Hyperbilirubinemia and neonatal infection

Hyperbilirubinemia is a relatively common disorder among infants in Iran. Bacterial infection and jaundice may be associated with higher morbidity. Previous studies have reported that jaundice may be one of the signs of infection. The aim of this study was to determine the incidence rate, presentation time, severity of jaundice, signs and complications of infection within neonatal hyperbilirubinemia. This cross sectional study was conducted between 2003 and 2011, at Ghaem Hospital, Mashhad- Iran. We prospectively evaluated 1763 jaundiced newborns. We finally found 434 neonates who were categorized into two groups.131 neonates as case group [Blood or/and Urine culture positive or sign of pneumonia] and 303 neonates with idiopathic jaundice as control group. Demographic data including prenatal, intrapartum, postnatal events and risk factors were collected by questionnaire. Biochemical markers including bilirubin level, urine and blood cultures were determined at the request of the clinicians. Jaundice presentation time, age on admission, serum bilirubin value and hospitalization period were reported significantly higher among case group in comparison with control group [p<0.0001]. Urinary tract infection [UTI], sepsis and pneumonia were detected in 102 [8%], 22 [1.7%] and 7 [0.03%] cases, respectively. We concluded that bacterial infection was a significant cause of unexplained Hyperbilirubinemia among jaundice newborns [10%]. Therefore, we advise performing screening test for UTI as part of the evaluation in asymptomatic jaundice infants presenting after five days of life and sepsis workup should be request in symptomatic infant especially in the first week of life

effect of traditional remedies [camel's thorn, flixweed and sugar water] on idiopathic neonatal jaundice

Jaundice is the most common reason of newborn's admission to neonatal ward. Many Iranian families give traditional remedies like sugar water, camel's thorn and flixweed extracts to breast-fed babies for reducing jaundice. This study investigated the effect of traditional remedies on idiopathic neonatal jaundice. This prospective study has been performed on 336 babies with idiopathic jaundice in a four year period [2005-2009] at Ghaem hospital, Mashhad, Iran. The babies were divided into two groups. In case group [n=234] breast-fed babies received no remedy and in control group [n=102], traditional remedies were given additional to breast milk and the results recorded and compared. In the present study significant differences were observed between the two groups in age of admission [6.8 +/- 3.2 vs 9.2 +/- 3.7 day, P<0.001], serum bilirubin values [17.8 vs 21.3 mg/dl, P<0.001] and percent of weight loss [P<0.01]. There were no significant differences between the two groups in birth weight, sex, gestational age and duration of hospitalization, age at jaundice remission, hematocrit value and maternal factors [age, gestational order, pregnancy and labor problems][P>0.05]. Traditional remedies [camel's thorn, flixweed and sugar water] cause more weight loss and delayed reexamination of newborns leading to increased hyperbilirubinemia. These remedies may raise pseudo confidence in parents, which postpones reexamination and follow up of the newborns

Serum interleukin 8 level as a diagnostic marker in late neonatal sepsis

Late-onset sepsis is responsible for high morbidity and mortality in newborn infants in the world and in particular in developing countries. In this study, we evaluated whether clinical characteristics, laboratory parameters and measurements of serum interleukin-8 [IL-8] are able to discriminate between late neonatal sepsis and normal baby. This was a prospective [case-control] study conducted between March 2007 and April 2008, at the neonatal intensive care unit, Ghaem Hospital, Mashhad, Iran. The study comprised 93 neonates >/= 72 hours of life. The infants were categorized in two groups based on the clinical presentation, and biochemical markers including complete blood count, C-reactive protein [CRP] and blood culture: 1] Control group including 42 infants with routine screening and 2] Case group consisting of 38 infants with definitive infection [positive blood and/or cerebrospinal fluid culture] or clinical sepsis [clinical and laboratory signs of infection without positive blood or CSF culture]. Receiver-operating characteristic curves were used for the determination of thresholds for the infection group versus healthy neonate group. Eighty infants were enrolled in this study. IL-8 and CRP decreased in order of definitive infection, clinical sepsis and healthy subjects respectively [P<0.001]. Sensitivity, specificity, positive predictive value, negative predictive value for serum levels were 0.95, 0.1, 0.97, 0.1 for IL-8 and 0.83, 0.86, 0.83, 0.69 for CRP respectively [cut-off point for IL-8 >60pg/ml and for CRP>6mg/dl]. IL-8 may be a valid and early predictive marker of neonatal infection. Also, IL-8 is associated with seventy of infection