Bilirubin/albumin ratio for predicting acute bilirubin-induced neurologic dysfunction

The aim of this study was to evaluate the bilirubin albumin [B/A] ratio in comparison with total serum bilirubin [TSB] for predicting acute bilirubin-induced neurologic dysfunction [BIND]. Fifty two term and near term neonates requiring phototherapy and exchange transfusion for severe hyperbilirubinemia in Children's Medical Center, Tehran, Iran, during September 2007 to September 2008, were evaluated. Serum albumin and bilirubin were measured at admission. All neonates were evaluated for acute BIND based on clinical findings. Acute BIND developed in 5 [3.8%] neonates. B/A ratio in patients with BIND was significantly higher than in patients without BIND [P<0.001]. Receiver operation characteristics [ROC] analysis identified a TSB cut off value of 25 mg/dL [area under the curve [AUC] 0.945] with a sensitivity of 100% and specificity of 85%. Also, according to the ROC curve, B/A ratio cut off value for predicting acute BIND was 8 [bil mg/al g] [AUC 0.957] with sensitivity of 100% and specificity of 94%. Based on our results, we suggest using B/A ratio in conjunction with TSB. This can improve the specificity and prevent unnecessary invasive therapy such as exchange transfusion in icteric neonates

Congenital brain tumors, a series of seven patients

Congenital brain tumors are very rare. We review these tumors in patients younger than 2 months diagnosed in our Department. Seven congenital brain tumors were diagnosed during five years. Clinical and radiological findings and prognosis are analyzed. The study included 5 female and two male infants. Two cases were diagnosed antenatally by means of ultrasonography. All patients presented with intracranial hypertension. The tumor was non-homogenous with cystic and solid components in all neuroimaging, except for the case with choroid plexus papilloma. Hydrocephalus was evident in all of them. Most findings were infra-tentorial lesions. There were three teratomas, one primitive neuro-ectodermal tumor, one ependymoblastoma and one choroid plexus papilloma. Six patients were operated on, with one intra-operative death. Two passed away postoperatively with aspiration pneumonia. One patient died due to complications of chemotherapy and another one due to tumor recurrence one year after surgery. Only the patient with choroid plexus papilloma is alive after 2 years. Today, the availability of noninvasive imaging procedures such as computerized tomography scan and magnetic resonance imaging has improved the diagnosis of congenital brain tumors. Inspite of development in prenatal diagnosis, appropriate pre and post operative management, the mortality associated with these tumors still remains high. The final prognosis in these patients is still discouraging despite early surgery and operative and anesthetic improvements. Choroid plexus papilloma accompanies the best prognosis, whereas teratoma and primitive neuroectodermal tumors have the worst prognosis