unconjugated neonatal hyperbilirubinemia in a tertiary care NICU

BACKGROUND Neonatal hyperbilirubinemia is treated with different modalities like single, double surface phototherapy and biliblankets. Reflecting curtains with single surface phototherapy is a cheaper and easy modality . So, this study was designed to compare the efficacy of single surface phototherapy with reflecting curtains [SSPRC] versus double surface phototherapy [DSP]. METHODS A prospective comparative study in 120 term neonates with unconjugated hyperbilirubinemia was conducted from July 2021 – Jan 2022 in Neonatal intensive care unit of College of Medical Sciences, Bharatpur. The study population was randomized to either SSPRC or DSP. The primary outcome was mean decrease and rate of decrease of bilirubin in subsequent 6 and 12 hours. Secondary outcome were duration of phototherapy and complications. The analysis was done using SPSS version 18.0. RESULTS Mean bilirubin level at 6 hours after starting phototherapy was 16.27 mg/dL vs 16.71 mg/dL, p=0.542 and at 12 hours 14.61 mg/dLvs 14.70 mg/dL, p= 0.428. Mean rate of decrease in SSPRC vs DSP was 1.63 mg/dL vs 1.81 mg/dL, p=0.154 at 6 hours, 3.29 mg/dL vs 3.82 mg/dL, p=0.39 at 12 hours. Mean duration of phototherapy was significantly lower in SSPRC 3.8 Vs 4.2 days, p=0.031.Complications were skin rashes 11.7% vs 16.7%, p=0.432 and change in frequency of stool 10.0% vs 8.3%, p=0.752. CONCLUSION Single surface phototherapy with reflecting curtain as double surface phototherapy is equally effective, reliable and successful in decreasing bilirubin in less duration with minimum complications. Therefore this technique can be of help where DSP is unavailable or unaffordable.

Risk Factors and Outcome of Neonatal Hyperbilirubinemia: A Case Control Study in a Tertiary Level Paediatric Hospital

Introduction: Neonatal jaundice is one of the most common morbidities observed during the neonatal period. Several risk factors are responsible for this condition.
 Objective: This study was aimed to determine the possible risk factors and immediate outcome for jaundice in newborns.
 Methods: This case control study was performed over a period of 18 months (March 2019 -August 2020) in the Special Care Newborn Unit (SCANU) of Dr. M R Khan Shishu Hospital & Institute of Child Health (ICH). Risk factors for jaundice were evaluated by comparing cases with jaundice and controls having no jaundice.
 Results: A total of 230 neonates with jaundice and 250 neonates having no jaundice were enrolled. Maternal age between 31-40 years, less than 4 antenatal visits, primi, presence of maternal diabetes, babies born via caesarian section, small for gestational age, prematurity and intra-uterine growth restriction were significantly associated with jaundice in neonates (p value < 0.05). Multi-variate analysis revealed, babies with mothers having <4 antenatal visits were found to have 13 times more risk of developing jaundice than their matched controls (p= 0.00, CI= 0.78-14.9). Mean duration of phototherapy was longer for babies having jaundice due to blood group incompatibilities (4.82 ± 1.94). Most of the patients (91%) were discharged to home.
 Conclusion: Less than four antenatal visit is a significant risk factor for neonates to develop significant jaundice requiring treatment. Babies with blood group incompatibilities tend to require longer duration of phototherapy wherever most of the babies discharged to home with good recovery.
 DS (Child) H J 2021; 37(2): 109-115

Phototherapy-induced hypocalcemia and hypoparathyroidism in icteric term newborns.

Phototherapy is demonstrated to cause hypocalcemia by decreasing melatonin levels and increasing cortisol levels. However, the relationship between parathyroid hormone (PTH) level and calcium has not been previously evaluated in patients receiving phototherapy. Our study aimed to evaluate the effect of phototherapy on ionized calcium (iCa), total calcium (tCa), corrected calcium (cCa), magnesium (Mg), phosphorus (P), 25-hydroxyvitamin D (25(OH)D), and PTH levels. Infants who were born at term and received inpatient phototherapy for indirect hyperbilirubinemia were included in our study. The patients' gestational age, birth weight, and phototherapy durations were recorded. Total bilirubin, albumin, iCa, tCa, cCa, Mg, 25(OH)D, and PTH levels before and after phototherapy were compared. Laboratory results were also compared between patients who received phototherapy for≤24h, 25-47h, and≥48h. A total of 166 term infants were included in the study. The mean duration of phototherapy was 31.9±9.2h. Albumin levels before and after phototherapy were similar (p=0.246). However, there were significant decreases in iCa, tCa, cCa, Mg, 25(OH)D, and PTH levels after phototherapy (p<0.001), while P level was significantly increased after phototherapy (p<0.001). In addition, P levels increased with >24h of phototherapy, while iCa, tCa, cCa, Mg, 25(OH)D, and PTH levels decreased significantly with≥48h of phototherapy (p=0.002, p=0.008, p=0.001, p=0.012, and p<0.001, respectively). This study demonstrates that PTH suppression is one of the causes of phototherapy-induced hypocalcemia.

Prevalence of 563 C – T&amp; 131 C-G G6PD polymorphisms in term and late preterm neonates with significant unconjugated hyperbilirubinemia from a tertiary level care neonatal unit in Uttarakhand

Objectives: This study aimed to estimate the frequency of Glucose-6-phosphate dehydrogenase (G6PD) Mediterranean variant (563 C-&gt;T) and G6PD Odisha (131 C-&gt;G) variants along with the prevalence of G6PD deficiency quantitatively. This study also estimated peak serum total bilirubin level and duration of phototherapy and correlated with the G6PD levels and G6PD mutations. Methods: All the consecutive term and late pre-term neonates of either gender with significant hyperbilirubinemia were enrolled after written informed consent and were screened for G6PD deficiency (quantitatively). These neonates were also evaluated for G6PD gene polymorphisms. Exclusion criteria: Neonates with congenital anomalies or conjugated hyperbilirubinemia and those who received treatment before enrollment were excluded from this study. Results: A total of 150 infants with hyperbilirubinemia were enrolled. Males were two-thirds. Median G6PD levels were 11.9 units/gm of Hb (Inter quartile range [IQR]: 9.4–16.2). The prevalence of G6PD deficiency in our study population was 24% among the whole population and 30.6% in male infants. As per the World Health Organization (WHO) classification, majority (94%) were in class IV, 5.3% (n=8) had WHO Class III. All the eight infants in Class III were males. Mean (SD) and median serum bilirubin levels were 16.7 (1.1) mg/dL. Median duration of phototherapy was 24 h. Gene polymorphisms were done in 119 neonates. G6PD Mediterranean mutations were seen in 6.7% and G6PD Orissa mutations were seen in 4.2% neonates. There was a good correlation between G6PD deficiency and serum total bilirubin, mean duration of phototherapy and gender. Conclusion: This study reported 24% prevalence of G6PD deficiency among the study population with 6.7% prevalence of G6PD Mediterranean mutations and 4.2% prevalence of G6PD Orissa mutations.

Light-Emitting Diode (LED) Phototherapy versus Non-LED Phototherapy Devices for Hyperbilirubinemia in Neonates: A Systematic Review and Meta-analysis.

This review was conducted to evaluate the efficacy of light-emitting diode (LED) phototherapy as compared with the conventional phototherapy in neonates with unconjugated hyperbilirubinemia and their adverse effects. We searched the following databases right from their inception till April, 2021: MEDLINE, EMBASE, Cochrane Library, and LILACS. Randomized clinical trials (RCTs) comparing the LED phototherapy with other light sources, which enrolled newborns (term and preterm) with unconjugated hyperbilirubinemia were included. We included 21 articles in this review. The treatment with the LED light therapy had a lower failure rate as compared with the non-LED one (RR = 0.60, 95% CI: 0.39-0.94). The mean duration of phototherapy was significantly shorter in the group with the LED light source as compared with the one with the non-LED light source (mean difference [hours]: -8.07, 95% CI: -8.45 to -7.68), regardless of the type of non-LED units. However, the rate of bilirubin showed a comparable decline (mean difference [mg/dL/h]: 0.01, 95% CI: -0.00, 0.03) in both the light sources, irrespective of irradiance or distance. No studies reported primary outcomes related to the neurotoxicity effects of hyperbilirubinemia in neonates. The LED light devices caused a significantly higher risk of hypothermia. Neonates were at a lower risk of developing hyperthermia and skin rash with the LED light therapy. Our findings provide support for the use of LED light source phototherapy due to its better clinical efficacy, which is evidenced by its shorter duration and lower rate of treatment failure, as compared with the non-LED light sources. KEY POINTS: · The efficacy of phototherapy is dependent on specific characteristics of light sources of phototherapy devices.. · LED phototherapy demonstrated better efficacy with shorter duration and lower rate of treatment failure.. · Adverse effects of phototherapy devices such as hypothermia, hyperthermia, and skin rash should be monitored..

Cylindrical intensive vs. double surface LED phototherapy for neonatal hyperbilirubinemia

Background High bilirubin levels may lead to complications such as bilirubin encephalopathy or even death. Therefore, neonatal hyperbilirubinemia patients require appropriate treatment in the form of phototherapy or exchange transfusion. With the advancement of technology, various types of phototherapy, such as the cylindrical intensive phototherapy (bilisphere) and double LED, are now available.&#x0D; Objective To compare cylindrical intensive phototherapy to double surface LED phototherapy in neonatal hyperbilirubinemia.&#x0D; Methods This cohort study was conducted in neonates with hyperbilirubinemia at at Syamsudin SH Hospital, Sukabumi, West Java, who were treated with either cylindrical intensive phototherapy or double surface LED phototherapy. The variables observed were subjects’ characteristics, bilirubin levels pre- and post-therapy, duration of phototherapy, length of stay, and total treatment cost. The data were analyzed using univariate and bivariate analyses.&#x0D; Results Of 47 neonates, the mean bilirubin levels were 19.36 mg/dL pre-therapy and 12.26 mg/dL post-therapy. Subjects’ overall mean duration of phototherapy was 24 hours, mean length of stay was 1 day, and mean cost of treatment was IDR 813,175. There was no significant difference in the bilirubin decrease between the cylindrical intensive phototherapy and double LED groups. However, there were significant differences between the cylindrical intensive phototherapy and double LED groups in duration of phototherapy (10.75 vs. 75.17 hours, respectively (P&lt;0.000), mean length of stay (1 vs. 3.13 days, respectively (P&lt;0.000), and total cost of treatment (IDR 598,918 vs. IDR 1,036,747, respectively P&lt;0.000).&#x0D; Conclusion While the decrease in bilirubin was not significantly different in neonatal hyperbilirubinemia patients who underwent cylindrical intensive phototherapy compared to double LED therapy, cylindrical intensive phototherapy relates to significant shorter phototherapy duration, length of stay, and total treatment cost. Hence, cylindrical intensive phototherapy phototherapy is considered to be more time-efficient and cost-efficient than double LED phototherapy.

Factors affecting the severity of hemolytic disease of the new-born due to ABO incompatibility

Background and Aim: ABO incompatibility is one of the most common cause of hemolytic disease of fetus and new born. Better understanding of the factors affecting its severity helps to optimise care. The objective of this study was to investigate the factors affecting the severity of HDN due ABO incompatibility in new-borns. Methods: This study was a prospective observational study conducted in the NICU, department of Pediatrics, P.D.U Government Medical College and Hospital, Rajkot. The study was conducted from January 2019 to June 2019; 50 new-borns with ABO incompatibility i.e., having blood group A or B born to mothers with blood group O, presenting with jaundice and or anemia were enrolled in the study. Various maternal and neonatal factors and their possible association in affecting the severity of HDN were studied. Results: In our study, 27 neonates (54%) were male and 23 neonates (46%) were female. Percentage of O-A and O-B incompatible neonates were 26 (52%) and 24 (48%) respectively. The various maternal and neonatal factors had no significant association in affecting the severity of the disease. The mean age of presentation was 3.74 ± 2.34 days. Jaundice was detected in the first 24 hours of life in 6% neonates. The mean initial indirect bilirubin was 19.77 ± 2.50, and initial hemoglobin was 14.41 ± 2.07. Ten neonates (20%) had anemia. Total of 15 neonates (30%) had evidence of hemolysis in the form of spherocytosis. Direct Coombs Test was positive in one case. The mean duration of phototherapy was 54.62 ± 5.79 hours. Three neonates (6%) required exchange transfusion and 4 neonates (8%) received IVIG. The mean duration of stay was 4.18 ± 1.04 days. Conclusion: Although none of the factors had a significant association in affecting the severity of HDN due to ABO incompatibility, we should remember that ABO incompatibility is not always a benign condition and should be considered even in those with a negative DCT. Early identification of high-risk neonates with ABO incompatibility and prompt diagnosis and treatment can reduce morbidity and mortality.

Efficacy and Safety of Fenofibrate in Uncomplicated Hyperbilirubinemia in Newborn: A Randomized Trial, with a 6-month Follow-up

Objective: To study the effect and safety of Fenofibrate in uncomplicated hyperbilirubinemia in newborn with 6-month follow-up.&#x0D; Materials and Methods: This is a randomized controlled clinical trial conducted in 60 normal term neonates admitted for uncomplicated hyperbilirubinemia in NICU at Sir T G Hospital, Bhavnagar from January 2012 to December 2012. The data included: age, sex, total serum bilirubin (TSB), weight and duration of phototherapy. All neonates enrolled in the study received phototherapy. They were divided in two groups of 30 each: control group A and group B receiving Fenofibrate (100 mg/kg single dose). There was statistically insignificant difference between the parameters of age, sex, weight and TSB between the two groups at hospitalization. Data was analyzed by using appropriate statistical methods.&#x0D; Results: Mean values for total serum bilirubin in Fenofibrate group B at 24 and 48 hours after admission were significantly lower than those for control group A (p&lt;0.0001, p=0.0001). There was no significant difference in fall of TSB between 24 and 48 hours. The mean duration of phototherapy in Fenofibrate group (44.8h: 24-72h) was significantly shorter than that in control group (55.2 h: 24‐96 h) (P=0.02). There were no side effects of the drug observed during the study and during 6 months follow up period.&#x0D; Conclusion: Fenofibrate as a single 100 mg/kg dose in healthy full term neonates, is effective and a safe drug (till six-month follow-up) for neonatal hyperbilirubinemia, that can decrease the time needed for phototherapy and hence hospitalization. Effect of a single dose seems to wane after 24 hours.

Electrolyte changes in the neonates receiving phototherapy

Background: Neonatal jaundice is the most commonly observed clinical condition of early neonatal period. It remains a common cause of readmission and important cause of concern for the parents and clinicians. Therefore, appropriate management of neonatal hyperbilirubinemia is of paramount importance. Phototherapy plays a significant role in its management but this modality is not devoid of complications. Authors studied electrolyte changes in the neonates, who received phototherapy.Methods: This perspective hospital based observational study conducted over the period of one year on 90 eligible admitted neonates who received phototherapy as per AAP guideline. Serum bilirubin, sodium, potassium and calcium were determined before and after termination of phototherapy. The first samples were considered as controls and compared with the samples collected after termination of phototherapy.Results: The incidence of LBW babies in this study was 21.9%, while mean birth weight and gestational age was2.76±0.38 kg and 38.34±0.88 weeks respectively. Mean duration of phototherapy was 38.48±09.34 hours. The mean sodium, potassium and calcium level before therapy were 146.6±6.2 mg/dl, 4.7±0.47 mg/dl and 9.4±0.73 mg/dl respectively. Authors found statistically significant changes in the electrolyte’s levels (Na+ 141.3±6.1, K+ 4.2±0.51 and Ca+2 8.4±0.68 respectively), after phototherapy however none of any neonate shown any clinical signs of dyselectolytemia.Conclusions: Neonates undergoing phototherapy are at greater risk of dyselectrolytemia especially in preterm babies therefore close clinical and biochemical monitoring is required for the prompt management of any significant electrolyte imbalance.

Comparing the effect of kangaroo mother care and field massage on serum bilirubin level of term neonates with hyperbilirubinemia under phototherapy in the neonatal ward.

Background:Several factors contribute to the effectiveness of phototherapy. The aim of this study was to compare the effect of kangaroo mother care (KMC) and field massage on bilirubin level of term neonates with hyperbilirubinemia under phototherapy in the neonatal ward.Methods:This double-blind clinical trial was performed on 90 term neonates aged 48 hours with hyperbilirubinemia, hospitalized in Fereydunkenar Hospital during 2018-2019. The infants were randomly divided into 3 groups of massage with phototherapy, KMC with phototherapy and control (received conventional phototherapy without KMC and massage). The massage group used field technique for three 15-minutes in 3 days and the KMC group received KMC for five 30 minutes in 3 days as well. In three groups, the serum bilirubin levels were compared at baseline, 24, 48, 72 hours after the onset and at the end of phototherapy. Moreover, the mean duration of phototherapy and hospitalization was compared during the treatment.Results:Serum bilirubin levels at baseline in the control, field massage and KMC groups were (17±1.38, 17.01±1.46 and 16.97±1.27mg/dl) and at the end of phototherapy were (6.97±0.47, 5.56±0.48 and 5.91±0.52 mg/dl) respectively. There was a significant difference between the intervention and control groups (p<0.001). The mean duration of phototherapy and hospitalization had no significant difference between two intervention groups (p>0.001), but it was significantly higher in control group than intervention groups (p<0.001).Conclusion:The use of massage or KMC with phototherapy, compared to the phototherapy alone, can reduce the bilirubin level, phototherapy duration and hospital stay.

Evaluating the effects of different doses of ursodeoxycholic acid on neonatal jaundice.

Icterus tends to be one of the most prevalent causes of neonatal hospitalization. The present study aimed to evaluate the effects of the different doses of ursodeoxycholic acid (UDCA) on neonatal jaundice. In this study, 120 newborns who were hospitalized for phototherapy were randomly assigned. Group A received phototherapy and UDCA 5 mg/kg/dose every 12 hours orally, group B patients were treated with phototherapy and UDCA 7.5 mg/kg/dose every 12 hours orally. Group C received phototherapy with a placebo. All patients were evaluated for bilirubin levels, the duration of phototherapy, and the length of hospital stay. The mean bilirubin level at hospital admission was 19.88 ± 2.33 mg/dl in group A, 19.33 ± 2.51 mg/ dl in group B, and 19.76 ± 2.64 mg/dl in group C (p= 0.58). The groups receiving phototherapy with UDCA showed a significant decrease in the bilirubin level. Bilirubin level decreased to 10.04 ± 1.11mg/dl in group A, 8.82 ± 1.11 mg/dl in group B, and 12.04 ± 2.05 mg/dl in group C (p= 0.000). Furthermore, the mean duration of phototherapy, as well as the average length of hospital stay, were significantly lower in group B as compared to the other groups (p= 0.000). The findings of this study indicated that the administration of UDCA in addition to phototherapy could effectively decrease the length of hospital stay and bilirubin levels in neonatal hyperbilirubinemia. However, further studies with a larger sample size are required before one can recommend the routine use of UDCA for the treatment of neonatal jaundice.

Study of sodium and potassium changes in term neonates receiving phototherapy

Background: Neonatal Hyperbilirubinemia (NH) is the commonest abnormal physical finding during the first week of life and also the most common cause for readmission during the early neonatal period is a cause of concern for the parents as well as for the Pediatricians. Hence appropriate management of Neonatal Hyperbilirubinemia is of paramount importance. Phototherapy plays a significant role in prevention and treatment of hyperbilirubinemia. However, this treatment modality may itself result in inherent complications. The present study was carried out with the objective of evaluating the sodium and potassium changes in neonates receiving phototherapy for neonatal hyperbilirubinemia.Methods: A prospective hospital based observational comparative study conducted on 96 eligible term neonates admitted in the neonatal intensive care unit receiving phototherapy at a teaching Hospital from October 1st to December 31st 2018. A predesigned proforma has aided the enrolment of new-borns into the study according to AAP guidelines. Serum bilirubin, sodium and potassium were determined before and after termination of phototherapy. The first samples were considered as controls. A comparative study was made between before and after phototherapy groups to determine the incidence of sodium and potassium changes.Results: The study group included 96 term neonates that were managed with phototherapy. Incidence of low birth weight babies was 21.9%. Mean birth weight and gestational age was 2.76±0.38 kg and of 38.34±0.88 weeks respectively. Mean duration of phototherapy was 38.48±09.34 hours. The incidence of Sodium and potassium changes were found to be statistically significant after phototherapy (p&lt;0.01) but neonates didn’t develop any signs of hyponatremia and hypokalemia.Conclusions: The study shows that neonates undergoing phototherapy are at a higher risk of sodium and potassium changes. This risk is greater in LBW babies and hence this group of babies should be closely monitored for changes in sodium, potassium and should be managed accordingly.

Efficacy of Home Phototherapy in Neonatal Jaundice

Background: Jaundice is one of the most common problems in the neonatal period. Phototherapy is one of the most commonly used treatments for jaundice that can be used as a simple, practical home-based treatment. Hospitalization during the first days of birth to conduct phototherapy may result in problems like nosocomial infections and mother separation from the baby. Objectives: The aim of this study was to evaluate the efficacy of home phototherapy in the duration of treatment, mean bilirubin level, and complications. Methods: This clinical trial was performed on newborns with jaundice in Isfahan health centers. The sample was randomly divided into two groups: Phototherapy at home (32 patients) and phototherapy at the hospital (32 patients). A demographic questionnaire and a researcher-made checklist were used to collect data on variables such as the duration of treatment, the frequency of treatment failure, mean bilirubin, and phototherapy complications. Results: The mean duration of phototherapy in both groups was two days, which showed no significant difference (P = 0.32). The most common complication in both groups was skin rashes and restlessness, which also showed no significant between two groups (P > 0.05). There was no significant difference in terms of treatment failure (P = 0.246). Statistical tests also revealed that bilirubin reduction was the same in both groups. Conclusions: Home phototherapy can be suggested as a safe treatment with no complication to the patients.

A STUDY OF NEONATAL HYPERBILIRUBINEMIA FROM A TERTIARY CARE HOSPITAL IN NORTHERN INDIA

Objective: The objective of this study was to analyze the incidence of pathological jaundice, average time of presentation, mean duration of phototherapy, and need for exchange transfusion with appropriate medical management. Methods: Thus, retrospective study was conducted at neonatal intensive care unit of a tertiary care hospital from August 2017 to August 2018. All live births who were diagnosed with neonatal hyperbilirubinemia and requiring treatment were included in the study. Exclusion criteria included any baby with conjugated serum bilirubin >20% of total serum bilirubin or >2 mg/dl or neonate with any congenital malformation. Results: Nearly 5% of total babies delivered developed neonatal jaundice requiring treatment. The most common causes isolated were ABO incompatibility followed by Rh incompatibility. Almost 46% of babies were not found to have any cause. The most likely etiology concluded in this group was breastfeeding jaundice. Conclusion: Breastfeeding jaundice should be considered as one of the common causes of pathological jaundice making lactational counseling during antenatal and postnatal period an essential component of management and prevention of pathological jaundice. Early detection and timely intervention with lesser invasive treatment modalities such as intravenous immunoglobulin G, hydration, and phototherapy should be attempted aggressively to avoid need for high-risk procedures like exchange transfusion.

Is calcium a concern in neonates undergoing phototherapy?

Background: Neonatal hypocalcemia is defined as total serum calcium concentration of &lt; 7 mg/dl or ionized calcium concentration of &lt;4 mg/dl (&lt;1 mmol/L). The current aim was to look the effect of phototherapy on ionized calcium levels before and after phototherapy in otherwise healthy term and late preterm (35 to 37 weeks) neonates.Methods: The study group included 50 neonates. Measurement of serum ionized calcium levels was done before and at the end of phototherapy.Results: At the end of phototherapy in study group, a significant fall in calcium level in 64% of term and 76% of late preterm neonates was observed, but almost all except one remained asymptomatic.Conclusions: The efficacy of phototherapy in the prevention and treatment of hyperbilirubinemia in newborn infants has been well established. The mean duration of phototherapy in our study was 32 hours. Duration of phototherapy may influence the severity of hypocalcaemia. The regulation of calcium homeostasis in the newborn period has been of considerable interest. Phototherapy increases calcium absorption by the bones and leads to the reduction of melatonin levels. Changes in melatonin levels affect the incidence of hypocalcaemia-induced phototherapy. The mechanism of hypocalcaemia effect of phototherapy was reported by inhibition of pineal gland via transcranial illumination, resulting to decline of melatonin secretion; which blocks the effect of cortisol on bone calcium. It is suggested that serum calcium levels be assessed in neonates treated with phototherapy. Neonatal Jaundice is one of the most common problems that can occur in the newborn. Hypocalcaemia during phototherapy has been reported in literature.

Hemolytic disease of the new-born due to ABO incompatibility

Background: Better understanding of the clinical characteristics of HDN due to ABO incompatibility helps to optimise care. The objective of this study was to investigate the clinical manifestations and outcome of treatment modalities.Methods:This study was a hospital based cross sectional study conducted in the neonatal unit of Cheluvamba hospital attached to Mysore Medical College and Research Institute. A total of 50 neonates with blood group A or B born to mothers with blood group O; with jaundice and or anemia were enrolled during the period from January 2015 to December 2015. The various maternal and neonatal parameter and their association with development of jaundice and or anemia was studied. The outcome of treatment modalities was studied.Results: Out of 50 ABO Incompatible neonates 24 (48%) were male and 26 (52%) were female. The percentage of O–A and O–B incompatible neonates were 38% (19) and 72% (31), respectively. Jaundice was detected within the first 24 hours in 6% and 18% neonates had anemia. The mean age of presentation was 2.9±0.89 days. The various maternal and neonatal factors had no significant association with development of jaundice and or anemia due to ABO Incompatibility. The mean initial Indirect Bilirubin was 21.26±3.97, initial hemoglobin was 14.3±2.31 and the mean Reticulocyte count was 16.6±5.3. Total 22 (44%) neonates had laboratory evidence of hemolysis (microspherocytosis). DCT was positive in 4 (8%) neonates. The main clinical manifestation was jaundice and was treated with phototherapy in 49 (98%) of the cases. The mean duration of phototherapy was 53.84±9.82 hours. Only one infant required exchange transfusion and on follow up had no neurological sequelae. The mean total duration of stay was 3.6±1.2 days. There was no significant difference in the HDN due to either O–A or O–B incompatibility.Conclusions:Early identification of high risk neonates with ABO Incompatibility, diagnosis and early intervention can reduce morbidity and mortality.

The Effect of Oral Zinc Sulfate on Serum Bilirubine Level in Term Neonates with Jaundice

Background The most commonly used treatment for neonatal hyperbilirubinemia (NH) are phototherapy and exchange transfusion. Among the drug therapy for NH less has been paid to the effect of zinc administration on serum bilirubin level (SBL). This study was carried out to determine the on the effect of oral zinc sulfate on the SBL in term neonates with hyperbilirubinemia. Materials and Methods In this randomized clinical trial, we studied term neonate with jaundice hospitalized in Amirkola Children’s Hospital, Babol-Iran for phototherapy. Eligible neonates were randomly divided into two; intervention (n=30) and control (n=30) groups. Both groups received standard conventional phototherapy but the intervention group received 5 mg per day oral zinc sulfate until discharge. The outcome variables were SBL and the duration of phototherapy. Results Out of the 105 studied neonates, 50 cases were in the intervention group and 55 patients were in the control group. The mean SBL before intervention in the intervention and control groups, was 17.4 ±2.1 and 17.1±2.2 mg/dl, respectively (P>0.05) but after the intervention, it decreased to 8.8±0.77 and 8.7±0.99 in intervention and control groups respectively (P>0.05). The mean differences in the decrease in SBL between the two groups were 8.8 and 8.3 in intervention and control groups respectively (P>0.05). But the mean duration of phototherapy in the intervention group and the control group was 4.1 days and 3.6 days respectively (P<0.05). Conclusion Administration of oral zinc in neonatal hyperbilirubinemia under the phototherapy could decrease the duration of phototherapy. Further studies are needed to recommend it as an adjunctive therapy to phototherapy.

Red cell alloimmunization in RhD positive pregnant women and neonatal outcome

The frequency of red blood cell (RBC) alloimmunization in RhD positive pregnant women is not known in our population. We planned to determine its frequency and correlation with neonatal outcome. We included 1000 RhD positive pregnant women: 500 had ‘normal pregnancy’ (Group I) and another 500 had ‘high risk pregnancy’ (Group II). ABO and extended Rh phenotyping were done by tube technique, antibody screening and identification by gel technique. For alloimmunized women, the paternal and neonatal ABO and extended Rh typing were done. Neonatal direct antiglobulin test (DAT) was also done and their clinical outcome observed. The frequency of RBC alloimmunization was 0.7% (7/1000) and all these women were from group II (p = 0.015). The alloantibodies were anti-E (85.7%), anti-c (71.4%), anti-Cw (14.3%) and anti-S (14.3%). Also, 6 women had history of transfusion (p < 0.01). Of the 7 neonates born to alloimmunized mothers, 4 (57.14%) had a positive DAT. The mean duration of phototherapy was higher in the DAT positive neonates (p < 0.01) and 2 (50%) required exchange transfusion. Thus, the frequency of alloimmunization was 0.7% in RhD positive pregnant women. High risk pregnancies and antenatal patients having a history of blood transfusion should be considered for regular antibody screening.

EFFECTS OF MASSAGE ON DURATION OF PHOTOTHERAPY IN PREMATURE INFANTS ADMITTED TO A NEONATAL INTENSIVE CARE UNIT

BACKGROUND AND OBJECTIVE: Approximately 80% of premature infants are diagnosed with icterus, most of whom are treated by phototherapy. Given the adverse effects of this treatment on neonates, minimizing the duration of phototherapy seems to be necessary. This study aimed to evaluate the effects of massage on the duration of phototherapy in premature infants admitted to neonatal intensive care units. METHODS: This clinical trial was performed on premature infants admitted to the neonatal intensive care unit of Qaem Hospital of Mashhad, Iran, in 2011. The infants were randomly divided into intervention (n=30) and control (n=30) groups. The infants of both groups were similar in terms of weight, age, and the level of bilirubin. The intervention group received massage therapy (including massage and passive movements of the body parts) on a daily basis for three 15-minute courses at three consecutive hours for five days. The control group received the routine care and phototherapy. After the intervention, the two groups were compared in terms of duration of phototherapy and level of transcutaneous bilirubin. FINDINGS: The mean duration of phototherapy in the intervention and control groups was 80.8±61.58 and 112.8±75.45 hours, respectively. However, this difference was not statistically significant. On the fifth day of the intervention, the level of transcutaneous bilirubin was 9.7 and 8.1 mg/dl in the intervention and control groups, respectively, this difference was not significant as well. CONCLUSION: Massage can be used as an effective method alongside with phototherapy to minimize the duration of phototherapy for premature healthy infants in clinically stable conditions.

Hypocalcemia in jaundiced neonates receiving phototherapy.

Objective:To determine the frequency of hypocalcemia in term neonates with jaundice receiving phototherapy.Methods:This was a cross sectional study conducted at Neonatal intensive care unit, National Institute of Child Health, Karachi from 1st January 2014 to 30th December 2014. A total of 123 term neonates with jaundice of either gender managed by phototherapy were enrolled in the study. Gestational age was assessed through modified Ballard scoring. Duration of phototherapy was recorded. A sample of 3 ml of blood was sent to the laboratory for serum calcium level before initiating phototherapy and after 24 hours of continued phototherapy. All the data were recorded in the preformed proforma. Data was analyzed using SPSS version 19. P value <0.05 was taken as significant.Results:The mean age of the neonates was 8.35±6.74 days. Mean gestational age at the time of birth was 39.08±1.37 weeks. Mean duration of jaundice was 2.4±1.20 days. Mean duration of phototherapy was 1.74±0.98 days. Serum calcium level before and after 24 hours of initiating phototherapy was 8.73±0.68 mg/dl and 7.47±0.82mg/dl respectively Frequency of hypocalcemia in term jaundiced neonates receiving phototherapy were observed in 22.76% (28/123).Conclusions:The frequency of hypocalcemia is significant in the jaundiced neonates treated with phototherapy. One needs to be vigilant in dealing neonates in this context while serial monitoring for hypocalcemia and its complications should be considered in institutional policy and research priority.