Treatment Of Hyperbilirubinemia Research Articles

Bilirubin Removal by Polymeric Adsorbents for Hyperbilirubinemia Therapy.

Hyperbilirubinemia, presenting as jaundice, is a life-threatening critical illness in newborn babies and acute severe hepatic failure patients. Over the past few decades, extracorporeal hemoadsorption by adsorbent therapy has been widely applied in the treatment of hyperbilirubinemia. The capability of hemoadsorption depends on the adsorbents. Most of the clinically used bilirubin adsorbents are made up of styrene/divinylbenzene copolymer and quaternary ammonium salt, which usually have poor biocompatibility and weak mechanical strength. To overcome the drawbacks of commercial polymer adsorbents, advanced synthetic and natural polymers with/without nanomaterials have been designed, and novel adsorbent fabrication technologies have also been developed. In this review, the adsorption mechanism of bilirubin adsorbents has been summarized, which is the basic criterion in adsorbent development. Furthermore, the preparation method, adsorption mechanism, relative merits and practicability of the emerging bilirubin adsorbents have been evaluated. Based on the existing studies, this work highlights the future direction of the efforts on how to design and develop bilirubin adsorbents with good overall clinical performance. Perhaps this study can change traditional perspectives and propose new strategies for bilirubin clearance from the aspects of pathogenic mechanisms, metabolic pathways, and material-based innovation.

Cardiovascular changes during phototherapy in newborns.

Phototherapy is the most effective non-invasive method of neonatal hyperbilirubinemia treatment. Application of this method can be associated with side effects including changes in the cardiovascular system. During phototherapy, the primary effects in the cardiovascular system include cutaneous vasodilation leading to skin hyperperfusion and subsequent redistribution of blood. The increased blood flow through the skin is associated with increased transepidermal water loss. Further effects include an increase in cerebral blood flow. Redistribution of blood to the cutaneous bed is compensated by hypoperfusion in the splanchnic area (mostly postprandial) and a significant reduction of the renal blood flow. Regarding closure/reopening of the ductus arteriosus, the results suggest that that phototherapy does not affect ductal patency. During phototherapy the cardiac output can be slightly reduced due to a decreased stroke volume, especially in preterm newborns. Systemic blood pressure is decreased and heart rate is elevated in both preterm and term newborns during phototherapy. The heart rate variability is slightly reduced. Symbolic dynamics analysis of the short-term HRV showed that during phototherapy the activity of the ANS regulating the heart rate is shifted towards the dominancy of the sympathetic activity. The responses in the cardiovascular system of premature/mature newborns without other pathology confirm a well physiologically functioning control of this system, even under specific conditions of phototherapy.

A review of existing neonatal hyperbilirubinemia guidelines in Indonesia

Background: Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the management of this condition were present. This study aimed to compare the existing guidelines regarding prevention, diagnosis, treatment and monitoring in order to create the best recommendation for a new hyperbilirubinemia guideline in Indonesia. Methods: Through an earlier survey regarding adherence to the neonatal hyperbilirubinemia guideline, we identified that three main guidelines are being used in Indonesia. These were developed by the Indonesian Pediatric Society (IPS), the Ministry of Health (MoH), and World Health Organization (WHO). In this study, we compared factors such as prevention, monitoring, methods for identifying, risk factors in the development of neonatal jaundice, risk factors that increase brain damage, and intervention treatment threshold in the existing guidelines to determine the best recommendations for a new guideline. Results: The MoH and WHO guidelines allow screening and treatment of hyperbilirubinemia based on visual examination (VE) only. Compared with the MoH and WHO guidelines, risk assessment is comprehensively discussed in the IPS guideline. The MoH guideline recommends further examination of an icteric baby to ensure that the mother has enough milk without measuring the bilirubin level. The MoH guideline recommends referring the baby when it looks yellow on the soles and palms. The WHO and IPS guidelines recommend combining VE with an objective measurement of transcutaneous or serum bilirubin. The threshold to begin phototherapy in the WHO guideline is lower than the IPS guideline while the exchange transfusion threshold in both guidelines are comparably equal. Conclusions: The MoH guideline is outdated. MoH and IPS guidelines are causing differences in approaches to the management hyperbilirubinemia. A new, uniform guideline is required.

Biliblanket Utilization for Outpatient Treatment of Newborn Jaundice.

Hyperbilirubinemia is a common neonatal diagnosis. Biliblankets have the potential to reduce readmission for hyperbilirubinemia. The study purpose was to characterize home biliblanket treatment for hyperbilirubinemia using retrospective medical record review of newborns with total serum bilirubin of 0.1 to 3 mg/dL below inpatient threshold seen at 9 pediatric clinics (N = 359). The main outcomes were whether a biliblanket was used and whether the usage impacted readmissions. Home biliblankets were used for 44% of newborns. Nine percent of newborns were readmitted for hyperbilirubinemia. Four percent of newborns treated with a biliblanket were readmitted compared with 13% of those not treated with a biliblanket (P = .002). Newborns treated with a biliblanket (odds ratio [OR] = 0.16; 95% confidence interval [CI] = 0.06-0.44) and newborns 3 days or older (OR = 0.16; 95% CI = 0.06-0.43) were less likely to be readmitted than newborns not treated with a biliblanket and 2-day-old newborns. We found that home biliblanket use was associated with lower odds of hospital readmission for newborn jaundice.

History and current standard of postnatal management in hemolytic disease of the fetus and newborn.

Multiple developments have improved the identification, monitoring, and care of pregnancies and neonates withHDFN throughout the centuries. Pediatricians should be aware of the (antenatally determined) risk of hemolysis inRBC alloimmunization and should provide treatment for hyperbilirubinemia in the early phase and monitor for lateanemia in the late phase of the disease. Future studies should be set in an international setting and ultimately aimto eradicate HDFN on a global scale. •Developments have led to a greater understanding of the pathophysiology, an improved serological identification and monitoring of at-risk cases and the current pre- and postnatal treatment. •This review provides the pediatrician with hands-on guidelines for the delivery and postnatal management of neonates with HDFN. • Future studies should be set in an international setting with the ultimate aim of eradicating HDFN.

Long-Awaited AAP Hyperbilirubinemia Guidelines Have Arrived.

Long-Awaited AAP Hyperbilirubinemia Guidelines Have Arrived.

Correlation of the transcutaneous bilirubin and serum bilirubin levels measured before and after phototherapy in newborns: a prospective observational study

Aim: The purpose of the present study was to show the reliability of the transcutaneous bilirubin (TcB) measurement as an alternative method to total serum bilirubin (TSB) when starting treatment with phototherapy (PT), which is one of the most important treatment methods of hyperbilirubinemia as a very common practice in the neonatal period and eliminates the disadvantages of blood collection.
 Materyal and Method: Two measurements were made to evaluate whether there was a correlation between the total serum bilirubin and transcutaneous bilirubin level measurement for follow-up in newborns who were hospitalized and prospectively followed up in the Newborn Intensive Care Unit of Karabuk University Medical Faculty Training and Research Hospital between April 13 and June 30, 2022 (Level III Neonatal Center) who were scheduled for starting phototherapy. The primary result was the correlation between TcB and TSB at the first 24 hours and after, at the initiation of FT, termination of FT, and 12 hours after PT was discontinued.
 Results: The TSB and TcB values of the newborns ​​were measured at the beginning of PT, at the end of PT, and 12 hours after PT was ended. The first measurement values ​​were 11.60±5.16 and 10.72±4.02, respectively; the second measurement values ​​were 7.45±2.34 and 6.35±2.83, respectively; and the third measurement values ​​were 8.03±2.45 and 7.35±2.63 mg/dL, respectively. A strong positive correlation was found among all measurement values. Also, when the newborns who received FT for the first 24 hours were evaluated by subgrouping, the high correlation between TcB and TSB levels continued.
 Conclusion: The present study showed that there is a significant relationship between TcB taken from the covered skin and TSB at the start, end, and 12 hours after PT. Also, when the newborns who received PT for the first 24 hours were evaluated in a subgroup, it was found that TCB measurement predicted the TSB level at a high level before and after PT. Based on these findings, it was concluded that TcB measurement, including in the first 24 hours, is reliable in the follow-up of newborns receiving PT for the treatment of hyperbilirubinemia. However, we think that larger prospective controlled studies are required in this respect.

Transcutaneous bilirubin-based screening reduces the need for blood exchange transfusion in Myanmar newborns: A single-center, retrospective study.

BackgroundNeonatal hyperbilirubinemia is a significant health problem in Myanmar. We introduced transcutaneous bilirubin (TcB) measurements in 2017 and developed an hour-specific TcB nomogram for early detection and treatment of hyperbilirubinemia in Myanmar neonates. This study aimed to evaluate whether our screening method for hyperbilirubinemia decreased the requirement of blood exchange therapy (ET).MethodsThis retrospective cohort study was conducted at the Central Women’s Hospital, Yangon. Two groups were included as follows: group 1 (control group; comprising infants born in 2016 and screened on the basis of Kramer’s rule), and group 2 (intervention group; comprising infants born in 2019 and screened by TcB measurement using a nomogram). The number of ETs was analyzed based on causes of hyperbilirubinemia and number of days after birth.ResultsGroups 1 and 2 comprised 12,968 and 10,090 infants, respectively. Forty-six and two infants in Groups 1 and 2, respectively, required an ET. The odds ratio for ET was 18.0 (Group 1 to Group 2; 95% confidence interval [CI]: 4.8–67.1; p = 0.000). Serum bilirubin values at the time ET was administered were significantly higher in Group 1 than those in Group 2 (median: 23.0 and 16.8, respectively).ConclusionThe management of hyperbilirubinemia using our screening method (TcB Nomogram) can effectively reduce the need for ET in neonates in Myanmar.

Why should the neonatologist give a closer look at the alkaline phosphatase?

Background. Alkaline phosphatase (ALP) has been intensively studied and proved to be useful in Neonatology. The first condition studied in correlation with increased ALP values was osteopenia of prematurity. In recent years there was an increase interested in correlations between ALP and bilirubin levels. In this article, we want to review the literature to find other benefits of ALP dosing in neonatal patients. Methods. Clinical trials were searched and analyzed by a single individual (via dedicated search engines such as Google Scholar, PubMed, and Scopus). We have included clinical studies from the last 7 years that present statistically significant results regarding the role of ALP dosing in the screening or diagnosis of other neonatal pathologies (jaundice with hyperbilirubinemia, necrotizing enterocolitis, liver dysfunction, renal failure and oncological diseases). Results. After excluding the clinical trials that did not meet the eligibility criteria, 6 clinical trials remained (n = 859). Following the analysis of these studies, correlations were highlighted between high ALP values in the umbilical cord and the need for phototherapy. It was also shown that all newborns with elevated ALP values required treatment for hyperbilirubinemia, as well as being a good predictor of severe jaundice and helping to predict its onset. Also, evidence about the correlation between high values of ALP and prematurity osteopenia was reaffirmed in recent studies. Conclusions. ALP is an easily dosed biomarker that can be successfully used in Neonatology. The existing studies to date encourage the use of ALP as a biomarker especially for the detection of osteopenia of prematurity and for the early detection of newborns who will develop intense forms of jaundice. There are still differences regarding the serum ALP values considered as cut-offs for the diagnosis of various neonatal conditions, but performing multicenter studies on a large number of cases could establish a valid consensus in order to use the same ALP cut-off values in all Neonatology departments.

Calycosin alleviates hyperbilirubin nerve injury in Ugt1-/- mice by inhibiting oxidative stress, apoptosis, and mitochondrial function

Background and purposeHyperbilirubinemia is a common condition in neonates that is associated with poor neurodevelopmental outcomes. Although studies have proposed that calycosin has a neuroprotective effect, the exact molecular mechanism underlying calycosin treatment of hyperbilirubinemia remains elusive. To fill this gap, we analyzed the mechanism of calycosin treatment in hyperbilirubinemia model mice. MethodThirty neonatal mice were randomly divided into wide type (WT), Ugt1-/- and calycosin treatment group. Neuronal damage was observed with Nissl staining. Immunofluorescence staining were carried out to determine DNA damage repair and neurodegeneration. Oxidative stress was investigated by immunostaining with 4-hydroxynonenal (4-HNE). Western blot (WB) and Qpcr were used to detect relative protein and mRNA expression levels. Mitochondrial CI/CII activity of mitochondria was analyzed with a spectrophotometer. ResultThe total bilirubin concentration was significantly higher in Ugt1-/- group compared with WT, but calycosin treatment reduced concentration of bilirubin. The total bilirubin and bilirubin/albumin ratio were significantly higher at postnatal day 4 compared with day 2. Calycosin treatment reduced serum bilirubin concentration and bilirubin/albumin ratio. After calycosin treatment, Nissl body count increased, apoptosis-related protein was downregulated and 4-HNE level decreased.Compared with Ugt-/- group, calycosin treatment increased neurons (NeuN+) and calbindin positive cells and decreased fluorojade C(FJC)positive neurons in WT group. In mitochondria, calycosin alleviated mitochondrial electron transport chain dysfunction in Ugt1-/- mice. ConclusionWe demonstrated that the mechanism of calycosin treatment on hyperbilirubinemia-induced Ugt1-/- was associated mainly with antioxidant effects, antiapoptosis and inhibition of normal mitochondrial function.

Evaluation of a mobile application tool (BiliNorm) to improve care for newborns with hyperbilirubinemia in Indonesia.

Severe hyperbilirubinemia is more frequent in low- and middle-income countries such as Indonesia than in high-income countries. One of the contributing factors might be the lack of adherence to existing guidelines on the diagnosis and treatment of hyperbilirubinemia. We developed a new national guideline for hyperbilirubinemia management in Indonesia. To help healthcare workers use this guideline, a web-based decision support tool application may improve both the adherence to the guideline and the care for infants with hyperbilirubinemia. We developed a web-based application (BiliNorm) to be used on a smartphone that displays the bilirubin level of the patient on the nomogram and advises about the treatment that should be started. Healthcare workers of two teaching hospitals in East Java, Indonesia, were trained on the use of BiliNorm. At 6 months after the introduction, a questionnaire was sent to those who worked with the application enquiring about their experiences. An observational study was conducted in two time epochs. A chart review of infants with hyperbilirubinemia in the two hospitals was sent. The appropriateness of hyperbilirubinemia management during a 6-month period before BiliNorm introduction was compared to that during a 7-month period after its introduction. A total of 43 participants filled in the questionnaire, the majority (72%) of them indicated that BiliNorm was well received and easy to use. Moreover, 84% indicated that BiliNorm was helpful for the decision to start phototherapy. Chart review of 255 infants before BiliNorm introduction and that of 181 infants after its introduction indicated that significantly more infants had received treatment according to the guideline (38% vs 51%, p = 0.006). Few infants received phototherapy, but bilirubin level was not measured (14% vs 7%, p = 0.024). There was no difference in the proportion of infants who were over- and under-treated (34% vs 32% and 14% vs 10%, respectively). The web-based decision tool BiliNorm appears to be a valuable application. It is easy to use for healthcare workers and helps them adhere to the guideline. It improves the care for infants with hyperbilirubinemia and may help reduce the incidence of severe hyperbilirubinemia in Indonesia.

Bilirubin Encephalopathy.

Hyperbilirubinemia is commonly seen in neonates. Though hyperbilirubinemia is typically asymptomatic, severe elevation of bilirubin levels can lead to acute bilirubin encephalopathy and progress to kernicterus spectrum disorder, a chronic condition characterized by hearing loss, extrapyramidal dysfunction, ophthalmoplegia, and enamel hypoplasia. Epidemiological data show that the implementation of universal pre-discharge bilirubin screening programs has reduced the rates of hyperbilirubinemia-associated complications. However, acute bilirubin encephalopathy and kernicterus spectrum disorder are still particularly common in low- and middle-income countries. The understanding of the genetic and biochemical processes that increase the susceptibility of defined anatomical areas of the central nervous system to the deleterious effects of bilirubin may facilitate the development of effective treatments for acute bilirubin encephalopathy and kernicterus spectrum disorder. Scoring systems are available for the diagnosis and severity grading of these conditions. The treatment of hyperbilirubinemia in newborns relies on the use of phototherapy and exchange transfusion. However, novel therapeutic options including deep brain stimulation, brain-computer interface, and stem cell transplantation may alleviate the heavy disease burden associated with kernicterus spectrum disorder. Despite improved screening and treatment options, the prevalence of acute bilirubin encephalopathy and kernicterus spectrum disorder remains elevated in low- and middle-income countries. The continued presence and associated long-term disability of these conditions warrant further research to improve their prevention and management.

Comparison of Intermittent vs. Continuous Phototherapy in the treatment of Non-Haemolytic Neonatal Hyperbilirubinemia

Introduction: Phototherapy is used in the treatment of hyperbilirubinemia in initial life-span of neonates. Our objective was the comparison of continuous vs intermittent phototherapy in the reduction of total serum bilirubin, bilirubin decrease rate, phototherapy time and hospital stay in non-haemolytic hyperbilirubinemia neonates. Place and Duration: The study was conducted at department of Pediatric medicine in Qazi Hussain Ahmad Medical Complex, Nowshera for the duration of six months from 16th January 2021 to 15th July 2021. Methods: The study involved 160 neonates with birth weight ≥2000 gm and age was above 34 weeks. They were randomly assigned to group A who were given continuous phototherapy for 3hrs and 50 mints and then rest for 45mints and group B who were given intermittent phototherapy for 3 hours and then rest for next 3 hours and so on. The levels of TSB were calculated in both groups and their comparison was made at every 12, 24 and 48 hrs after the start of phototherapy. Results: The mean of total serum bilirubin on admission was 16.01 ± 3.91 mg / dL for the continuous group and 15.21 ± 1.12 mg / dL for the intermittent group. The TSB mean after 12, 24 and 48 hrs. for continuous phototherapy was 13.30 ± 2.3 mg / dl, 11.1 ± 2.01 mg / dl, 9.26 ± 0.92 mg / dl and 13.1 ± 1.70 mg / dL, 9.54 ± 1.7 mg / dL, 8.9 ± 0.61 mg / dl (p <0.05) for the intermittent group, respectively. The mean rate of decrease in serum concentration of bilirubin was 0.30 ± 0.14 mg / dl / h in group A and 0.19 ± 0.07 mg / dl / h in group B (p = 0.5). There was no big variance between the mean hospital stay in groups A and B (p = 0.550). Conclusions: Intermittent phototherapy is a better choice than continuous phototherapy in the treatment of non-haemolytic hyperbilirubinemia, with added benefits such as less frequent disruption of the mother-child relationship and reduced radiation therapy. Keywords: Intermittent phototherapy; Continuous phototherapy; Total serum bilirubin and Neonatal hyperbilirubinemia.

Comparison of diagnostic accuracy of transcutaneous bilirubinometry during phototherapy by using skin patch

Background: Neonatal jaundice is a very common condition. Serious unconjugated hyperbilirubinemia may result in neurological dysfunction as catastrophic as kernicterus. Phototherapy is the method of choice in treatment of hyperbilirubinemia. Aim and objectives: the aim of the study was to assess the accuracy of transcutaneous bilirubin measurement during phototherapy by using skin patch and comparing this with skin and serum bilirubin measurement at the same time. Subjects and methods: This was an observational prospective study was conducted in special care baby unit at Al-wahda teaching hospital –Derna-Libya over a period of nine months (June 1st 2021 to March 2022).Eighty (80) newborn (41 Male, 39 Female) were enrolled in the study .Transcutaneous bilirubin measurement from skin over sternum, skin under patch at Rt. Side of chest, simultaneously serum bilirubin sample were collected. Results: during phototherapy; the mean± SD TSB (14.94 ± 4.57 μmol/L) and mean± SD TCBC (13.52 ± 4.84) and at skin level was 9.45 ± 3.62. Bland–Altman plot showed significant agreement between TcB from patched site and TSB Conclusion: TCB measurements correlate strongly with TSB levels during and after PT.

Lifelong Impact? The Effect of Phototherapy Admission on Future Breastfeeding.

Lifelong Impact? The Effect of Phototherapy Admission on Future Breastfeeding.

Treatment practices and implementation of guidelines for hyperbilirubinemia and rebound hyperbilirubinemia.

Hyperbilirubinemia (HB), defined as elevated total serum bilirubin (TSB) levels, commonly affects neonates and requires prompt treatment to prevent neurological complications. Up to 10%of neonates experience rebound hyperbilirubinemia (RHB), requiring re-initiation of treatment. Unfortunately, treatment guidelines lack practical recommendations surrounding subthreshold phototherapy, treatment termination, and RHB investigations. We examined local management practices for HB and RHB treatment in a well newborn nursery. As a secondary aim, we investigated the association between treatment practices and RHB rates. Retrospective chart review identified neonates treated for hyperbilirubinemia between January 2015 and December 2019 during their birth hospitalization at a tertiary care centre. Standardized data collection sheets were used to record treatment parameters. Over the 5-year period, there were 9683 births and 305 (3.15%) neonates received phototherapy. Of the treated cases, 20-25%were subthreshold to practice guideline values. Upon treatment termination 25-55%of cases had TSB levels within 3 mg/dL, which may increase the risk of RHB. In our cohort, 20.3%of treated cases experienced one episode of RHB and 3.9%experienced two episodes of RHB. Although clinicians evaluated neonates for RHB 0-12 hours following treatment termination prior to discharge, many cases were identified in outpatient settings and required re-admission for phototherapy. When managing HB and RHB, treatment practices such as when to terminate treatment in relation to threshold values, and timing of RHB investigations, are largely inconsistent amongst clinicians. Future studies are required to better understand the landscape of hyperbilirubinemia treatment beyond initiation of phototherapy.

Oridonin alleviates hyperbilirubinemia through activating LXRα-UGT1A1 axis

Hyperbilirubinemia is a serious hazard to human health due to its neurotoxicity and lethality. So far, successful therapy for hyperbilirubinemia with fewer side effects is still lacking. In this study, we aimed to clarify the effects of oridonin (Ori), an active diterpenoid extracted from Rabdosia rubescens, on hyperbilirubinemia and revealed the underlying molecular mechanism in vivo and in vitro. Here, we showed that liver X receptor alpha (LXRα) deletion eliminated the protective effect of Ori on phenylhydrazine hydrochloride-induced hyperbilirubinemia mice, indicating that LXRα acted as a key target for Ori treatment of hyperbilirubinemia. Ori significantly increased the expression of LXRα and UDP-glucuronosyltransferase 1A1 (UGT1A1) in the liver of wild-type (WT) mice, which were lost in LXRα-/- mice. Ori or LXR agonist GW3965 also reduced lipopolysaccharide/D-galactosamine-induced hyperbilirubinemia via activating LXRα/UGT1A1 in WT mice. Liver UGT1A1 enzyme activity was elevated by Ori or GW3965 in WT mice. Further, Ori up-regulated LXRα gene expression, increased its nuclear translocation and stimulated UGT1A1 promoter activity in HepG2 cells. After silencing LXRα by siRNA, Ori-induced UGT1A1 expression was markedly reduced in HepG2 cells and primary mouse hepatocytes. Taken together, Ori stimulated the transcriptional activity of LXRα, resulting in the up-regulation of UGT1A1. Therefore, Ori or its analogs might have the potential to treat hyperbilirubinemia-related diseases through modulating LXRα-UGT1A1 signaling.

Therapeutic effect of Green synthesized MnO2 nanoparticles for treatment of hyperbilirubinemia -An In-Vivo Study

Therapeutic effect of Green synthesized MnO2 nanoparticles for treatment of hyperbilirubinemia -An In-Vivo Study

Plasma Exchange Is an Effective Adjunct in the Management of Hyperbilirubinemia in Early Allograft Dysfunction and Small for Size Syndrome after Liver Transplant

Background: Management of early allograft dysfunction (EAD) and small for size syndrome (SFSS) after liver transplant remains challenging and care is largely based around supportive treatment. The role of plasmapheresis/plasma exchange in SFSS is not well established. However, it can potentially serve an important role as a salvage option by reducing the metabolic load of toxins including bilirubin and supplying important coagulation proteins to maintain coagulation homeostasis. Methods: We present three cases. A 19-year-old female underwent living-donor liver transplant (LDLT) and received a healthy right lobe graft. Graft-to-recipient weight ratio (GRWR) was 0.85. She developed SFSS and underwent one cycle of plasma exchange on post-operative day (POD) 8 (peak bilirubin 414umol/l) that was prematurely terminated as she developed an allergic response. A 58-year-old female underwent deceased-donor liver transplant and developed acute worsening hyperbilirubinemia on POD8-10 (from 116umol/l to 858 umol/l). She underwent one cycle of plasma exchange that was sufficient to serve as a bridge to treat the hyperbilirubinemia until liver biopsy diagnosis of acute cellular rejection was obtained and definitive steroid treatment was initiated. A 42-year-old female underwent LDLT and received a left lobe graft (GRWR 0.75). She developed SFSS despite portal inflow modulation performed during transplant. She underwent three sessions of plasma exchange (POD25,27,30). Results: In the three cases bilirubin levels improved significantly following plasma exchange, and graft recovery was evident. Conclusion: Our cases suggest the efficacy of plasma exchange as a potential adjunct for the supportive treatment of hyperbilirubinemia in EAD and SFSS to avoid re-transplantation.

Brain stem auditory evoked potential response in neonates after recovery from hyperbilirubinemia: A neurophysiological approach to screening neuronal hearing loss

Objectives: Neonatal hyperbilirubinemia leads to neurological damages including encephalopathy and hearing loss. This study aimed to screen and evaluate the hearing loss in neonates after recovery from hyperbilirubinemia using the Brainstem evoked response audiometry (BERA) test. Materials and Methods: This cross-sectional comparative study was conducted in Physiology Department at Chitwan Medical College, Nepal. It included 20 age and sex-matched neonates recently recovered from hyperbilirubinemia and 20 normal healthy controls. The external acoustic canals of subjects were checked for any blockage or collapse before BERA testing. The BERA recordings were performed after the neonate’s natural sleep following a standard lab protocol explained by Taylor’s Evoked Potential in Clinical Testing. Results: The BERA wave latencies were delayed with a higher number of case group neonates I (IL-75%, IR-80%), III (IIIL-70%, III R-80%), and V (VL-80%, VR-85%) than those of controls. The percentage of neonates with delayed interwave latencies was comparable between groups. The neonate’s hearing sensitivity assessed using the grades of hearing impairment by WHO revealed slight (threshold of hearing left ear [THL]-25% and threshold of hearing right ear [THR]-30%) and moderate (THL-40% and THR-35%) grades among cases whereas no impairment (THL-60% and THR-55%) in controls. The hearing thresholds were more in cases. Conclusion: The auditory pathway is highly sensitive to elevated serum bilirubin. BERA detects even a minute degree of hearing damage seen after complete treatment of hyperbilirubinemia. Therefore, BERA is a helpful tool in the early screening of hearing impairment in neonates. This improves prognosis by early management so that the neurosensory systems develop to their full extent and one can enjoy a normal social life.