Cuidados de enfermagem aos recém-nascidos submetidos a fototerapia em unidades neonatais: um protocolo de scoping review / Nursing care for newborns undergoing phototherapy in neonatal units: a scoping review protocol

Objetivo: Mapear a produção do conhecimento sobre os principais cuidados de enfermagem realizados aos recém-nascidos submetidos a fototerapia em unidades neonatais. Método: Trata-se de um protocolo de revisão de escopo, realizado de acordo com a metodologia do Joanna Briggs Institute e checklist do Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), seguindo as seguintes etapas: seleção da questão de pesquisa; busca por estudos relevantes; seleção dos estudos; extração e análise dos dados; e, agrupamento, resumo e apresentação dos resultados. Para identificar os documentos as seguintes bases de dados bibliográficas serão pesquisadas: Medical Literature Analysis and Retrievel System Online, Cumulative Index to Nursing & Allied Health Literature, Web of Science, SciVerse Scopus, Base de Dados de Enfermagem, Literatura Latino-Americano e do Caribe em Ciências da Saúde, Scientific Electronic Library Online, Cochrane Library, Catálogo de Teses e Dissertações da Capes e Google Acadêmico. O resultado do fluxo de seleção, desta etapa metodológica, será apresentado em forma de figura, conforme o Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Resultados: O mapeamento dos dados permitirá o agrupamento dos cuidados além de evidenciar a necessidade destes para os recém-nascidos submetidos à fototerapia. Conclusão: Espera-se salientar a indispensabilidade dos cuidados de enfermagem a este público e reforçar a necessidade de educação continuada aos profissionais.

Objetivo: Mapear la producción de conocimiento sobre los principales cuidados de enfermería brindados a las criaturas recién nacidas sometidas a fototerapia en unidades neonatales. Revisión: Se trata de un protocolo de revisión del alcance realizado, según la metodología del Instituto Joanna Briggs y la lista de verificación Elementos de informe preferidos para revisiones sistemáticas y extensión de metaanálisis para revisiones de alcance (PRISMA-ScR). Lo anterior, siguiendo los siguientes pasos: selección de la pregunta de investigación, buscar estudios relevantes, selección de estudios, extracción y análisis de datos y, agrupar, resumir y presentar los resultados. Para identificar los documentos, se buscará literatura en las siguientes bases de datos: Sistema de recuperación y análisis de literatura médica en línea, Índice acumulativo de enfermería y Literatura relacionada con la salud, Web of Science, SciVerse Scopus, base de datos de Enfermería, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Scientific Electronic Library Online, Cochrane Library, Capes Theses and Dissertations Catalog y Google Scholar. El resultado del flujo de selección de este paso metodológico se presentará en forma de figura, de acuerdo con PRISMA-ScR. Resultados: El mapeo de datos permitirá la agrupación de cuidados, además, resaltar la necesidad de estos para las criaturas recién nacidas sometidas a fototerapia. Conclusión: Se espera resaltar la indispensabilidad del cuidado de enfermería para este público y reforzar la necesidad de educación continua para las personas profesionales en esta área.

Objective: To map the production of knowledge on the main nursing care provided to newborns undergoing phototherapy in neonatal units. Method: This is a scoping review protocol carried out following the Joanna Briggs Institute methodology and the Preferred checklist Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The following the following steps were followd: selection of the research question, search for relevant studies, selection of studies, data extraction and analysis, and, grouping, summarizing and presenting the results. The following databases will be consulted to identify the documents: Medical Literature Analysis and Retrievel System Online, Cumulative Index to Nursing & Allied Health Literature, Web of Science, SciVerse Scopus, Database of Nursing, Latin American and Caribbean Literature in Health Sciences, Scientific Electronic Library Online, Cochrane Library, Capes Theses and Dissertations Catalog, and Google Scholar. The result of this methodological step's selection flow will be presented in figure form as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results: The data mapping will allow the grouping of care and it will also highlight the need for care in newborns undergoing phototherapy. Conclusion: It is expected to highlight the indispensableness of nursing care for this public and reinforce the need for continuing education in professionals.

Análise macroscópica e radiográfica de dentes decíduos com hiperbilirrubinemia de crianças com doenças hepáticas crônicas e transplante hepático / Macroscopic and radiographic analysis of primary teeth with hyperbilirubinemiain children with chronic liver disease and liver transplantation

Objetivo: identificar mediante análise macroscópica e ra-diográfica as alterações estruturais em tecidos dentários afetados pela hiperbilirrubinemia, normalmente constatada a partir do sinal clínico de icterícia e provoca o desenvolvi-mento de pigmentos intrínsecos esverdeados nas estruturas dentárias. Materiais e Métodos: a amostra foi composta por 31 dentes decíduos dividida em grupo controle (n= 7) e grupo experimental (n= 24). As análises macroscópicas foram efetuadas por meio de fotografias individuais padroniza-das e as radiográficas obtidas com aquisições de imagem a 9 mA, 70 kVp, distância de 8cm, exposição 0,4 segundos e com XDR Sensor®. As imagens foram convertidas pelo software XDR Brasil 3.1.6 e padronizadas pelo programa GIMP 2.10.22. Os dados da média simples do histograma foram analisados pelo teste T-Student e Mann-Whitney (p<0,05). Resultados: demonstraram a maior intensidade de pigmentação em região cervical da raiz, com diferença de densidade radiográfica estaticamente significante na porção radicular entre os grupos experimental e controle (p=0,043). Na análise da densidade radiográfica da estrutura radicular do grupo experimental houve diferença estatica-mente significante (p=0,016) entre os terços cervical e apical. Discussão: Os dados evidenciaram que dentes pigmentados pela hiperbilirrubinemia não possuem alterações na densidade mineral nos terços coronários. Conclusão: Dentes com pigmentação esverdeada bilirrubina possuem diferenças na densidade radiográfica so-mente na região radicular.

Aim: is to identify, through macroscopic and radio-graphic analysis, structural changes in dental tissues affected by hyperbilirubinemia, usually seen from the clinical sign of icterus and causes the development of intrinsic greenish pigments in dental structure. Materials and Methods: The sample consisted of 31 primary teeth divided into a control group (n=7) and an experimental group (n=24). Macroscopic analyzes were performed using standardized individual photographs and radiographic ones obtained by image acquisition at 9 mA, 70 kVp, 8cm distance, 0.4 seconds exposure and with XDR Sensor®. The images were converted by XDR Brasil 3.1.6 software and standardized by GIMP 2.10.22 software. The Histogram's simple mean data were analyzed by T-Student and Mann-Whitney tests (p<0.05). Results: showed intensity of pigmentation in the cervical region of the root, with a statistically significant difference in the root portion between the experimental and control groups (p=0.043. In the analysis of radiographic density of the root structure of the experimental group, there was a statistically significant difference (p= 0.016) between the cervical and apical thirds. Discussion: The data showed that teeth pigmented by hyperbilirubinemia do not have changes in mineral density in the coronary thirds. Conclusion: Greenish pigments teeth have differences in radiographic density only in the root structure.

Enfermedad hemolítica del feto y del recién nacido por aloanticuerpos contra el antígeno M / Hemolytic disease in fetuses and newborns due to antibodies against the M-antigen

Resumen | Hay pocos reportes de enfermedad hemolítica del feto y del recién nacido causada por aloanticuerpos contra el sistema de antígenos MNS, especialmente, porque los anticuerpos que se generan contra estos antígenos son del tipo IgM, los cuales tienen reactividad a temperaturas inferiores a los 37 °C, y, por lo tanto, no son de importancia clínica. A pesar de ello, se han reportado casos con presencia de anticuerpos anti-M de tipo IgG causantes de la enfermedad hemolítica del recién nacido e, incluso, casos de muerte intrauterina por incompatibilidad materno-fetal en el sistema MNS. El proceso hemolítico se asemeja al causado por los anticuerpos anti-Kell, con anemia progresiva por supresión hematopoyética que induce la destrucción de precursores hematopoyéticos en la médula ósea y ausencia de reticulocitos en la periferia. Se reporta el caso de una mujer con 38,5 semanas de gestación, que presentó discrepancia en la hemoclasificación directa y en la inversa. Como resultado, el recién nacido fue positivo en la prueba de Coombs directa sin que existiera incompatibilidad ABO con la madre. La correlación de estos resultados llevó a la detección de un anticuerpo anti-M en el suero materno. El diagnóstico definitivo fue posible gracias a la discrepancia en la hemoclasificación de la sangre materna. A pesar de que los anticuerpos anti-M usualmente no desempeñan un papel importante en la enfermedad hemolítica perinatal, este caso resalta la importancia de determinar la presencia de diferentes anticuerpos que pueden ser de vital interés a la hora de prevenir resultados graves asociados con dicha condición. Además, abre la puerta a nuevas recomendaciones relacionadas con la tamización y el tratamiento temprano de la hemólisis en los recién nacidos.

Abstract | There are few case reports of hemolytic disease in fetuses and newborns (HDFN) caused by alloantibodies against the MNS blood group system. The reason for this dearth is that antibodies toward these antigens are usually IgM, which not only cannot cross the placental circulation but also react at temperatures below 37°C. They are, therefore, of minimal clinical importance. Nevertheless, cases have been reported in which the presence of anti-M IgG antibodies caused severe HDFN and even intrauterine death in the presence of maternal-fetal MNS incompatibility indicating that they could have a high clinical impact. The hemolytic pattern observed in these cases is similar to that caused by anti-Kell antibodies. Progressive anemia is mediated and developed through hematopoietic suppression inducing the destruction of bone marrow precursor cells with the resulting absence of reticulocytes in peripheral blood. This occurred in the case of a woman at 38.5 weeks of gestation who showed a discrepancy between direct and reverse blood type determination. A direct Coombs test was performed on the newborn's blood, which was positive in the absence of maternal-fetal ABO incompatibility. Further tests were performed and anti-M antibodies were found in the maternal serum screening. Our final diagnosis was largely due to discrepancy issues in maternal blood. Although anti-M antibodies do not usually play a significant role in HDFN, this case stresses the importance of identifying the presence of antibodies that can be crucial in preventing HDFN and lead to new recommendations for the screening and prompt treatment of hemolysis in newborns.

The predictive value of general movement assessment combined total bilirubin for motor development outcomes in infants with severe neonatal jaundice / 中国医师杂志

Objective:To study the predictive values of the general movements (GMs) assessment combined total bilirubin for motor development outcomes in infants with severe neonatal jaundice.Methods:From June of 2014 to June of 2019, infants with severe neonatal jaundice in Chenzhou First People′s Hospital were enrolled in the study. Inclusion criteria included , the serum total bilirubin was measured at the time of admission, corrected gestational age of 37 to 48 weeks. General assessment were carried out when the infant was stable. The patients were regularly followed-up until the age of 12months to evaluate the predictive values.Results:A total of 204 patients with severe neonatal jaundice were enrolled in the study, with mean serum total bilirubin value (485.4±109.6)μmol/L. They were divided into two groups according to the outcome of motor development. The total bilirubin value, the proportion of abnormal GMs and dangerous total bilirubin level in the abnormal group were significantly higher than those in the normal group (all P<0.05). 13 cases (6.4%) were normal in the torsion stage of GMs; 191 cases (93.6%) were abnormal, including 164 cases (85.9%) of poor repertoire (PR) and 27 cases (14.1%) of cramped-synchronized (CS). Abnormal GMs and total bilirubin were the risk factors of abnormal motor development ( OR=4.651, 1.017, P<0.05). The predictive values of abnormal GMs for abnormal motor development outcomes were as following: sensitivity 100%, specificity 8.4%, negative predictive value (NPV) 100%. The predictive values of CS for cerebral palsy were as following: sensitivity 63.2%, specificity 97.8%, NPV 96.0%. Receiver operating characteristic (ROC) curve showed that the area under the curve predicted by GMs and total bilirubin was 0.765 and 0.757, respectively. The area under the curve of motor dysplasia predicted by combining the two was 0.854. Conclusions:The evaluation of general movement assessment combined total bilirubin has certain clinical predictive value for the outcomes of motor development in infants with severe neonatal jaundice.

Remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease / 浙江大学学报·医学版

OBJECTIVE@#To explore the feasibility of remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease.@*METHODS@#Forty six neonates of gestational age >35 weeks with ABO hemolytic disease admitted to Women's Hospital, Zhejiang University School of Medicine from January 20th, 2020 to February 29th, 2020 were enrolled in the study (study group). The newborns were followed up at home after discharge, the transcutaneous bilirubin (TCB) levels were measured by parents using the provided device and the results were sent to the doctor by smart phone using the installed APP. Fifty six newborns with ABO hemolytic disease admitted in 2018 who received conventional outpatient follow-up after discharge served as the control group. The demographic characteristics, total serum bilirubin (TSB) level during hospitalization, number of outpatient visit and rate of re-admission due to rebound hyperbilirubinemia were compared between the two groups.@*RESULTS@#There were no significant differences between the two groups in gestational age, birth weight, delivery mode, gender, length of the first hospitalization, TSB level before phototherapy and before discharge, and the managements during the first hospitalization (all @*CONCLUSIONS@#The remote follow-up for neonatal jaundice at home can effectively reduce the number of outpatient visits without increasing the risk of readmission and severe neonatal hyperbilirubinemia for newborns with ABO hemolytic disease.

Breastfeeding Experiences of Taiwanese Mothers of Infants with Breastfeeding or Breast Milk Jaundice in Certified Baby-Friendly Hospitals

PURPOSE: The purpose was to explore the breastfeeding experiences of mothers of infants with breast-feeding or breast milk jaundice. METHODS: In-depth qualitative interviews and content analysis were conducted with nine mothers of newborns with breastfeeding and/or breast milk jaundice who breastfed their babies during the first year postpartum. RESULTS: Mothers' experiences can be described in four phases and six themes. (1) Prenatal stage: build breastfeeding belief, i.e., breastfeeding is best and a natural behavior, without awareness of neonatal jaundice; (2) stage after neonatal jaundice started to appear: include two themes, questioning beliefs in breastfeeding and happiness in being a mother. Mothers lacked knowledge and ignored the threat of neonatal jaundice, mainly focused on their physical discomforts and worried about insufficient breast milk; they also felt an intimate mothereinfant bond through breastfeeding; (3) stage when newborns had confirmed diagnosis of breastfeeding or breast milk jaundice that required medical attention: include two themes, diagnosis of breastfeeding or breast milk jaundice and phototherapy caused negative emotions and regaining original beliefs about breastfeeding. They struggled through emotional swings and inconsistent advices about whether phototherapy and formula supplementation are needed. Then, they decided breastfeeding or breast milk jaundice is only temporary and retrieved initial beliefs of breastfeeding. (4) Stage after neonatal jaundice faded and mothers continued breastfeeding: insisting and adapting. CONCLUSION: Breastfeeding mothers were unaware of neonatal jaundice until medical attention was required; they experienced physical and mental distress and gradually learned to manage jaundice while insisting on breastfeeding through their breastfeeding beliefs and happiness in being mothers.

InfLuences on accuracy of automated image-based estimation of neonataL serum biLirubin LeveL using smartphone appLication under different circumstances / 中华围产医学杂志

Objective To study the influence factors on the accuracy of a smartphone software application (APP) , which is an automated image-based bilirubin (AIB) testing technique for neonatal bilirubin. Methods This was a prospective study involving 179 jaundiced neonates admitted to the Department of Neonatology of the Affiliated Xuzhou Hospital of Southeast University from August to December, 2017. If blood sampling was required to determine total serum bilirubin (TSB), the transcutaneous bilirubin (TcB) and AIB on the sternum (glabella or the visible darkest yellow area were tested in 36 cases at the same time) were also tested. The concentrations of AIB were measured using a mobile phone-based neonatal jaundice monitoring APP with images taken by OPPO R11 smartphone (55 cases were also taken by Huawei Mate 8 and iPhone 6). The accuracy and non-inferiority of AIB comparing with TcB, the correlation and consistency between AIB and TSB and the value of AIB in predicting TSB were analyzed. Non-inferiority trial, student's t test, variance analysis, Pearson's correlation analysis, Bland-Altman plots and receiver operating characteristic (ROC) curve were used as statistical methods. ResuLts A total of 179 neonates were enrolled in this study with the mean gestational age of (36.2±2.1) weeks and the mean birth weight of (2 871±735) g. Based on all data, the mean difference between the absolute value of AIB minus TSB (|AIB － TSB|) and the absolute value of TcB minus TSB (|TcB － TSB|) was 0.77 mg/dl (1 mg/dl=17.1 μmol/L) with the 95%CI of (0.60-0.95) mg/dl, suggesting that the accuracy of AIB was not inferior to that of the TcB. Furthermore, AIB was not inferior to TcB in its accuracy in different subgroups based upon the time after birth ( ≤ 48 h and >48 h), gestational age (≤35 weeks and >35 weeks) and in the daytime subgroup. In the nighttime subgroup, the mean difference between ∣ AIB － TSB ∣ and ∣ TcB － TSB ∣ was 1.47 mg/dl [95%CI: (1.08-1.87) mg/dl], which indicated that the accuracy of AIB was inferior to that of the TcB. There were good correlation (r=0.788) and highly consistency between AIB and TSB based on all data [96.4% (238/247) of the samples were within the 95% limits of agreement of (－4.75 to 5.71) mg/dl]. Such results were also found in different subgroups, such as smartphone brands, detection areas, the time after birth and gestational age. The correlation and consistency between AIB and TSB in daytime subgroup (r=0.924, 98.4%) were obviously stronger than those of the nighttime subgroup (r=0.727, 87.5%). The mean difference between the absolute value of ocular value minus TSB (|ocular value－TSB|)and|AIB－TSB|was 2.13 mg/dl [95%CI: (1.68-2.58) mg/dl], implying a superior accuracy of AIB than ocular estimation. The areas under the ROC curves, the sensitivity and the specificity of AIB for the prediction of TSB >10, >15 and >20 mg/dl were 0.94, 93% and 85%; 0.89, 75% and 87%; and 0.84, 50% and 88%, respectively. ConcLusions AIB is not inferior to TcB in accuracy, and is significantly superior to ocular estimation. There are good correlation and strong consistency between AIB and TSB. The accuracy of AIB, and the correlation and consistency between AIB and TSB are less likely to be affected by the time after birth, gestational age, smartphone brands and areas being examined, but are largely affected when examining during nighttime. Therefore, it is recommended to detect AIB at daytime with bright natural light.

From suffering to resignation: Grounded Theory approach to maternal experience with newborn in phototherapy / Do sofrimento à resignação: experiência materna com recém-nascido em fototerapia na abordagem Grounded Theory

Abstract Objectives: understanding the experience of puerperal womenwith newborn in phototherapy treatment in rooming-in care. Methods: qualitative research analyzed according to the Grounded Theory and the results discussed in the light of Symbolic Interactionism. The interviews were audiotaped and transcribed in full. The theoretical saturation was based on the analysis of the 15th interview with puerperal women, undergoing the experience in the maternity of the Public Hospital of São Paulo State. Results: from the analysis emerged four categories (sub processes): getting disappointed with the bad news; feeling recluse, separated from her baby, accountable and with not enough support for care; resigning to the protective role of mother of a baby in suffering and at risk; seeking strategies to deal with the situation. From the realignment of these categories (sub processes) emerged the core category (process): from suffering to resignation in order to deal with the maternal experience with NB in phototherapy. Conclusions: the symbolic intervening component, mother's protective role, prompted her to attempt to cope with the challenging experience by feeling compelled to exercise the function of caretaker. The same way that the rooming-in care team emerged in the experience of the mother, using the same symbol, to hold her accountable for constant vigilance in maintaining the integrity of baby's vision.

Resumo Objetivos: compreender a experiência de puérperas com recém-nascido em tratamento fototerápico em alojamento conjunto. Métodos: pesquisa qualitativa analisada segundo a Teoria Fundamentada nos Dados e os resultados discutidos à luz do Interacionismo Simbólico. As entrevistas foram audio-gravadas e transcritas na íntegra. A saturação teórica deu-se a partir da análise da 15ª entrevista com puérperas, vivenciando a experiência em maternidade de Hospital Público do Estado de São Paulo. Resultados: da análise emergiram quatro categorias (subprocessos): decepcionando-se com a má notícia; sentindo-se reclusa, apartada do bebê, responsabilizada e com apoio insuficiente para o cuidado; resignando-se ao papel protetor de mãe de bebê em sofrimento e em risco; buscando estratégias para lidar com a situação. Do realinhamento dessas categorias (subprocessos) emergiu a categoria central (processo): do sofrimento à resignação para enfrentar a experiência materna com recém-nascido em fototerapia. Conclusões: o componente interveniente simbólico, papel protetor de mãe, impulsionou-a a tentativas de lidar com a experiência desafiante ao se sentir compelida ao exercício de cuidadora. Da mesma forma que, a equipe do alojamento conjunto emergiu na vivência dessa mãe, utilizando-se do mesmo símbolo, para responsabilizá-la pela vigilância constante na manutenção da integridade da visão do bebê.

Effects of different umbilical cord ligation methods on anemia and jaundice in preterm infants with a gestational age less than 32 weeks / 中华护理杂志

Objective To investigate the effects of different umbilical cord ligation methods on anemia and jaundice in preterm infants with a gestational age less than 32 weeks.Methods A total of 135 preterm infants with a gestational age less than 32 weeks were recruited and randomly divided into the umbilical cord milking group,the delayed cord clamping group and the immediate cord clamping group,with 45 cases in each group.Comparisons among three groups were performed on hemoglobin,hematocrit at 1 h and 1 week after birth,and bilirubin peak,total time of phototherapy,the incidence of anemia,pathologic jaundice as well as polycythemia before discharge.Results Finally 40 cases in the umbilical cord milking group,42 cases in the delayed cord clamping group and 38 cases in the immediate cord clamping group were recruited.Compared with the immediate cord clamping group,Hb(g/L)and hematocrit(％) levels were significantly higher in the umbilical cord milking group and the delayed cord clamping group(P＜0.05),the anemia rate was significantly lower in umbilical cord milking group and the delayed cord clamping group(P＜0.05).However,there were no statistical differences in Hb(g/L) and hematocrit(％) levels as well as ane mia rate between the umbilical cord milking group and the delayed cord clamping group (P＞0.05).There were no significant differences among three groups in bilirubin peak,total time of phototherapy and the incidence of pathologic jaundice as well as polycythemia.Conclusion Umbilical cord milking and delayed cord clamping can both reduce the anemia rate,but not increase the risk of pathological jaundice.Umbilical cord milking can be preferred method for preterm infants with a gestational age less than 32 weeks and asphyxia.

Effects of delayed umbilical cord clamping on maternal and neonatal outcomes / 中华护理杂志

Objective To determine the effects of delayed umbilical cord clamping on the postpartum hemorrhage,instant and long-term newborn anemia,newborn jaundice.Methods In total,303 infants were selected during October 2016 to June 2017 in three hospitals in Beijing.They were randomly allocated into two groups receiving instant clamping of umbilical cord (less than 60s after delivery,n=158) and delayed clamping of umbilical cord(after cord pulsation ceased,n=145).Relevant indicators of maternal and neonatal outcomes are compared.Results There were significant differences between two groups in instant hemoglobin concentration and in 5～7 days (P＜0.05).There were no differences between two groups in transcutaneous bilirubin,the risk of anemia in three months,the risk of jaundice in 5～7 days and the need of blue-light therapy (P＞0.05).There were no differences between two groups of women in postpartum hemorrhage,the length of third stage of labor and the rate of breast feeding (P＞0.05).Conclusion Clamping the umbilical cord when cord pulsation has ceased does not have negative effects on delivery process and postpartum hemorrhage,but it increases the instant hemoglobin concentration and hemoglobin concentration after delivery in 5～7 days.Still it is unclear whether it will affect the risk of jaundice.

Neonatal and early infantile jaundice: assessment by the use of the smartphone / 中国新生儿科杂志

Objective To assess the accuracy of automated image－based bilirubin ( AIB ) of newborns or early infants obtained using a smartphone application called BiliScan for Newborn Jaundice . Method Jaundiced neonates (gestational age≥35 weeks) and early infants (postnatal age≤60 days) from out－patient or in－patient of our hospital during November 2016 to September 2017 were prospectively included.The total serum bilirubin ( TSB ), transcutaneous bilirubin ( TcB ) and AIB on chest were completed simultaneously on hospitalization , pre phototherapy, 0 h and 12 ～24 h after cessation of phototherapy for in－patients, and after diagnosis of breast－feeding jaundice for out－patients participants.The AIB were all detected by smartphone with an application of BiliScan for Newborn Jaundice .Statistical analysis was performed by SPSS 20.0.Result A total of 296 sets of data were enrolled from 194 neonates or infants in this study.The accuracy of AIB was not inferior to the TcB (The difference between the mean of the absolute value of AIB －TSB and the absolute value of TcB －TSB was 0.77 mg/dl, 95% confidence interval were 0.63 ～0.91 mg/dl).These results of the subgroups from male and female term infants , postnatal age＞2 days and the value of TSB≤20 mg/dl were similar to the overall results.However, in the subgroup of TSB＞20 mg/dl, the accuracy of AIB was lower than that of TcB compared to TSB.There were good correlation (r＝0.824) and consistency (96.5% samples lay within the 95% limits of agreement ) between AIB and TSB.In the subgroup of 10 mg/dl ＜TSB≤20 mg/dl, the correlation and consistency between AIB and TSB were better than those of the subgroups of TSB ≤10 mg/dl and TSB ＞20 mg/dl. Furthermore, TSBs of 97.5% neonates were not beyond AIB plus 3.80 mg/dl.Conclusion When 10 mg/dl＜TSB≤20 mg/dl, the accuracy of AIB was not inferor to TcB , and the correlation and consistency between AIB and TSB were relatively superior.The application BiliScan for Newborn Jaundice was suitable for dynamic monitoring moderate jaundice of neonates and early infants at home.

A study on the correlation of miRNA in breast milk and neonatal breast milk associated jaundice / 中国新生儿科杂志

Objective To study the relationship of microRNA (miR) in breast milk and neonatal breast milk associated jaundice.Method From Sep.to Dec.2016,neonates with severe hyperbilirubinemia caused by breast milk were selected as the observation group,and breast-fed neonates without jaundice were selected as the control group.Their breast milk were collected,and the expression profile of miR in the breast milk was examined using miR sequencing.The variation of miR profile was screened using bioinformatics method,and miR related to neonatal breast milk associated jaundice was studied and the target genes were predicted.Result The breast milk contained many miRs associated with immunity regulation and metabolism,including miR-148-3p,miR-30a-5p,miR-146-5p,let-7f-5p,miR-181-5p,miR-22-3p,and miR-182-5p.The expressions of miR-30a-5p,miR-146a-5p and miR-141-3p in the observation group were significantly higher than the control group,and the differences were 2.600,2.038 and 1.899-fold,respectively.Uridine diphosphate glucuronosyl transferase1A1 gene was one of the target genes of miR-141-3p.Conclusion Breast milk miR may influence the growth and development,immunity regulation and metabolism of newborns.Some miRs,such as miR-141-3p,may be correlated with neonatal breast milk associated jaundice.

Clinical value of single photon emission computed tomography imaging in differential diagnosis of neonatal obstructive jaundice / 中国基层医药

Objective To investigate and explore the clinical value of single-photon emission computed tomography(SPECT) imaging in the differential diagnosis of neonatal obstructive jaundice.Methods From January 2012 to April 2017,130 cases of suspected neonatal obstructive jaundice in the First Hospital of Jiaxing were enrolled in the study.All patients were given SPECT hepatobiliary scintigraphy,were injected 99mTc-EHIDA imaging agent,99mTc-MIBI imaging agent,diagnosis of hepatobiliary scintigraphy after the acquisition.The result of operative cholangiography was viewed as the gold standard,the diagnostic sensitivity,specificity,accuracy of simple 99mTc-EHIDA SPECT imaging examination,combined with SPECT imaging agent in the diagnosis of neonatal obstructive jaundice were calculated and compared.The coincidence rate of differential diagnosis of different etiologies of neonatal obstructive jaundice was also compared.Results The diagnostic sensitivity,specificity and accuracy of combined with SPECT imaging agent in the diagnosis of neonatal obstructive jaundice were 94.23％,96.15％,94.61％,respectively,which of simple 99mTc-EHIDA imaging agent SPECT were 83.65％,76.92％,82.31％,respectively,the differences were statistically significant(x2 =5.915,4.127,9.646,all P ＜ 0.05).The coincidence rates of extrahepatic biliary atresia,hepatitis syndrome of the two kinds of SPECT imaging agents combined examination were 96.05％,96.43％,respectively,which were significantly higher than those of the 99mTc-EHIDA imaging agent SPECT examination (84.21％,85.00％) (x2 =5.991,5.250,all P ＜ 0.05).Conclusion SPECT imaging in the diagnosis of neonatal obstructive jaundice has high sensitivity and accuracy,especially in combination with 99mTc-EHIDA imaging agent,99mTc-MIBI imaging agent can identify and distinguish different causes of jaundice,and provide a reliable basis for clinical treatment.

Factores predisponentes para ictericia neonatal en los pacientes egresados de la UCI neonatal, Hospital Infantil los Ángeles de Pasto / Predisposing factors for neonatal jaundice in patients discharged from neonatal ICU, in los Ángeles children's Hospital in Pasto

Resumen Introducción: La ictericia neonatal es una de las condiciones más frecuentes en los recién nacidos, a pesar de ser benigna, un tratamiento inadecuado puede llegar a ser nocivo para el paciente. Objetivo: Determinar los factores predisponentes de ictericia neonatal en los pacientes egresados de la UCI neonatal del Hospital Infantil Los Ángeles de la ciudad de Pasto (Nariño) en el periodo enero de 2007 - agosto de 2011. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo y cuantitativo. Se estudiaron 608 historias clínicas de neonatos egresados con diagnóstico de ictericia neonatal; las variables estudiadas se analizaron con el complemento de Excel, XLSTAT-Pro 7.5.2. Resultados: Los principales factores predisponentes encontrados en la población, fueron la lactancia materna exclusiva y el género masculino en un 87%, y 57,40% respectivamente, además 90,79% fueron recién nacidos a término, 92,93% tuvieron peso adecuado para la edad gestacional y 54,93% presentaron ictericia neonatal entre los 2 y 7 días de vida extrauterina. Conclusiones: La ictericia neonatal está asociada a factores maternos y neonatales, tanto modificables como no modificables, que pueden ser abordados con estrategias adecuadas para reducir la carga de enfermedad.

Abstract Introduction: Neonatal jaundice is one of the most common conditions in newborns; however, improper treatment can be harmful to the patient, despite being benign. Objective: To determine the predisposing factors of neonatal jaundice in patients discharged from the neonatal ICU of Los Angeles children's Hospital in the city of Pasto (Nariño) between January 2007and August 2011. Materials and methods: An observational, descriptive, retrospective and quantitative study was conducted. 608 clinical histories of discharged infants diagnosed with neonatal jaundice were studied. The variables studied were analyzed with the complement of Excel, XLSTAT-Pro 7.5.2. Results: The main predisposing factors found in the population were exclusive breastfeeding and male gender in 87%, and 57.40% respectively; besides, 90.79% were newborns at term, 92.93% had adequate weight for their gestational age and 54.93% presented neonatal jaundice between 2 and 7 days of extrauterine life. Conclusions: Neonatal jaundice is associated with both modifiable and non-modifiable maternal and neonatal factors that can be addressed with appropriate strategies to reduce the burden of disease.

The clinical effect of live Bacillus Subtilis and Enterococcus Faecium granules combined with blue light irradiation in the treatment of neonatal jaundice / 中国基层医药

Objective To explore the clinical effect of live Bacillus Subtilis and Enterococcus Faecium granulescombined with blue light irradiation in the treatment of neonatal jaundice.Methods 90 patients with neonatal jaundice were randomly divided into control group and observation group.The control group received the blue light treatment,the observation group was given blue light irradiation combined with live Bacillus Subtilis and Enterococcus Faecium granules treatment,the patients were treated for 7 days.The clinical efficacy,serum bilirubin and main indicators of complex constant time were observed in the two groups.Results After treatment,the total effective rate of the observation group was 95.6％,which of the control group was 68.9％,the difference was statistically significant (x2 =5.473,P ＜ O.05).After treatment for 1 day,3 days,7 days,the serum bilirubin values of the observation group were (185.6 ± 25.1) μmol/L,(136.7 ± 19.1) μmol/L,(82.1 ± 10.3) μmol/L,respectively,which of the control group were (205.3 ± 26.4) μmol/L,(184.1 ± 20.3) μmol/L,(128.4 ± 16.7) μmol/L,the differences between the two groups were statistically significant (t =3.628,11.408,15.829,all P ＜ 0.05).The recovery time of serum bilirubin in the observation group was (7.1 ± 2.4) d,which of the control group was (12.9 ±3.1) d,there was significant difference between the two groups (t =9.924,P ＜ 0.05).The hospitalization time of observation group was (3.5 ± 1.1) d,which of the control group was (5.8 ± 1.5) d,the difference between the two groups was statistically significant (t =8.295,P ＜ 0.05).Conclusion Live Bacillus Subtilis and Enterococcus Faecium granules combined with blue light irradiation in the treatment of neonatal jaundice is helpful to improve the clinical efficacy,reduce the treatment time and improve the clinical symptoms.

The reliability of transcutaneous bilirubin measurements at different sites before and after phototherapy compared with total serum bilirubin in neonates / 中国新生儿科杂志

Objective To evaluate the accuracy of the transcutaneous bilirubin (TcB) at different sites including the chest (covered and uncovered),forehead and scapula,compared with total serum bilirubin (TSB) before and after phototherapy.Method Neonates who underwent blood test of TSB together with the average TcB at chest over 6 mg/dl from September 2015 to July 2016 in our Hospital were enrolled in our study.TcB measurements were done by the transcutaneous bilirubinometer (JH20-1 C) at the sites of the chest,forehead and scapula within 30 minutes after venous or arterious blood sampling for testing TSB after admission.An area of 2 cm diameter over the left chest was covered during phototherpy.TSB was tested immediately and within 12 ～ 24 hours after phototherapy,while TcB was measured within 0.5 hour after blood sampling at the covered sites over the left chest,right chest,forehead and scapula.IBM SPSS 20.0 software was used for data analysis.Data were compared via Pearson correlation analysis,ANOVA of repeated measurement data,student's t test and Bland-Altman analysis.Result A total of 437 data were collected from 364 neonates were enrolled in our study.Before phototherapy,the values of TcB at different sites were highly correlated and consistent with TSB (P ＜ 0.05),especially taken from the chest (the difference value of TcB and TSB-1.2 ± 2.3 mg/dl).Immediately and within 12 ～ 24 hours after the phototherapy,the values of TSB and TcB taken from the covered left chest showed the highest consistency (-1.2±2.3 mg/dl and-0.5 ± 1.6 mg/dl).When TSB exceeded 15 mg/dl before phototherapy,the difference between TSB and TcB taken from chest was 1.5 ± 1.6 mg/dl,while if TSB was below 15 mg/dl,the difference was-1.9 ± 1.9 mg/dl.They were significantly different (P ＜ 0.001).And difference between TSB and TcB taken from chest was not affected by gender gestational age,birth weight,days of birth and different measurements.When TcB taken from the covered or uncovered chest was less than the TSB threshold value of 3.3 mg/dl for phototherapyl,or the TcB of the left covered sternum lower than the threshold value of 2.6 mg/ml for cessation of phototherapy,97.5％ of the TSB would not exceed the corresponding value.Conclusion The TcB values of both uncovered chest before phototherapy and covered chest after phototherapy were highly consistent with TSB,and could be applied in the replacement of TSB in the assessment and management of neonatal jaundice.

Comparison of the effect and prognosis of intermittent blue light and continuous blue light therapy for neonatal jaundice / 中国基层医药

Objective To observe the effect of intermittent and continuous blue light therapy for pathological neonatal jaundice,and to evaluate the prognosis of newborns.Methods 214 patients with pathologic neonatal jaundice who treated with blue light irradiation were slected,they were randomly divided into two groups according to the admission number combined with single and double numbers,107 patients in each group.Group A received continuous blue light irradiation treatment.Group B received intermittent blue light irradiation.The clinical efficacy and prognosis of children,blue light exposure time,serum total bilirubin (TBiL) recovery time,the hospitalization time and the adverse reactions during the treatment were observed.The levels of serum TBiLwere measured before and after light exposure 3,5 days.Results The total effective rate of group B was 97.18％ (104/107),which was higher than that of group A [90.65 ％ (97/107)],the difference was statistically significant (x2 =10.30,P ＜ 0.05).The time of blue light irradiation and hospital stay time of group B were (71.59 ± 7.05) d and (11.51 ± 1.23) d,respectively,which were significantly shorter than those of group A [(79.54 ± 6.82) d and (13.64 ± 1.18) d],the differences were statistically significant (u =11.42,9.87,all P ＜ 0.05).The level of TBiL of group B was (96.28 ± 10.25) μmol/L,which was significantly lower than (104.52 ± 10.31) μmol/L of group A (u =8.94,P ＜ 0.05).The incidence rate of adverse reactions in group B was 2.55％ (4/157),which was lower than that in group A [7.01％ (11/157)],the difference was statistically significant (x2 =9.66,P ＜ 0.05).The prognosis of neonatal in the two groups was good.Conclusion The intermittent and continuous blue light in the treatment of pathological neonatal jaundice has good clinical effect and the neonatal prognosis is good.The clinical efficacy of intermittent blue light irradiation is better,which can significantly shorten the treatment time and has higher safety.

Close monitoring of transcutaneous bilirubin ensures better outcome in neonates with hyperbilirubinemia / 中华围产医学杂志

Objective To explore the influence of regular measurement of transcutaneous bilirubin (TcB) on clinical outcome of neonatal hyperbilirubinemia.Methods Healthy term and late-preterm newborns (gestational age ≥ 35 weeks) born between January 1 and December 31,2013 at Peking University Third Hospital were reviewed retrospectively.All neonates were divided into monitoring group (n=1 071)or control group (n=2 437) according to whether regular monitoring of TcB was performed.General clinical information and TcB levels on admission were recorded.The incidence of hyperbilirubinemia and readmission for hyperbilirubinemia,level of bilirubin and length of hospital stay were compared between the two groups.Chi-square test or independent sample t test were used for statistical analysis.Results (1) The incidence of hyperbilirubinemia and readmission rate for hyperbilirubinemia were lower in monitoring group when compared with control group [4.7％ (50/1 071) vs 7.1％ (172/2 437) and 1.3％ (14/1 071) vs 3.3％ (81/2 437) respectively,P＜0.05].There was no significant difference of bilirubin level and hospital stay between the two groups (P＞0.05).(2) Of all the 222 hyperbilirubinemia patients,the number of neonates with gestational age ＜37 weeks,37-38 weeks and ＞38 weeks was 26 (11.7％),33(14.9％) and 163(73.4％),respectively.There was no significant difference of gestational age,birth weight and gender proportion between the two groups.(3) The follow-up rate in January was 41.5％ (49/118),and the mean follow-up rate in February,April,July and October (with revised follow-up methods) was 83.1％ (345/415),higher than that in January (x2=82.505,P＜0.01).(4) The first three causes of hyperbilirubinemia in all 222 patients were early-onset breast milk jaundice (72 cases,32.4％),perinatal causes (60 cases,27.0％) and unknown reasons (50 cases,22.5％).The first three causes of hyperbilirubinemia in monitoring group (50 cases) were unknown reasons (24 cases,48.0％),early-onset breast milk jaundice (14 cases,28.0％) and hemolysis (9 cases,18.0％).Those in the control group (172 cases) were early-onset breast milk jaundice (58 cases,33.7％),perinatal causes (57 cases,33.1％) and unknown reasons (26 cases,15.1％).Conclusions Regular monitoring of TcB can reduce the incidence ofhyperbilirubinemia and the readmission for hyperbilirubinemia.

Efectividad de la fototerapia en la hiperbilirrubinemia neonatal / Effectiveness of phototherapy in neonatal hyperbilirubinemia / Efetividade da fototerapia na hiperbilirrubinemia neonatal

Introducción: La ictericia neonatal es la pigmentación amarilla de la piel causada por aumento de bilirrubina en sangre. Los tratamientos más utilizados para la hiperbilirrubinemia han sido la fototerapia y, la fototerapia más fenobarbital. Objetivo: Identificar las mejores evidencias para mejorar el uso y la efectividad de la fototerapia en el tratamiento de la hiperbilirrubinemia neonatal. Métodos: Se realizó una búsqueda de artículos publicados de 2007 a 2014 con las siguientes palabras clave, hiperbilirrubinemia neonatal, fototerapia de halógenos, fototerapia LEDS, en la Biblioteca Cochrane, en las Bases de datos REDALyC, Scielo, Medline, CINAHL y CUIDEN. Se identificaron 28 artículos relacionados con la efectividad de la fototerapia. Se realizó un análisis de los artículos encontrados. Resultados: La fototerapia con luz de LED tiene mayor eficacia en el control de bilirrubina sobre la fototerapia de halógeno y fibra óptica (diferencia de medias -0.43, IC 95%: -1.91 a 1.05 h). Las sábanas blancas alrededor de la cuna de calor radiante aumentan la eficacia de la fototerapia; respecto a la protección de los genitales, la literatura menciona que si los niveles de bilirrubina están muy altos se deberá quitar el pañal, solo cuando se utiliza la fototerapia de LEDS. Con cualquiera de los dispositivos de fototerapia se deberá utilizar protección ocular; se precisa que los cubre bocas o ese tipo de material no es útil para la aplicación de esta. Conclusiones: La fototerapia de mayor efectividad es de LEDS, las sábanas blancas aumentan la efectividad de la fototerapia, se puede quitar el pañal del neonato cuando la bilirrubina haya incrementado.

Introduction: newborn jaundice is the yellowish skin pigmentation caused by an increase in the blood bilirubin level. The most utilized treatments have been phototherapy and phototherapy plus phenobarbital. Objective: to identify the best evidence on the effective use of phototherapy as a treatment for newborn hyperbilirubinemia. Methods: a search was conducted on articles published from 2007 to 2014 using the keywords: hyperbilirubinemia, newborn, halogen phototherapy, and leds phototherapy, and included in the Cochrane Library, in REDALyC, Scielo, Medline, CINAHL, and CUIDEN databases. Twenty eight articles related to the effectiveness of phototherapy were identified and analyzed. Results: compared to halogen and optical fiber phototherapy, the leds light phototherapy is more efficient for the control of bilirubin (average difference -0.43, CI 95%: -1.91, at 1.05 hrs.). White sheets around the radiant heat cradle increase the effectiveness of phototherapy. With regard to protection of the genitals, the literature mentions that if the bilirubin levels are very high, the diaper must be removed but only while using leds phototherapy. Eye protection must be used with any phototherapy device. It is also mentioned that face masks or similar-material covers are not protective enough while giving these treatments. Conclusions: the leds phototherapy is the most effective treatment. White sheets augment the effectiveness of the phototherapy. The newborn diaper can be removed when the bilirubin level increases.

Introdução: A icterícia neonatal, pigmentação amarela da pele, é causada pelo aumento de bilirrubina no sangue. Os tratamentos mais utilizados para a hiperbilirrubinemia têm sido a fototerapia e a fototerapia com fenobarbital. Objetivo: Identificar as melhores evidências para melhorar o uso e a efetividade da fototerapia no tratamento da hiperbilirrubinemia neonatal. Métodos: Realizou-se uma busca de artigos publicados entre 2007 e 2014 com as seguintes palavras-chave: hiperbilirrubinemia em neonatos, fototerapia de halógeno e fototerapia de leds, na biblioteca Cochrane, nas bases de dados REDALyC, Scielo, Medline, CINAHL e CUIDEN. Identificaram-se 28 artigos relacionados com a efetividade da fototerapia. Realizou-se uma análise dos artigos encontrados. Resultados: A fototerapia com luz de led tem maior eficácia no controle de bilirrubina sobre a fototerapia de halógeno e a fibra óptica (diferença de medias -0,43, IC 95%: -1,91 a 1,05 horas). Os lençóis brancos em volta do berço de calor radiante aumentam a eficácia da fototerapia. Conforme a literatura recomenda para a proteção dos genitais, deve-se tirar a fralda se os níveis de bilirrubina estiverem muito altos, e só quando utilizar a fototerapia de leds. Como em todos os dispositivos de fototerapia deve utilizar-se proteção ocular, as máscaras faciais ou tipos destes materiais não são úteis para a sua aplicação. Conclusões: a fototerapia de maior efetividade é a de leds; os lençóis brancos aumentam a efetividade da fototerapia; pode-se tirar a fralda do neonato quando a bilirrubina seja incrementada.

Síndrome de Crigler-Najjar tipo 2 ? um caso atípico / Crigler-Najjar syndrome type 2 ? an atypical case

Objetivos: Os autores descrevem um caso de síndrome de Crigler-Najjar tipo 2, um distúrbio hereditário do metabolismo da bilirrubina, resultante de um déficit parcial da enzima uridino-difosfo-glicuronil-transferase (UDPG T).Descrição do caso: Uma lactente de etnia asiática foi internada com cinco semanas de vida por icterícia persistente desde o nascimento, com relato materno de agravamento progressivo. Ao exame objetivo apresentava-se ativa, reativa, ictérica e com ligeira hipotonia axial. A investigação complementar mostrou um aumento da bilirrubina total (32,94 mg/dL), com bilirrubina direta de 0,94 mg/dL, e o estudo molecular revelou duas mutações em heterozigotia no gene UGT1A1 (c.211G>A e c.1456T>G), resultado compatível com síndrome de Crigler-Najjar tipo 2. Foi submetida a fototerapia intensiva em associação com quelante dos ácidos biliares, com resposta parcial. Após conhecimento do resultado do estudo molecular iniciou fenobarbital, ocorrendo normalização dos valores de bilirrubina após duas semanas.Conclusões: A síndrome de Crigler-Najjar tipo 2, embora fenotipicamente semelhante ao tipo 1, tem tratamento e prognóstico diferentes. Neste caso, a apresentação neonatal precoce e os valores de bilirrubina muito elevados, que não cediam totalmente à fototerapia intensiva, levaram inicialmente à suspeita de síndrome de Crigler-Najjar tipo 1, que é a forma mais grave. Os autores pretendem com este caso alertar para uma causa rara de icterícia, que não teve a apresentação típica.

Aims: The authors describe a case of Crigler-Najjar syndrome type 2, an inherited disorder of bilirubin metabolism resulting from a partial deficit of the enzyme uridine- diphospho-glucuronyl transferase (UDPG-T).Case description: A female infant of Asian ethnicity was admitted with five weeks of age by persistent jaundice since birth, with maternal report of progressive worsening. Upon physical examination the patient was active, reactive, and jaundiced, with mild axial hypotonia. Complementary examination showed increase in total bilirubin (32.94 mg/dL), with direct bilirubin of 0.94 mg/dL, and molecular study revealed two heterozygous mutations in the UGT1A1 gene (c.211G>A and c.1456T>G), consistent with Crigler-Najjar syndrome type 2. She was submitted to intensive phototherapy in combination with bile acid chelator, with a partial response. After reading the results of molecular studies, phenobarbital was started, leading to normal levels of bilirubin in two weeks.Conclusions: Crigler-Najjar syndrome type 2, although phenotypically similar to type 1, has different prognosis and treatment. In this case, early neonatal presentation and very high bilirubin values not fully yielded to intensive phototherapy, initially raised the suspicion of Crigler-Najjar syndrome type 1, which is the most severe form of the syndrome. With this report, the authors wish to draw attention to a rare cause of jaundice, which did not have its typical course.