Reduction In Bilirubin Levels Research Articles

The effect of oral zinc sulfate supplementation on hospitalized infants with hyperbilirubinemia: a double-blind randomized clinical trial.

Previous investigations on the impact of oral zinc sulfate treatment on newborns' serum bilirubin levels have produced conflicting results. As a result, the goal of this clinical study was to evaluate how oral zinc sulfate affected the levels of serum bilirubin in term infants who were admitted to the neonatal intensive care unit. The study was conducted at the Neonatal Care Unit of Besat Hospital in Sanandaj, Kurdistan Province, as a double-blind randomized controlled trial. The participants included term infants (37-42weeks of gestation) who required phototherapy and were admitted to the neonatal intensive care unit. A total of 290 infants were enrolled and randomly divided into two groups. The intervention group received oral zinc sulfate supplementation at a dosage of 1mg/kg per day in addition to phototherapy, while the placebo group received an equivalent amount of placebo daily. Bilirubin measurements were obtained at the initiation of the intervention and subsequently every 24h until discharge. The collected data were analyzed using STATA software version 17. After the infants were randomly allocated to the zinc-sulfate and placebo groups, the study outcomes, including the average changes in bilirubin levels after intervention, the hours of phototherapy, and the number of days of hospitalization, were analyzed and compared for a total of 160 infants in the zinc sulfate group and 130 infants in the placebo group. The reduction in bilirubin levels in infants receiving zinc sulfate was (- 3.75 ± 0.19 CI 95% - 4.12, - 3.37) and for placebo group was (- 1.81 ± 0.15 CI 95% - 2.12, - 1.50) 24h after the intervention. Furthermore, 48 and 72h following the intervention, bilirubin levels in the intervention group demonstrated a more substantial decline. The zinc sulfate group had a shorter hospital stay (2.13 ± 0.04 vs. 2.83 ± 1.42) and required less phototherapy hours than the placebo group (6.21 ± 2.16 vs. 8.78 ± 1.40). Conclusions: Oral zinc sulfate supplementation in term neonates with hyperbilirubinemia decreased the level of bilirubin levels, duration of phototherapy, and hospital stay. Trial registration: IRCT, IRCT20220806055625N1. Study Registered 25 December 2022, http://irct.ir/trial/66,722 .

Comparison of Intermittent Versus Continuous Phototherapy in Neonatal Hyperbilirubinaemia

Background: Neonatal jaundice is a common condition characterized by elevated bilirubin levels, which, if untreated, can lead to severe complications such as kernicterus. Phototherapy is a widely used treatment modality, with two primary approaches: continuous and intermittent phototherapy. While both methods aim to reduce bilirubin levels, there is ongoing debate about their relative efficacy and safety. Objective: This study aimed to compare the efficacy and safety of intermittent versus continuous phototherapy in the management of neonatal hyperbilirubinaemia in terms of bilirubin reduction, treatment duration, and associated complications. Methods: A quasi-experimental study was conducted at the Department of Paediatrics, Combined Military Hospital, Rawalpindi, from January 2022 to December 2023. The study included 62 full-term neonates with indirect bilirubin levels >15.0 mg/dL but ≤20 mg/dL. Neonates were randomly assigned to receive either intermittent phototherapy (two hours on, two hours off) or continuous phototherapy. Serum indirect bilirubin levels were measured at 24 and 48 hours post-initiation of phototherapy. The total duration of phototherapy, volume of milk consumed, and complications such as hyperthermia and hypocalcaemia were recorded. Data were analyzed using SPSS version 25, with a p-value ≤ 0.05 considered statistically significant. Results: At 24 hours post-treatment, the median indirect bilirubin level was 12.70 mg/dL (IQR: 1.20) in the intermittent group versus 12.50 mg/dL (IQR: 1.90) in the continuous group (p=0.893). At 48 hours, the levels were 6.40 mg/dL (IQR: 1.10) and 6.50 mg/dL (IQR: 1.10), respectively (p=0.821). The median total duration of phototherapy was significantly shorter in the intermittent group (22.0 hours, IQR: 2.0) compared to the continuous group (45.0 hours, IQR: 3.0; p<0.001). Neonates in the intermittent group consumed more milk (420.0 mL, IQR: 93.0) than those in the continuous group (397.0 mL, IQR: 57.0; p=0.014). Hyperthermia was less frequent in the intermittent group (3.2% vs. 25.8%, p=0.026), as was hypocalcaemia (16.1% vs. 45.2%, p=0.013). Conclusion: Intermittent phototherapy is as effective as continuous phototherapy in reducing bilirubin levels and offers additional benefits, including a shorter treatment duration, improved feeding, and fewer complications. Intermittent phototherapy should be considered a preferred option for managing neonatal hyperbilirubinaemia in clinical practice.

Improved Survival With Chemotherapy in Patients With Malignant Biliary Tract Obstruction After Percutaneous Transhepatic Biliary Drainage (PTBD).

Introduction Biliary tree stenting for malignant biliary tract obstructions is a routine modality for the relief of jaundice. Treatment is palliative in most circumstances. However, adequate reduction in bilirubin levels after percutaneous transhepatic biliary drainage (PTBD) may help to offer chemotherapy, which may improve survival in a limited number of cases. Materials and methods Between March 2017 and March 2023, patients who were treated with PTBD to relieve malignant biliary tract obstruction were included in the analysis. Patients who achieved bilirubin levels ≤5 mg/dLafter PTBD were considered for chemotherapy. For survival analysis, a comparison was done between patients treated with chemotherapy after PTBD versus patients who did not receive any treatment after PTBD. Results Data was available for 43 (100%) patients. After PTBD, 16 (37.2%) patients responded and were considered for further treatment. One patient who was advised of radical surgery refused treatment and did not return for further treatment or follow-up. The remaining 15 cases (34.9%) received Gemcitabine and platinum-based chemotherapy as a first-line option. Out of 15 cases who received chemotherapy only one patient (6.6%) received neoadjuvant chemotherapy and the rest of14 (32.5.%) cases received palliative chemotherapy in view of metastatic disease. PTBD complications including leakage, dislodgement of PTBD catheter, pain, and bleeding were seen in 16 (37.2%) cases. Overall survival was 57% for the entire population. Patients treated with chemotherapy after PTBD had better overall survival compared to patients who did not receive any treatment after PTBD (73.3% vs 33% (p=0.008)). Conclusion PTBD is an excellent technique for the relief of biliary obstruction. More than one-third (34.9%) of the cases received further cancer-directed treatment after relief of jaundice by PTBD. Chemotherapy after PTBD is associated with improvement in overall survival in malignant biliary obstructions.

Outcomes of endoscopic ultrasound-guided gallbladder drainage: A multicenter study from India (with video).

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) offers a safe and minimally invasive alternative for percutaneous cholecystostomy (PCC) in acute cholecystitis patients with high-surgical risk. Additionally, EUS-GBD serves as a rescue biliary drainage in malignant distal biliary obstruction. Despite its widespread application, data within the Indian context remains sparse. This study aims to report the outcomes of EUS-GBD through the first multi-center study from India. We retrospectively analyzed patients undergoing EUS-GBD at six tertiary care centers of India from March 2022 to November 2023. EUS-GBD was performed by free hand or over-the-guidewire technique with lumen-apposing metal stent (LAMS) or large caliber metal stent (LCMS). The primary outcome was technical success (defined as successful deployment of stent between gallbladder and stomach/duodenal lumen). The secondary outcomes were clinical success (defined as resolution of symptoms of acute cholecystitis and more than > 50% reduction in bilirubin level within two weeks in distal biliary obstruction), adverse event rate, 30-day mortality rate and 90-day reintervention rate. Total29 patients (mean age 65.86 ± 12.91, 11 female) underwent EUS-GBD. The indication for EUS-GBD were acute cholecystitis (79.31%) and rescue biliary drainage for malignant distal biliary obstruction (20.69%). LAMS was deployed in 92.86%, predominantly by free-hand technique (78.57%). Technical and clinical success rates were 96.55% and 82.75%, respectively. Adverse events occurred in 27.59% patients, with severe adverse events (bile leak and bleeding) being uncommon (10%). Both 30-day mortality rate and 90-day reintervention rate were 13.79% in patients. Cholecysto-duodenal fistula facilitated cholecystoscopic intervention and stone removal in one patient and transgastric EUS-GBD did not hamper bilio-enteric anastomosis during Whipple surgery in two patients. EUS-GBD is a safe and effective technique for managing acute cholecystitis in high-risk patients and for biliary drainage in cases with malignant distal biliary obstruction.

The Effect of Abdominal Massage on Bilirubin Levels in Term Infants Receiving Phototherapy: A Randomized Controlled Trial.

The incidence of neonatal hyperbilirubinemia in Europe and the United States is estimated to be 3.2 and 4.4 per 10,000 live births, respectively. Abdominal massage for hyperbilirubinemia is considered a safe complementary treatment for infants that may increase number of defecations and decrease bilirubin levels. This study was designed as a randomized controlled trial to determine the effect of abdominal massage on bilirubin levels in term infants receiving phototherapy. The sample consisted of 43 term newborns (intervention group: 23; control group: 20) who received phototherapy in a university hospital between June 2019 and February 2021. Information and observation forms were used for data collection. The intervention group received 6 abdominal massages over 2 days, performed 3 times a day, 6 hours apart, and lasting 5 minutes each. Transcutaneous bilirubin levels and heart rate were significantly lower in the intervention group than in the control group at 48 hours (P = .015 and P = .033, respectively). Number of defecations was higher in the intervention group at 24 hours (P = .007) but there was no significant difference at 48 hours. The decrease in serum bilirubin between 24 and 48 hours was significantly greater in the intervention group (P = .005). Abdominal massage was effective in reducing bilirubin levels and may increase the number of defecations. Providing massage training to the parents of infants who are discharged early could be a protective approach to prevent the rise in bilirubin levels.

A prospective study on the causes of hyperbilirubinemia and its clinical markers in term and near-term newborns admitted to a tertiary care hospital in Patna, India

This study aimed to investigate the root causes, prognostic factors, and therapeutic strategies for neonatal hyperbilirubinemia among term and near-term infants admitted to the Neonatal Intensive Care Unit (NICU) at IGIMS, Patna. Furthermore, the research aimed to analyze the clinical progression of these infants throughout their NICU stay.Conducted within the NICU at IGIMS, Patna, Bihar, this study encompassed term and late preterm infants admitted with serum bilirubin levels exceeding 12 mg/dl. The primary focus was on identifying risk factors, etiological factors, and the clinical profile of these infants during their NICU tenure.The study examined birth weight distribution and concurrent medical conditions. Parameters included the initiation of phototherapy based on bilirubin levels and treatment methodologies. Out of the 210 infants studied, 27.14% and 47.62% weighed between 2001 and 2500 grams. The most prevalent causes were physiological (129 cases), fetal prematurity (30 cases), birth asphyxia (7 cases), and prolonged labor (18 cases). Idiopathic causes were observed in 28 instances, ABO incompatibility in 7 cases, and Rh incompatibility in 7 cases. G6PD deficiency was identified once. At the commencement of phototherapy, 19.52% had bilirubin levels between 12 and 15 mg/dl, 58.57% between 15.1 and 18 mg/dl, 11.91% above 20 mg/dl, and 10% between 18.1 and 20 mg/dl.Physiological causes emerged as the most frequent contributors to neonatal hyperbilirubinemia, followed by septicemia and idiopathic factors. Infrequent causes included blood group incompatibility. Phototherapy was established as a cost-effective and efficient method for reducing bilirubin levels in neonatal jaundice. Exchange transfusion proved to be a safe therapeutic measure in cases of severe hyperbilirubinemia. Blood group incompatibility was the main determinant requiring exchange transfusion.

Wireless Incubators and Photodynamic Therapy Enhance Premature Infant Care

This study addresses the critical health challenges faced by premature infants by developing an innovative, wirelessly controlled incubator using Arduino technology. By maintaining optimal environmental conditions (37°C and 50% humidity), similar to a mother's womb, and utilizing photodynamic therapy with a 400nm wavelength light to treat jaundice, our system reduces the risks associated with traditional wired setups and operational costs. The results demonstrate effective regulation of temperature and humidity, as well as a reduction in bilirubin levels, suggesting that this technology has significant potential to enhance neonatal care for premature infants. Highlights: Wireless control systems in incubators improve safety and reduce the complexity and cost associated with traditional wired setups. Photodynamic therapy effectively reduces bilirubin levels, addressing jaundice in premature babies. Maintaining optimal incubator conditions of 37°C temperature and 50% humidity mirrors the environment of a mother’s womb, enhancing survival rates. Keywords: Premature Infants, Wireless Technology, Incubator, Photodynamic Therapy, Neonatal Care

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.

Effect of vitamin E supplementation on bilirubin levels in infants with hyperbilirubinemia: a double-blind randomized clinical trial.

The effect of vitamin E supplementation on bilirubin levels in infants was previously explored, but the results were inconclusive. To examine the effect of vitamin E supplementation on bilirubin levels in term infants in the neonatal intensive care unit (NICU). This interventional double-blind randomized clinical trial was conducted in the Sanandaj Besat Hospital NICU. Enrolled newborns were between 37 and 42 weeks and 6 days of gestation and required phototherapy according to American Academy of Pediatrics clinical guidelines. A total of 138 infants were randomly assigned to vitamin E (n=68) or placebo (n=70) groups. In addition to phototherapy, the vitamin E group received 0.5 mL (5 IU) of supplemental vitamin E daily, whereas the placebo group received 0.5 mL of oral dextrose daily. STATA 17 was used for the data analysis. Changes in bilirubin levels at 24 hours postintervention did not differ significantly from baseline in either group. Vitamin E supplementation did not significantly reduce total bilirubin levels at 24 hours postintervention (mean difference [MD], -0.18; P=0.204; 95% confidence interval [CI], -1.39 to 1.02). However, the vitamin E group exhibited lower total bilirubin levels than the placebo group at 48 hours postintervention (MD, 0.18; P=0.365; 95% CI, -0.89 to 1.27) and 72 hours (MD, 0.36; P=0.356; 95% CI, -2.34 to 1.61), although the differences were not statistically significant. A subgroup analysis revealed that female infants experienced a greater reduction in total bilirubin levels than male infants. Infants administered vitamin E versus placebo demonstrated similar reductions in bilirubin levels and hospital stays. Although the average bilirubin changes did not differ significantly between groups, the vitamin E group showed a more noticeable reduction over time, indicating a positive effect of vitamin E supplementation on serum bilirubin reduction. Trial registration: IRCT20220806055625N2 (registered December 26, 2022; http://irct.ir/trial/67135).

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

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

LITERATURE REVIEW: PENGARUH PIJAT BAYI TERHADAP PERUBAHAN KADAR BILIRUBIN DIRECT DAN BILIRUBIN INDIRECT PADA BAYI DENGAN TERAPI SINAR

Infant massage is one of the tactile stimulation and has become a hereditary tradition and has been studied in research in the fields of neonatal science, neurology, psychology, and several other health sciences. The incidence of hyperbilirubinemia in general is a physiological problem that occurs in almost 80% of newborns with prematurity and up to 60% of aterm newborns and occurs in the first week of life. This study aims to determine the implementation of massage therapy in neonates to reduce bilirubin levels. The research method used literature review by searching articles obtained through databases including Science Direct, Elsevier and Google Scholar. The results showed five articles involving neonates in five countries with a randomized control trial (RCT) design, stating that infant massage therapy is the most influential in reducing the degree of neonatal jaundice in the group given massage therapy because it can stimulate defecation. In addition, the provision of physiological massage therapy can improve the circulation of blood flow, lymph and tissue fluids thereby increasing bilirubin output.

Effectiveness of Tactile and Kinaesthetic Stimulation on Hyperbilirubinemia: A Feasibility Study

Introduction: Neonatal hyperbilirubinemia is common among newborns, often necessitating hospitalisation and posing a risk of neural complications. Phototherapy, commonly used to treat hyperbilirubinemia, also has side effects, including eye and genital harm, dehydration, diarrhoea, and bronze baby syndrome. Therefore, there is a need to find alternatives or reduce treatment duration. Aim: To investigate the efficacy of tactile and kinaesthetic stimulation as adjunctive therapies with phototherapy for reducing bilirubin levels in preterm neonates with hyperbilirubinemia. Materials and Methods: A randomised controlled feasibility study, including 12 preterm neonates with hyperbilirubinemia, was conducted in the Neonatal Intensive Care Unit (NICU) of a Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, India. The experimental group (n=6) received three sessions of tactile and kinaesthetic stimulation for 15 minutes per session alongside phototherapy, compared to a control group (n=6) receiving phototherapy alone for three days. Results: While no significant differences (p>0.05) in demographics of neonates were observed, both groups experienced significant reductions (p<0.001) in Total Serum Bilirubin (TSB) and Transcutaneous Bilirubin (TCB) levels, with change scores of 7.88±2.29 (TSB experimental), 7.84±2.85 (TSB control), 6.63±2.77 (TCB experimental), and 6.27±1.92 (TCB control). However, the change in mean levels of TSB and TCB was not significantly different when compared between the two groups (p>0.05). Conclusion: There were significant reductions in TSB and TCB levels from Day 1 to Day 3 within each group. Both interventions were equally effective in reducing the bilirubin levels in the neonates.

Hidden Effect of Baby Massage on Hyperbilirubinemia

Hyperbilirubinemia can occur when the level of bilirubin in the blood is more than 5 mg/dL, clinically characterized by the presence of jaundice with physiological and non-physiological causes. The main treatment for cases of hyperbilirubinemia today is phototherapy. However, in recent years there have been alternative interventions carried out, one of which is baby massage. The purpose of this paper is to analyze the effect of giving massage on the bilirubin levels of infants who have hyperbilirubinemia based on empirical studies of the last 10 years. The writing design uses a literature review with inclusion criteria according to the PICOS format. Methods to find sources or articles through the Pubmed, Proquest, Scient Direct, and Google Scholar databases (2016-2021) published in English and Indonesian. The keywords used are related to hyperbilirubinemia and baby massage. Based on the 10 articles reviewed, it was found that baby massage was given 1 to 3 times a day with a duration of 15-20 minutes in every session. Evaluation of bilirubin levels can use serum bilirubin levels or transcutaneous bilirubin levels, besides that giving massage also increases the frequency of defecation which plays a role in removing bilirubin from the baby's body. Baby massage is expected to prevent and treat standardized hyperbilirubinemia so that it can become uniform and as an alternative intervention in reducing bilirubin levels in infants

LITERATUR REVIEW: PENGARUH FOTOTERAPI TERHADAP NEONATUS DENGAN HIPERBILURUBIN

Hyperbilirubin is an excessive level of bilirubin in the blood with an amount of more than 10 mg% in the first week which causes jaundice or yellow color in infants to be clearly visible on the skin, sclera, mucosa, urine, and several others. organs, while the normal level of total bilirubin in infants is normal. infants, namely 5 mg% (Sembiring, 2019). Hyperbilirubinemia is the term used for neonatal jaundice after laboratory results show an increase in bilirubin levels. This hyperbilirubinemia can be caused by physiological and pathological processes (Sukadi; 2012 cited by Saptanto; 2016). Objective: To present a review and also a summary of phototherapy therapy in neonates with hyperbilirubinemia and provide an explanation of the therapies that can be performed in neonates with hyperbilirubinemia based on current evidence. Method: database search includes Google Scholar, Science Direct and Proquest with keywords phototherapy and hyperbilirubin Results: An analysis of 10 journals, 8 national journals and 2 international journals as well as 5 books showed that phototherapy was effective in reducing bilirubin levels in hyperbilirubin newborns. Conclusion: All interventions from this literature review were phototherapy efficacy in neonates with hyperbilirubinemia.

Hepatitis-Induced Hemolysis in Pediatrics: A Rare Case Report

This article presents a case study of a 6-year-old boy diagnosed with acute Hepatitis A virus (HAV) infection compounded by glucose-6-phosphate dehydrogenase (G6PD) deficiency. The patient exhibited a constellation of symptoms, including low-grade fever, upper abdominal pain, fatigue, and anorexia, over an 8 to 10-day period. Notably, jaundice, dark-colored urine, and hepatomegaly were prominent clinical features. Laboratory investigations revealed severe intravascular hemolysis, evidenced by a decline in hemoglobin, elevated reticulocytes, and unconjugated hyperbilirubinemia. The diagnosis of HAV hepatitis was confirmed through positive IgM anti-hepatitis A virus. Over the subsequent two weeks, the patient experienced peak levels of serum bilirubin, AST, and ALT. Conservative management focused on avoiding hepatotoxic drugs, ensuring adequate urine output, and monitoring metabolic parameters. Gradual improvement was observed over the subsequent month, with a significant reduction in bilirubin levels, restoration of hemoglobin, and a decline in liver enzymes. The patient was discharged for outpatient follow-up, and four weeks post-onset, G6PD levels approached normal, emphasizing the importance of comprehensive care in such complex cases. This case underscores the intricate interplay between viral hepatitis and G6PD deficiency, contributing valuable insights into the clinical presentation and management of severe hemolysis in this specific population

PIJAT BAYI DAN PENURUNAN KADAR BILIRUBIN BAYI IKTERIK: A SCOPING REVIEW

Jaundice is a disorder manifested by yellow discoloration of the skin, sclera and mucous membranes due to an increase in total serum bilirubin (TSB) in the circulation which is usually called hyperbilirubinemia. The aim of this study was to determine the effectiveness of massage to reduce bilirubin levels in icteric babies undergoing phototherapy. The type of research was a systematic review with PRISMA method. Data was accessed from; Google Scholar, PubMed, Research gate, One search, Garuda in the period 2013 to 2023. The article is original research, written in English or Indonesian and the research design is in the form of experimental research with designs: quasi experiments and randomized controlled trials. The number of articles that correspond is 7 articles. The research subjects were healthy babies and babies with jaundice. The results of the systematic review are that regular massage therapy in infants with jaundice undergoing phototherapy has an effective effect in reducing total serum bilirubin (TSB), increasing bilirubin excretion with defecation, reducing the duration of hospitalization. This complementary therapy is an effort to increase the effectiveness and efficiency of treating icteric babies during the hospitalization period.

An Overview on Neonatal Jaundice

A significant proportion of term and preterm infants develop neonatal jaundice. Jaundice in a healthy term infant is the most common reason for readmission to hospital. Jaundice is caused by a significant increase in serum bilirubin levels, largely due to the breakdown of red blood cells. Bilirubin is transported in the blood as 'unconjugated' bilirubin, largely bound to albumin. The bilirubin is converted into a conjugated form by the liver, which is excreted in the bile. Very high levels of unconjugated bilirubin led to neurotoxicity. In most infants, severe hyperbilirubinemia is caused due to an increase in bilirubin production (e.g., due to haemolysis) and thus reducing bilirubin production is a rational approach for its management. The situation can become critical in infants with an associated impaired bilirubin elimination mechanism as a result of a genetic deficiency and polymorphism. The simplest way to reduce bilirubin levels is by phototherapy. Current management of jaundice in the UK is guided by the NICE guideline.1

Bilirubin- and Blue-Green Light-Induced Damage of Human Erythrocytes

Phototherapy is widely used for neonatal hyperbilirubinemia treatment; however, the most important but not completely recognized issue is the determination of the optimal spectral range of light that provides an effective reduction of bilirubin level in the blood of a newborn with minimal adverse side effects. This study demonstrates that the exposure of radiation from LED sources of blue (emission wavelength λ max = 463 nm, FWHM 20 nm) and green (λ max = 517 nm, FWHM 38 nm) spectral regions to the erythrocyte suspension with the same energy dose (D = 14.4 J/cm 2 ) leads to approximately equally effective hemolysis of erythrocytes. It is concluded that the damage of erythrocyte membranes is caused by the excitation of endogenous porphyrin and flavin photosensitizers contained in the cells in low concentrations, but characterized by high efficiency of singlet oxygen generation. When bilirubin is added to the erythrocyte suspension, a spontaneous (dark) erythrocyte hemolysis intensifies, but the light-induced hemolysis slows down (compared to cells containing no bilirubin). Under the same conditions, the leakage of potassium ions from light-exposed erythrocytes is accelerating, with the light of green spectral region has a more pronounced effect, despite more intense absorption of blue light by bilirubin localized in cells.

The beneficial effects of infant’s massage on jaundiced neonates receiving phototherapy

Aim: To determine the effects of infant massage on newborns with jaundice who are on phototherapy. Methodology: We randomly assigned newborns(full-term) with jaundice to either a control group or a massage group while they were admitted for phototherapy. The medical data, including total feeding volume, weight, frequency of bowel movements, and level of bilirubin, was gathered and compared between two groups. Results: There were 25 neonates in the control group and 25 neonates in the test group. In comparison to the control group on the third day, the massage group showed significantly higher defecation frequency and significantly reduced bilirubin levels. There were no statistically significant differences in the two groups between body weights or food intake. Conclusion: The massaging of infant reduces bilirubin level and increases the frequency of faeces while they are receiving phototherapy for jaundice

Respiratory Distress of Newborn dengan Pemantauan Respirasi dan Alih Baring untuk Mengatasi Hiperbilirubinemia di Ruang Neonatal Intensive Care Unit: Studi Kasus

Respiratory Distress of Newborn (RDN) is a common cause of newborns respiratory distress. The RDN appears within a few hours after birth, and mostly often appears soon after birth. RDN usually has symptoms of tachypnea with a respiratory rate of more than 60 breaths per minute accompanied by grunting, chest retractions, nostril breathing, and cyanosis. Asphyxia is one of the causes of RDN. In addition, asphyxia can cause an increase in bilirubin levels in newborns leading to hyperbilirubinemia.
 This study was to observe the patient's breathing pattern and bilirubin levels among infants with RDN. A descriptive study, specifically case study design was utilized. The subject of this case study was baby H who diagnosed with RDN with CPAP installed on the 4th day.
 Results showed that monitoring vital signs for 3 days can improve breathing patterns and prevent respiratory failure. Meanwhile, phototherapy along with bed transfer has been shown to reduce bilirubin levels from bilirubin levels before the intervention, namely 20.65 mg/dl to 7.57 mg/dl after the intervention.
 Respiratory monitoring can improve respiratory rate. In addition to phototherapy, infants can also be given bed rest while monitoring vital signs to treat hyperbilirubinemia in RDN infants.