Audit of Neonatal Jaundice as Experienced at a Mission Hospital in Western Nigeria

Introduction: Neonatal jaundice (NNJ) is a common disorder in neonates that can impact negatively on the brain and cause death. The peculiarities in aetiology and solutions for different settings are a knowledge gap. This informed the desire to determine local aetiology and solutions for neonatal jaundice in a missionary hospital in Abeokuta, Southwestern Nigeria. Methods: Consecutive consenting babies diagnosed with significant neonatal jaundice were studied between July 2016 and June 2019. Institutional ethical consent was obtained. A proforma was used to obtain socio-demographic data and other relevant information such as age, sex, birthweight, gestational age and history regarding the jaundice. All the information obtained was inputted into a computer and analysed with SPSS version 16. Results: A total of 179 babies with neonatal jaundice comprising of 120 (67.0%) boys and 59 (33.0%) girls with ages ranging between 1 and 12 days (mean 2.7 ± 2.9) were studied. Prematurity, ABO incompatibility, neonatal sepsis and glucose-6-phosphate enzyme deficiency accounted for over 80% of the causes of significant NNJ. Sixty (33.5%) of the 179 babies studied developed acute bilirubin encephalopathy and 11 (6.1%) mortalities were recorded. Higher proportions of babies that were out-born with spontaneous vaginal delivery modes had acute bilirubin encephalopathy (p < 0.05). Mothers with formal education had better outcome compared to mothers without, in terms of mortalities (p < 0.05). Conclusion: Neonatal jaundice is still a significant cause of morbidity and mortality in the neonatal age group. Maternal education is key to good outcome in neonatal jaundice.

Clinical Study on the Treatment of Neonatal Jaundice with Lidan Tuihuang Formula Combined with Bifid Lriple Viable and Blue Ray Irradiation

OBJECTIVE: To observe the clinical efficacy of Lidan Tuihuang formula combined with Peifeikang and blue light irradiation in the treatment of neonatal jaundice. METHODS: a total of 140 cases of neonatal jaundice were randomly divided into the observation group and the control group, with 70 cases in each group. The control group was treated with blue light irradiation and oral Bifid Lriple Viable, on the basis of conventional clinical interventions. The observation group was treated with Lidan Tuihuang formula on the basis of the control group. After 7 days of treatment, the scores of clinical symptom(skin yellowness, reduced milk volume, constipation, abdominal distension) and level of serum bilirubin before and after treatment were compared between the two groups, and the adverse reactions and clinical recurrence of the 2 groups were statistically analyzed. RESULTS: After treatment, the effective rate was 94.3% in the observation group which was significantly higher than that in the control group(77.1%)(P < 0.05). The degree of yellowing of the skin, the reduction of the amount of milk, the concentration of constipation and the distension of bloating were all significantly reduced in the 2 groups after treatment(P < 0.05), and the improvement of the above indexes in the observation group was significantly better than that in the control group(P < 0.05). The level of serum bilirubin was significantly lower in the 2 groups after treatment and even for 2 weeks after treatment(P < 0.05). The improvement level of serum bilirubin in the observation group after treatment and even for 2 weeks after treatment were significantly better than that in the control group(P < 0.05). The recurrence rate in the observation group was 8.7%, which was significantly lower than that in the control group 22.2 %(P < 0.05); No serious adverse reactions occurred in both groups. CONCLUSION: The combination of Lidan Tuihuang Formular, Bifid Lriple Viable, blue light irradiation for neonatal jaundice can rapidly improve the clinical symptoms of children, reduce the level of serum bilirubin and shorten the treatment time, with no obvious adverse reactions and high clinical safety.

Effects of Yinzhihuang oral liquid and albumin on bilirubin, inflammatory factors, immune indexes and related factors in neonatal pathologic jaundice

Objective: To explore the effects of Yinzhihuang oral liquid and albumin on bilirubin, inflammatory factors, immune indexes and related factors in neonatal pathologic jaundice. Methods: A total of 134 neonates with pathologic jaundice admitted to our hospital from May 2017 to April 2018 were randomly selected as the control group (n=67) and the observation group (n=67), the control group was treated with albumin, the observation group was treated with Yinzhihuang Oral Liquid on the basis of the control group. The bilirubin, inflammatory factors, immune indicators, alpha-fetoprotein (AFP) and transferrin (TRF) were compared and analyzed before and after treatment. Results: After treatment, the levels of TBIL, DBIL and IBIL in both groups were significantly lower than those before treatment (P<0.05), and the levels of TBIL, DBIL and IBIL [(118.60±10.85) μmol/L, (6.95±1.52) μmol/L, (115.30±14.20)μmol/L] in observation group were significantly lower than those in control group;the levels of CRP and IL-6 in both groups were significantly lower than those before treatment (P<0.05), and the levels of CRP and IL-6 [(8.26±2.07) mg/L, (12.69±2.15) pg/mL] in observation group were significantly lower than those in control group (P<0.05);the levels of CD4+, CD4+/CD8+ in both groups were significantly higher than those before treatment (P<0.05), while the levels of CD8+ was significantly lower than that before treatment, the levels of CD4+, CD4+/CD8+ [(47.08±5.70)%, (2.08±0.41)] in observation group were significantly higher than those in control group (P<0.05), and the level of CD8+ [(22.90±2.05)%] was significantly lower than that in control group (P<0.05);the levels of AFP in significantly higher than before treatment (P<0.05), and the levels of AFP [(12.69±3.04)mg/L] in observation group were significantly lower than those in control group (P<0.05), the levels of TRF [(2.02±0.35) g/L] were significantly higher than those in control group (P<0.05). Conclusions: The combination of Yinzhihuang oral liquid and albumin can effectively reduce the bilirubin level in neonatal jaundice, inhibit its inflammatory reaction, enhance the cellular immune function and improve the expression of AFP and TRF, which is of clinical significance.

Assessment of adjuvant ademetionine therapy for the bilirubin metabolism and target organ function of neonatal jaundice

Objective: To study the effect of adjuvant ademetionine (SAMe) therapy on the bilirubin metabolism and target organ function of neonatal jaundice. Methods: A total of 68 children who were diagnosed with neonatal jaundice in Hubei Jianghan Oilfield General Hospital between March 2015 and April 2017 were selected as the research subjects and randomly divided into the SAMe group who received ademetionine combined with blue ray irradiation and the control group who received blue ray irradiation. The serum contents of bilirubin metabolism indexes and target organ injury markers before treatment as well as 3 d and 7 d after treatment. Results: 3 d and 7 d after treatment, serum TBIL, ALT, AST, GGT, TBA, CK-MB, cTnT, MYO, HBDH, NSE, S100B and GFAP levels of both groups were lower than those before treatment, and serum TBIL, ALT, AST, GGT, TBA, CK-MB, cTnT, MYO, HBDH, NSE, S100B and GFAP levels of SAMe group were lower than those of control group. Conclusion: Adjuvant ademetionine therapy can improve the bilirubin metabolism of neonatal jaundice and reduce the central nerve, myocardial and liver injury.

Study on the mechanism of Yinzhihuang granules, Blue light irradiation combined with Bifid Triple Viable Capsules for neonatal jaundice treatment

Objective:To observe the mechanism of Yinzhihuang granules, Blue light irradiation combined with Bifid Triple Viable Capsules for neonatal jaundice treatment and offer clinical help to neonatal jaundice treatment. Methods:80 children with neonatal jaundice were selected and randomly divided into groups:the observation group (40 children) and the control group (40 children). The patient in the control group were treated with blue light and the patients in the observation group were treated with Yinzhihuang granules, Blue light irradiation combined with Bifid Triple Viable Capsules. Biochemical parameters [TBA (total bile acid), TSB (serum total bilirubin), DB (Direct bilirubin) and TCB (Percutaneous jaundice index)], nerve factor [NSE (neuronspecific enolase), Aβ(βamyloid protein) and S100B (Astrocyte derived protein)] and myocardial enzyme spectrum [LDH (lactate dehydrogenase), CK (creatine kinase) and CK-MB (isoenzymes of creatine kinase)], liver function [ALT (Alanine aminotransferase) and AST (glutamic-oxalacetic transaminase)] and renal function (BUN and Cr) were detected and analyzed before and after treatment. Results:The comparison of Biochemical parameters, nerve factor and myocardial enzymes, liver function and renal function in the two groups before treatment were not statistically significant (P>0.05). Biochemical parameters (TBA, TSB, TCB and DB), nerve factor (NSE, Aβand S100B) and myocardial enzyme spectrum (LDH, CK and CK-MB), liver function (ALT and AST) and renal function [BUN (urea nitrogen) and Cr (creatinine)] in both groups after treatment significantly decreased compared with that before treatment. The changes were statistically significant (P<0.05). Biochemical parameters (TBA, TSB, TCB and DB), nerve factor (NSE, Aβand S100B) and myocardial enzyme spectrum (LDH, CK and CK-MB), liver function (ALT and AST) and renal function (BUN and Cr) in observation group after treatment decreased more significantly compared with that in control group. The difference between two groups was considered to be statistically significant (P<0.05). Conclusions:Yinzhihuang granules, Blue light irradiation combined with Bifid Triple Viable Capsules could regulate the Biochemical parameters, protect nerve function and cardiac muscle cells and improve liver and kidney function in newborns with jaundice. So it has a very important clinical significance of the treatment to neonatal jaundice.

Incidence and Risk Factors to Neonatal Jaundice in Jalingo, Taraba State

This cross-sectional study was aimed to determine the incidence and the significant risk factors to neonatal jaundice in FMC, Jalingo. Four hundred and thirty three neonates admitted to special baby care unit (SBCU) FMC, Jalingo with their mothers were surveyed. Data were collected through a data extraction format looking on the medical records of the neonates (from 1st January, 2021 to 31st August, 2021) and interviewing the mothers. Data were transferred to an Excel data sheet and results were summarized by frequencies and percentages (categorical variables). Logistic regression analysis was used to determine the strength of the risk factors to neonatal jaundice while the significance was tested at p-value ≤ 0.05. The findings revealed that the incidence of neonatal jaundice in FMC Jalingo was 40.18% while the significant risk factors were age group 41 - 50 years (I = 15.01%, OR: 2.970 at 95% CI: 1.566 - 5.634, p = 0.000), spontaneous vaginal delivery (I = 18.01%, OR: 1.382 at 95% CI: 0.940 - 2.033, p = 0.000), premature rupture of membrane (I = 24.94%, OR at: 2.252 at 95% CI: 1.520 - 3.337, p = 0.000), hypertension in pregnancy (I = 21.02%, OR: 1.831 at 95% CI: 1.240 - 2.703, p = 0.002). Others were breech fetal presentation (I = 23.33%, OR: 2.689 at 95% CI: 1.809 - 3.995, p = 0.000), birth asphyxia (I = 22.40%, OR: 3.469 at 95% CI: 2.3105.210, p = 0.000), significant bruising (I = 22.86%, OR: 1.705 at 95% CI: 1.157 - 2.513, p = 0.007), neonatal sepsis (I = 21.02%, OR: 1.688 at 95% CI: 1.145 - 2.488, p = 0.008) and congenital hemolytic anemia (I = 21.71%, OR: 1.723 at 95% CI: 1.169 - 2.540, p = 0.006). Therefore, the need for all concerned to ensure the incidence is reduced and the risk factors identified early and tackled.

The Effect of Pomegranate Paste on Neonatal Jaundice Incidence: A Clinical Trial in Women during Pregnancy

Purpose: Some topics such as women’s life style and nutrition and using some special medicines during pregnancy have been discussed and demonstrated as effective factors on infant’ health. Based on recommendations in Iranian traditional medicine, we aimed to evaluate the efficacy of pomegranate paste consumed by women during their pregnancy on the neonatal jaundice incidence. Methods: In this single-blinded controlled clinical trial, 80 healthy pregnant women were randomly divided into 2 groups, as treatment and control. The treatment group members added pomegranate paste to their daily diet from the 34th week of the pregnancy to birth, as administered. The levels of neonates’ bilirubin were checked in the 5th day of the delivery. Results: Both the need of phototherapy and the mean level of neonates’ bilirubin in the group fed with pomegranate paste were significantly lesser compared to control group. The number of neonates who were undergone phototherapy in the pomegranate paste receiving group was significantly lesser than that in the control group (P value = 0.029). By measuring the total bilirubin, statically significant difference between the treatment group and the control group was seen (P value = 0.021). Conclusion: The results of this study suggest the possible effect of adding pomegranate paste to pregnant women’s diet on the incidence of neonatal jaundice.

Neonatal Graves’ Disease and Cholestatic Jaundice: Case Series and Review of the Literature

Cholestatic jaundice and elevated liver enzymes are uncommon, but recognized, manifestations of neonatal thyrotoxicosis. Current guidelines for evaluation of cholestatic jaundice and reviews in Neonatology literature do not discuss hyperthyroidism in the differential diagnosis of cholestatic jaundice. We report two cases of neonatal thyrotoxicosis secondary to neonatal Graves’ disease that presented with cholestatic jaundice and elevated liver enzymes at birth. Early recognition of thyrotoxicosis as a cause of the hepatic disease in the neonate is crucial to prevent unnecessary diagnostic procedures and to initiate timely treatment.

Correlation between Transcutaneous Bilirubinemia and Blood Bilirubinemia in Screening Term Newborn for Neonatal Jaundice at the Essos Hospital Centre (EHC), Yaoundé, Cameroon

Background: Early and non-invasive diagnosis of neonatal hyperbilirubinemia remains critical in dark skinned babies of low resource settings. Objective: To assess correlation/agreement between transcutaneous bilirubin (Tcb) and serum bilirubin (Tsb) values in full term neonates with jaundice. Methodology: An analytical cross-sectional study was conducted at the neonatology unit of the Essos Hospital Centre (EHC) from January to June 2019. All full-term neonates aged 0 to 7 days with suspected jaundice who did not receive phototherapy were eligible for the study. The enrolled neonates in the study were assessed clinically, then with the MBJ20 transcutaneous bilirubinometer (TcB). The MBJ20 transcutaneous bilirubinometer highest measurement over the forehead and the sternum were compared to TsB. Data were entered and then analysed with the CsPro7.2 and R (version 3.6.0) software. Correlation was captured by Bland & Alman plots and Concordance Correlation Coefficient (CCC) estimates. The Pearson correlation coefficient and Student test for paired data were used for descriptions purposes, and the significance level was 5%. Results: We recruited 88 neonates. The sex ratio of the babies included was 1.25 favouring males. Median Post-natal age was 3 days with 62% aged 72 hours or more. The mean TcB corresponding to the maximum average between frontal and sternal measurement was 153 mg/dl ± 48 and the average Tsb was 123.80 mg/dl ± 50.48. A good linear correlation was found between TcB and total serum bilirubin level r = 0.86 [0.80;0.91]. Positive correlation was noted between both (forehead and sternum) TcB measurements sites, namely r = 0.78 and r = 0.86. The Bland & Altman plot measured the bias at -29.68 mg/l (confidence interval at 95%, 21.14 - 80.50). The CCC estimate was 0.2 varying from -0.22 to 0.76 according to TcB measurement threshold and post-natal age. The ROC area under the curve value for a threshold < 100 mg/l equals 90% proving to be a good predictor for this threshold. Conclusion: A good linear correlation was found despite a poor agreement between TcB and Tsb. TcB method systematically overestimated the value of TsB.

The effect of traditional Chinesemedicine washing combined withmassage for neonataljaundice： a meta-analysis

Objective： To systematically assess the effect of traditional Chinese medicine washing （TCM washing） combined withmassage for the treatment of neonatal jaundice.Methods and analysis： Databases, including PubMed, the Cochrane Library, Embase, Web of Science, the ChineseBiomedical Literature Database （CBM）, CNKI, and Wanfang Data were electronically searched for randomizedcontrolled trials （from inception to July 2017）. The methodological qualities of included trials were evaluated by theCochrane risk of bias assessment tool. The meta-analysis was performed by using RevMan 5.3 software.Results： Overall, thirteen trials with a total of 1998 participants were included. The results of meta-analysis indicatedthat TCM washing combined with massage group was significantly superior to the control group in the first meconiumtime （MD, -16.67; 95% CI, -24.59 to -8.74; P〈0.001）, time for transformation of meconium （MD, -15.44; 95% CI,-23.59 to -7.28; P〈0.001）, transcutaneous bilirubin index changes [after treating three days （MD, -1.99; 95% CI, -2.57 to-1.40; P〈0.001）, after treating four days （MD, -1.86; 95% CI, -2.77 to -0.95; P〈0.001）, after treating five days （MD,-2.44; 95% CI, -3.47 to -1.42; P〈0.001）, after treating six days （MD, -2.23; 95% CI, -3.30 to -1.16; P〈0.001）, and thechanges of serum bilirubin levels [after treating five days （MD, -3.17; 95% CI, -5.83 to -0.50; P=0.02）, after treating sixdays （MD, -1.63; 95% CI, -3.10 to -0.16; P=0.03）, after treating fifteen days （MD,-1.20; 95% CI, -1.99 to -0.41; P=0.003）.Conclusions： TCM washing combined with massage may be an effective therapy for the treatment of neonatal jaundice.It can accelerate the excretion of meconium, shorten the time for transformation of meconium, and decreasetranscutaneous bilirubin index and the level of serum bilirubin. But it should be careful to interpreting these findings.Well-designed RCTs are needed to further clarify the conclusion.

Percentile analysis of plasma total bilirubin—How different will the rate of phototherapy for jaundice of neonates be by different standards?

Phototherapy of a jaundiced neonate is usually started when bilirubin exceeds a threshold in the standard. There are several standards used in the developed countries even though the guideline of American Academy of Pediatrics is considered to be a global standard. Although the purpose of phototherapy is the prevention of kernicterus, nowadays the prevalence of kernicterus in otherwise healthy term neonates in the developed countries is rare. Meanwhile several potential adverse effects of phototherapy have been reported. In the present study we tried to estimate how different the rate of phototherapy for the jaundice of neonates at lower risk of kernicterus would be by different standards. For this purpose, we utilized the records of plasma total bilirubin (TB) values of 1893 healthy neonates of 38 weeks and more which were measured on day 6 for the percentile analysis. However, this database did not include the TB values of the neonates who received phototherapy by day 6. Then the database was corrected with an assumption that TB on day 6 would have been normally distributed if no phototherapy had been performed. The mean and the standard deviation (SD) of corrected database were 11.29 mg/dl (193 μmol/l) and 3.63 mg/dl (62 μmol/l), respectively. Using a standard distribution with these mean and SD, the percents of TB values which exceed 18.0, 19.0, 20.0 and 21.0 mg/dl on day 6 were estimated 3.22%, 1.70%, 0.82% and 0.35%, respectively. Results of the present report would help to estimate the relative rate of phototherapy that is performed for the neonates who are term and otherwise healthy by different standards.

Correlation between UGT1A1 Polymorphism and Neonatal Hyperbilirubinemia of Neonates in Wuhan

This study attempts to discuss the correlation between UGT1A1＊28 as uridine diphosphate glucuronosyltransferase gene promoter and coding region Gly71 Arg gene polymorphism with neonatal hyperbilirubinemia of neonates in Wuhan. A total of 168 neonates were divided into the hyperbilirubinemia group（case group, n=108） and healthy neonates group（control group, n=60）. Their DNA was obtained through blood extraction. The gene exon mutation of UGT1A1 was detected by Sanger sequencing, which revealed the relationship between UGT1A1＊28 and Gly71 Arg polymorphism with neonatal hyperbilirubinemia of neonates. The results showed that：（1） The frequency of UGT1A1＊28 allele mutation in the case group and the control group was 9.3% and 10% respectively, with the difference being not significant between the two groups（P〉0.05）.（2） The frequency of Gly71 Arg allele mutation in the case group and the control group was 35.1% and 21.7% respectively, with the difference being significant between the two groups（P〈0.01）.（3） The serum bilirubin level of Gly71 Arg mutant homozygous and heterozygous subgroups（n=66） in the case group was 302.7±31.4 μmol/L, which was significantly higher than 267.3±28.5 μmol/L of the wild subgroup（n=42）（P〈0.01）. It was suggested that the occurrence of neonatal hyperbilirubinemia of neonates in Wuhan was not associated with UGT1A1＊28 gene polymorphism, but closely with the Gly71 Arg gene polymorphism. Meanwhile, the Arg allele mutation was related to the degree of jaundice.

Effects of massage on newborn infants with jaundice: A meta-analysis

Objective:This meta-analysis aims to systematically evaluate the effects of massage on infants with jaundice.Methods:Multiple electronic databases,including Cochrane Library,PubMed,EMBASE,Web of Science,China Biology Medicine (CBM),Wan Fang Data,VIP Database for Chinese Technical Periodicals and China National Knowledge Infrastructure (CNKI),were used to search for studies on the effects of massage on infants with jaundice.Data were analysed by Rev Man 5.3.Results:A total of 14 randomised controlled trials with 1889 patients were included.Statistically significant difference in percutaneous bilirubin [MD =-1.21,95% CI (-1.90,-0.52),P< 0.05;MD =-2.00,95% CI (-2.68,-1.32),P<0.05;MD=-2.00,95% CI (2.56,-1.44),P<0.05;MD=-1.93,95% CI (-2.44,-1.43),P< 0.05] was found between two groups at 48,72,96 and 168 h.Studies on the serum total bilirubin level were divided into two subgroups according to sample size,and the results of subgroup analysis showed that the serum total bilirubin level in the intervention group was significantly lower than that in the control group [MD =-52.06,95% CI (-57.76,-46.36),P< 0.05 and MD =-10.65,95% CI (-14.66,-6.63),P < 0.05].Statistically significant difference in defecation frequency was observed between the two groups at 48 h after birth[SMD =0.44,95%CI (0.02,0.87),P< 0.05].Conclusion:Massage can decrease serum total bilirubin and percutaneous bilirubin levels and increasing defecation frequency.However,due to heterogeneity among studies,numerous multi-centre,largesample and high-quality randomised controlled trials are needed to verify the effects of massage.

Glucose-6-phosphate-dehydrogenase deficiency and its correlation with other risk factors in jaundiced newborns in Southern Brazil

Objective:To evaluate the correlation between glucose-6-phosphate-dehydrogenase(G6PD) deficiency and neonatal jaundice.Methods:Prospective,observational case-control study was conducted on 490 newborns admitted to Hospital de Clinicas de Porto Alegre for phototherapy, who all experienced 35 or more weeks of gestation,from March to December 2007.Enzymatic screening of G6PD activity was performed,followed by PCR.Results:There was prevalence of 4.6% and a boy-girl ratio of 3:1 in jaundiced newborns.No jaundiced neonate with ABO incompatibility presented G6PD deficiency,and no Mediterranean mutation was found.A higher proportion of deficiency was observed in Afro-descendants.There was no association with UGT1A1 variants. Conclusions:G6PD deficiency is not related to severe hyperbilirubinemia and considering the high miscegenation in this area of Brazil,other gene interactions should be investigated.

Analysis of the histologic features in the differential diagnosis of intrahepatic neonatal cholestasis

AIM:To compare the histologic features of the liver in intrahepatic neonatal cholestasis(IHNC)with infectious,genetic-endocrine-metabolic,and idiopathic etiologies. METHODS:Liver biopsies from 86 infants with IHNC were evaluated.The inclusion criteria consisted of jaundice beginning at 3 mo of age and a hepatic biopsy during the 1st year of life.The following histologic features were evaluated:cholestasis,eosinophilia,giant cells,erythropoiesis,siderosis,portal fibrosis,and the presence of a septum. RESULTS:Based on the diagnosis,patients were classified into three groups:group 1(infectious;n=18),group 2(genetic-endocrine-metabolic;n=18),and group 3(idiopathic;n=50).There were no significant differences with respect to the following variables:cholestasis,eosinophilia,giant cells,siderosis,portalfibrosis,and presence of a septum.A significant difference was observed with respect to erythropoiesis,which was more severe in group 1(Fisher's exact test,P=0.016). CONCLUSION:A significant difference was observed in IHNC of infectious etiology,in which erythropoiesis was more severe than that in genetic-endocrine-metabolic and idiopathic etiologies,whereas there were no significant differences among cholestasis,eosinophilia,giant cells,siderosis,portal fibrosis,and the presence of a septum.

Jaundice in the Newborn at the Teaching Hospital of Brazzaville

Introduction: Jaundice is a major symptom during neonatal time. It is defined by a bilirubin ≥ 50 mg/l. Objectives: To determine the frequency of neonatal jaundice at the Brazzaville University Hospital, to determine the main etiologies, to evaluate the management, to specify the evolution. Patients and Method: It was a prospective and descriptive study that was conducted in the Neonatology Department and Biochemistry Laboratory of the University Hospital of Brazzaville, from 1st August 2015 to 31st July 2016. It included newborn children admitted into the neonatal unit for treatment of jaundice. The variables studied were epidemiological, clinical, etiological therapy and outcome. Results: The frequency of the neonatal jaundice is 7.2%. The hyperbilirubinemia as not conjugated was found in 99.1% of cases. The main causes are bacterial neonatal infection n = 102 (47.9%), the physiological icterus n = 46 (21.6%) and the ABO incompatibility n = 40 (18.8%). The treatment consists of the phototherapy in all cases. Each phototherapy session lasts 3 hours n = 99 (56.9%), 6 hours n = 58 (33.3%) and 12 hours n = 17 (9.8%). The average duration of the administering of the therapy is of 3 ± 2 days. Hyperbilirubinemia encephalopathy occurred in 62 (29.1%) cases, including 49 cases of kernicterus. The death occurred in 70 (32.9%) children. Conclusion: The importance and the gravity of the neonatal jaundice require primary preventive means based on proper care in pregnancy and the birth. While the secondary prevention includes high index of suspicion, comprehensive diagnostic equipment availability to prevent acute bilirubin encephalopathy.

Range of Thresholds Used for Treatment of Neonatal Hyperbilirubinemia at Different Gestational Ages across Neonatal Units in Great Britain

Objectives: To review the range of thresholds used for treatment of neonatal jaundice at different gestational ages across neonatal units in Great Britain. To investigate the time at which the threshold values plateau, in terms of hours after birth, for various gestational ages. Methods: We contacted 72 neonatal units in Great Britain and enquired about the unit guidelines for management of neonatal jaundice. We requested a copy of the guidelines and jaundice action charts used. Levels for treatment with phototherapy and exchange transfusion for various times after birth and for different gestational ages were extracted and the data was transferred to an Excel spreadsheet. Identical values were excluded so that there was no duplication of charts. The data was analysed to explore the variation in charts used and the time at which the threshold value reached a plateau was recorded for each chart. Results: Of the 72 units contacted 46 responded with charts. Four neonatal units were using formulas and one hospital was using separate chart for every gestation. The data displayed wide variation in treatment levels (phototherapy and exchange transfusion) at 12 to 168 hours after birth in the three gestational groups studied (28, 32 and 37 weeks). For a term neonate at 72 hours of age the threshold to commence phototherapy varied between 220-370 micromol/l and the exchange transfusion threshold varied between 300-510 micromol/l. A wide variation in practice was seen for all three gestations. The median plateau time was also analysed and for phototherapy this corresponded to 72 hours for all three gestations. For exchange transfusion data the median time of plateau was highest for the term babies (72 hours) and lowest for 32 weeks gestation (48 hours). There was no reference of evidence quoted in the jaundice action charts surveyed. Conclusions: Jaundice action charts reviewed in our study showed significant variation in the threshold for treatment of neonatal jaundice. Both the studied parameters (variation in threshold and the median time to plateau) point towards the fact that the charts being used in the neonatal units are not evidence based and need modification. With the lack of standard treatment guidelines for this common neonatal problem, it is likely that neonatal units are either under or over treating a significant number of babies.

Otoacoustic Emissions and Evoked Potentials in Infants after Breast-Feeding Jaundice——Hearing Dysfunction in Breast-Feeding Jaundice

We study hearing in a group of infants with Breast-feeding jaundice (BFJ) by means of Transient-evoked otoacoustic emissions (T-EOE) and Brainstem auditory evoked potentials (BAEP) searching for relationship between bilirubin serum levels and auditory dysfunction. Eleven infants born at-term with BFJ were selected for the study. We studied also 11 control age- and gender matched healthy at-term infants without signs of jaundice. T-EOAE studies were performed between 5-7 days after birth, and 3 months later. BAEP studies were performed once. BFJ group infants exhibited lower amplitudes in T-EOE than infants in the control group. These differences disappear at the 3-month evaluation. In BAEP, we observed a significant latency delay of waves I and V in Breast-feeding jaundice group infants. All infants in both groups demonstrated reproducible wave V response at 30 decibels. No significant correlation values were observed between bilirubin serum levels and T-EOE and BAEP variables. Our data suggest that BFJ can result in transient peripheral and central auditory dysfunction. Dysfunction is reversible after treatment of infants with BFJ.

Correlation between Late Cord Clamping and Phototherapy and Other Neonatal Unfavorable Outcomes: A Randomized Clinical Trial

Background: Recently, late umbilical cord clamping is generally recommended, which decreases neonatal anemia;however, it may also increase neonatal jaundice and some other poor outcomes. Objectives: We here attempted to determine whether late clamping actually increases the incidence of phototherapy for jaundice and other poor outcomes of the term “low-risk newborns”. Methods: With the approval of the Brazilian Registry of Clinical Trials (REBEC), a total of 357 low-risk newborns (singleton, uncomplicated pregnancy/delivery, in a Brazilian public institution) were randomized into two groups: group I (n = 114): cord clamping 1 minute (early clamping) or group II (n = 243): cord clamping between 1 - 3 minutes (late clamping). Statistics were used appropriately (i.e., measures of central tendency, dispersion for continuous variables, Shapiro-Wilk, Mann-Whitney test, or Chi-square test). Results: Phototherapy was performed in 5.3% in both groups. Also, there were no statistical differences in the occurrence of secondary outcomes, such as sepsis, neonatal ICU admission, and transient tachypnea of the newborns: i.e., 0.9%, 15.8%, and 3.5%, respectively for group I versus 1.2%, 15.6%, and 5.8%, respectively for group II. Conclusion: Late umbilical cord clamping does not increase the need for phototherapy in low-risk neonates. This result corroborates the current recommendation of late cord clamping, whenever appropriate.

高产胆盐水解酶乳杆菌的筛选及对新生大鼠黄疸的防治作用

为筛选高产胆盐水解酶的乳杆菌,探究其对新生儿黄疸的防治作用。采用添加了25 U/mL制霉菌素的LBS选择性培养基,从健康新生儿粪便和母乳中筛选乳杆菌并鉴定种类;以鼠李糖乳杆菌LGG为阳性对照,体外评估菌株的益生菌特性;利用盐酸苯肼诱导新生SD大鼠黄疸模型,通过分析血清胆红素水平和肝脏组织的损伤情况,以及肝脏炎症因子、核转录因子的相对表达水平,探究高产胆盐水解酶乳杆菌对新生大鼠黄疸的防治作用及机制。结果表明,来自婴儿粪便的格氏乳杆菌FWJL-5在体外具良好的益生特性,并且产胆盐水解酶能力优于LGG,能够显著缓解新生大鼠胆红素水平升高、肝脏组织肿胀和溶血症状,减少肝脏损伤中肝酶的释放,抑制促炎因子的分泌,促进UGt1A1和上游核转录因子孕烷X受体(pregnane X receptor,pXR)、法尼醇X受体(farnesol X receptor,FXR)的表达。综上所述,婴儿粪便来源的格氏乳杆菌FWJL-5可通过上调核受体FXR/pXR促进UGt1A1表达以调节肝脏胆红素代谢,从而减轻新生大鼠黄疸症状,本研究可为格氏乳杆菌防治新生儿黄疸提供新思路。