Physiologic Hyperbilirubinemia Research Articles

THE EFFECT OF MASSAGE ON SERUM BILIRUBIN LEVELS AND NEONATUS BODY WEIGHT WITH PHOTOTHERAPY

Approximately 25-50% of newborns experience physiological hyperbilirubinemia in the first week of life, 80% occur in premature babies and 60% in full-term babies. Hyperbilirubinemia can be toxic and dangerous, such as encephalopathy. At Ummi Hospital, Bogor, the number of babies born from January to April 2021 was 704, and 11.4% had hyperbilirubinemia and no baby massage intervention had been carried out. Massage for newborns with hyperbilirubinemia reduces bilirubin levels and increases the baby's weight. This study aims to find out whether massage can reduce serum bilirubin levels and increase the weight of hyperbilirubinemia babies who receive phototherapy. This research was conducted in the perinatology room at Ummi Hospital, Bogor, Indonesia with ethical permit no. 02/KEPK/X/2021. The research design used a quasi-experimental pretest-posttest with a control group design, with a sample of 40 hyperbilirubinemia babies. After analysis using the dependent t-test and independent t-test, the results of the study showed that there was no significant difference between body weight before the intervention and after the intervention with p > 0.05 in the intervention group (p=0.054) and the control group (p =0.286). There was a significant difference in bilirubin levels (p<0.05) before and after the intervention in both the intervention group and the control group (p=0.001). Conclusion: Phototherapy alone or combined with massage can reduce serum bilirubin levels in babies. Adding massage to provide comfort to the baby and other benefits.

A prospective observational study to evaluate the association of various maternal risk factors with increasing incidence of term neonatal jaundice

<p><strong><em>Background: </em></strong><em>In our setting majority of the mothers were discharged on postnatal day 3.but over the past few years the NICU admissions also increased prolonging the hospital stay of mothers leading to increase in the hospital acquired infections for both mother and baby. This study was developed in this context. <strong></strong></em></p><p><strong><em>Objectives:</em></strong><em> The present study was performed with the purpose of establishing the incidence of neonatal jaundice in term neonates and the role of the various maternal factors being responsible for exaggerated physiological hyperbilirubinemia in term neonates. <strong></strong></em></p><p><strong><em>Methods: </em></strong><em>Using the NICE gestational age-based phototherapy chart, this study analysed serum bilirubin of the term newborns on their day 2 of life. Total 155 antenatal mothers were taken for study. Associations between maternal risk factors and neonatal jaundice and comparing risk factors in early-term, term, and late-term newborns were assessed using chi-squared or Fisher’s exact tests</em></p><p><strong><em>Results: </em></strong><em>Incidence of neonatal jaundice is 58.1% in this study. Age, BMI, weight gain of the mother had no significant correlation with neonatal jaundice. Blood group incompatibility had a positive corelation (P=.001) Gestational age at the time of delivery determines the neonatal outcome. (P=.001). As gestation advances the neonatal outcomes are better. Hyperbilirubinemia incidence more at 37 -38 weeks when compared to 39 weeks. Maternal comorbidities, amniotic fluid volume changes, mode of delivery didn’t have statistical significance. when new-born factors are considered birth weight, gender growth problems, blood group has no statistical significance whereas dehydration proved to be significant (P=.001). meconium-stained amniotic fluid[P-0.034] were found to be associated with the development of neonatal jaundice.</em></p><p><strong><em>Conclusions: </em></strong><em>The prevalence of jaundice is higher in this study. maternal and foetal blood group incompatibility, gestational age at delivery, meconium-stained amniotic fluid, neonatal dehydration was found to be associated with the development of neonatal jaundice.</em></p>

Effect of Phototherapy on Biochemical Markers of Neonates with Unconjugated Hyperbilirubinemia

BACKGROUND
 Hyperbilirubinemia is one of the commonest clinical problems encountered in the neonatal period, especially during the first week of life which can be classified into unconjugated & conjugated hyperbilirubinemia. Phototherapy plays an important role in the treatment of neonatal hyperbilirubinemia. The study intended to evaluate changes in serum electrolyte levels in neonates undergoing phototherapy for exaggerated physiological hyperbilirubinemia.
 METHODS
 A prospective cross-sectional observational study was conducted in a tertiary care teaching hospital from April 2020 to March 2021 on neonates born after achieving gestational age of 28 weeks.
 RESULTS
 A significant incidence of hypocalcaemia was noted in neonates post phototherapy (19.2 %; P-value < 0.001). The incidence of hypocalcaemia was higher in preterm (31.7 %) than the term (8.6 %) and at low birth (41.7 %) than in normal-weight (10.6 %). It was also found to be much more when the duration of PTH was > 24 hours (28.6 %) as compared to the duration of PTH when less than 24 hours (12.2 %). No adverse events due to hypocalcaemia were noted. The incidence of hyponatraemia and hypokalaemia after phototherapy was found to be non-significant (P values 0.371 and 0.301 respectively) before and after phototherapy.
 CONCLUSIONS
 The study thus does not recommend any calcium supplementation over and above the prescribed guidelines recommended by AAP and NNF. However, in view of higher incidence, LBW and preterm neonates may be considered for monitoring and calcium prophylaxis on an individual basis.

Nursing diagnoses of hospitalized infants with physiologic hyperbilirubinemia: A cross sectional study

Background and aimNursing diagnoses are the common language of nurses which indicate the labels given to human responses to health problems/developmental processes. Neonatal physiologic hyperbilirubinemia is a developmental disorder common in neonates. The responses to this health problem need to be identified.This study aimed to find physiologic hyperbilirubinemia related nursing diagnoses in some domains of the NANDA-I classification in hospitalized newborns in a maternal-neonatal educational hospital in Tehran, Iran. MethodsIn this cross-sectional study, a checklist contains labels, defining characteristics and related factors of selected nursing diagnosis of six domains of the NANDA-I classification and a maternal-neonatal information questionnaire were used for conveniently selected 140 hospitalized newborns with physiologic hyperbilirubinemia. The data was analyzed using SPSS software 23 (IBM Corp, Armonk, NY). FindingsRisk for deficient fluid volume, Risk for electrolyte imbalance (hyponatremia/hypocalcemia/hypernatremia), risk for vascular trauma, risk for impaired skin integrity, risk for infection, risk for injury (retinal damage/bilirubin hyperbilirubinemia) and risk for thermal injury were the nursing diagnoses identified for more than 90% of the neonates. ConclusionThe nursing diagnoses identified in this study for physiologic neonatal hyperbilirubinemia can guide clinical neonatal nurses in providing high-quality care in neonatal settings.

Evolving Scalp Lesions in an 8-day-old Infant

Evolving Scalp Lesions in an 8-day-old Infant

THE RELATIONSHIP BETWEEN EFFECTIVENESS OF BREASTFEEDING WITH THE INCIDENCE OF PHYSIOLOGIC HYPERBILIRUBINEMIA IN NEONATAL MATURE AGE OF 2-4 DAYS

Newborn who receive initation of breastfeeding effectively and colostrum is believed to reduce incidence of physiologic hyperbilirubinemia. breastfeeding.The purpose of this study was to the effectiveness of breastfeeding relationship with the incidence of physiologic hyperbilirubinemia in infants mature age of 2-4 days.This study uses a descriptive quantitative analytic method with a cross-sectional approach. Data were taken from the baby room of RSIA UMMI Bogor in November 2015. Respondents from this study were all mothers of infants and hyperbilirubinemic infants who met the inclusion criteria. The sampling technique was total sampling, namely all members of the population were used as a sample of 30 respondents. Data collection using a questionnaire. The data analysis used univariate analysis which was presented in the frequency distribution table while the bivariate data used the chi-square test. From the results of the study, it was found that the effectiveness of breastfeeding with the incidence of hyperbilirubinemia where out of 12 (40%) mothers who were ineffective in breastfeeding their babies experienced hyperbilirubinemia. And based on the chi-square test, there was a relationship between the effectiveness of breastfeeding and the incidence of hyperbilirubinemia (p = 0.027). The effectiveness of breastfeeding can reduce the incidence of hyperbilirubin in infants. The faster and more often the mother gives breast milk to her baby, the faster and more milk production will be to meet nutritional intake The important role of health workers in the success of breastfeeding or breastfeeding, should add knowledge about lactation, so that it can help post partum mothers if there are problems with breastfeeding. There is also a need for a professional breastfeeding counselor in dealing with breastfeeding problems.

Neonatal Hyperbilirubinemia, Types, Causes and Treatments: A Review Study

Neonatal hyperbilirubinemia results from a readiness for the bilirubin production in neonates and limited their ability to excrete it. The diagnosis of hyperbilirubinemia based on yellow discoloration of the skin and whiteness of eyes, idle in the child's movement and the lack of lactation. The baby seems sick or is difficult to awaken. Bilirubin is a tetrapyrrole pigment derived from breakdown product of normal heme catabolism in senescent red blood cells. Unconjugated bilirubin normal elevation is named newborn physiologic hyperbilirubinemia, whereas the level of bilirubin of infant normally to be a bit higher after birth, In the same context the placenta in the womb of the mother. Pathologic hyperbilirubinemia is defined as odd of bilirubin from the normal level so intervention required. Many reasons for this type of jaundice

Assessments of Serum 25-Hydroxy Cholecalciferol Levels in Neonates with Physiological Jaundice Candidate for Phototherapy

Background In newborns, jaundice is the most common ailment that necessitates medical treatment and hospital readmission. The aim of this study was to evaluate vitamin D3 status and investigate the role of phototherapy in the treatment of jaundice and the improvement of vitamin D3 status in neonates with physiological jaundice. Materials and Methods: This prospective research included 50 full-term neonates with physiological hyperbilirubinemia who were phototherapy candidates. They came from Egypt's Qena University Hospitals' Neonatal Intensive Care Units. Colorimetric assays of albumin and ionized calcium, as well as daily serum bilirubin and an ELISA assay of vitamin D3 were performed on the included cases before and 5 days after phototherapy, in addition to clinical assessments. Results: The findings revealed a high prevalence of vitamin D3 deficiency (96.7%), and a lower frequency of optimal and insufficient vitamin D3 status (3.3%) with lack of optimal vitamin D3 status among cases. Post-phototherapy total, direct, and indirect bilirubin levels were significantly lower than pre-therapy levels, with substantial improvement in vitamin D3 status (p <0.05 for all). Furthermore, both serum total bilirubin (r=-0.703, p <0.001) and serum indirect bilirubin (r=-0.710, p <0.001) had significantly negative associations with vitamin D3 serum levels. Conclusion Without vitamin D3 supplementation, neonates with low vitamin D and physiological jaundice who were received phototherapy had considerably improved vitamin D status 5 days later.

Physiological and Hereditary Hyperbilirubinemia in Athletes: Role in Reducing Efficiency and Correction Methodology

Under high-intensity loads, the athlete's bodies take place a number of biochemical reactions and physiological processes that can lead to hyperbilirubinemia. The factors that can initiate the onset of this phenomenon include the syndrome of micro-damage muscle, violation of the integrity of erythrocyte membranes, decreased blood pH, malnutrition and increase oxygen demand of the body. Degree of expression of manifestations of physiological bilirubinemia depends on the level of adaptation of the athlete to the physical activities offered. Hyperbilirubinemia in athletes can be one of the components of the deterioration of the functional state, forming the symptoms of endogenous intoxication. The relevance of this problem in sport lies in the relatively low detection rate of hyperbilirubinemia due to the lack of regular screening studies. However, in drawing up a plan of nutritional- metabolic support for training and competitive activity and recovery measures, must not only the individual reaction of the athlete body to physical activity, but also the severity of shifts in the indicators of bilirubin metabolism and their ratio. The article describes the reasons for the increase in bilirubin levels, which can be caused by both the effect of physical activity and by the presence of pathological processes in athletes. The factors influencing the blood serum’s bilirubin content are also highlighted, which include the state of erythrocyte cell membranes and the rate of hemoglobin destruction, the functional state of the liver, the specifics of physical loads and the use of ergogenic pharmacological agents by athletes. Particular accent has been placed on the illumination of hereditary hyperbilirubinemias, which may have been detected at the stage of selection of athletes. The most common phenomenon is Gilbert's syndrome, which occurs in 2-5% of cases in the general population, is characterized in the clinic by a benign flow and is manifested by episodes of jaundice and an increase in total bilirubin content to moderate values due to indirect. The frequency of detection of hyperbilirubinemias in the population of athletes is 4.68%, among which Gilbert's disease accounts for almost half (48.7%). Conclusion. The work highlighted the pathogenesis and diagnostic algorithm of Gilbert's disease, and also emphasized that its drug prevention and correction in athletes to maintain functional and physical fitness should be carried out taking into account anti-doping rules, which requires upon diagnosis timely receipt of a therapeutic exclusion

Molecular Physiology and Pathophysiology of Bilirubin Handling by the Blood, Liver, Intestine, and Brain in the Newborn.

Bilirubin is the end product of heme catabolism formed during a process that involves oxidation-reduction reactions and conserves iron body stores. Unconjugated hyperbilirubinemia is common in newborn infants, but rare later in life. The basic physiology of bilirubin metabolism, such as production, transport, and excretion, has been well described. However, in the neonate, numerous variables related to nutrition, ethnicity, and genetic variants at several metabolic steps may be superimposed on the normal physiological hyperbilirubinemia that occurs in the first week of life and results in bilirubin levels that may be toxic to the brain. Bilirubin exists in several isomeric forms that differ in their polarities and is considered a physiologically important antioxidant. Here we review the chemistry of the bilirubin molecule and its metabolism in the body with a particular focus on the processes that impact the newborn infant, and how differences relative to older children and adults contribute to the risk of developing both acute and long-term neurological sequelae in the newborn infant. The final section deals with the interplay between the brain and bilirubin and its entry, clearance, and accumulation. We conclude with a discussion of the current state of knowledge regarding the mechanism(s) of bilirubin neurotoxicity.

ANALYSIS OF HEMOGLOBIN LEVELS AND LEUKOCYTE COUNT IN NEONATES WITH HYPERBILIRUBINEMIA

Hyperbilirubinemia is one of the most common clinical phenomena in neonatal patient. Etiology is generally physiological, only about 10% being pathological. It is important for clinicians to distinguish between physiological and pathological hyperbilirubinemia, because uncontrolled pathological conditions can cause severe complications of kern icterus, one ofthe causes of death in infants.This study was retrospective study by obtaining data of all neonatal patients with diagnosis of hyperbilirubinemia, who undergone hemoglobin and leukocyte count test. The data were classified into two groups: physiological and pathological hyperbilirubinemia. Statistical tests were performed to assess the association of hemoglobin levels and leukocytes count between the two groups. A total of 144 data were collected, 54 physiological and 90 pathological hyperbilirubinemia. In physiological hyperbilirubinemia, hemoglobin levels and leukocyte counts were found to be normal, whereas in pathological anemia and leukocytosis developed and the difference between the two groups was statistically significant (p&lt;0,001). Anemia was found in neonates with pathological hyperbilirubinemia caused by RDN, LBW, sepsis, hemolytic, and hemorrhagic. Leukocytosis was found in pathological hyperbilirubinemia caused by sepsis.There was a significant difference between the incidence of anemia and leukocytosis in physiological and pathological hyperbilirubinemia. It can be concluded that routine blood tests can be used to distinguish whether hyperbilirubinemia experienced by neonatel patient is a physiological or pathological condition, so it can be one of the tests suggested when the neonate is hyperbilirubinemia.

Study of incidence of breastfeeding failure jaundice in cases of neonatal hyperbilirubinemia in a suburban hospital

Background: Neonatal jaundice is the most common cause of readmission after discharge from birth hospitalization. Breastfeeding failure jaundice (BFFJ) is an important subtype of pathological neonatal jaundice. It typically occurs with lactation failure during the first postnatal week that leads to insufficient intake, dehydration, weight loss and sometimes hypernatremia. Incidence of breast-feeding failure is expected to rise as the exclusive breast-feeding rates are rising. This problem is not well studied especially in Indian setting hence study was conducted.Methods: This was retrospective observational study done in Department of Pediatrics from the April 1, 2016 to March 31, 2018. 179 neonates, who presented with jaundice as main complaint with total bilirubin value above the age &amp; risk factor matched cut off, were sampled and their clinical data was analyzed.Results: Breast feeding failure jaundice contributed 31.8% (N = 57) cases, second to the exaggerated physiological hyperbilirubinemia (48% N = 86), followed by hemolytic (13.8%, N = 25). BFFJ presented at median age of 6.8 days and had mean duration of hospital stay of 3 days. Incidences of exaggerated physiological jaundice and BFFJ were found to be higher in winter months i.e. 6.7% (N = 48/716) compared to summer months i.e. 4.1% (N = 28/679) significantly (p value = 0.045).Conclusions: Breast feeding failure jaundice (BFFJ) contributed to one third of cases of neonatal pathological jaundice requiring re-admission and is the second most common cause after exaggerated physiological jaundice. The high incidence of BFFJ in the study warrants focused efforts for a structured program of breast-feeding education, training and surveillance.

Decreased The Risk of Hyperbilirubinemia Incidence With The Initiation of Early Breastfeeding

Hyperbilirubinemia is a state where increase value of in serum bilirubin in the blood more &gt; 5mg/dl, which is clinically characterized by jaundice on sclera and skin, hyperbilirubinemia can be caused by physiological processes, non-physiological, or a combination of both. Neonates were given early initiation will result in the expenditure of meconium early so tend to have a low risk of the occurrence of physiological hyperbilirubinemia. Research will aim to detect early initiation on the incidence of neonates physiologic hyperbilirubinemia in neonates born at Khadijah room Islamic Hospital Muhammadiyah Kendal. Research kind quasi-experiment by using plant form post test only in a body (one group post test only design). Population in this research patient newborn at Khadijah room Islamic Hospital Muhammadiyah Kendal. Research sample as much as 30 respondens early initiation and 30 respondens not early initiation by using technique purposive sampling. Data analysis included univariate analysis by finding frequency distribution, bivariate analysis with Mann-Whitney Test. The research result of bivariate analysis shows that neonates with early initiation total serum bilirubin value performed intervention group averaged 8,200mg/dl while control group averaged 11,647mg /dl. The initiation of early breastfeeding (IMD) effect on total serum billirubin content of the neonatus. The variables that have contributed to the total serum billirubin content were the implementation of early breastfeeding initiation (IMD) with an effect of 61.2% and influenced by other variables of 38.8%. The conclusion there is influence of early initiation of suckling on physiological hyprbilirubinemia at Islamic Hospital Muhammadiyah Kendal.

Clinical profile of meconium aspiration syndrome in relation to birth weight and gestational age

Background: Meconium aspiration syndrome (MAS) is commonly encountered entity in neonates delivered in rural health centres.Methods: A prospective observational study was conducted in 50 consecutive cases of MAS who were admitted in Level III NICU of the Department of Pediatrics of a tertiary care teaching hospital located 50 kms from Jaipur city amidst rural surroundings from 1st January 2016 to 31st July 2017. Appropriate statistical analysis was carried out using Medcalc statistical software (version 16.4).Results: Out of 3585 deliveries, prevalence of MSAF and MAS was 14% and 8.5% respectively. The M:F ratio of study subjects was 1.2:1.The maternal risk factors significantly associated with MAS were maternal anemia (p value-&lt;0.001), maternal age &gt;30 (p value-0.025) and unbooked pregnancies (p value-0.032). The mean birth weight was 2734±499gms. Majority of cases of MAS were seen in babies with birth weight between 2.5-3.5 kg (n=30, 60%).The mean gestational age was 38.6±2.4 weeks. 30 (60%) babies were delivered after completing 37-&lt;40 weeks of gestation and 9 (18%) babies were of 40-&lt;42 weeks of gestation. The common complications observed were exaggerated physiological hyperbilirubinemia (75%), birth asphyxia (50%) and septicaemia (27.08%). The commonest cause of mortality was birth asphyxia (57.14%) and pneumonia (42.8%).Conclusions: MAS is a cause of concern for the attending obstetrician and pediatrician as it is associated with life threatening complications and mortality. Efforts need to be invested in promotion of institutional antenatal care and institutional deliveries so that maternal risk factors can be identified and managed effectively, especially in rural areas.

Systemic regulation of bilirubin homeostasis: Potential benefits of hyperbilirubinemia.

Neurotoxic bilirubin is the end product of heme catabolism in mammals. Bilirubin is solely conjugated by uridine diphospho-glucuronosyltransferase 1A1, which is a membrane-bound enzyme that catalyzes the transfer of glucuronic acid. Due to low function of hepatic and intestinal uridine diphospho-glucuronosyltransferase 1A1 during the neonatal period, human neonates develop mild to severe physiological hyperbilirubinemia. Accumulation of bilirubin in the brain leads to the onset of irreversible brain damage, termed kernicterus. Breastfeeding is one of the most significant factors that increase the risk of developing kernicterus in infants. Why does this most natural way of feeding increase the risk of brain damage or even death? This question leads to the hypothesis that breast milk-induced hyperbilirubinemia might bring certain benefits that outweigh those risks. While bilirubin is neurotoxic and cytotoxic, this compound is also a potent antioxidant. There are studies showing improved clinical conditions in patients with hyperbilirubinemia. Accumulating evidence also shows that genetic polymorphisms linked to hyperbilirubinemia are beneficial against various diseases. In this review article, we first introduce the production, metabolism, and transport of bilirubin. We then discuss the potential benefits of neonatal and adult hyperbilirubinemia. Finally, epigenetic factors as well as metabolomic information associated with hyperbilirubinemia are described. This review article advances the understanding of the physiological importance of the paradoxical compound bilirubin. (Hepatology 2018;67:1609-1619).

Severe Neonatal Hyperbilirubinemia in Crigler-Najjar Syndrome Model Mice Can Be Reversed With Zinc Protoporphyrin.

Neurotoxic bilirubin is solely conjugated by UDP‐glucuronosyltransferase (UGT) 1A1. Due to an inadequate function of UGT1A1, human neonates develop mild to severe physiological hyperbilirubinemia. Accumulation of bilirubin in the brain leads to the onset of irreversible brain damage called kernicterus. Breastfeeding is one of the most significant factors that increase the risk of developing kernicterus in infants. Why does the most natural way of feeding increase the risk of brain damage or even death? This question leads to the hypothesis that breast milk‐induced neonatal hyperbilirubinemia might bring certain benefits to the body. One of the barriers to answering the above question is the lack of animal models that display mild to severe neonatal hyperbilirubinemia. A mouse model that develops neonatal hyperbilirubinemia was previously developed by a knockout of the Ugt1 locus. Deletion of Ugt1a1 results in neonatal lethality from bilirubin neurotoxicity. Bilirubin is the end product of heme catabolism in which heme oxygenase‐I is largely involved. When zinc protoporphyrin, an inhibitor of heme oxygenase I, was administered to newborn Ugt1 −/− mice, serum bilirubin levels dropped dramatically, rescuing the mice from bilirubin‐induced neonatal lethality. Zinc protoporphyrin‐treated Ugt1 −/− mice developed normally as adults capable of reproducing, but their newborns showed even more severe hyperbilirubinemia. Microarray analysis of the hyperbilirubinemic livers indicated that a number of genes associated with nucleotide, transport, and immune response were significantly down‐regulated in a serum bilirubin level‐dependent manner. Conclusion: Our study provides an opportunity to advance the development of effective therapeutics to effectively and rapidly prevent bilirubin‐induced toxicity. Neonatal hyperbilirubinemia has various impacts on the body that could be driven by the antioxidant property of bilirubin. (Hepatology Communications 2017;1:792–802)

A Randomized Controlled Trial of Glycerin Suppositories During Phototherapy in Premature Neonates

ObjectiveTo determine if glycerin suppositories were effective in reducing total duration of phototherapy in premature neonates. We hypothesized that glycerin suppositories would have no effect on phototherapy duration or total serum bilirubin levels. DesignProspective randomized controlled double-blinded trial. SettingLevel IV NICU. ParticipantsNeonates born between 30 weeks, 0 days and 34 weeks, 6 days gestational age who developed physiologic hyperbilirubinemia needing phototherapy. MethodsNeonates were randomized to the no-suppository group or to the suppository group. Neonates were randomized to receive glycerin suppositories every 8 hours while under phototherapy or to a sham group. The primary outcome was total hours of phototherapy. Secondary outcomes included peak total serum bilirubin levels, time from start to discontinuation of phototherapy, rate of decline in bilirubin levels, repeat episodes of phototherapy, and number of stools while the neonates received phototherapy. ResultsA total of 39 neonates were assigned to the no-suppository group and 40 to the suppository group. Withholding suppositories was not inferior to providing suppositories. The total hours of phototherapy were not longer (i.e., noninferior) among neonates not provided suppositories (61 ± 53 hours) than among those given suppositories (72 ± 49 hours). There were no differences in peak bilirubin levels, rate of bilirubin decline, or repeat episodes of phototherapy. ConclusionRoutine use of glycerin suppositories among preterm neonates who receive phototherapy does not affect bilirubin levels or phototherapy duration.

Correlation of various maternal factors with exaggerated hyperbilirubinemia of the newborn

Background: Maternal factors could help determine the potential incidence of hyperbilirubinemia. This study was performed with the purpose of establishing the role of the various maternal factors previously indicated as being responsible for exaggerated physiological hyperbilirubinemia in term neonates with serum bilirubin level of 12 mg/dL or more. Materials and Methodology: It was a prospective, cross-sectional study conducted from July 2012 to August 2014 in Pimpri, Pune. A total of 2000 healthy term deliveries were screened, out of which 100 neonates with exaggerated hyperbilirubinemia were included. Data were collected with maternal information. The data were analyzed using t -test (for parametric distributions). Results: During the period of study, 330 babies out of 2000 deliveries had achieved the serum bilirubin level of >12 mg/dL. Thus, the prevalence of exaggerated neonatal hyperbilirubinemia in the current study was 16.5%. There is strong association between maternal infection and serum bilirubin even when only 5 mothers had infection (Z = 2.31 and P Conclusions: Maternal infection was found to have a significant effect on neonatal exaggerated hyperbilirubinemia. Therefore, interventions should be prioritized to prevent maternal sepsis. The first approach targets facility-based deliveries and requires increased provision and uptake of proper antenatal care early in pregnancy.

Effect of phototherapy on serum calcium level in neonatal jaundice

Objectives The aim of the study was to determine the effect of phototherapy on serum calcium level in neonatal jaundice. Background Phototherapy plays a significant role in the treatment and prevention of hyperbilirubinemia in neonates. However, this treatment modality may result in the development of some complications such as induction of hypocalcemia. Patients and methods This study included 50 full-term neonates with jaundice (25 males and 25 females) who received phototherapy for treatment of neonatal indirect hyperbilirubinemia and 25 neonates (13 males and 12 females) complaining of exaggerated physiological hyperbilirubinemia taken as control not exposed to phototherapy. Serum calcium was checked before and 48 h after starting phototherapy. A comparative study was conducted between these groups to determine the effect of phototherapy on serum calcium level. Results In the neonates of the study group, the serum bilirubin level before phototherapy was 15.48 ± 1.94 mg/dl. However, the serum bilirubin level after phototherapy was 12.41 ± 2.10 mg/dl. There was highly statistically significant decrease of the serum bilirubin levels after phototherapy as compared with serum bilirubin levels before phototherapy in the study group (P Conclusion Hypocalcemia is a common complication of phototherapy.

Quantitative Trait Analysis of Polymorphisms in Two Bilirubin Metabolism Enzymes to Physiologic Bilirubin Levels in Chinese Newborns

To explore the effects of variants in Uridine Diphosphate Glucuronosyl Transferase 1A1 (UGT1A1) and Heme Oxygenase-1 (HMOX1) on daily physiological bilirubin levels and bilirubin changes during the first week after birth in Chinese newborns. Both UGT1A1 and HMOX1 code rate-limiting enzymes in the bilirubin metabolism pathway. We conducted a retrospective quantitative trait study to analyze 4154 daily bilirubin values, 3129 bilirubin changes, and 11 polymorphisms of 988 newborns during the natural course of physiological hyperbilirubinemia. For UGT1A1, we found minor allele A of rs4148323 (G211A, UGT1A1*6) contributed to higher daily bilirubin levels on days 4-6 (with contributions to variations increasing from 4.8% to 12.3%), minor allele T of rs887829 (c-364t) contributed to lower daily bilirubin levels for days 6 and 7 (with contributions to variations increasing from 7.0% to 10.2%) (P < .03 for all). In addition, minor alleles of rs887829 and (TA)n repeat (UGT1A1*28), and haplotype T-long-G at rs887829-(TA)n-rs4148323 were associated with a decrease in bilirubin levels from day 5 to day 6 (P < .01 for all). No contribution from HMOX1 was found. Bilirubin levels and changes during the middle and late parts of the first week were attributed to variants and haplotypes in UGT1A1. This quantitative trait study may provide a more robust statistical method for determining the association of genetic factors and bilirubin kinetics to predict the development of neonatal bilirubin in early postnatal life.