Neonatal Bilirubin Levels Research Articles

Preventive effect of purgative manna on neonatal jaundice: A double blind randomized controlled clinical trial

Ethnopharmacological relevanceCotoneaster nummularioides Pojark manna (Shir-e-Khesht) is popular in Persian medicine. Different effects of some Cotoneaster species manna include antibacterial, antioxidant, anticancer, and hepatoprotective effects, as well as bilirubin serum levels reduction. Cotoneaster species manna is used in many parts of Iran as a laxative and accelerates the passage of meconium. Neonatal jaundice has relatively costly and sometimes invasive therapeutic interventions, which its prevention from becoming severe cases can be a priority in neonatal medicine. Aim of the studyThe aim of this study was to evaluate the effectiveness of an herbal product (Purgative Manna, native to Iran and Asian countries) in preventing severe cases of jaundice and reducing total bilirubin levels in neonates. Materials and methodsThis randomized double-blind controlled clinical trial included full-term babies. Four hundred and forty-five (445) eligible neonates were assigned to two groups using the block balanced randomization method; 222 neonates received the Purgative Manna product as drops, and 223 neonates received placebo drops. The neonates received a dose of 5 drops per kilogram of neonatal weight (divided into three doses per day) for three days. The treatment period was three days, and a 24-h (three times) examination was performed to measure the initial outcome of the trial (i.e., the total serum bilirubin level). The secondary outcomes of this trial were the need for hospitalization due to jaundice and/or phototherapy from 4 to 14 days after birth, the frequency of defecation within 24 h, and the triple complications of diarrhoea, dehydration symptoms, and abdominal colic. ResultsIn this study, 220 neonates in the Purgative Manna product group and 222 neonates in the placebo group completed their interventions within the predicted period of the study. At the end of study, the total bilirubin level in the Purgative Manna treated group was significantly lower than that of the placebo group. The difference between the mean total bilirubin levels of the two groups was approximately 2.1 mg/dl on the third day after treatment, with an effect size of 0.79 (95% CI: 0.06–0.98). The relative risk for reducing the need for hospitalization or phototherapy in the group treated with Purgative Manna drops was 0.26, compared with the placebo group. The risk of occurrence of severe jaundice or phototherapy in the Purgative Manna group was 75% lower than that of the placebo group. The median frequency of defecation in the intervention group at three time intervals in the first, second and third days after treatment was 1–2 times more than that of the comparison group (p < 0.001). ConclusionsMeanwhile, considering the fact that one in every eight neonates who used the product avoided having a severe and high-risk case of jaundice or the need for phototherapy intervention (even through an exchange transfusion), the use of Purgative Manna drops can be recommended; however, further study is necessary.

A Novel Whole Spectrum-Based Non-Invasive Screening Device for Neonatal Hyperbilirubinemia.

Careful screening of bilirubin level in newborns is mandatory as per American Academy of Pediatrics (2004), to reduce incidents of kernicterus and acute bilirubin encephalopathy. Although, invasive capillary collection of blood and subsequent biochemical test is considered a gold standard for jaundice detection in neonates, transcutaneous bilirubin measurement using various non-invasive instruments is also used sporadically across the globe. The major aim of this study was to develop a non-invasive spectrometry-based technique for measurement of neonatal bilirubin level as an alternative of total serum bilirubin (TSB) test without limitations of other available bilirubinometers. The instrument comprises of a light source and a spectroscopic detector. A light beam from source incident on the neonatal nail plate through optical fibers. The retro reflected light is acquired using the detector. An indigenously developed software is used to acquire and analyze the optical signal and to calculate the bilirubin value. The instrument was calibrated and validated in reference to TSB on 1033 subjects. The result (r = 0.95 and P < 0.001) indicates a strong correlation between the bilirubin value obtained from our method and TSB. Time variant analysis of the subjects undergoing phototherapy provided a good correlation (r = 0.98). The repeatability test result shows the mean coefficient of variation is less than 5.0%. The indigenously developed non-invasive technique successfully detects the bilirubin level in newborns under various physiological conditions with high accuracy and precision.

Glucuronidated bilirubin: Significantly increased in hepatic encephalopathy.

Bilirubin is produced by the breakdown of hemoglobin in senescent erythrocytes by macrophages and carried by albumin from blood circulation to the liver for removal in normal physiology. Glucuronic acid modification of bilirubin by UDP-glucuronyltransferase in the liver is the key event for its subsequent elimination from human body. Conditions that accelerate the breakdown of erythrocytes may cause an elevated blood level of unconjugated bilirubin whereas the factors affect the glucuronidated bilirubin formation and subsequent elimination may cause decreased or increased blood level of glucuronidated bilirubin, the water soluble "direct bilirubin" measured by clinical blood test. Studies showed that increased total serum bilirubin has a protective effect on cardiovascular and other related diseases, but it is unknown how direct bilirubin levels were related to different diseases. By taking advantage of the data collected in the clinical laboratory of our hospital, the direct bilirubin data from 192,535 patients with 72 clinically defined diseases were compared to that of healthy controls (10,497). Based on the mean, median, and p values, we found that patients with hepatic encephalopathy had the highest serum direct bilirubin level, which resembled acute hepatic encephalopathy caused by increased serum direct bilirubin level in neonates. In contrast, patients with uremia, nephrotic syndrome, and preeclampsia had significantly lower levels of serum direct bilirubin. Taken together, our data revealed that serum direct bilirubin levels were either increased or decreased in a disease-dependent manner. The possible molecular mechanisms of increased direct bilirubin levels in patients suffering hepatic encephalopathy are discussed.

Comparison of Bilirubin Levels in Neonates with Hyperbilirubinemia according to Delivery Methods

Objective: This study aimed to find out the correlation between bilirubin levels and delivery methods in term babies with neonatal hyperbilirubinemia. Methods: This retrospective study was performed in a single center. The subjects were full-term neonates (37-41 weeks of gestational age) with a chief complaint of hyperbilirubinemia (serum total bilirubin ≥12 mg/dL) admitted to the Bundang Jesaeng General Hospital from May 2015 to July 2018. The subjects were divided into two groups according to delivery methods (vaginal delivery [VD] and cesarean section [CS]). Total bilirubin levels were compared between the two groups, and the correlation between severe hyperbilirubinemia (serum total bilirubin ≥25 mg/dL) and delivery methods was analyzed. Results: A total of 87 neonates were enrolled. Of 87 neonates, 59 (67.8%) were born by VD and 28 (32.2%) by CS. The mean serum total bilirubin level of the VD group was significantly higher than that of the CS group (21.5±4.0 mg/dL and 17.5±3.4 mg/dL, respectively; P<0.001). There were also significant differences in bilirubin levels according to delivery methods in subgroups based on demographic characteristics, except in cases when the age of neonates exceeded 7 days on admission and in breast-feeding neonates. In addition, VD was significantly correlated with an increased risk of severe hyperbilirubinemia (relative risk 1.5; 95% confidence interval 1.2-1.9; P=0.031). Conclusion: This study showed that term neonates with hyperbilirubinemia born by VD had significantly higher bilirubin levels than those born by CS, and were also significantly correlated with severe hyperbilirubinemia.

Effect of Massage Therapy on Transcutaneous Bilirubin Level in Healthy Term Neonates: Randomized Controlled Clinical Trial

Background: Neonatal jaundice is a common condition in approximately 60% of term newborns during the first week after birth. Therefore, it is necessary to detect methods for the prevention of this problem.This study was conducted to evaluate the impact of massage therapy on transcutaneous bilirubin level in healthy term newborns. Methods: The present study was conducted on102 healthy term newborns. The newborns were randomly assigned to massage group and control group. The massage group received daily massage for five days from the first postnatal day while the control group received only routine neonatal care (without massage). In both groups, transcutaneous bilirubin level and frequency of defecation were the main studied variables. Results: The frequency of defecation in the massage group increased from 1.08 on the first day to 4.08 on the fifth day, whereas it increased from 0.865 on the first day to 2.731 on the fifth day in the control group, indicating a significant difference between the two groups (P<0.005). Moreover, transcutaneous bilirubin levels on the first and second days were not significantly different in both groups, while it was significantly lower during the third to fifth days in the massage group compared to that in the control group (P<0.005). Conclusion: The results of this study revealed that massage therapy could reduce transcutaneous bilirubin level and increase the frequency of defecation in healthy term neonates.

Effect of Massage Therapy on Transcutaneous Bilirubin Level in Healthy Term Neonates: Randomized Controlled Clinical Trial

Effect of Massage Therapy on Transcutaneous Bilirubin Level in Healthy Term Neonates: Randomized Controlled Clinical Trial

Effect of Phototherapy Treatment on Urinary Calcium Excretion in Neonates with Jaundice in Zahedan, Iran

Background: One of the recognized symptoms of phototherapy in neonates is hypocalcemia and hypercalciuria, and its etiology has not been identified yet. The present study investigated the recurrence of hypercalciuria among neonates with jaundice treated with phototherapy. Methods: This cross-sectional diagnostic examination was conducted on 100 newborns with jaundice treated with phototherapy in Ali-ibn-Abi-Talib hospital in Zahedan, Iran, during 2013 and 2014. In the present study, the subjects were collected in an accessible way after agreement and considering exclusion criteria. Calcium and creatinine (Ca/Cr) proportion in urinary tests of the neonates was estimated at the baseline and 24 h after the onset of phototherapy. The information was analyzed utilizing paired t-test. Results: The mean of gestational age was 38.5±2.5 weeks. Out of 100 cases, 53 newborns (53%) were male and 47 (47%) were female. The mean scores of birth weight was 2.52±0.59 kg and neonatal serum bilirubin level was 16.5±0.92 mg/dl. Ca/Cr ratios in neonates with jaundice were 0.28±0.21 and 0.40±0.34 before and after the phototherapy, respectively. Regarding that, the increase in Ca/Cr ratio was statistically significant (P<0.001). Hypercalciuria was not observed in the neonates before the phototherapy; however, it was noticed in 13 neonates after the phototherapy. Ca/Cr ratios in neonates with hypercalciuria and other newborns were 1.16±0.19 and 0.29±0.18, respectively. Furthermore, the difference between the two groups was statistically significant (P<0.001). Conclusion: Based on the results of this study, it was suggested that the neonates undergoing the phototherapy were at risk of hypercalciuria and the increased amount of urinary calcium excretion by means of phototherapy.

Laboratory validation and field usability assessment of a point-of-care test for serum bilirubin levels in neonates in a tropical setting.

Background: Screening and monitoring serum bilirubin (SBR) in neonates is crucial to prevent neonatal hyperbilirubinemia (NH)-associated morbidity and mortality worldwide. A lack of resources is often a barrier for measuring SBR in developing countries. Reliable, cost-effective, easy to use point-of-care (POC) SBR tests are needed. This study aimed to evaluate the technical accuracy and usability of the Bilistick System (BS), a new bilirubin POC test, in a tropical setting. Methods: This was a mixed-methods study, including laboratory validation of the BS, direct observation of technical procedures as performed by the midwives and midwives' assessment of the device's easiness of use through focus group discussions (FGD) and a self-administered questionnaire. The study was conducted in a field clinic of the Shoklo Malaria Research Unit along the Thailand-Myanmar border between January and December 2017. Results: A total of 173 samples were tested at a median age of 4 days. BS generated an error message-providing no SBR readout-in 48.6% of the tests performed. For the tests that yielded a result, the correlation coefficient (95% CI) between BS and routine laboratory bilirubinometer SBR was 0.87 (0.77-0.93). The accuracy decreased with increasing haematocrit and at higher humidity (≥75%). Direct observation of the operators using the device and analysis of the focus group discussions and questionnaires indicated that the BS was considered easy to use and required limited training. Conclusions: This evaluation showed that the BS, in its current formulation, does not provide reliable results for measuring SBR in a tropical, low-resource setting but has acceptable usability features.

Laboratory validation and field usability assessment of a point-of-care test for serum bilirubin levels in neonates in a tropical setting

Background: Screening and monitoring serum bilirubin (SBR) in neonates is crucial to prevent neonatal hyperbilirubinemia (NH)-associated morbidity and mortality worldwide. A lack of resources is often a barrier for measuring SBR in developing countries. Reliable, cost-effective, easy to use point-of-care (POC) SBR tests are needed. This study aimed to evaluate the technical accuracy and usability of the Bilistick System (BS), a new bilirubin POC test, in a tropical setting. Methods: This was a mixed-methods study, including laboratory validation of the BS, direct observation of technical procedures as performed by the midwives and midwives’ assessment of the device’s easiness of use through focus group discussions (FGD) and a self-administered questionnaire. The study was conducted in a field clinic of the Shoklo Malaria Research Unit along the Thailand-Myanmar border between January and December 2017. Results: A total of 173 samples were tested at a median age of 4 days. BS generated an error message—providing no SBR readout—in 48.6% of the tests performed. For the tests that yielded a result, the correlation coefficient (95% CI) between BS and routine laboratory bilirubinometer SBR was 0.87 (0.77-0.93). The accuracy decreased with increasing haematocrit and at higher humidity (≥75%). Direct observation of the operators using the device and analysis of the focus group discussions and questionnaires indicated that the BS was considered easy to use and required limited training. Conclusions: This evaluation showed that the BS, in its current formulation, does not provide reliable results for measuring SBR in a tropical, low-resource setting but has acceptable usability features.

Laboratory validation and field usability assessment of a point-of-care test for serum bilirubin levels in neonates in a tropical setting.

Background: Screening and monitoring serum bilirubin (SBR) in neonates is crucial to prevent neonatal hyperbilirubinemia (NH)-associated morbidity and mortality worldwide. A lack of resources is often a barrier for measuring SBR in developing countries. Reliable, cost-effective, easy to use point-of-care (POC) SBR tests are needed. This study aimed to evaluate the technical accuracy and usability of the Bilistick System (BS), a new bilirubin POC test, in a tropical setting. Methods: This was a mixed-methods study, including laboratory validation of the BS, direct observation of technical procedures as performed by the midwives and midwives' assessment of the device's easiness of use through focus group discussions (FGD) and a self-administered questionnaire. The study was conducted in a field clinic of the Shoklo Malaria Research Unit along the Thailand-Myanmar border between January and December 2017. Results: A total of 173 samples were tested at a median age of 4 days. BS generated an error message-providing no SBR readout-in 48.6% of the tests performed. For the tests that yielded a result, the correlation coefficient (95% CI) between BS and routine laboratory bilirubinometer SBR was 0.87 (0.77-0.93). The accuracy decreased with increasing haematocrit and at higher humidity (≥75%). Direct observation of the operators using the device and analysis of the focus group discussions and questionnaires indicated that the BS was considered easy to use and required limited training. Conclusions: This evaluation showed that the BS, in its current formulation, does not provide reliable results for measuring SBR in a tropical, low-resource setting but has acceptable usability features.

Neonatal Outcomes in Cord Clamping; An Observational Study Highlighting the Correlation of Cord Clamping Time with Haematological Parameters

Objectives: The purpose of this study was to evaluate the neonatal outcomes in cord clamping and to find their correlation with different haematological parameters in neonates of Jinnah Postgraduate Medical Centre, Karachi Methodology: This was an observational study in which non-probability convenient sampling technique was used after taking ethical approval. The study was conducted on 342 pregnant women in the Obstetrics &amp; Gynaecology ward of Jinnah Postgraduate Medical Centre, Karachi, from 1st July 2016 to 31st December 2016.All the pregnant women from age of 25 to 45 years and without any haemolytic disease, with previous spontaneous vaginal deliveries, with a singleton pregnancy diagnosed via ultrasound during the first trimester and presenting in the 3rd stage of labour with a gestational age of ≥ 37weeks were included in the study. Soon after the delivery of placenta, the uterus was massaged either by patient herself or by the caretaker. Neonatal blood samples were gathered by the researcher through venipuncture following expulsion of the fetus and 24 hours after it and sent to the pathology laboratory of Jinnah Hospital for analysis. Data were analyzed in SPSS Version 20. Descriptive analysis was done. Pearson and Spearman tests were applied to see the correlation of cord clamping time. P-value of &lt; 0.05 was taken as significant. Results: A total of 342 pregnant females in their third stage of labor were selected for this study. No correlation existed between hemoglobin and hematocrit with cord clamping time (p-value 0.661) and (p-value 0.439) respectively. Weak positive correlation (p=0.002, r = 0.169) existed between billirubin levels with clamping time. No correlation was observed with cord clamping time and anemia, low hematocrit or polycythemia (p-value 0.422), (p-value 0.058) and (p-value 0.20) respectively while weak negative correlation (ρ = -0.221) existed between high bilirubin levels in neonates with increasing cord clamping time (p-value &lt; 0.001). Conclusion: According to our study, no correlation exists between hemoglobin and hematocrit with cord clamping time but weak positive correlation was observed between billirubin levels with clamping time in seconds. Keywords: cord clamping; correlation; haematological parameters

Maternal Administration of Cichorium intybus L. Extract Decreases the Plasma Total and Conjugated Bilirubin Level in Rat Neonates

Background: Neonatal hyperbilirubinemia, a high-incidence disease, arises from an imbalance of bilirubin production and elimination. Neonatal jaundice requires medical attention in the clinic. Finding new therapeutic approaches, besides available strategies such as phototherapy, seems necessary. In traditional beliefs Cichorium intybus could exert hepatoprotective effects. Objectives: In this study we evaluated the effect of administration of hydroalcoholic Cichorium intybus extract to the lactating rats in δ-aminolaevulic acid-induced hyperbilirubinemia in rat neonates. Methods: We injected δ-aminolaevulic acid (i.p, 80 micromolar) three times at the intervals of 4 hours to rat newborns (7 to 10-day-old). Cichorium intybus extract (p.o, 25 and 50 mg/kg) was administered to lactating rats at the time of interval of 2 hours (0 - 10 hours). After neonatal feeding, we assessed the bilirubin plasma levels in 0, 8, 16, and 48 hours. Results: Injection of δ-aminolaevulic acid significantly enhanced the conjugated and total bilirubin concentration in rat newborns. Maternal administration of Cichorium intybus extract at the dose of 25 and 50 mg/kg led to significant reduction of bilirubin plasma levels in neonates after feeding. The dose of 50 mg/kg showed a more potent effect. Conclusions: Taken together, treatment of lactating rats with Cichorium intybus extract exerts protective effects in the δ-aminolaevulic acid-induced hyperbilirubinemia of rat neonates.

Correlation Between Maternal and Neonatal Vitamin B12 Serum Levels in Full Term Neonates with Physiologic Jaundice

Introduction: Vitamin B12 (vitB12)deficiency causes failure of red blood cells (RBC) maturation leading to cell lysis causing excess heme production resulting in indirect hyperbilirubinemia. Purpose: We aimed toassess vitB12 serum levels in neonates with jaundice and compare these levels with that of apparently healthy neonates and detect the impact of the maternal vitB12 on both vitB12 and bilirubin of their neonates. Patients and methods: Complete blood count (CBC), C- reactive protein (CRP), and VitB12 were assessed in both groups; 60 full term neonates with jaundice (Group I) and 60 full term controls. VitB12 levels were assessed for the mothers of all included neonates. Results: VitB12 in jaundice neonates were significantly lower than that of controls. Maternal vitB12 was positively correlated with neonatal vitB12 and negatively correlated with neonatal total serum bilirubin levels (TSB). Conclusion: Low maternal vitB12 affects both vitB12 and bilirubin levels of their neonates.

Relevance of the jaundice meter in determining significant bilirubin levels in term neonates at a tertiary hospital in Lagos State

Background and Aim: Jaundice is the yellowish discoloration of the skin and mucous membranes or the visible manifestation as a result of elevated serum bilirubin. With spectroscopic tools now available, it is possible to assess the skin's condition by quantitative measures and to access information from deeper layers of skin not visible to the eye. The aim of this study was to determine the relevance of the jaundice meter in determining significant bilirubin levels in term neonates at a tertiary hospital in Lagos State using the Konica Minolta JM-103. Materials and Methods: One hundred and fifty consecutive neonates who presented at the neonatal unit of the hospital were recruited for the study after checking them with set inclusion and exclusion criteria. The transcutaneous bilirubinometry (TcB) readings of the neonates were taken on the forehead, sternum, and abdomen of the calm neonate in a supine position, and blood samples for total serum bilirubin (TSB) estimation were drawn from a peripheral vein within 10 min of TcB measurement. Pearson's correlation analysis with linear regression was done to test the relationship between TSB and TcB values as well as for TcB measurements taken at different sites. Results: The difference between the bilirubin values measured with TcB and TSB was low, with 104 neonates (69.3%) having a difference that was 12 mg/dl was 45.2% compared with 56.8% obtained by TcB. In the present study, bilirubin levels measured with the JM-103 show a good agreement with TSB levels in the study neonates. A comparison of the extent of neonatal jaundice in our study at the different body sites using the Kramer's chart showed that there were similar mean recordings for TcB and TSB, with mean values of 10.27 ± 2.90 and 10.58 ± 2.90 for involvement of the face/neck and 18.34 ± 1.61 and 18.43 ± 1.42 for hand/feet obtained by TSB and TcB, respectively. Conclusion: The excellent correlation of TcB with TSB obtained from this study even at levels of bilirubin that necessitates the initiation of phototherapy is encouraging. The JM-103 device thus appears relevant in determining significant bilirubinemia in black neonates.

Effect of Chicory Extract Bath on Neonatal Bilirubin Levels: A Randomized Clinical Trial study

Objective: Jaundice is a common problem in infants, particularly premature infants (60-80%). The most common treatment of neonatal jaundice is phototherapy; however, traditional and complementary medicine is preferred due to complications of phototherapy in newborns. This study evaluates the effect of Chicory extract bath on bilirubin levels of infants with jaundice hospitalized in educational hospitals in Isfahan, Iran.Methods: This study was a double blind randomized clinical trial in which participants included 64 mature infants with neonatal jaundice admitted to the selected hospitals of Isfahan. The infants were randomly assigned to two groups receiving phototherapy (n=32), and phototherapy with bath with 500 cc of chicory extract prepared by hydroalcoholic method and made in Iran (n=32). The infants were bathed by trained nurse with chicory extract before phototherapy as well as 24 and 48 hours after phototherapy; then, the infants received phototherapy. During treatment, serum bilirubin was measured and recorded every 24 hours continuously. Control infants only received phototherapy; during treatment, serum bilirubin was measured and recorded every 24 hours.Results: The results showed no significant difference in mean bilirubin levels between the two groups on admission (P=0.37), while mean bilirubin level of phototherapy infants was significantly higher than that of infants receiving phototherapy and chicory extract bath in 24 hours after (P=0.014), and 48 hours after intervention (P=0.011).Conclusion: The results showed that chicory extract bath with phototherapy can be effective in reducing neonatal jaundice. Keywords: Bilirubin, Chicory extract, Infants, Jaundice, Phototherapy.

Comparison of Transcutaneous Bilirubin Measurement With Total Serum Bilirubin Levels in Preterm Neonates Receiving Phototherapy.

To compare transcutaneous bilirubin with total serum bilirubin in preterm neonates after initiation of phototherapy. Jaundice was assessed in 30 preterm neonates with transcutaneous bilirubin and total serum bilirubin before initiation of phototherapy and at 12 hr after initiation of phototherapy. A photo-occlusive patch was applied over the sternum. Transcutaneous bilirubin has a good correlation with total serum bilirubin after initiation of phototherapy. (r=0.918, P<0.001). Transcutaneous bilirubin at 28-32 weeks of gestation (r = 0.97) was better correlated with total serum bilirubin than those at 32-37 weeks (r =0.88). The correlation was better for neonates <72 hours old (r = 0.96) than those >72 hours of age (r = 0.82). Transcutaneous bilirubin correlates significantly with total serum bilirubin at the patched sternal site after initiation of phototherapy in preterm neonates.

Probiotics Supplementation Therapy for Pathological Neonatal Jaundice: A Systematic Review and Meta-Analysis.

Background: Neonatal jaundice is a relatively prevalent disease and affects approximately 2.4–15% newborns. Probiotics supplementation therapy could assist to improve the recovery of neonatal jaundice, through enhancing immunity mainly by regulating bacterial colonies. However, there is limited evidence regarding the effect of probiotics on bilirubin level in neonates. Therefore, this study aims at systematically evaluating the efficacy and safety of probiotics supplement therapy for pathological neonatal jaundice.Methods: Databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database (Wan Fang), Chinese Biomedical Literature Database (CBM), VIP Database for Chinese Technical Periodicals (VIP) were searched and the deadline is December 2016. Randomized controlled trials (RCTs) of probiotics supplementation for pathological neonatal jaundice in publications were extracted by two reviewers. The cochrane tool was applied to assessing the risk of bias of the trials. The extracted information of RCTs should include efficacy rate, serum total bilirubin level, time of jaundice fading, duration of phototherapy, duration of hospitalization, adverse reactions. The main outcomes of the trials were analyzed by Review Manager 5.3 software. The relative risks (RR) or mean difference (MD) with a 95% confidence interval (CI) was used to measure the effect.Results: 13 RCTs involving 1067 neonatal with jaundice were included in the meta-analysis. Probiotics supplementation treatment showed efficacy [RR: 1.19, 95% CI (1.12, 1.26), P < 0.00001] in neonatal jaundice. It not only decreased the total serum bilirubin level after 3day [MD: −18.05, 95% CI (−25.51, −10.58), P < 0.00001], 5day [MD: -23.49, 95% CI (−32.80, −14.18), P < 0.00001], 7day [MD: −33.01, 95% CI (−37.31, −28.70), P < 0.00001] treatment, but also decreased time of jaundice fading [MD: −1.91, 95% CI (−2.06, −1.75), P < 0.00001], as well as the duration of phototherapy [MD: −0.64, 95% CI (−0.84, −0.44), P < 0.00001] and hospitalization [MD: −2.68, 95% CI (−3.18, −2.17), P < 0.00001], when compared with the control group. Additionally, no serious adverse reaction was reported.Conclusion: This meta-analysis shows that probiotics supplementation therapy is an effective and safe treatment for pathological neonatal jaundice.

Does anaesthesia in mothers during delivery affect bilirubin levels in their neonates?

PurposeThis study aimed to assess whether different anesthetic techniques and oxytocin use applied during delivery affect transcutaneous bilirubin levels during the first 24 hours in neonates.MethodsA total of 1,044 neonates delivered by either caesarian section (C/S) or normal vaginal delivery (NVD) were included in the study. They were classified into 5 groups as follows: group 1: born by C/S using general anesthesia, group 2: C/S using spinal anaesthesia, group 3: C/S using general anesthesia after failed spinal block, group 4: by NVD without anesthesia, and group 5: oxytocin-induced vaginal delivery without anesthesia. Transcutaneous total bilirubin levels (TBLs) were measured during the first 24 hours and on the fifth and eighth days of life and the levels in different groups were compared.ResultsThe TBLs were significantly higher in neonates delivered by C/S using general anesthesia rather than spinal anesthesia (P<0.001), and both groups had higher levels than those born by NVD without anesthesia (P≤0.001). However, the group receiving general anesthesia after failed spinal block was found to have the highest bilirubin level. Moreover, TBLs were significantly higher with the use of oxytocin (P≤0.001).ConclusionsC/S and general anesthesia adversely affect the bilirubin levels in neonates, and the use of oxytocin during vaginal delivery also increases TBLs in neonates.

Comparison of bilirubin level in term infants born by vaginal delivery and C/S

Background: Given the overriding importance of neonatal jaundice and scarcity of studies on the role of route of delivery on its occurrence, this study aimed to investigate the association between neonatal bilirubin level and the route of delivery (i.e., normal vaginal delivery [NVD] and cesarean section [CS]). Methods: This prospective, cross-sectional study was conducted in 2012 in Imam Reza Hospital of Mashhad, Iran, 2012. In all term infants, who met the inclusion criteria, serum bilirubin level was measured by the bili-test device between the second and seventh days after birth. In cases with skin bilirubin level>5 mg/dl, serum bilirubin was also checked. The collected data were analyzed using SPSS, version 16. Results: A total of 182 neonates were enrolled in the study, 56% of whom were male. The mean bilirubin levels in the NVD and CS groups were 9.4±2.9 mg/dl and 9.8±3.4 mg/dl, respectively (P=0.53). Additionally, comparison of the mean bilirubin levels between the two groups based of demographic characteristics demonstrated no significant differences. Conclusion: This study showed no significant correlation between neonatal jaundice in term infants and the route of delivery.

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

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