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Cai Y, Li X, Wang P, Song Y. Predictive factors for readmission due to neonatal hyperbilirubinemia: A retrospective case-control study. PLoS One 2025; 20:e0320767. [PMID: 40168352 PMCID: PMC11960944 DOI: 10.1371/journal.pone.0320767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 02/24/2025] [Indexed: 04/03/2025] Open
Abstract
OBJECTIVE Hyperbilirubinemia is a common cause of hospital readmission among neonates, but the factors contributing to post-discharge readmission remain unclear. Our study aimed to identify predictive factors associated with readmission for neonatal hyperbilirubinemia. METHODS This retrospective case-control study included 421 neonates born at ≥ 35 weeks of gestation with hyperbilirubinemia between January and December 2021. The neonates were divided into a readmission group and a control group, and logistic regression was used to identify predictive factors associated with readmission. RESULTS Among the 421 neonates studied, 32 (7.6%) were readmitted. Logistic regression analysis identified preterm birth (<37 weeks), ABO hemolysis, Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, and Total Serum Bilirubin (TSB) level at discharge as significant predictive factors for readmission due to hyperbilirubinemia in newborns. Additionally, a decrease in birth weight was significantly linked to an increased risk of readmission (OR = 0.998, P = 0.013), although the effect size was relatively small. CONCLUSIONS Prolonging hospitalization and implementing robust post-discharge monitoring may be essential for neonates with prematurity, ABO hemolysis, G6PD deficiency, or elevated TSB levels at discharge.
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Affiliation(s)
- Yueju Cai
- Department of Neonatology, Guangzhou Wowen and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaolan Li
- Department of Child Health, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ping Wang
- Department of Neonatology, Guangzhou Wowen and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanyan Song
- Department of Child Health, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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Nikouei M, Cheraghi M, Mansouri M, Hemmatpour S, Moradi Y. The effect of oral zinc sulfate supplementation on hospitalized infants with hyperbilirubinemia: a double-blind randomized clinical trial. Eur J Pediatr 2024; 183:4649-4658. [PMID: 39172170 DOI: 10.1007/s00431-024-05739-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/15/2024] [Accepted: 08/17/2024] [Indexed: 08/23/2024]
Abstract
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 (37-42 weeks 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 1 mg/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 24 h 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) 24 h after the intervention. Furthermore, 48 and 72 h 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 .
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Affiliation(s)
- Maziar Nikouei
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mojtaba Cheraghi
- Cancer and Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Majid Mansouri
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Siros Hemmatpour
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Cheraghi M, Nikouei M, Mansouri M, Hemmatpour S, Moradi Y. Effect of vitamin E supplementation on bilirubin levels in infants with hyperbilirubinemia: a double-blind randomized clinical trial. Clin Exp Pediatr 2024; 67:249-256. [PMID: 38549357 PMCID: PMC11065639 DOI: 10.3345/cep.2023.01312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/09/2023] [Accepted: 02/01/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND The effect of vitamin E supplementation on bilirubin levels in infants was previously explored, but the results were inconclusive. PURPOSE To examine the effect of vitamin E supplementation on bilirubin levels in term infants in the neonatal intensive care unit (NICU). METHODS 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. RESULTS 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. CONCLUSION 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).
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Affiliation(s)
- Mojtaba Cheraghi
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Maziar Nikouei
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Majid Mansouri
- Department of Pediatric, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Siros Hemmatpour
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Belide S, Uddin MW, Kumar S, Sethi RK, Diwakar K, Jhajra S. Clinical study to determine the predictability of significant rebound hyperbilirubinemia in neonates after phototherapy and conditions likely to be associated with it: Prospective observational study in a teaching hospital in Eastern India. J Family Med Prim Care 2023; 12:3362-3367. [PMID: 38361853 PMCID: PMC10866226 DOI: 10.4103/jfmpc.jfmpc_1148_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/05/2023] [Accepted: 09/11/2023] [Indexed: 02/17/2024] Open
Abstract
Aim Neonatal hyperbilirubinemia is defined as yellowish discoloration of the skin, conjunctive, and sclera from the elevated serum or plasma bilirubin in the newborn. The standard of care for the management of neonatal hyperbilirubinemia is phototherapy to prevent long-term neurological sequelae. The aim of this study was to ascertain the predictability of significant rebound hyperbilirubinemia (SRH) in neonates after phototherapy and the factors associated with it. Materials and Methods Neonates ≥ 35 weeks of gestation, who received treatment for hyperbilirubinemia and admitted in our hospital from 15th of March 2019 to 15th of September 2020 were enrolled after taking parental consent. SRH was defined as bilirubin levels crossing the treatment threshold within 72 hours of phototherapy termination. Logistic regression analysis was used to identify the predictability of SRH. Results Out of 400 neonates treated with phototherapy, 10% developed SRH. Prematurity (Gestational age < 37 weeks), low birth weight (Birth weight < 2000 gram), ABO and Rh incompatibility, Glucose-6-phophate dehydrogenase deficiency (G6PD) deficiency, sepsis, and longer duration of primary phototherapy were found to be significantly associated with rebound hyperbilirubinemia. The probability of SRH increases for all American Academy of Paediatrics (AAP) risk categories as the gestational age decreases and total serum bilirubin at the stoppage of phototherapy increases. Conclusions The presence of risk factors should be taken into account while planning discharge and follow-up of neonates admitted for neonatal hyperbilirubinemia to prevent long-term complication of bilirubin neurotoxicity.
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Affiliation(s)
- Shivakumar Belide
- Department of Paediatrics, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Md Waseem Uddin
- Department of Paediatrics, Manipal Tata Medical College, MAHE, Jamshedpur, Jharkhand, India
| | - Sushil Kumar
- Department of Paediatrics, Manipal Tata Medical College, MAHE, Jamshedpur, Jharkhand, India
| | - Rajesh Kumar Sethi
- Department of Paediatrics, Manipal Tata Medical College, MAHE, Jamshedpur, Jharkhand, India
| | - Kumar Diwakar
- Department of Paediatrics, Manipal Tata Medical College, MAHE, Jamshedpur, Jharkhand, India
| | - Sandeep Jhajra
- Department of Paediatrics, Manipal Tata Medical College, MAHE, Jamshedpur, Jharkhand, India
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Almohammadi H, Nasef N, Al-Harbi A, Saidy K, Nour I. Risk Factors and Predictors of Rebound Hyperbilirubinemia in a Term and Late-Preterm Infant with Hemolysis. Am J Perinatol 2022; 39:836-843. [PMID: 33231268 DOI: 10.1055/s-0040-1718946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to assess the incidence and predictors of rebound in term and late-preterm infants with hemolytic hyperbilirubinemia postphototherapy. STUDY DESIGN A 4-year retrospective data analysis of neonates with hemolytic indirect hyperbilirubinemia admitted to the neonatal intensive care unit (NICU) of Medina Maternity and Children's Hospital was conducted. Bilirubin rebound was defined as the return of total serum bilirubin (TSB) to phototherapy threshold within 72 hours of postphototherapy. RESULTS Of 386 identified neonates; 44 (11%) experienced rebound. Neonates in the rebound group demonstrated significantly higher levels of peak TSB, TSB at discontinuation of phototherapy, and lower value of relative TSB (difference between TSB at phototherapy termination and the American Academy of Pediatrics [AAP] threshold for phototherapy at concurrent age) compared with nonrebound group (p-value: <0.001, <0.001, and 0.007, respectively). Lower value of relative TSB at stoppage of phototherapy was the single independent predictor for rebound hyperbilirubinemia by mutivariate regression (p < 0.001). A cut-off value for relative TSB at stoppage of phototherapy of 190 µmol/L had 98% sensitivity and 32% specificity to predict rebound hyperbilirubinemia. CONCLUSION Relative TSB at phototherapy termination is the best predictor for postphototherapy rebound hyperbilirubinemia in neonates with hemolytic etiology. KEY POINTS · 11% of neonates showed postphototherapy rebound.. · The relative TSB at stoppage of phototherapy is the best predictor for rebound hyperbilirubinemia.. · The first cohort to assess rebound in neonates with hemolysis..
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Affiliation(s)
- Hanaa Almohammadi
- Neonatal Intensive Care Unit, Medina Maternity and Children's Hospital, Medina, Kingdom of Saudi Arabia
| | - Nehad Nasef
- Neonatal Intensive Care Unit, Medina Maternity and Children's Hospital, Medina, Kingdom of Saudi Arabia.,Departement of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Aziza Al-Harbi
- Neonatal Intensive Care Unit, Medina Maternity and Children's Hospital, Medina, Kingdom of Saudi Arabia
| | - Khalid Saidy
- Neonatal Intensive Care Unit, Medina Maternity and Children's Hospital, Medina, Kingdom of Saudi Arabia
| | - Islam Nour
- Neonatal Intensive Care Unit, Medina Maternity and Children's Hospital, Medina, Kingdom of Saudi Arabia.,Departement of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
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Validation of published rebound hyperbilirubinemia risk prediction scores during birth hospitalization after initial phototherapy: a retrospective chart review. Pediatr Res 2022; 91:888-895. [PMID: 33824457 DOI: 10.1038/s41390-021-01478-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hyperbilirubinemia commonly affects newborns and may lead to neurotoxicity if untreated. Neonates can experience rebound hyperbilirubinemia (RHB), defined as elevated bilirubin levels requiring re-initiation of treatment. Although studies have formulated risk prediction scores, they lack external validation. In this study, we examine the discrimination and calibration performance of risk prediction scores for RHB, to provide external validation. METHODS We reviewed charts of neonates born ≥35 weeks of gestation between January 2015 and December 2019 receiving phototherapy at birth hospitalization. We plotted predicted probabilities against observed outcome proportions to assess model calibration and evaluated discrimination using area under the receiver operating characteristic (AUROC) curves. Odds ratios (ORs) were estimated to evaluate variables associated with RHB. RESULTS Of the 271 infants identified, 24% developed RHB. Two- and three-variable prediction scores had lower discrimination in our cohort with AUROC of 0.662 (95% CI 0.590-0.735) and 0.691 (95% CI, 0.619-0.763) compared to 0.876 (95% CI 0.854-0.899) and 0.881 (95% CI 0.859-0.903), respectively, in the published studies. Estimated ORs confirm associations between RHB and variables included in prediction scores. CONCLUSIONS Current prediction models for RHB have unclear clinical utility in our patient population. Additional studies are required to further validate these scores. IMPACT Describes performance characteristics of two- and three-variable risk prediction scores that lack external validation beyond the initial study cohort. Our findings suggest unclear clinical utility in our clinical population of neonates during birth hospitalization, with lower performance of these prediction scores than observed in the derivation cohort. Odds ratios estimated by logistic regression in our study cohort provide further evidence that variables in published risk prediction scores are associated with rebound hyperbilirubinemia. Further studies are required to externally validate these risk prediction scores and to assess their generalizability.
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Preloger E, Wedoff M, Lemke JT, Pan A, Nelson A. Decreasing Laboratory Testing for Neonatal Jaundice Through Revision of a Clinical Practice Pathway. Hosp Pediatr 2022; 12:e67-e72. [PMID: 34984444 DOI: 10.1542/hpeds.2021-006019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study was to minimize unnecessary laboratory services for hospitalized neonates with hyperbilirubinemia by revising a local clinical practice pathway (CPP). METHODS A retrospective cohort study was performed to compare the number of laboratory tests and blood draws in patients hospitalized with neonatal hyperbilirubinemia before and after implementation of a revised CPP. The study included infants with neonatal hyperbilirubinemia <14 days old admitted after their birth hospitalization between April 2017 and October 2019. Primary outcome measures included the total number of blood draws and the number of laboratory tests obtained per patient and length of stay. Secondary outcome measures included 7-day readmission rate, charges, and discharge bilirubin level. RESULTS The median number of blood draws per patient after implementation of the CPP decreased to 2 (interquartile range [IQR], 2-3) compared with 3 (IQR, 2-3) before implementation (Poisson model-based estimated mean difference, 1.1; 95% confidence interval, 1.0-1.3; P = .018). The median number of laboratory tests per patient after implementation decreased from 4 (IQR, 3-6) to 3 (IQR, 2-4; Poisson model-based estimated mean difference, 1.3; 95% confidence interval, 1.2-1.5; P < .0001). There was no significant change in length of stay, readmission rate, charges, or discharge bilirubin level. CONCLUSIONS Implementation of a revised CPP was associated with a significant decrease in the number of blood draws and laboratory tests per patient for infants admitted to the hospital for neonatal hyperbilirubinemia.
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Affiliation(s)
- Erin Preloger
- Children's Wisconsin Milwaukee Wisconsin.,Department of PediatricsMedical College of Wisconsin Milwaukee Wisconsin
| | - Michael Wedoff
- Medical University of South Carolina Charleston South Carolina
| | - Jennifer T Lemke
- Department of PediatricsMedical College of Wisconsin Milwaukee Wisconsin
| | - Amy Pan
- Department of PediatricsMedical College of Wisconsin Milwaukee Wisconsin
| | - Anika Nelson
- Children's Wisconsin Milwaukee Wisconsin.,Department of PediatricsMedical College of Wisconsin Milwaukee Wisconsin
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Iskander I, Abdelmonem S, El Houchi S, Mandour I, Aly H. Intensive phototherapy and oxidant-antioxidant status in infants with jaundice. Early Hum Dev 2021; 161:105465. [PMID: 34517206 DOI: 10.1016/j.earlhumdev.2021.105465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Conventional phototherapy converts unconjugated bilirubin to its oxidation products and consequently causes oxidative stress with lipid peroxidation products. New devices that deliver intensive phototherapy are efficacious in treating severe hyperbilirubinemia and minimizing the need for exchange transfusions. However, the oxidative stress status when using these devices has not been explored. Therefore, we aimed to study the impact of using intensive phototherapy on the oxidant-antioxidant status in severely jaundiced neonates. STUDY DESIGN This prospective case-control study included term newborns admitted with severe hyperbilirubinemia managed with intensive phototherapy. Baseline oxidant-antioxidant concentrations were compared to healthy controls and re-measured after 8 h of intensive phototherapy exposure. RESULTS The study included 40 cases with severe jaundice and 40 non-jaundiced apparently normal controls. Total serum bilirubin at enrollment was 23.4 ± 4.2 mg/dl that significantly decreased after 8 h of therapy to 15.4 ± 3.4 mg/dl (p < 0.001). The decline of total serum bilirubin was 1 mg/dl/h. Bilirubin: albumin ratio decreased from 3.45 ± 0.28 to 2.7 ± 0.21 (p < 0.001). Total antioxidant capacity (TAC), superoxide dismutase (SOD), malondialdehyde (MDA), and total oxidative stress (TOS) concentrations were lower in cases (p < 0.001, p < 0.001, p = 0.049, and p < 0.001 respectively) compared to controls. Following 8 h of intensive phototherapy, further decline of TAC (p = 0.016) with increased concentrations of TOS (p = 0.005) were noted. SOD and MDA did not change. CONCLUSIONS Although efficacious, intensive phototherapy was associated with increased oxidative stress. The clinical correlates for harms related to such oxidative stress need further studying.
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Affiliation(s)
- Iman Iskander
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt
| | - Samira Abdelmonem
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt
| | - Salma El Houchi
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt
| | - Iman Mandour
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, United States of America.
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So V, Khurshid F. Treatment practices and implementation of guidelines for hyperbilirubinemia and rebound hyperbilirubinemia. J Neonatal Perinatal Med 2021; 15:335-343. [PMID: 34542033 DOI: 10.3233/npm-210781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- V So
- Department of Pediatrics, School of Medicine, Queen's University, Kingston, Ontario, Canada.,Queen's School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - F Khurshid
- Department of Pediatrics, School of Medicine, Queen's University, Kingston, Ontario, Canada
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Nawaz H, Naseem I, Rehman T, Nawaz M. Optimization of zinc oxide nanoparticle-catalyzed in vitro bilirubin photolysis and in vivo treatment of hyperbilirubinemia. Nanomedicine (Lond) 2021; 16:1377-1390. [PMID: 34085551 DOI: 10.2217/nnm-2021-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To optimize the Zinc oxide nanoparticles (ZnONPs)-catalyzed in vitro photolysis of bilirubin and to test their effect on bilirubin clearance in vivo. Materials & methods: ZnONPs, synthesized in an alkaline medium, were characterized. Response surface methodology was used to optimize the in vitro photolysis catalyzed by the nanoparticles (NPs). Blood samples from phenylhydrazine-induced hyperbilirubinemic rabbits which had been administered ZnONPs and UV light were analyzed to assess in vivo clearance of bilirubin. Results: The ZnONP-assisted UV treatment showed the linear and quadratic positive effects on the in vitro bilirubin photolysis with an optimal photolysis of bilirubin at 225 mg dl-1 concentration of ZnONPs and a UV exposure of 1.80 h. The ZnONP-assisted phototherapy of hyperbilirubinemic animals was also found to be more effective for in vivo clearance of bilirubin than phototherapy alone. Conclusion: After further trials, ZnONP-assisted phototherapy could be a potential treatment for hyperbilirubinemia in humans.
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Affiliation(s)
- Haq Nawaz
- Department of Biochemistry, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Iqra Naseem
- Department of Biochemistry, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Tanzila Rehman
- Department of Chemistry, The Women University Multan, Multan 60800, Pakistan
| | - Mubashir Nawaz
- Department of Biochemistry, Bahauddin Zakariya University, Multan 60800, Pakistan
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Chou JH. Predictive Models for Neonatal Follow-Up Serum Bilirubin: Model Development and Validation. JMIR Med Inform 2020; 8:e21222. [PMID: 33118947 PMCID: PMC7661258 DOI: 10.2196/21222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/03/2020] [Accepted: 09/27/2020] [Indexed: 01/16/2023] Open
Abstract
Background Hyperbilirubinemia affects many newborn infants and, if not treated appropriately, can lead to irreversible brain injury. Objective This study aims to develop predictive models of follow-up total serum bilirubin measurement and to compare their accuracy with that of clinician predictions. Methods Subjects were patients born between June 2015 and June 2019 at 4 hospitals in Massachusetts. The prediction target was a follow-up total serum bilirubin measurement obtained <72 hours after a previous measurement. Birth before versus after February 2019 was used to generate a training set (27,428 target measurements) and a held-out test set (3320 measurements), respectively. Multiple supervised learning models were trained. To further assess model performance, predictions on the held-out test set were also compared with corresponding predictions from clinicians. Results The best predictive accuracy on the held-out test set was obtained with the multilayer perceptron (ie, neural network, mean absolute error [MAE] 1.05 mg/dL) and Xgboost (MAE 1.04 mg/dL) models. A limited number of predictors were sufficient for constructing models with the best performance and avoiding overfitting: current bilirubin measurement, last rate of rise, proportion of time under phototherapy, time to next measurement, gestational age at birth, current age, and fractional weight change from birth. Clinicians made a total of 210 prospective predictions. The neural network model accuracy on this subset of predictions had an MAE of 1.06 mg/dL compared with clinician predictions with an MAE of 1.38 mg/dL (P<.0001). In babies born at 35 weeks of gestation or later, this approach was also applied to predict the binary outcome of subsequently exceeding consensus guidelines for phototherapy initiation and achieved an area under the receiver operator characteristic curve of 0.94 (95% CI 0.91 to 0.97). Conclusions This study developed predictive models for neonatal follow-up total serum bilirubin measurements that outperform clinicians. This may be the first report of models that predict specific bilirubin values, are not limited to near-term patients without risk factors, and take into account the effect of phototherapy.
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Affiliation(s)
- Joseph H Chou
- Massachusetts General Hospital, Boston, MA, United States
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12
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Determinants of Neonatal Jaundice among Neonates Admitted to Neonatal Intensive Care Unit in Public General Hospitals of Central Zone, Tigray, Northern Ethiopia, 2019: a Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4743974. [PMID: 33145350 PMCID: PMC7596433 DOI: 10.1155/2020/4743974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/26/2020] [Accepted: 10/04/2020] [Indexed: 01/27/2023]
Abstract
Background Neonatal jaundice is common a clinical problem worldwide. Globally, every year, about 1.1 million babies develop severe hyperbilirubinemia with or without bilirubin encephalopathy and the vast majority reside in sub-Saharan Africa and South Asia. Strategies and information on determinants of neonatal jaundice in sub-Saharan Africa are limited. So, investigating determinant factors of neonatal jaundice has paramount importance in mitigating jaundice-related neonatal morbidity and mortality. Methodology. Hospital-based unmatched case-control study was conducted by reviewing medical charts of 272 neonates in public general hospitals of the central zone of Tigray, northern Ethiopia. The sample size was calculated using Epi Info version 7.2.2.12, and participants were selected using a simple random sampling technique. One year medical record documents were included in the study. Data were collected through a data extraction format looking on the cards. Data were entered to the EpiData Manager version 4.4.2.1 and exported to SPSS version 20 for analysis. Descriptive and multivariate analysis was performed. Binary logistic regression was used to test the association between independent and dependent variables. Variables at p value less than 0.25 in bivariate analysis were entered to a multivariable analysis to identify the determinant factors of jaundice. The level of significance was declared at p value <0.05. Results A total of 272 neonatal medical charts were included. Obstetric complication (AOR: 5.77; 95% CI: 1.85-17.98), low birth weight (AOR: 4.27; 95% CI:1.58-11.56), birth asphyxia (AOR: 4.83; 95% CI: 1.617-14.4), RH-incompatibility (AOR: 5.45; 95% CI: 1.58-18.74), breastfeeding (AOR: 6.11; 95% CI: 1.71-21.90) and polycythemia (AOR: 7.32; 95% CI: 2.51-21.311) were the determinants of neonatal jaundice. Conclusion Obstetric complication, low birth weight, birth asphyxia, RH-incompatibility, breastfeeding, and polycythemia were among the determinants of neonatal jaundice. Hence, early prevention and timely treatment of neonatal jaundice are important since it was a cause of long-term complication and death in neonates.
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Mokhtar WA, Sherief LM, Elsayed H, Shehab MM, El Gebaly SM, Khalil AMM, Sobhy M, Kamal NM. Conventional intensive versus LED intensive phototherapy oxidative stress burden in neonatal hyperbilirubinaemia of haemolytic origin. Paediatr Int Child Health 2020; 40:30-34. [PMID: 30931835 DOI: 10.1080/20469047.2019.1586185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
Background: Phototherapy causes oxidative stress which is of particular importance in neonates because of the increased susceptibility of neonatal red blood cell membranes to oxidative damage.Aim: To evaluate the oxidant/antioxidant status in neonates with haemolytic hyperbilirubinaemia before and after exposure to two different intensive phototherapy light sources.Patients and Methods: A randomised controlled study was undertaken in 54 full-term neonates with indirect haemolytic hyperbilirubinaemia admitted to a neonatal intensive care unit in the first week of life. They were randomly divided into two equal groups. Group 1 infants were exposed to intensive conventional phototherapy (Bilisphere 360) and Group 2 were exposed to an intensive light-emitting diode (LED) phototherapy device (Bilitron bed 3600). Total serum bilirubin (TSB), total oxidative stress (TOS), total antioxidant capacity (TAC) and the oxidative stress index (OSI) were measured before and 48 hours after initiation of phototherapy.Results: There was a significant decrease in TSB after phototherapy in both groups (p < 0.001). The TOS and OSI were significantly increased after phototherapy in both groups (p < 0.001) but more so in Group 1 with conventional phototherapy (p = 0.05 and 0.01, respectively). TAC was significantly decreased after phototherapy in both groups (p < 0.00) but more so in Group 1 (p = 0.03).There were significant increases in the incidence of dehydration, hyperthermia and skin rash in the conventional compared with the LED phototherapy group (p = 0.02, 0.01 and 0.02, respectively). However, there was a significant increase in the incidence of hypothermia in the LED compared with the conventional phototherapy group (p = 0.001).Conclusion: Both intensive conventional and LED phototherapy are equally effective in decreasing TSB, but intensive LED phototherapy is safer than intensive conventional phototherapy with regard to oxidative stress and oxidant/antioxidant imbalance.Abbreviations: DSB: direct serum bilirubin; G6PD: glucose-6-phosphate dehydrogenase enzyme; LED: light-emitting diode; OSI: oxidative stress index; TAC: total antioxidant capacity; TOS: total oxidative stresses; TSB: total serum bilirubin.
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Affiliation(s)
- Wesam A Mokhtar
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Laila M Sherief
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hany Elsayed
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M Shehab
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sherief M El Gebaly
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Atef M M Khalil
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Sobhy
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Naglaa M Kamal
- Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Chang PW, Newman TB. A Simpler Prediction Rule for Rebound Hyperbilirubinemia. Pediatrics 2019; 144:peds.2018-3712. [PMID: 31196939 DOI: 10.1542/peds.2018-3712] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We previously reported a clinical prediction rule to estimate the probability of rebound hyperbilirubinemia using gestational age (GA), age at phototherapy initiation, and total serum bilirubin (TSB) relative to the treatment threshold at phototherapy termination. We investigated (1) how a simpler 2-variable model would perform and (2) the absolute rebound risk if phototherapy were stopped at 2 mg/dL below the threshold for treatment initiation. METHODS Subjects for this retrospective cohort study were infants born 2012-2014 at ≥35 weeks' gestation at 1 of 17 Kaiser Permanente hospitals who underwent inpatient phototherapy before age 14 days. TSB reaching the phototherapy threshold within 72 hours of phototherapy termination was considered rebound. We simplified by using the difference between the TSB level at the time of phototherapy termination and the treatment threshold at the time of phototherapy initiation as 1 predictor, and kept GA as the other predictor. RESULTS Of the 7048 infants treated with phototherapy, 4.6% had rebound hyperbilirubinemia. The area under the receiver operating characteristic curve was 0.876 (95% confidence interval, 0.854 to 0.899) for the 2-variable model versus 0.881 (95% confidence interval, 0.859 to 0.903) for the 3-variable model. The rebound probability after stopping phototherapy at 2 mg/dL below the starting threshold was 2.5% for infants ≥38 weeks' GA and 10.2% for infants <38 weeks' GA. CONCLUSIONS Rebound hyperbilirubinemia can be predicted by a simpler 2-variable model consisting of GA and the starting threshold-ending TSB difference. Infants <38 weeks' gestation may need longer phototherapy because of their higher rebound risk.
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Affiliation(s)
- Pearl W Chang
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington; Departments of
| | - Thomas B Newman
- Epidemiology and Biostatistics and.,Pediatrics, University of California, San Francisco, San Francisco, California; and.,Division of Research, Kaiser Permanente Northern California, Oakland, California
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15
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Incidence and risk factors of post-phototherapy neonatal rebound hyperbilirubinemia. World J Pediatr 2018; 14:350-356. [PMID: 29464578 DOI: 10.1007/s12519-018-0119-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/15/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND To determine the incidence and risk factors of post-phototherapy rebound hyperbilirubinemia because data about bilirubin rebound in neonates are lacking and few studies have concerned this condition. METHODS A prospective observational study was conducted on 500 neonates with indirect hyperbilirubinemia who were treated according to standard guidelines. Total serum bilirubin (TSB) was measured at 24-36 h after phototherapy; significant bilirubin rebound (SBR) is considered as increasing TSB that needs reinstitution of phototherapy. RESULTS A total of 124 (24.9%) neonates developed SBR with TSB increased by 3.4 (2.4-11.2) mg/dL after stopping phototherapy. Multiple logistic regression model revealed the following significant risk factors for rebound: low birth weight (B = 1.3, P < 0.001, OR 3.5), suspected sepsis (B = 2.5, P < 0.001, OR 12.6), exposure to intensive phototherapy (B = 0.83, P = 0.03, OR 2.3), hemolysis (B = 1.2, P < 0.001, OR 3.1), high discharge bilirubin level (B = 0.3, P = 0.001, OR 1.3), and short duration of conventional phototherapy (B = - 1.2, P < 0.001, OR 0.3). CONCLUSIONS SBR should be considered in neonates with hemolysis, low birth weight, suspected sepsis, short duration of conventional phototherapy, exposure to intensive phototherapy, and relatively high discharge TSB. These risk factors should be taken into account when planning post-phototherapy follow-up.
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16
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Paul IM, Maisels MJ. Can I Stop Phototherapy for This Baby? Pediatrics 2017; 139:peds.2016-3832. [PMID: 28196933 DOI: 10.1542/peds.2016-3832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ian M Paul
- Departments of Pediatrics, and .,Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; and
| | - M Jeffrey Maisels
- Department of Pediatrics, Beaumont Children's Hospital and Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
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17
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Chang PW, Kuzniewicz MW, McCulloch CE, Newman TB. A Clinical Prediction Rule for Rebound Hyperbilirubinemia Following Inpatient Phototherapy. Pediatrics 2017; 139:peds.2016-2896. [PMID: 28196932 DOI: 10.1542/peds.2016-2896] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The American Academy of Pediatrics provides little guidance on when to discontinue phototherapy in newborns treated for hyperbilirubinemia. We sought to develop a prediction rule to estimate the probability of rebound hyperbilirubinemia after inpatient phototherapy. METHODS Subjects for this retrospective cohort study were infants born in 2012 to 2014 at ≥35 weeks' gestation at 16 Kaiser Permanente Northern California hospitals who received inpatient phototherapy before age 14 days. We defined rebound as the return of total serum bilirubin (TSB) to phototherapy threshold within 72 hours of phototherapy termination. We used stepwise logistic regression to select predictors of rebound hyperbilirubinemia and devised and validated a prediction score by using split sample validation. RESULTS Of the 7048 infants treated with inpatient phototherapy, 4.6% had rebound hyperbilirubinemia. Our prediction score consisted of 3 variables: gestational age <38 weeks (adjusted odds ratio [aOR] 4.7; 95% confidence interval [CI], 3.0-7.3), younger age at phototherapy initiation (aOR 0.51 per day; 95% CI, 0.38-0.68), and TSB relative to the treatment threshold at phototherapy termination (aOR 1.5 per mg/dL; 95% CI, 1.4-1.7). The model performed well with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.86-0.91) in the derivation data set and 0.88 (95% CI, 0.86-0.90) in the validation data set. Approximately 70% of infants had scores <20, which correspond to a <4% probability of rebound hyperbilirubinemia. CONCLUSIONS The risk of rebound hyperbilirubinemia can be quantified according to an infant's gestational age, age at phototherapy initiation, and TSB relative to the treatment threshold at phototherapy termination.
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Affiliation(s)
- Pearl W Chang
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington;
| | - Michael W Kuzniewicz
- Division of Research, Kaiser Permanente Northern California, Oakland, California; and.,Departments of Pediatrics, and
| | - Charles E McCulloch
- Epidemiology & Biostatistics, University of California, San Francisco, California
| | - Thomas B Newman
- Division of Research, Kaiser Permanente Northern California, Oakland, California; and.,Departments of Pediatrics, and.,Epidemiology & Biostatistics, University of California, San Francisco, California
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18
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Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy. J Perinatol 2016; 36:858-61. [PMID: 27279078 DOI: 10.1038/jp.2016.91] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/29/2016] [Accepted: 05/04/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We tested the accuracy of transcutaneous bilirubin (TcB) measure in newborns undergoing phototherapy. STUDY DESIGN In a prospective study of 150 term Caucasian neonates, 255 measurements of total serum bilirubin (TSB) and TcB concentration were obtained 2 h after discontinuing phototherapy. TcB measurements obtained on the forehead, sternum, abdomen and covered lower abdomen were statistically compared with the corresponding TSB. RESULT TcB consistently underestimated TSB levels significantly. The smallest but significant difference between TSB and TcB was found on the lower abdomen. The correlation between TSB and TcB was found to be moderately close (r=0.4 to 0.5). TcB measurements were inaccurate, regardless of phototherapy technique (Bilibed, conventional phototherapy). CONCLUSION Phototherapy significantly interferes with the accuracy of transcutaneous bilirubinometry. TcB measurements performed 2 h after stopping phototherapy were not reliable, even if they were carried out on the unexposed body area. TSB assessment remains necessary, if treatment of hyperbilirubinemia is being considered.
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Nawaz H, Shad MA, Iqbal MS. Optimization of phenylhydrazine induced hyperbilirubinemia in experimental rabbit. Exp Anim 2016; 65:363-372. [PMID: 27210076 PMCID: PMC5111839 DOI: 10.1538/expanim.16-0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Induction of hyperbilirubinemia in experimental rabbits by phenylhydrazine was optimized
in terms of dose, dose interval and number of doses using response surface methodology.
Central Composite Design was employed using five levels for each of the three input
variables. Degree of hyperbilirubinemia was measured in terms of bilirubin level in serum
of animals. A dose dependent significant elevation (P<0.05) of total
serum bilirubin level was observed which was optimized by using eight factorial, six axial
and six central points as suggested by experimental design. Optimum levels of
phenylhydrazine dose, total number of doses and a dose interval to achieve maximum
elevation (4.06 mg/dl−1) of total serum bilirubin were found to be 11.56
mg/kg−1 body weight, 8 and 24.65 h, respectively. The induction procedure was
validated by performing five replicate experiments on a group of five animals which showed
3.56 ± 0.47 mg/kg−1 body weight elevation in total serum bilirubin level.
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Affiliation(s)
- Haq Nawaz
- Institute of Chemical Sciences, Bahauddin Zakariya University, Multan, Punjab, Pakistan
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20
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Mabogunje CA, Olaifa SM, Olusanya BO. Facility-based constraints to exchange transfusions for neonatal hyperbilirubinemia in resource-limited settings. World J Clin Pediatr 2016; 5:182-90. [PMID: 27170928 PMCID: PMC4857231 DOI: 10.5409/wjcp.v5.i2.182] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 12/15/2015] [Accepted: 01/05/2016] [Indexed: 02/06/2023] Open
Abstract
Several clinical guidelines for the management of infants with severe neonatal hyperbilirubinemia recommend immediate exchange transfusion (ET) when the risk or presence of acute bilirubin encephalopathy is established in order to prevent chronic bilirubin encephalopathy or kernicterus. However, the literature is sparse concerning the interval between the time the decision for ET is made and the actual initiation of ET, especially in low- and middle-income countries (LMICs) with significant resource constraints but high rates of ET. This paper explores the various stages and potential delays during this interval in complying with the requirement for immediate ET for the affected infants, based on the available evidence from LMICs. The vital role of intensive phototherapy, efficient laboratory and logistical support, and clinical expertise for ET are highlighted. The challenges in securing informed parental consent, especially on religious grounds, and meeting the financial burden of this emergency procedure to facilitate timely ET are examined. Secondary delays arising from post-treatment bilirubin rebound with intensive phototherapy or ET are also discussed. These potential delays can compromise the effectiveness of ET and should provide additional impetus to curtail avoidable ET in LMICs.
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Berkwitt A, Osborn R, Grossman M. The utility of inpatient rebound bilirubin levels in infants readmitted after birth hospitalization for hyperbilirubinemia. Hosp Pediatr 2015; 5:74-78. [PMID: 25646199 DOI: 10.1542/hpeds.2014-0074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVES There are few data evaluating the role of inpatient rebound bilirubin levels in the management of infants readmitted after their birth hospitalization for indirect hyperbilirubinemia. The goal of the present study was to evaluate the clinical utility of inpatient rebound bilirubin levels within this patient population. METHODS A retrospective cohort study was conducted of 226 infants readmitted after their birth hospitalization for indirect hyperbilirubinemia. Data from 130 infants with rebound bilirubin levels drawn at a mean of 6.1±2.4 hours after discontinuation of phototherapy were compared with data from 96 infants without rebound bilirubin levels. The primary outcome was readmission to the hospital, and secondary outcomes included length of stay and discharge time. A subgroup analysis compared characteristics of children who required repeat phototherapy versus those who did not. RESULTS Overall, 5 of 130 patients from the rebound group were readmitted compared with 4 of 96 patients from the no-rebound group (P=.98). Length of stay was significantly longer for patients with rebound bilirubin levels (27.7 vs 23.2 hours; P=.001). Patients with bilirubin levels lowered to ≤14 mg/dL were less likely to receive repeat phototherapy than those with levels>14 mg/dL (2 of 129 vs 12 of 97; P=.001). CONCLUSIONS Early inpatient rebound bilirubin levels do not successfully predict which patients will require hospital readmission for repeat phototherapy. Children with bilirubin levels lowered to ≤14 mg/dL with phototherapy are unlikely to receive repeat phototherapy.
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Affiliation(s)
- Adam Berkwitt
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Rachel Osborn
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew Grossman
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
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Viau Colindres J, Rountree C, Destarac MA, Cui Y, Pérez Valdez M, Herrera Castellanos M, Mirabal Y, Spiegel G, Richards-Kortum R, Oden M. Prospective randomized controlled study comparing low-cost LED and conventional phototherapy for treatment of neonatal hyperbilirubinemia. J Trop Pediatr 2012; 58:178-83. [PMID: 21914717 DOI: 10.1093/tropej/fmr063] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our objective was to carry out a prospective, randomized, single-blind study to evaluate whether light emitting diode (LED) phototherapy using a low-cost set of lights is as effective as conventional phototherapy in treating hyperbilirubinemia in neonates. The study included 45 pre-term neonates requiring phototherapy as per American Academy of Pediatrics guidelines; participants were randomized to receive phototherapy using LED-based lights, conventional fluorescent blue lights or conventional halogen lights. There were no statistically significant differences in the average bilirubin levels at the onset, at the maximum and at the end of treatment, nor in the duration of phototherapy treatment and the rate of decrease in bilirubin levels in the neonates receiving conventional fluorescent blue light, conventional halogen light and LED phototherapy. (Differences were considered significant at p < 0.05). The average rate of decrease of bilirubin levels was 0.047 ± 0.037 mg dl(-1) h(-1), 0.055 ± 0.056 mg dl(-1) h(-1) and 0.057 ± 0.045 mg dl(-1) h(-1) in the groups receiving conventional fluorescent blue light, conventional halogen light and LED phototherapy, respectively. The average duration of phototherapy treatment in the three groups was 108.8 ± 85.9 h, 92.8 ± 38.1 h, 110.4 ± 42.6 h, respectively. In this pilot study, LED phototherapy using a simple, low-cost set of lights was as effective as conventional phototherapy in the treatment of neonatal hyperbilirubinemia. LED phototherapy lights that deliver 30-40 µW cm(-2 )nm(-1) can be assembled in small quantities for <US$ 100 each using off-the-shelf parts; such lights may enable phototherapy to be safely and reliably delivered in low-resource settings.
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Affiliation(s)
- Johanna Viau Colindres
- Departamento de Pediatria, Servicio de Minimo Riesgo, Unidad de Neonatologia, Hospital Roosevelt, Cuidad de Guatemala, Guatemala
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Mitra S, Samanta M, Sarkar M, De AK, Chatterjee S. Pre-exchange 5% albumin infusion in low birth weight neonates with intensive phototherapy failure--a randomized controlled trial. J Trop Pediatr 2011; 57:217-21. [PMID: 20823089 DOI: 10.1093/tropej/fmq083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the role of 5% albumin infusion before exchange transfusion in reducing post-exchange unconjugated serum bilirubin (UCB) levels in low birth weight (LBW) neonates with intensive phototherapy failure. METHODS In a placebo-controlled Randomized Controlled Trial, 42 healthy LBW (birth weight between 1000 and 2499 g and gestational age ≥ 32 weeks) neonates were randomly allocated into intervention and control groups. Post-exchange UCB at 6 and 12 h were compared in the two groups along with the duration of post-exchange phototherapy, repeat-exchange requirement, adverse effects of albumin and hospital stay. RESULTS The intervention group (n = 21) with mean birth weight 1619 ± 324 g, gestational age 34.5 ± 1.65 weeks, peak UCB 19 ± 3.85 mg dl(-1), was demographically comparable with the control group (n = 21) (1660 ± 320 g, 34 ± 1.6 weeks, 19.4 ± 3.59 mg dl(-1), respectively). Significant reduction in the post-exchange UCB (10.55 ± 1.53 mg dl(-1) at 6 h; 5.86 ± 1.21 mg dl(-1) at 12 h in albumin group; 15.26 ± 1.78 mg dl(-1) at 6 h; 11.69 ± 1.52 mg dl(-1) at 12 h in control group) and phototherapy duration (23.8 ± 3.2 h vs. 40.3 ± 7.2 h) was observed in the intervention group (p < 0.0001). Repeat exchange requirement was reduced by 86% (RR = 0.14; 95%CI: 0.19-1.06). Mean duration of hospital stay was significantly lower (10.1 ± 5.8 days vs. 12.4 ± 6.6 days) (p = 0.021). No albumin transfusion-related complications were observed.
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Affiliation(s)
- Souvik Mitra
- Department of Pediatrics, Medical College, Kolkata, 88, College Street, Kolkata-700 073, India.
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