Treatment Of Hyperbilirubinemia Research Articles

Characteristics and treatment outcomes in chromhidrosis: A systematic review

Characteristics and treatment outcomes in chromhidrosis: A systematic review

Hour-specific nomogram for transcutaneous Bilirubin in newborns in Myanmar.

Neonatal hyperbilirubinemia is a significant health problem in Myanmar, and the rate of kernicterus is also higher than in developed countries. Non-invasive methods for early detection and treatment of hyperbilirubinemia are urgently needed. In this study, we used transcutaneous bilirubin (TcB) measurements to develop an hour-specific TcB nomogram for the effective management of hyperbilirubinemia in Myanmar newborns. The bilirubin levels of neonates born in Central Women Hospital in Yangon, Myanmar were measured three times a day within 72h after birth using a transcutaneous bilirubinometer. An hour-specific TcB nomogram was created based on the data. Participants were 512 infants (287 boys, 225 girls) born in Central Women's Hospital in Yangon. The mean (±SD) gestational age was 38.4±1.2weeks; birthweight was 3078±412g. A total of 3,039 plots were obtained, and the TcB nomogram was created with smoothed percentile curves (97.5th, 50th, and 2.5th percentiles) for 0-72h after birth. An hour-specific TcB nomogram was successfully created to manage hyperbilirubinemia in Myanmar newborns.

Induction of fecal cholesterol excretion is not effective for the treatment of hyperbilirubinemia in Gunn rats.

Unconjugated hyperbilirubinemia, a feature of neonatal jaundice or Crigler-Najjar syndrome, can lead to neurotoxicity and even death. We previously demonstrated that unconjugated bilirubin (UCB) can be eliminated via transintestinal excretion in Gunn rats, a model of unconjugated hyperbilirubinemia, and that this is stimulated by enhancing fecal fatty acid excretion. Since transintestinal excretion also occurs for cholesterol (TICE), we hypothesized that increasing fecal cholesterol excretion and/or TICE could also enhance fecal UCB disposal and subsequently lower plasma UCB concentrations. To determine whether increasing fecal cholesterol excretion could ameliorate unconjugated hyperbilirubinemia, we treated hyperbilirubinemic Gunn rats with ezetimibe (EZE), an intestinal cholesterol absorption inhibitor, and/or a liver X receptor (LXR) and farnesoid X receptor (FXR) agonist (T0901317 (T09) and obeticholic acid (OCA), respectively), known to stimulate TICE. We found that EZE treatment alone or in combination with T09 or OCA increased fecal cholesterol disposal but did not lower plasma UCB levels. These findings do not support a link between the regulation of transintestinal excretion of cholesterol and bilirubin. Furthermore, induction of fecal cholesterol excretion is not a potential therapy for unconjugated hyperbilirubinemia. Increasing fecal cholesterol excretion is not effective to treat unconjugated hyperbilirubinemia. This is the first time a potential relation between transintestinal excretion of cholesterol and unconjugated bilirubin is investigated. Transintestinal excretion of cholesterol and unconjugated bilirubin do not seem to be quantitatively linked. Unlike intestinal fatty acids, cholesterol cannot "capture" unconjugated bilirubin to increase its excretion. These results add to our understanding of ways to improve and factors regulating unconjugated bilirubin disposal in hyperbilirubinemic conditions.

Top 100-Cited Articles in Tinnitus: A Bibliometric Analysis

Neonatal hyperbilirubinemia is a widespread and significant clinical condition amongst neonates worldwide Methods: A specially designed questionnaire was distributed to a random sample of 200 pediatricians working in the main childhood hospitals in Sana'a. Results: The pediatricians involved in the study stated high use (61.8%) of the cephalo-caudal progression as a method to evaluate jaundice in the newborn. Less proportion of pediatricians tested total serum bilirubin levels in jaundiced neonates ahead of their discharge from the hospital as compared to jaundiced neonates examined at the post-discharge visit (73.9% vs. 83.4%). The majority of pediatricians did not believe neonatal jaundice noted after discharge and gestational ages 37–38 weeks as being risk factor for the development of acute bilirubin encephalopathy. A considerable number of our pediatricians initiated phototherapy as well as exchange transfusion at lower levels of serum bilirubin than the recommended by the AAP guidelines at age of 24-48 hr, (66.7% and 57.6% respectively). Conclusion: although Yemeni pediatricians in the study were liable to start up phototherapy and exchange blood transfusion at points lesser than those recommended, the study revealed an overall consistency of their practice with hyperbilirubinemia treatment guidelines of the American Academy of Pediatrics, 2004.

Evaluation of the safety and efficacy of glucocorticoid therapy for hyperbilirubinemia in patients with hepatocellular carcinoma who have undergone transcatheter arterial chemoembolization

Abstract Objective The aim of this study was to analyze the safety and efficacy of glucocorticoid treatment for hyperbilirubinemia in patients with hepatocellular carcinoma (HCC) who have undergone transcatheter arterial chemoembolization (TACE). Methods We conducted a retrospective analysis of the clinical data of 198 patients with HCC who were admitted to The Fifth Medical Center of PLA General Hospital from June 2014 to August 2019 and underwent TACE therapy. The patients were divided into glucocorticoid (GCC) treatment group and control group. Standard liver-protecting procedures were used in both groups. The treatment group also received intravenous injections of methylprednisolone sodium succinate for 3-5 days. Reduction in bilirubin concentration, mean duration of hospitalization, and complications were compared between the two groups to investigate the safety and efficacy of GCCs for treatment of hyperbilirubinemia after TACE treatment. Results Bilirubin concentrations were significantly lower in the treatment group than in control group on days 3 and 5 after GCC/conventional liver-protecting treatment (P < 0.05). The treatment group had significantly shorter durations of total post-surgery hospitalization, and recovery time than the control group (14.5 ± 4.6 days vs. 17.5 ± 6.6 days, P < 0.001; 9.2 ± 3.3 days vs. 11.8 ± 5.4 days, P = 0.001; 7.0 ± 3.3 days vs. 9.3 ± 4.6 days, P < 0.001). No GCC-associated complications were detected in the treatment group. Conclusion Short-term use of GCCs to treat hyperbilirubinemia in patients with HCC who have undergone TACE is safe and associated with rapid decline in bilirubin concentration and shorter hospital stay compared with patients who did not receive GCCs.

Is Neonatal Hyperbilirubinemia Exposure Associated with a Risk of Autism Spectrum Disorder? A Nationwide Cohort Study.

This study aimed to determine whether neonatal hyperbilirubinemia is associated with a risk of autism spectrum disorder (ASD) using a large population-based cohort. This retrospective cohort study used data from the children's database (2000-2012) of the National Health Insurance Research Database (1996-2012) in Taiwan. We included neonates who were born between 2000 and 2004 and aged <1 month diagnosed with and without hyperbilirubinemia. The primary outcome was physician-diagnosed ASD. At the end of 2012, multivariate Cox's regression analysis was used to estimate hazard ratios (HRs). A total of 67,017 neonates were included. The neonates with hyperbilirubinemia were associated with 1.28-fold increased risk of ASD (HR = 1.28, 95% confidence interval [CI]: 1.05-1.57) compared with those without hyperbilirubinemia. In subanalysis to determine how phototherapy and exchange transfusion treatment for hyperbilirubinemia were associated with ASD showed no association between treatment and ASD, suggesting the lack of a dose-response effect of hyperbilirubinemia on the risk of ASD. Boys had a nearly six-fold higher risk of ASD than girls (HR = 5.89, 95% CI: 4.41-7.86). Additionally, neonates born with preterm birth and low birth weight were associated with a risk of ASD (HR = 1.46, 95% CI: 1.00-2.13). We did not observe a dose-response effect of hyperbilirubinemia on ASD, but neonatal hyperbilirubinemia may be an independent risk factor for ASD if there is a residual confounding by other perinatal complications. Therefore, this study does not support a causal link between neonatal hyperbilirubinemia exposure and the risk of ASD.

Assessement of Behavioral and Neurological Responses of Neonates with Jaundice undergoing Phototherapy

Abstract Background: Phototherapy has been the standard of care for the treatment of hyperbilirubinemia in neonates. It is generally safe procedure, although behavioral and neurological side-effects can occur. Aim of Study: To assess behavioral and neurological responses of neonates with jaundice undergoing phototherapy. Subjects and Methods: A descriptive exploratory research design was utilized on a convenient sample of sixty neonates with jaundice, total serum bilirubin level ranged from seven to twenty mg/dl and undergoing phototherapy at the NICU of El-Monera Pediatric Hospital, Cairo University. A neonatal characteristics assessment sheet, and Neonatal Behavioral Assessment Scale (NBAS) were used to collect data from September 2018 to February 2019. After written consent from parents, neonatal characteristics were recorded from the medical sheet and every neonate was assessed individually using (NBAS) two times, before starting and after stopping phototherapy. Results: The current study revealed that all neonates were full term and their mean weight was 2.86±0.53. Behavioral and neurological responses of neonates with jaundice were differed significantly after than before starting phototherapy on the NBAS. Conclusion: There were behavioral differences of studied neonates after phototherapy related to their habituation, social interactive, motor response, state organization, state regulation and reflexes. Recommendation: NBAS must be used as a tool in the routine care for neonates with jaundice undergoing photother-apy and establishment of health educational instruction for all working nurses in NICUs about appropriate nursing care to minimize the potential side effects and complications of phototherapy.

Prevalence, factors associated and treatment outcome of hyperbilirubinaemia in neonates admitted to St Francis hospital, Nsambya, Uganda: a descriptive study.

With targeted management of neonatal hyperbilirubinaemia in high-income countries, there has been a drastic drop in both the prevalence and mortality. On the contrary, over two-thirds of the global burden of neonatal hyperbilirubinaemia is in Sub-saharan Africa and South East Asia with a high mortality risk of 16-35%. Neonatal hyperbilirubinaemia is not a leading global cause of neonatal mortality, however leads to irreversible neurological damage and death when managed poorly. Three-quarters of the babies admitted to the national referral hospital in Uganda had significant hyperbilirubinaremia; 16.6% of these babies died. We aimed at determining the prevalence, treatment outcome and describing factors associated with hyperbilirubinaemia in neonates admitted to St Francis hospital, Nsambya. A cross sectional study was carried out. A total of 242 files of babies with a preliminary diagnosis of hyperbilirubinaemia were retrieved retrospectively. Relevant data was extracted from the files and analysed using STATA version 14.0. The prevalence of significant hyperbillirubinaemia was 22.7% (55/242). Seventy-seven percent of the babies admitted did not require treatment for hyperbilirubinaemia. No factors were found to be significantly associated with significant hyperbilirubinaemia. The case fatality for severe hyperbilirubinaemia was 20% (6/30); half of these babies had haemolytic disease of the newborn. Establishment of local guidelines will prevent unnecessary admissions and ensure timely treatment is administered. Longitudinal studies are required to discover factors associated with neonatal hyperbilirubinaemia in this region.

Causes And Management Of Neonatal Jaundice In Almosawi Pediatric Hospital In Nasiryiah City A: Retrospective Study

Background Neonatal jaundice is the most common reason for admission in the neonatal period. The yellow coloration of the skin and sclera in newborn with jaundice is the result of accumulation of unconjugated bilirubin. Neonatal physiological jaundice results from simultaneous occurrence of two phenomena, bilirubin production is elevated and hepatic excretory capacity is low (1).The aim of this study is to determine the etiology,severity,risk factors and management of neonatal jaundice. Methods A retrospective study was conducted on 100 case_sheets (random sample) to neonates who had jaundice in Almosawi paediatric hospital in Nasiryiah city.The obtained data were analysed and the results were tabulated. Results 100 case_sheets of neonates who have jaundice were studied.ABO blood group incompatibility were the most common cause of jaundice.Phototherapy is the mainstay of hyperbilirubinemia treatment in neonates.It has resulted in a marked reduction in the need to perform exchange transfusion. Conclusion Blood group incompatibility,and unknown causes,are the most common cause of neonatal jaundice .The less common cause is G6pd deficiency.Most of neonates who have jaundice were breast feeding,lowbirth weight and preterm are risk facters.

A Novel Approach to Phototherapy Initiation in Preterm Infants

Therapeutic interventions in preterm infants are determined based on birth weight. Phototherapy (PTx) is the treatment for hyperbilirubinemia, started based on serum bilirubin level. However, weight-based guidelines for PTx in preterm infants are lacking. We present a simple way of calculating the bilirubin to initiate PTx. A percentage body weight, ranging from 0.5%-1%, is used to calculate bilirubin.

Development of a new treatment for hyperbilirubinemia induced psychiatric disorders; preclinical study

Development of a new treatment for hyperbilirubinemia induced psychiatric disorders; preclinical study

Clinical study of bilirubin adsorption in the treatment of hyperbilirubinemia after cardiac surgery

Clinical study of bilirubin adsorption in the treatment of hyperbilirubinemia after cardiac surgery

Fabrication of chitosan/graphene oxide composite aerogel microspheres with high bilirubin removal performance.

Functional chitosan/graphene oxide (CS/GO) composite aerogel microspheres were fabricated via CO2 supercritical drying, which displayed excellent performance for bilirubin removal. The morphology and chemical structure of CS/GO composite aerogel microspheres were characterized, which illustrated a nanoporous structure with a maximum specific surface area of 174.69 m2/g, and a special pore size distribution at 20-40 nm, also a good mechanical property. Importantly, the composite aerogel microspheres (10% GO) revealed a large adsorption capacity (178.25 mg/g) for bilirubin within 2 h. Dynamic adsorption experiment illustrated that the aerogel microspheres adsorbed much more bilirubin with a shorter equilibrium time of about 30 min. Besides, the adsorption mechanism of bilirubin by the CS/GO composite aerogel microspheres was investigated through the relevant model fitting, including adsorption kinetics and adsorption isotherm, which illustrated that the mechanism included both physical and chemical processes, but chemical adsorption was dominated. Adsorption isotherm indicated that bilirubin adsorption by the microspheres was fitted well with Freundlich isotherm, which ascribed to multilayer adsorption. After five adsorption-desorption cycles, the adsorption capacity still maintains large adsorption capacity. In addition, the hemolysis rate and coagulation time tests presented the good blood compatibility for the adsorbents. Therefore, the CS/GO composite aerogel microspheres with rapid, high adsorption capacity and good blood compatibility might be promising for hyperbilirubinemia treatment.

141 Total bilirubin rate of rise of in moderate preterm neonates: impact of gestational age

Abstract Background As compared to term neonates, those &amp;lt; 35 weeks gestation (wks GA) are at greater risk for both acute and chronic bilirubin encephalopathy (ABE, CBE). Among these with postnatal total bilirubin rate of rise, (TB ROR) at age 0 to 72 hours has been observed because of either loss placental elimination system or increased postnatal production due to hemolysis. The ranges are known to vary &amp;gt; 8.5 umol/L/h in neonates with Rh disease to &amp;gt;3.4 umol/L/h at the 95th percentile track of the hour-specific nomogram. TB ROR in healthy term neonates is &amp;lt;3.4 umol/L/h. Objectives To determine the GA ranges on TB ROR to explore predictive TB ROR in preterm neonates who are more vulnerable with each &amp;lt;35 wks GA. Design/Methods A multi-site observational study to quantify TB ROR in preterm infants between 28 to 35 weeks. 1804 infants born between January 2013- March 2018 at 28–35 wks GA from three canadian perinatal centres were included and those with Rh disease were excluded. Analysis included infants &amp;gt;27 weeks with at least one TB prior to the initiation of treatment for severe hyperbilirubinemia treatment. Feeding patterns, birth history and maternal health conditions were documented. Results The TB ROR were compared by two prematurity GA groups (28–31 weeks and 32–35 weeks) then per individual gestational age in four time periods in hours, 0–24, 24–48, 48–96, and 96 -120 in 1049 preterm infants using 3065 TB samples. Infants &amp;lt;28 weeks GA were excluded since they represented a more diverse population. TB ROR by prematurity groups over all was higher in 32–35 weeks group at 0–12 hours (3.85 umol/L/h) and 25–36 hours (2.81umol/L/h) and decreased at 49–72 hours (0.24umol/L/h) time period as compared to the less mature group. Conclusion Though TB ROR were of similar patterns between prematurity groups (28–31 weeks and 32–35 weeks) it was at higher rate of rise between 13–36 hours and decreasing from 36–72 hours, with a plateau after 72 hours of age. There was a significant difference in the magnitude of TB ROR between prematurity groups at 0–24 hours. Additional research into the clinical care impact on the TB ROR should be conducted to study impact of production and elimination.

Study of sodium and potassium changes in term neonates receiving phototherapy

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

Sunlight for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates

Sunlight for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates

Structural Insights into Azole-based Inhibitors of Heme Oxygenase-1: Development of Selective Compounds for Therapeutic Applications.

The development of isozyme-selective heme oxygenase (HO) inhibitors promises powerful pharmacological tools to elucidate the regulatory characteristics of the HO system. It is already known that HO has cytoprotective properties with a role in several disease states; thus, it is an enticing therapeutic target. Historically, the metalloporphyrins have been used as competitive HO inhibitors based on their structural similarity to the substrate, heme. However, heme's important role in several other proteins (e.g. cytochromes P450, nitric oxide synthase), results in non-selectivity being an unfortunate side effect. Reports that azalanstat and other non-porphyrin molecules inhibited HO led to a multi-faceted effort over a decade ago to develop novel compounds as potent, selective inhibitors of HO. The result was the creation of the first generation of non-porphyrin based, non-competitive inhibitors with selectivity for HO, including a subset with isozyme selectivity for HO-1. Using X-ray crystallography, the structures of several complexes of HO-1 with novel inhibitors have been elucidated and provided insightful information regarding the salient features required for inhibitor binding. This included the structural basis for non-competitive inhibition, flexibility and adaptability of the inhibitor binding pocket, and multiple, potential interaction subsites, all of which can be exploited in future drug-design strategies. Notably, HO-1 inhibitors are of particular interest for the treatment of hyperbilirubinemia and certain types of cancer. Key features based on this initial study have already been used by others to discover additional potential HO-1 inhibitors. Moreover, studies have begun to use selected compounds and determine their effects in some disease models.

Effect of Synbiotic on the Treatment of Jaundice in Full Term Neonates: A Randomized Clinical Trial.

PurposeJaundice accounts for most hospital admissions in the neonatal period. Nowadays, in addition to phototherapy, other auxiliary methods are used to reduce jaundice and the length of hospitalization. This study aimed to investigate the effect of probiotics on the treatment of hyper-bilirubinemia in full-term neonates.MethodsIn this randomized clinical trial, 83 full-term neonates, who were admitted to the hospital to receive phototherapy in the first 6 months of 2015, were randomly divided into two groups: synbiotic (SG, n=40) and control (CG, n=43). Both groups received phototherapy but the SG also received 5 drops/day of synbiotics. Serum bilirubin, urine, stool, feeding frequency, and weight were measured daily until hospital discharge. A p-value<0.05 was considered statistically significant.ResultsThe mean total serum bilirubin in the SG was lower than that in the CG (9.38±2.37 and 11.17±2.60 mg/dL, respectively). The urine and stool frequency in the SG was significantly higher than that in the CG (p<0.05). The duration of hospitalization in the SG was shorter than that in the CG.ConclusionUse of synbiotics as an adjuvant therapy had a significant treatment effect on jaundice in full-term neonates. Further studies including larger samples with long follow-up periods are essential to confirm the benefits of routine use of synbiotics in neonatal patients with jaundice.

Phototherapy and Seizures: Should We Change Practice?

* Abbreviations: HR — : hazard ratio TSB — : total serum bilirubin It is axiomatic that for every treatment there are associated adverse events. For many medical conditions, the risk/benefit assessment of treatment is trivial, with an example being antibiotics for patients with bacterial meningitis. Even the risk of therapies leading to serious adverse events may be outweighed by the potential benefit, such as chemotherapy for a child with leukemia. However, the calculus becomes more difficult when the likelihood of an adverse outcome without treatment is small and/or the patients receiving the treatment are not sick but healthy. Such is the case with phototherapy. In this issue of Pediatrics , Newman et al1 analyzed data from a large and rich database and found an increased risk of subsequent seizures in newborns treated with phototherapy. Although the increased risk was small, with an adjusted hazard ratio (HR) of 1.22, and only truly apparent in boys, the results are troubling. Phototherapy is a common therapy for newborns; in the data evaluated by Newman et al,1 ∼8% of ∼500 000 newborns received this treatment for hyperbilirubinemia. Most of the infants who … Address correspondence to James A. Taylor, MD, Department of Pediatrics, University of Washington, Box 354920, Seattle, WA 98195. E-mail: uncjat{at}uw.edu

Prospective study of clinical profile, causes, risk factors and treatment of hyperbilirubinemia in preterm and term babies

Background: Neonatal jaundice is often physiologic and benign, but dangerous, at levels producing neurological injury, adding on to mortality and morbidity in developing nations. Hence the present study is undertaken to document the proportion, clinical profile, causes, risk factors and treatment of hyperbilirubinemia in preterm and term babies.Methods: This study conducted over 100 hyperbilirubinemia babies who admitted in Rich Pediatric Hospital, Pogathota, Nellore during the period of October 2014 to September 2015.Hyperbilirubinemia is more common among preterm babies born to mothers of 19-22 years and term babies born to mothers of 21-26 years age group.Results: The most common etiological factors identified among all the gestational categories were sepsis (23.0%) followed by ABO incompatibility (20.0%) and Rh incompatibility (6.0%). Among preterm babies (35-37 wks.) the most common were ABO incompatibility (15.0%), Sepsis (10.0%) and polycythemia (10.0%), while among term babies, the most common factors were ABO incompatibility (23.9%), Sepsis (16.4%) Rh incompatibility (7.5%) and Cephalhaematoma (7.5%). In a large proportion of cases, etioliogy remined idiopathic (44.0%).Conclusions: Requirement of exchange transfusion was more among term babies compared to preterm babies. Rh incompatibility was the only etiology.