Unconjugated Hyperbilirubinemia Research Articles

Синдром Жильбера: термінологія, епідеміологія, генетика, патогенез (частина I)

Мета огляду — аналіз даних літератури щодо поширеності, етіології, генетики, патогенезу синдрому Жильбера. Проведений огляд наукової літератури щодо синдрому Жильбера за ключовими словами «синдром Жильбера», «гіпербілірубінемія», «уридиндифосфатглюкуронілтрансфераза» з використанням як пошукової системи PubMed. Беручи до уваги дослідження, проведені в останні 10 років, проаналізовані тези 75 статей. Більш детально вивчено результати дослідження, висвітлені у 28 статтях.

Giggles: An indigenous new eye covering device used during neonatal phototherapy

Objectives: Phototherapy (PT) is commonly used for neonates with indirect hyperbilirubinemia. Dislodgment and inability for spontaneous eye opening are few shortcomings with the traditionally used eye covering devices in neonates while under PT. The study objective was to describe the development of an invention for eye protection in neonatal PT. This invention aims to develop and improvised means that are comfortable for the baby. Materials and Methods: The present descriptive study was conducted in level III NICU. Results: The invention consists of an eye protector model (Giggles) for use during the neonate’s PT, allowing lesser dislodgements and ophthalmic complications with better esthetics. Conclusion: The device is easy to use, and appropriate for neonates, causing no discomfort, and its safety has been proved through radiance tests.

Severe Presentation of Congenital Hemolytic Anemias in the Neonatal Age: Diagnostic and Therapeutic Issues.

Congenital hemolytic anemias (CHAs) are a group of diseases characterized by premature destruction of erythrocytes as a consequence of intrinsic red blood cells abnormalities. Suggestive features of CHAs are anemia and hemolysis, with high reticulocyte count, unconjugated hyperbilirubinemia, increased lactate dehydrogenase (LDH), and reduced haptoglobin. The peripheral blood smear can help the differential diagnosis. In this review, we discuss the clinical management of severe CHAs presenting early on in the neonatal period. Appropriate knowledge and a high index of suspicion are crucial for a timely differential diagnosis and management. Here, we provide an overview of the most common conditions, such as glucose-6-phosphate dehydrogenase deficiency, pyruvate kinase deficiency, and hereditary spherocytosis. Although rare, congenital dyserythropoietic anemias are included as they may be suspected in early life, while hemoglobinopathies will not be discussed, as they usually manifest at a later age, when fetal hemoglobin (HbF) is replaced by the adult form (HbA).

Clinical characterization of NTCP deficiency in paediatric patients : A case-control study based on SLC10A1 genotyping analysis.

Na+‐taurocholate cotransporting polypeptide deficiency (NTCPD) is a newly described disorder arising from biallelic mutations of the SLC10A1 gene. As a result of a lack of compelling evidence from case‐control studies, its genotypic and phenotypic features remain open for in‐depth investigation. This study aimed to explore the genotypic and clinical phenotypic characteristics of paediatric patients with NTCPD. The SLC10A1 genotypes of all NTCPD patients were confirmed by screening for the prevalent variant c.800C>T and Sanger sequencing when necessary. The clinical presentations and laboratory changes were collected, reviewed and analysed, and then qualitatively and quantitatively compared with the relevant controls. A total of 113 paediatric NTCPD patients were diagnosed while c.374dupG and c.682_683delCT were detected as two novel pathogenic mutations. Hypercholanemia was observed in 99.12% of the patients. Indirect hyperbilirubinemia in affected neonates exhibited higher positive rates in comparison to controls. Moreover, transient cholestatic jaundice, elevated liver enzymes and 25‐hydroxyvitamin D (Vit D) deficiency during early infancy were more commonly observed in patients than in controls. All NTCPD patients exhibited favourable clinical outcomes as a result of symptomatic and supportive treatment. The findings enriched the SLC10A1 mutation spectrum and provided comprehensive insights into the phenotypic characteristics of NTCPD. NTCPD should be considered and SLC10A1 gene should be analysed in patients with above age‐dependent clinical features. Furthermore, over investigation and intervention should be avoided in the management of NTCPD patients.

Animal Kernicterus Models: Progress and Challenges

Kernicterus is a leading cause of neonatal death throughout the world, especially in low-middle-income countries. It is developed by an unconjugated hyperbilirubinemia in the blood and brain tissue, triggering pathological processes that spawn neurotoxicity and neurodegeneration. However, the biological mechanism (s) of bilirubin-induced neurotoxicity and Kernicterus development remain to be well elucidated. Likewise, a practical therapeutic approach for human Kernicterus has yet to be found. Undoubtedly, animal models of Kernicterus can be helpful in the identification of underlying biological processes of hyperbilirubinemia evolution to Kernicterus, as well as the evaluation of various treatments efficacy in preclinical studies. More importantly, establishing an animal model that can mimic the Kernicterus and its behavioral, neuro-histological, and hematological manifestations is a severe priority in preclinical studies. So far, several Kernicterus animal models have been established that could partially mimic one or more clinical and paraclinical signs of human Kernicterus. The present study aimed to review all methods modeling Kernicterus with a focus on their potentials and shortcomings and subsequently provide the optimal methods for an ideal Kernicterus animal model.

Risk Factors of Rebound Hyperbilirubinemia in Post Phototherapy Hyperbilirubinemia Infants

Background: Post phototherapy rebound hyperbilirubinemia is a cause for readmission in some infants.However, this phenomenon data of rebound hyperbilirubinemia is lacking from Indonesia. Our study aimsto describe the risk factor of post phototherapy rebound hyperbilirubinemia in the infant.Method: Cross-sectional study of all infants with indirect hyperbilirubinemia who were treated phototherapyaccording to standard guidelines in neonate intermediate unit Dr. Soetomo hospital for 6 months from June2017 until December 2017. Bilirubin was measured 24 hours after phototherapy. Bilirubin rebound isconsidered as increasing total serum bilirubin that needs reinstitution of phototherapy.Result: A total of 53 (44.9%) infants developed rebound hyperbilirubinemia. We revealed the following riskfactor for rebound hyperbilirubinemia was the onset of jaundice on < 3 days, (10 babies, p <0.05). Otherresults are 30 (56.6%) female infants, 39 (73%) birth weight < 2500 g, 36 (67%) infants with a history ofcesarean section, and 38 (71%) preterm infants but there are not statistically significant.Conclusion: Post phototherapy rebound hyperbilirubinemia should be considered in the onset of jaundice< 3 days.

Thrombotic Thrombocytopenic Purpura (TTP)

Thrombotic thrombocytopenic purpura is a medical emergency with varied clinical manifestations. TTP is a rare condition, but one that carries a high mortality. High index of suspicion with careful evaluation of thrombocytopenia and hemolytic anemia is of paramount importance. Symptoms result from microthrombi affecting microcirculation and can be varied depending on the organs involved. Laboratory parameters of microangiopathic hemolytic anemia i.e. schitocytosis and increased LDH and indirect hyperbilirubinemia support the diagnosis. Plasma exchange is the treatment of choice. Other modalities that may provide therapeutic benefit in cases of relapsing TTP or in patients with slow or partial response to plasma exchange include vincristine and rituximab. Splenectomy done in remission may decrease recurrence in patients with relapsing TTP.

Phototherapy Induced Hypocalcaemia in Neonates with Jaundice

Introduction: Neonatal hyperbilirubinemia is seen mainly in the first week of life and in many of the cases it is only in physiological range which requires no intervention. Approximately 5-10% of them have clinically significant jaundice that requires phototherapy and even exchange transfusion. Phototherapy can produce various adverse effects; hypocalcaemia is one of the lesser known effects. So, estimation of calcium levels before and after phototherapy should be done in neonates with jaundice. Aims: The aim of this study is to determine hypocalcaemia, in neonates receiving phototherapy, by measuring serum calcium levels. Methods: This cross sectional study was conducted, from February 2020 to August 2020, on 50 neonates admitted in Neonatal Intensive Care Unit of Nepalgunj Medical College, Kohalpur with unconjugated hyperbilirubinemia requiring phototherapy. Serum calcium levels were evaluated before and after phototherapy. Neonates were assessed for clinical features of hypocalcaemia i.e. jitteriness, irritability/ excitability and convulsions. Data were analyzed using SPSS version 25.P value <0.05 was taken as significant. Results: Frequency of hypocalcaemia after phototherapy was 26%. There was significant change in serum calcium levels before and after phototherapy (p<0.01). Among hypocalcaemic neonates, 56% were symptomatic; 38% developed jitteriness, 18% developed irritability / excitability and none of them developed convulsions. Conclusion: Neonates undergoing phototherapy are at increased risk for hypocalcaemia. Monitoring for hypocalcaemia and its complications should be considered. However, universal recommendation of calcium supplementation is yet to be established but seems reasonable.

The Spectrum of Hemolytic Disease of the Newborn: Evaluating the Etiology of Unconjugated Hyperbilirubinemia Among Neonates Pertinent to Immunohematological Workup.

Background and objectiveThe exact burden of hemolytic disease of the newborn (HDN) attributed to neonatal unconjugated hyperbilirubinemia (NUH) in developing nations is still unclear. Still, anti-D is reported to be the most common cause of HDN in India. ABO incompatibility has emerged as a leading cause of exchange transfusion (ET) in many countries. But many centers in our country rely on direct antiglobulin test (DAT) as a screening tool to evaluate immunological causes, whereas advanced immunohematological workup like antibody screening, identification, and elution tests are also required. Early identification of implicated antibodies resulting in HDN can aid in the proper selection of blood units when ET is indicated, and hence also in managing the subsequent pregnancy. This study focused on determining the causes of neonatal hyperbilirubinemia (NH), especially with respect to immunohematological evaluation. This cross-sectional study was conducted on 240 neonates requiring neonatal intensive care unit (NICU) support for NUH at a tertiary care hospital.Materials and methodsDemographic data, along with detailed history pertaining to the cause of hyperbilirubinemia, was collected. Clinical and laboratory evaluation and complete immunohematological work including DAT, heat elution, antibody screening, antibody identification, and Rh Kell phenotyping were performed from neonate blood samples. Data were analyzed using SPSS Statistics version 19 (IBM Corp., Armonk, NY).ResultsPathological jaundice was more common (62.1%) than physiological jaundice (37.9%). The various pathological causes identified were HDN (42.6%), sepsis (12%), cephalohematoma (5.4%), and idiopathic (1.7%). Among HDN cases, ABO incompatibility (39.2%) was the most prevalent cause, followed by Rh HDN and G6PD deficiency (1.7% each). DAT was positive in only 14 cases out of 94 ABO-incompatible cases. Elution revealed antibodies in four DAT-negative neonates with ABO incompatibility and more specificity to the OA setting. DAT was positive with 100% sensitivity in Rh HDN cases (n=4). Elution demonstrated the presence of anti-D (n=2), anti-D + anti-C (n=1) and anti-E (n=1), confirming Rh HDN. DAT strength was found to be significantly associated with hemoglobin (Hb) level (p=0.048). The majority of cases were treated with phototherapy only (94.1%), and 10 cases received both ET and phototherapy. Four neonates' condition improved without any intervention.ConclusionThis study highlighted the shift in the trend from Rh HDN to ABO incompatibility as the cause of hemolytic jaundice in NICU neonates. Elution tests can aid in the diagnosis of DAT-negative ABO-incompatible hemolytic anemia. Early diagnosis, along with timely intervention and appropriate measures, can prevent neonatal morbidity and mortality. Negative DAT does not rule out HDN. Sensitive techniques like elution must be used in the presence of clinical suspicion.

Türkiye, Konya'da bebek dostu bir hastanede indirekt neonatal hiperbilirubinemi ve uzun fototerapi süresi ile ilişkili risk faktörleri

Aim: Indirect neonatal hyperbilirubinemia is a common neonatal disorder worldwide which can remain benign if prompt management is available. However there is a higher morbidity and mortality risk in settings with limited access to diagnosis and care. The aim of this study was to evaluate the etiologies of indirect neonatal hyperbilirubinemia, to determine the effectiveness of phototherapy treatment and to specify the associated risk factors for prolonged phototherapy duration. Materials and Method: Infants with ≥37 weeks of gestation, postnatal age of ≤14 days, and diagnosis of hyperbilirubinemia at admission, defined as serum bilirubin level at or above the phototherapy treatment threshold were included in the study. All the study participants were treated with intermittent phototherapy. The data were retrospectively analized and duration of phototherapy was classified as ≤24 hours (early discharge) and >24 hours (late discharge). Results: A total of 205 newborns were included in the study. The mean birth weight was 3171.12±436.19 g and mean gestational age was 38.87±1.18 (37–39) weeks. Also, ABO incompatibility and cephalic hematoma were found to be the most common etiologies in our series. On the other hand, male gender (p=0.03) and formula as the first prelacteal feeds (p=0.03) were significantly higher in late discharge group. Additionally; male gender, formula as the first prelacteal feed, ABO incompatibility, Rh isoimmunization, cephalic hematoma and sepsis were risk factors for long phototherapy duration of >24 hours. Discussion and Conclusion: Determination of possible risk factors for neonatal jaundice can provide early hospital admissions by informing mothers before discharge after birth.

Patients with Gilbert syndrome and type 2 diabetes have lower prevalence of microvascular complications

ObjectiveAccumulating clinical evidence indicates an inverse relationship between oxidative stress and unconjugated hyperbilirubinemia. This study aimed to compare the prevalence of diabetes microvascular complications in patients with Gilbert syndrome and type 2 diabetes mellitus (T2D). MethodsA total of 1200 electronic records with T2D were reviewed. From them, 50 patients with Gilbert syndrome (cases [indirect bilirubin ≥1.2 mg/dl without evidence of hemolysis or liver disease]) and 50 controls (T2D without hyperbilirubinemia) were included. Linear and logistic regression models were performed to evaluate the independent association between indirect hyperbilirubinemia with microvascular complications related with T2D. ResultsBoth case and control group had the same proportion of gender (female = 20 [40 %]) and diabetes duration (14.0 ± 6.5 years) and similar mean of age (60 ± 9.6 and 60 ± 9.2 years, respectively, p = 0.91). The median of unconjugated bilirubin of case and control group was 1.4 (1.2–1.6) vs. 0.4 (0.2–0.6) mg/dl (p < 0.001), respectively. Patients with elevated unconjugated bilirubin had less urine albumin-creatinine ratio compared with control group (8.5 [4.3–23] vs. 80 [8–408] mg/g, p < 0.001), and lower rate of diabetes microvascular complications and metabolic syndrome. After adjustment for BMI, age, HbA1c, blood pressure, triglycerides, and the metabolic syndrome, the lineal regression analysis showed that unconjugated bilirubin protects against microalbuminuria in T2D patients (β = −414.11, 95 % CI [-747.9, −80.3], p = 0.006. Also, unconjugated hyperbilirubinemia was independently associated with a better glomerular filtration rate (GFR) (β = 9.87, 95 % CI [1.5, 18.3], P = 0.02). ConclusionsPatients with Gilbert syndrome and T2D had a lower prevalence of diabetes microvascular complications.

Efficacy of single phototherapy with low-cost reflective sheets versus single phototherapy alone in mild-to-moderate unconjugated hyperbilirubinaemia in full-term neonates

ABSTRACT Background An economical alternative method of increasing the light intensity of phototherapy for neonatal jaundice is the use of reflective sheets placed on the sides of the incubator. Aim To determine whether reflective sheets in addition to phototherapy increase the reduction of bilirubin levels and the duration of hospital stay. Methods The study was undertaken in the neonatal intensive care unit of Cairo University Children’s Hospital. There were two groups: a study group of 90 full-term neonates with neonatal jaundice who received single phototherapy in incubators covered with white plastic reflective sheets and a control group of 90 full-term neonates with neonatal jaundice who received single phototherapy without the reflective sheets. Results The mean (SD) rate of bilirubin decline in the first 24 hours of phototherapy was greater in the study group [3.7 (0.86) µmol/L/hr] than in the control group [2.2 (0.14) µmol/L/hr] (p<0.001). Conclusion Use of reflective sheets decreases the total duration of phototherapy and the cost and duration of hospitalisation without any added complications. Abbreviations: AAP: American Academy of Pediatrics; HIDS: high-intensity double-surface; LMIC: low- and middle-income countries; MCTP: mirror-covered tunnel phototherapy; NICU: neonatal intensive care unit; TSB: total serum bilirubin.

Factors Affecting Prevalence of Urinary Tract Infection in Neonates with Unexplained Hyperbilirubinemia: A Systematic Review and Meta-Analysis Study in Iran.

Background:The prevalence and risk factors of urinary tract infection (UTI) in neonates with unexplained hyperbilirubinemia are not studied thoroughly. Since the prevalence of UTI is highly variable in different areas and countries, this study aimed to review the existing data of Iranian neonates with UTI presented with unexplained hyperbilirubinemia.Methods:This study is a meta-analysis of Iranian newborns with unexplained hyperbilirubinemia. We identified all studies indexed in international (Web of Science, PubMed, Scopus, Google Scholar) and national (Science Information Database, Magiran) databases from 2000–2018. Search terms included: Urinary Tract Infections OR UTI AND urine OR culture OR microbio, jaundice OR icter OR hyperbili, AND Iran.Results:Overall, 4210 neonates from 17 studies were included. The pooled prevalence of UTI in neonates with unexplained hyperbilirubinemia was 6.81% (95% CI: 4.86–8.77). Considering the subgroups analyses; the prevalence of UTI was higher in the prolonged vs. not-prolonged state (8.34% vs. 4.00%), low birth weight vs. normal birth weight (7.81% vs. 4.51%), and exclusive vs. non-exclusive breastfeeding (8.84% vs. 4.72%). Male gender and low birth weight increased the risk of UTI about two times compared to the female gender and normal birth weight, respectively. The results of the analyses in neonates with unconjugated hyperbilirubinemia also showed the above-mentioned subgroup differences.Conclusion:Due to considerable prevalence of UTI in neonates with unexplained hyperbilirubinemia and risk factors in this age group, investigation for UTI is essential for the workup in this situation.

Exchange Transfusion for Hyperbilirubinemia among Term and Near Term in NICU of a Tertiary Care Hospital of Bangladesh: Findings from a Prospective Study.

BackgroundExchange transfusion in newborns is recommended as emergency management of hyperbilirubinemia to prevent bilirubin encephalopathy and kernicterus.AimThis study aimed to determine the frequency and document common side effects of exchange transfusion and outcomes of newborns requiring exchange transfusion.Materials and methodsThis prospective study was done in the Neonatal Intensive Care Unit (NICU) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, from January 2016 to December 2019. Information was obtained regarding maternal details, newborn demographics, and clinical status. Blood grouping and Rh typing were done for both mothers and newborns. In all newborns, pre-exchange complete blood count, peripheral blood film, Coombs test, reticulocyte count, serum bilirubin and post-exchange serum bilirubin, hemoglobin, random blood sugar, serum electrolyte, and calcium were done. G6PD level was done wherever suspected. Frequency, maternal and neonatal factors, indications, and outcomes were analyzed.ResultsAmong 839 admitted cases of unconjugated hyperbilirubinemia, 41 patients (4.9%) required exchange transfusion. Most of the babies were inborn (90.2%). Ninety-five percent of mothers received regular antenatal care; among them, 76.3% had bad obstetric history. Only 36.6% of mothers received anti-D in previous pregnancy. None had sonographic findings of hydrops. The commonest indication was Rh incompatibility (80.5%). Coombs test was positive in 58.5% of cases. Mean pre-exchange TSB was 9.44 ± 6.4, and post-exchange TSB was 4.41 ± 2.59. The commonest adverse events noted were hyperglycemia (51.2%), sepsis (19.5%), anemia requiring top-up transfusion (17.1%), and hypocalcemia (14.6%). There were no catheter-related complications. Bilirubin encephalopathy was present in 4.9% of cases. There was one mortality but not due to the procedure.ConclusionExchange transfusion was required among 4.9% of the admitted newborns with unconjugated hyperbilirubinemia. The common adverse effects were hyperglycemia and sepsis. The commonest indication was Rh incompatibility (80.5%). Overall outcome after exchange transfusion was favorable.How to cite this articleDey SK, Jahan S, Jahan I, et al. Exchange Transfusion for Hyperbilirubinemia among Term and Near Term in NICU of a Tertiary Care Hospital of Bangladesh: Findings from a Prospective Study. Euroasian J Hepato-Gastroenterol 2021;11(1):21–26.

EFFECT OF PHOTOTHERAPY ON HEMATOLOGICAL PROFILE OF NEWBORNS WITH UNCONJUGATED HYPERBILIRUBINEMIA

Background: Phototherapy despite being very safe is found to be associated with various untoward effects. The objective of this article was to study the changes in various hematological parameters as a result of phototherapy in neonates treated for unconjugated hyperbilirubinemia. Methods: A cross sectional study was conducted in 120 neonates with unconjugated hyperbilirubinemia to determine the changes in the blood cell counts. We compared the complete blood counts at the time of admission and after 48 hours of phototherapy. The data was analyzed in SPSS 25 using paired t test. Results: We observed that there was an increase in the lymphocyte counts from 5,650 cells/mm3 before phototherapy to 6,360 cells/mm3 after phototherapy with a p-value 0.028. MCH increased from 32.22 pg before phototherapy to 33.34 pg after phototherapy with a p-value of 0.018. The mean monocyte counts decreased from 730 cells/mm3 before phototherapy to 530 cells/mm3 after phototherapy with a p-value of 0.016. The mean platelet count also decreased from 241×103 cells/mm3 to 258×103 cells/mm3 with a p-value of 0.041 which was significant. Rest of the blood cell counts seem to be unaltered by phototherapy. Conclusions: Phototherapy was found to be associated with significant decrease in the absolute monocyte count and platelet counts and caused an increase in the lymphocyte count and MCH. However, it does not cause significant changes in the total count and hemoglobin levels.

НАСЛЕДСТВЕННАЯ НЕКОНЪЮГИРОВАННАЯ ГИПЕРБИЛИРУБИНЕМИЯ (СОЧЕТАНИЕ СИНДРОМА КРИГЛЕРА-НАЙЯРА II ТИПА И СИНДРОМА ЖИЛЬБЕРА)

Background. Enzymopathic jaundices are manifested by intermittent hyperbilirubinemia, no changes in the structure of the liver, no hemolysis, Rh-conflict as well as cholestasis being noted. These jaundices include Crigler-Najjar syndrome type I, Crigler-Najjar syndrome type II and Gilbert's syndrome. They are characterized by an autosomal recessive inheritance due to the presence of mutations and polymorphisms in uridine 5'-diphosphate-glucuronosyltransferase gene (UGT1A1) leading to a decrease of the enzyme activity or to its complete loss. Objective. To demonstrate the peculiarities of diagnosis and treatment of a rare case of hereditary unconjugated hyperbilirubinemia - a combination of Crigler-Najjar syndrome type II and Gilbert's syndrome. Material and methods. Clinical observation of a patient G. aged 19, who was examined and treated at the Department of gastroenterology of a multidisciplinary hospital in Moscow in January 2021. Results. The patient G. has had icteric sclerae and skin since birth; he occasionally suffers from easy fatigability and general malaise. Physical examination revealed no changes (except for icteric discoloration). An increase in unconjugated bilirubin up to 270 μmol/L (median - 170 μmol/L) was detected. The molecular genetic study of UGT1A1 gene identified mutations in exon 4 Val378Asp (2002) and Arg108Cys as well as polymorphism 6/7TA in the promoter region, confirming the diagnosis of autosomal recessive inherited disease – a combination of Crigler Najjar syndrome type II and Gilbert's syndrome (heterozygous state), complicated by the development of hepatic encephalopathy stage 2. There was noted a significant decrease in unconjugated bilirubin up to 170.5 μmol/L, as well as improvement in general condition – reduced fatigue and weakness during the treatment with microsomal enzyme inducer (phenobarbital) and hyperammonemia corrector (ornithine aspartate). Conclusions. The use of molecular genetic analysis allows tailoring strategies for patient-specific disease diagnostics, treatment and prevention. The preservation of quality of life within satisfactory level is achieved through elimination of adverse effects provoking the development of this syndrome and through control of risk factors.

Effect of Oral Fenofibrate on Serum Bilirubin Level in Term Neonates with Unconjugated Hyperbilirubinaemia: A Randomized Control Trial

Introduction: Hyperbilirubinemia is a common problem in the neonatal period. Phototherapy is the most important proposed treatments for hyperbilirubinemia, but several drugs along with phototherapy are used with recent advances. Aim: To see the effect of oral fenofibrate on serum bilirubin level in term neonates with unconjugated hyperbilirubinaemia. Methods: This prospective study was carried out in Combined Military Hospital Cumilla from July 2018 to June 2019. Total 60 term and normal birth weight neonates with neonatal jaundice were enrolled in this study. Jaundiced newborns presenting with infection, G6PD deficiency, conjugated bilirubin &gt;2 mg/dl or &gt;15% of total serum bilirubin (TSB) and congenital anomalies were excluded from this study. These neonates were randomly allocated to the Fenofibrate group (30 cases) and Control group (30 cases). Total serum bilirubin was measured every 24 hours till the end of phototherapy and at the time of discharge. Statistical analysis was done using SPSS 22.0 and p&lt;0.05 was considered significant. Results: There were no significant differences in gender, age, weight, gestational age and type of delivery between two groups. Mean duration of hospital stay were 4.0±0.7 and 5.5±1.4 days in Fenofibrate group and Control group respectively (p&lt;0.001). In Fenofibrate group, TSB was decreased from 17.2 mg/dl to 15.2 mg/dl after 24 hours, to 13.6 mg/dl after 48 hours, and to 10.1 mg/dl at the time of discharge. In control group, TSB was decreased from 17.0 mg/dl to 16.3 mg/dl after 24 hours, to 15.9 mg/dl after 48 hours, and to 10.3 mg/dl at the time of discharge. Conclusion: Treatment of neonatal unconjugated hyper- bilirubinemia with fenofibrate reduces neonatal bilirubin levels and decreases the need for phototherapy and hospitalization. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 35-38

Effect of Phototherapy on Cardiac Functions in Neonates with Hyperbilirubinemia. A Prospective Cross-Sectional Study

Background: Phototherapy has been reported to alter cardiovascular function by causing increased peripheral blood flow, diminished cardiac output and increased sympathetic activity that may be of concern, particularly in neonates with hyperbilirubinemia. Aim of work: To assess the myocardial function in neonates with hyperbilirubinemia by using echocardiography, especially tissue Doppler imaging (TDI). Patients and Methods: It was a prospective, cross- sectional study. All participants in this study were full-terms and appropriate for gestational age newborns with hyperbilirubinemia who received phototherapy for jaundice (bilirubin level greater than 15 mg/dl). Myocardial functions were assessed using conventional echocardiography and tissue Doppler imaging techniques. Results: The study population consisted of 110 neonates with hyperbilirubinemia; their mean gestational age was 38.8 ± 1.7 weeks and mean birth weight 2785 ± 652 g. After phototherapy, respiratory rate and heart rate were faster whereas oxygen saturation and systolic blood pressure were lower (p 0.05). Pulsed wave Doppler parameters showed no significant difference in the mitral E velocity, mitral A velocity, and E/A ratio (p > 0.05). Conclusion:Phototherapy had no adverse effects on either systolic or diastolic function of the left ventricle in term neonates with indirect hyperbilirubinemia.

Fototerapi Alfa Melanosit Uyarıcı Hormon Seviyelerini Etkiler mi?

Objective: We aimed to investigate the effect of phototherapy on plasma alpha-melanocyte-stimulating hormone (α-MSH) levels of newborns with indirect hyperbilirubinemia (IHB) for the first time. Materials and Methods: A total of 45 cases, who were hospitalized in neonatal intensive care units between July 1, 2019, to September 30, 2019, and received phototherapy, were retrospectively included in the study. Plasma α-MSH and bilirubin levels were measured before and after the phototherapy. Results: A total of 45 newborns (19 girls and 26 boys) were included in to study. The average birth weight was 3202 grams and the mean total bilirubin level was 17.2 mg/dL. α-MSH levels before and after phototherapy were 326.2 (4.0-2228.0) ng/L and 373.9 (8.7-2283.0) ng/L, respectively and did not represent a significant difference (p&amp;gt;0.05). Conclusion: This study demonstrated that there was no effect between phototherapy applied for newborn IHB and plasma α-MSH levels.

UGT1A1 mutation association with increased bilirubin levels and severity of unconjugated hyperbilirubinemia in ABO incompatible newborns of China

BackgroundNeonatal hyperbilirubinemia causing jaundice is common in East Asian population. Uridine diphosphate glucuronosyltransferase isoenzyme (UGT1A1) glucuronidates bilirubin and converts the toxic form of bilirubin to its nontoxic form.MethodA retrospective study was conducted to review clinical information of ABO hemolysis neonates (ABO HDN) admitted to the Department of Neonatology, referred for neonatal hyperbilirubinemia, in a large general hospital of southern China from 2011 to 2017. Variation status of UGT1A1 was determined by direct sequencing or genotype assays.ResultSixty-nine ABO HDNs were included into the final analysis. UGT1A1 c.211 G > A mutation (UGT1A1*6, p.Arg71Gly, rs4148323) was significantly associated with the increased bilirubin level in ABO HDNs, after adjusted by age, sex and feeding method (P = 0.019 for TBIL, P = 0.02 for IBIL). Moreover, heterozygous and/or homozygous UGT1A1 mutations in the coding sequence region were significantly associated with the increased risk of developing hazardous hyperbilirubinemia (as defined by TSB > 427 umol/L) as compared those with a normal UGT1A1 genotype (ORadj = 9.16, 95%CI 1.99–42.08, P = 0.002) in the study cohort.ConclusionUGT1A1 variant in coding region is actively involved in the pathogenesis of ABO hemolysis related neonatal hyperbilirubinemia. Genetic assessment of UGT1A1 may be useful for clinical diagnosis of neonatal unconjugated hyperbilirubinemia.