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1.
Rev. bras. cir. cardiovasc ; 36(2): 219-228, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1251096

ABSTRACT

Abstract Objective: To determine the possible risk factors associated with hepatic dysfunction during open-heart surgeries. Methods: After excluding 71 patients, 307 patients with possible low and moderate cardiac risk who underwent either coronary artery bypass graft surgery (CABG) (n=176) or valve repair surgery (mitral valve, mitral and aortic valves and/or tricuspid valve) (n=131) were investigated prospectively during a 6-month period. Hyperbilirubinemia is defined as an occurrence of a plasma total bilirubin concentration >34 µmol/L (2 mg/dL) in any measurement during the postoperative period; the patients were divided into groups with or without postoperative hyperbilirubinemia. The collected parameters were: alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), total bilirubin (TBil), gamma-glutamyl transpeptidase (GGT) and albumin. The parameters were collected preoperatively and postoperatively on days 1, 3 and 7. Preoperative, intraoperative, and postoperative risk factors were investigated. Logistic regression analysis was performed to identify the risk factors for postoperative hyperbilirubinemia. Results: Postoperative hyperbilirubinemia was observed in 7 of 176 patients (4%) who underwent CABG, and in 11 of 131 patients (8.4%) who underwent valve replacement surgeries. Independent risk factors for early postoperative hyperbilirubinemia were found as: ejection fraction (EF), aortic cross-clamp (ACC) time, intensive care unit stay and extubation time (P<0.001). In comparison to CABG procedures, postoperative hyperbilirubinemia was observed more frequently in patients undergoing valve surgeries (P=0.027). Conclusion: Low EF and prolonged ACC time are significant independent risk factors for early postoperative hyperbilirubinemia during open-heart surgeries with cardiopulmonary bypass. Valve surgeries show a higher incidence of hyperbilirubinemia in comparison to CABG.


Subject(s)
Humans , Heart Valve Prosthesis Implantation/adverse effects , Cardiac Surgical Procedures/adverse effects , Aortic Valve/surgery , Retrospective Studies , Risk Factors , Treatment Outcome , Hyperbilirubinemia/etiology , Mitral Valve/surgery
2.
Article in Chinese | WPRIM | ID: wpr-879884

ABSTRACT

OBJECTIVE@#To study brainstem auditory evoked potential (BAEP) in neonates with hyperbilirubinemia using short auditory stimuli (60 dBnHL), and to investigate the differences in the inter-aural latency difference (ILD) of wave V between neonates with different total serum bilirubin (TSB) levels.@*METHODS@#A prospective study was conducted in neonates with hyperbilirubinemia who were admitted to the Department of Neonatology, Yuhuan People's Hospital of Zhejiang Province, from May 2019 to October 2020. The neonates were divided into a severe group (@*RESULTS@#Compared with the mild group, the severe group had significantly higher proportions of neonates with abnormal hearing threshold and abnormal ILD (@*CONCLUSIONS@#Serum bilirubin in neonates affects the ILD of BAEP wave V, especially in those with severe hyperbilirubinemia. ILD at the optimal cut-off value of ≥0.4 ms shows potential value in the diagnosis of hearing impairment caused by neonatal hyperbilirubinemia.


Subject(s)
Bilirubin , Evoked Potentials, Auditory, Brain Stem , Hearing Loss , Humans , Hyperbilirubinemia , Hyperbilirubinemia, Neonatal , Infant, Newborn , Prospective Studies
3.
Rev. colomb. gastroenterol ; 35(1): 76-86, 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1115602

ABSTRACT

Resumen La colestasis es uno de los motivos de consulta más frecuentes en hepatología. Se genera por una alteración en la síntesis, la secreción o el flujo de la bilis, a través del tracto biliar. Esta se define por una elevación de enzimas como la fosfatasa alcalina (Alkaline Phosphatase, ALP) y la gamma-glutamil transferasa, y en estadios tardíos con la hiperbilirrubinemia, al igual que con otras manifestaciones clínicas, tales como el prurito y la ictericia. El enfoque diagnóstico implica establecer el origen de dicha elevación, determinando si es intrahepática o extrahepática. Si es intrahepática, se debe esclarecer si proviene de los hepatocitos o de la vía biliar de pequeño y de gran calibre. El tratamiento dependerá de la etiología, por lo cual es importante un diagnóstico preciso. En esta revisión se presenta la fisiopatología y un enfoque diagnóstico y terapéutico.


Abstract Cholestasis is one of the most frequent reasons for hepatology consultation. It is generated by altered synthesis, secretion or flow of bile through the biliary tract and is defined by elevated levels of enzymes such as alkaline phosphatase and gamma glutamyl transferase. In late stages, hyperbilirubinemia and clinical manifestations such as pruritus and jaundice develop. The diagnostic approach involves establishment of the reasons for elevated enzyme levels and determination of whether it is intrahepatic or extrahepatic. If it is intrahepatic, the source must be determined (hepatocytes, small bile ducts, or large caliber bile ducts). Treatment depends on the etiology, so accurate diagnosis is important. This review presents the pathophysiology and a diagnostic and therapeutic approach.


Subject(s)
Humans , Therapeutics , Cholestasis , Diagnosis , Pruritus , Lifting , Alkaline Phosphatase , Hyperbilirubinemia , Jaundice
4.
Rev Assoc Med Bras (1992) ; 66(7): 1002-1008, 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136306

ABSTRACT

SUMMARY The increase in bilirubin levels in newborns can cause toxic effects on the auditory system, which can lead to hearing loss. This review aimed to verify the impact of hyperbilirubinemia in the hearing of newborns, relating audiological findings to serum levels of bilirubin. A literature review was conducted during October 2017, using the terms "hyperbilirubinemia", "jaundice", "infant", "newborn" and "hearing loss", on databases CAPES journals, MEDLINE and BIREME (SciELO, BBO). 827 studies were identified and 59 were selected for full-text reading, resulting in the selection of seven articles that met the inclusion criteria and were considered relevant to the sample of this study. All the reviewed studies performed brainstem auditory evoked potential as the main test for audiological evaluation. Changes in the audiological findings of neonates with hyperbilirubinemia were observed in all studies. There was no consensus on the serum bilirubin levels that may cause auditory changes; however, the relationship between hearing disorders and blood levels of bilirubin was positive. We identify the need to establish reference values for bilirubin levels considered critical for the occurrence of hearing disorders as well as the audiological follow-up of neonates with hyperbilirubinemia.


RESUMO O aumento nos níveis de bilirrubina no neonato pode provocar efeitos tóxicos no sistema auditivo, podendo levar à perda auditiva. O objetivo desta revisão foi verificar o impacto da hiperbilirrubinemia na audição de recém-nascidos, relacionando os achados audiológicos aos níveis séricos de bilirrubina. Realizou-se uma revisão sistemática de literatura durante o mês de outubro de 2017, utilizando-se os termos hyperbilirubinemia, jaundice, infant, newborn e hearing loss, nas bases de dados periódicos Capes, Medline e Bireme (SciELO, BBO). Foram identificados 827 estudos, dentre os quais 59 foram selecionados para leitura do texto na íntegra, resultando na seleção de sete artigos que atendiam aos critérios de inclusão e foram considerados relevantes para a amostra deste trabalho. Em todas as pesquisas revisadas, o potencial evocado auditivo de tronco encefálico foi o principal exame audiológico realizado. Em todos os estudos foram observadas alterações nos resultados audiológicos de neonatos com hiperbilirrubinemia. Não houve consenso quanto aos níveis séricos de bilirrubina que podem causar alterações auditivas, porém, a relação entre as alterações audiológicas e os níveis sanguíneos de bilirrubina foi positiva. Percebeu-se a necessidade de estabelecer valores de referência para os níveis de bilirrubina considerados críticos para a ocorrência de alterações audiológicas, assim como de acompanhamento audiológico dos neonatos com hiperbilirrubinemia.


Subject(s)
Humans , Infant, Newborn , Evoked Potentials, Auditory, Brain Stem , Hearing Loss/complications , Audiometry , Bilirubin , Hyperbilirubinemia/complications
5.
Article in Chinese | WPRIM | ID: wpr-879767

ABSTRACT

OBJECTIVE@#To study the effectiveness of Saccharomyces boulardii combined with phototherapy in the treatment of hyperbilirubinemia in neonates.@*METHODS@#The neonates with hyperbilirubinemia who were hospitalized from January to December 2018 were enrolled and randomly divided into an observation group (n=61) and a control group (n=63). The neonates in the observation group were treated with phototherapy combined with Saccharomyces boulardii, and those in the control group were treated with phototherapy combined with placebo. Treatment outcomes were compared between the two groups. Fecal samples were collected 72 hours after treatment and 16s rRNA high-throughput sequencing was used to compare the features of gut microbiota between the two groups.@*RESULTS@#There was no significant difference in the total serum bilirubin level between the two groups before treatment (P>0.05). At 24, 48, and 72 hours after treatment, the observation group had a significantly lower level of total serum bilirubin than the control group (P<0.05). Compared with the control group, the observation group had a significantly lower proportion of neonates requiring phototherapy again [20% (12/61) vs 75% (47/63), P<0.05]. Compared with the control group, the observation group had a significantly higher abundance of Bacteroides (P<0.05) and a significantly lower abundance of Escherichia coli and Staphylococcus in the intestine at 72 hours after treatment (P<0.05).@*CONCLUSIONS@#In neonates with hyperbilirubinemia, phototherapy combined with Saccharomyces boulardii can effectively reduce bilirubin level and prevent the recurrence of jaundice. Saccharomyces boulardii can favour the treatment outcome by regulating the gut microbiota of neonates.


Subject(s)
Humans , Hyperbilirubinemia , Hyperbilirubinemia, Neonatal/therapy , Infant, Newborn , Phototherapy , Prospective Studies , RNA, Ribosomal, 16S , Saccharomyces boulardii
7.
Med. leg. Costa Rica ; 36(1): 73-83, ene.-mar. 2019.
Article in Spanish | LILACS | ID: biblio-1002560

ABSTRACT

Resumen La bilirrubina es el producto final de la degradación del grupo hem. La bilirrubina no conjugada (BNC) se forma en las células retículoendoteliales, transportada al hígado, donde es conjugada a glucurónidos y secretada a los canalículos. La BNC se solubiliza en el suero por medio de su fuerte unión con la albúmina. La unión bilirrubina-albúmina es una función de las concentraciones de la albúmina y de la bilirrubina y de la afinidad de unión por la bilirrubina. La fracción de bilirrubina no unida o bilirrubina libre plasmática (Bf) se incrementa significativamente conforme el nivel de bilirrubina sérica total (BST) alcanza la capacidad de unión de la albúmina. La Bf es considerada un mejor indicador de neurotoxicidad que la BST, a causa de que solamente la bilirrubina libre puede cruzar la barrera hematoencefálica. En la práctica médica la bilirrubina es un marcador de disfunción hepática, colestasis o enfermedad hemolítica. Una variedad de factores limita la sensibilidad y la especificidad de la medición de la bilirrubina para detectar anormalidades: lipemia, hemólisis, exposición a la luz visible y el estado de ayuno. La hiperbilirrubinemia puede ser clasificada como prehepática, hepática y poshepática, y esto brinda un marco útil para identificar la causa subyacente. Además, hay bilirrubina conjugada y no conjugada. La hiperbilirrubinemia y la ictericia neonatales se presentan en casi todos los recién nacidos y puede ser benigna si su progresión a hiperbilirrubinemia es reconocida, monitoreada y prevenida o tratada en una manera oportuna.


Abstract Bilirubin is the end product of heme breakdown. Unconjugated bilirubin (UB) is formed in reticuloendothelial cells, transported to the liver where it is conjugated to glucuronides, and then secreted into the canaliculi. UB is solubilized in serum via very tight linkage to albumin. Bilirubin-albumin binding is a function of the concentration of bilirubin and albumin and the binding affinity for bilirubin. The fraction of unbound bilirubin or plasma free bilirubin (Bf) increases significantly as the total serum bilirubin (TSB) level approaches the binding capacity of albumin. Bf is thought to be better indicator of neurotoxicity than TSB, because only plasma free bilirubin can cross the blood-brain barrier. In medical practice bilirubin is a marker of liver dysfunction, cholestasis or hemolytic disease. A variety of factors limit both the sensitivity and the specificity of bilirubin measurement to detect the abnormalities: lipemia, hemolysis, exposure of visible light and fasting state. Hyperbilirubinemia can be categorised as prehepatic, hepatic or poshepatic, and this provides a useful framework for identifying the underlying cause. In addition, there are conjugated and unconjugated bilirubin. Neonatal hyperbilirubinemia and jaundice occur in almost all newborns and may be benign if its progression to extreme hyperbilirubinemia is recognized, monitored and prevented or managed in a timely manner.


Subject(s)
Humans , Bilirubin , Biomarkers , Hyperbilirubinemia , Jaundice , Liver Function Tests
8.
S. Afr. fam. pract. (2004, Online) ; 61(5): 177-183, 2019. tab
Article in English | AIM | ID: biblio-1270115

ABSTRACT

Background:Babies who are delivered outside hospital are most at risk of serious illnesses such as perinatal asphyxia and severe hyperbilirubinaemia. These conditions are major contributors to neonatal mortalities in resource-poor settings. Objective: To explore the relationship between pre-admission and intra-facility care and immediate outcomes among neonates with acute bilirubin and hypoxic-ischaemic encephalopathies. Methods: Using a retrospective design, the outcome of outborn babies with acute bilirubin encephalopathy (ABE) and hypoxic-ischaemic encephalopathy (HIE) were studied in a Nigerian hospital between 2012 and 2016. Results: A total of 40 and 80 babies with ABE and HIE were studied. Among babies with ABE, 67.5% arrived at the hospital on self-referral and of the babies with official referral, only 61.5% had had a serum bilirubin check prior to referral. Among the babies with ABE, 25.0% had both social and facility-related challenges, 45.0% had only facility-related challenges and 20.0% had only social challenges. All the babies with ABE who died had either social or facility-related challenges. For the babies with HIE, 56.2% came on self-referral while 70% received no care prior to presentation at the hospital. Some 40% of babies with HIE had both social and facility-related challenges while 12.5% had only facility-related challenges. None of the babies who died presented early. Comparable proportions of babies who died or survived had social challenges and facility-related challenges. Conclusion: Most of the outborn babies with HIE and ABE who arrived at the hospital on self-referral and facility-based care were hindered by social issues and facility-related challenges


Subject(s)
Asphyxia , Hyperbilirubinemia , Hypoxia-Ischemia, Brain , Infant, Newborn , Nigeria
9.
Article in English | AIM | ID: biblio-1272009

ABSTRACT

Abstract: One of the challenges of managing significant neonatal hyperbilirubinaemia in resource-poor settings is limited access to effective phototherapy devices hence the need to try appropriate technologies. The objective was to assess the effectiveness of Compact Fluorescent Lamps phototherapy devices in the management of significant neonatal hyperbilirubinaemia in a resource-poor setting. A cohort of babies with significant hyperbilirubinaemia managed with locally fabricated Compact Fluorescent Lamps (CFL) phototherapy devices (2014-2016) were compared with historical controls managed with conventional imported phototherapy devices (2007-2010) for the severity of hyperbilirubinaemia and requirements for Exchange Blood Transfusion. A total of 96 babies in the subject group and 202 babies in the control group were studied. The proportion of babies with peak TSB >30mg/dl was significantly higher among the controls compared to the subjects (p < 0.001). The interval between the commencement of phototherapy and the peak TSB was greater than 1 day among 30.2% (29/96) subjects compared to 74.3% (150/202) babies in the control group (p < 0.001). The mean duration of phototherapy was significantly shorter for the subjects compared to the controls. EBT was performed for 38.5% of the subjects and 51.5% of the controls. Single sessions of EBT were required for 78.4% of the subjects compared to 45.2% of the controls (p = 0.001). In conclusion, the locally fabricated Compact Fluorescent Lamps phototherapy devices reduced EBT rate among babies with significant hyperbilirubinaemia


Subject(s)
Blood Transfusion , Hyperbilirubinemia , Hyperbilirubinemia, Neonatal , Phototherapy
10.
Pediatr. (Asunción) ; 46(3): 159-164, Set-Dic 2019.
Article in Spanish | LILACS | ID: biblio-1026149

ABSTRACT

Introducción: Las pautas para prevención y tratamiento de hiperbilirrubinemia neonatal recomiendan medición de bilirrubina sérica total (BST) o bilirrubina transcutánea (BTc) para determinar el grado de ictericia antes del alta del recién nacido (RN); ésta última no invasiva, proporciona información instantánea y de calidad superior a la evaluación clínica. A pesar de ello aún no ha sido aplicada en forma sistemática en los hospitales de Paraguay. Objetivo: evaluar la aplicación en nuestro medio de la medición de bilirrubinemia transcutánea antes del alta correlancionando con la bilirrubina sérica. Materiales y Métodos: Estudio observacional, descriptivo con componente analítico, de corte transversal. Fueron incluidos RN con edad gestacional ≥ a 35 semanas, con peso ≥ a 2000 gramos, luego de las 24 hs de vida hasta los 8 días; bajo consentimiento informado de los padres, durante un año. Los datos fueron consignados en una planilla de Microsoft Excel y procesado por el software IBM SPSS Statistics ®. Resultados: De 271 RN que ingresaron al estudio, en la primera medición con el Bilirrubinómetro transcutáneo, cumplían con criterios para toma de bilirrubina sérica 90 (33,2%) de ellos. En los restantes 181 RN (66,8%), los datos emparejados no estaban disponibles debido a que siguiendo las recomendaciones de las guías actuales no fue necesario medir la bilirrubina sérica. El valor del coeficiente de correlación para la primera medición fue r = 0.574. Para la segunda medición las medidas emparejadas estaban disponibles para 131 RN. En este caso se encontró correlación positiva entre ambos métodos de 0,590. Conclusión: La bilirrubina transcutánea puede utilizarse en forma rápida, segura y válida, como un test de screening para la detección de hiperbilirrubinemia y podría evitar una proporción importante de toma de muestras sanguíneas, mejorando la seguridad del paciente.


Introduction: The guidelines for prevention and treatment of neonatal hyperbilirubinemia recommend measurement of total serum bilirubin (BST) or transcutaneous bilirubin (BTc) to determine the degree of jaundice before discharge of the newborn (NB); the latter non-invasive method provides instant information which is superior to the clinical evaluation. Despite this, it has not yet been systematically applied in hospitals in Paraguay. Objective: to evaluate transcutaneous measurement of bilirubin concentration as compared to serum bilirubin levels prior to discharge in our setting. Materials and Methods: This was an observational, cross-sectional, descriptive study with an analytical component. For a period of one year, we tracked NBs with a gestational age ≥ 35 weeks, weighing ≥ 2000 grams, from 24 hours of life until 8 days of life, obtaining the informed consent of the parents. The data was entered in a Microsoft Excel spreadsheet and processed by the IBM SPSS Statistics ® software. Results: Of 271 NBs who entered the study, 90 (33.2%) met criteria for measurement of serum bilirubin at their first measurement with the transcutaneous bilirubinometer. In the remaining 181 RN (66.8%), the paired data were not available as measurement of serum bilirubin was not required per the recommendations of current guidelines. The correlation coefficient value for the first measurement was r = 0.574. For the second measurement, paired measurements were available for 131 NBs. In this case, a positive correlation was found between both methods of 0.590. Conclusion: Transcutaneous bilirubin can be used quickly, safely and accurately as a screening test for the detection of hyperbilirubinemia and could avoid a significant proportion of blood sampling, improving patient safety.


Subject(s)
Bilirubin , Infant, Newborn , Hyperbilirubinemia, Neonatal , Hyperbilirubinemia
11.
Article in Chinese | WPRIM | ID: wpr-781708

ABSTRACT

A girl was admitted to the hospital on day 2 after birth due to jaundice of the skin and sclera for half a day. The main clinical manifestations were persistent severe jaundice and thrombocytopenia, and she was finally diagnosed with congenital thrombotic thrombocytopenic purpura (TTP). Her conditions were improved after phototherapy, exchange transfusion, and infusion of fresh frozen plasma, red blood cells, and platelets. Gene detection showed a homozygous mutation of c.3650T>C(p.I1217T) in the ADAMTS13 gene, while her parents had a heterozygous mutation at this locus. Congenital TTP is a rare autosomal recessive disease, and timely infusion of fresh frozen plasma can achieve a good clinical outcome. This is the first case of congenital TTP caused by homozygous mutation at this locus reported in China and overseas.


Subject(s)
ADAMTS13 Protein , Anemia , China , Female , Humans , Hyperbilirubinemia , Infant, Newborn , Purpura, Thrombotic Thrombocytopenic
12.
Article in English | WPRIM | ID: wpr-763304

ABSTRACT

OBJECTIVES.: Neonatal hyperbilirubinemia is considered one of the most common causative factors of hearing loss. Preterm infants are more vulnerable to neuronal damage caused by hyperbilirubinemia. This study aimed to evaluate the effect of hyperbilirubinemia on hearing threshold and auditory pathway in preterm infants by serial auditory brainstem response (ABR). In addition, we evaluate the usefulness of the unconjugated bilirubin (UCB) level compared with total serum bilirubin (TSB) on bilirubin-induced hearing loss. METHODS.: This study was conducted on 70 preterm infants with hyperbilirubinemia who failed universal newborn hearing screening by automated ABR. The diagnostic ABR was performed within 3 months after birth. Follow-up ABR was conducted in patients with abnormal results (30 cases). TSB and UCB concentration were compared according to hearing threshold by ABR. RESULTS.: The initial and maximal measured UCB concentration for the preterm infants of diagnostic ABR ≥40 dB nHL group (n=30) were statistically higher compared with ABR ≤35 dB nHL group (n=40) (P=0.031 and P=0.003, respectively). In follow-up ABR examination, 13 of the ABR ≥40 dB nHL group showed complete recovery, but 17 had no change or worsened. There was no difference in bilirubin level between the recovery group and non-recovery group. CONCLUSION.: UCB is a better predictor of bilirubin-induced hearing loss than TSB in preterm infants as evaluated by serial ABR. Serial ABR testing can be a useful, noninvasive methods to evaluate early reversible bilirubin-induced hearing loss in preterm infants.


Subject(s)
Auditory Pathways , Bilirubin , Evoked Potentials, Auditory, Brain Stem , Follow-Up Studies , Hearing , Hearing Loss , Humans , Hyperbilirubinemia , Hyperbilirubinemia, Neonatal , Infant, Newborn , Infant, Premature , Mass Screening , Neurons , Parturition
13.
Blood Research ; : 108-113, 2019.
Article in English | WPRIM | ID: wpr-763063

ABSTRACT

BACKGROUND: Bendamustine is an attractive option for the management of both de novo and relapsed lymphomas. It is being increasingly used in the conditioning regimen for autologous stem cell transplantation (SCT) and can be an alternative to the traditionally-used carmustine. In this study, we aimed to determine the safety and efficacy of bendamustine in the conditioning regimen for autologous SCT in refractory/relapsed lymphomas. METHODS: We designed a descriptive study to evaluate bendamustine in combination with etoposide, cytarabine, and melphalan (BeEAM) in the conditioning regimen for autologous SCT. RESULTS: Fourteen patients (median age, 28 yr) with Hodgkin's lymphoma (HL) (N=8), non-Hodgkin's lymphomas (NHL) (N=5), or peripheral T-cell lymphoma, not otherwise specified (PTCL NOS) (N=1) were included in the study. A median number of 5.95×10⁶ CD34+ cells/kg were transfused. Median times to absolute neutrophil count and platelet engraftment were 17 days and 24 days, respectively. The 100-day transplantation mortality rate was 28% (4 patients). Eight patients (57.14%) had GII-III acute kidney injury, four patients (28.5%) had GIII-IV hyperbilirubinemia, and twelve patients (85%) had GII-III diarrhea. After 3 months, 37% (5 patients) and 21.4% (3 patients) demonstrated complete response and partial response, respectively. The median follow-up was 5.5 months (15 days–19 mo). At the final follow-up, 7 patients (50%) were alive and in CR. CONCLUSION: Our study showed that bendamustine is a potentially toxic agent in the conditioning regimen for autologous SCT, resulting in significant liver, kidney, and gastrointestinal toxicity. Further studies are required to assess its safety and efficacy at reduced doses.


Subject(s)
Acute Kidney Injury , Bendamustine Hydrochloride , Blood Platelets , Carmustine , Cytarabine , Diarrhea , Etoposide , Follow-Up Studies , Hodgkin Disease , Humans , Hyperbilirubinemia , Kidney , Liver , Lymphoma , Lymphoma, Non-Hodgkin , Lymphoma, T-Cell, Peripheral , Melphalan , Mortality , Neutrophils , Stem Cell Transplantation , Stem Cells
15.
Article in Chinese | WPRIM | ID: wpr-775132

ABSTRACT

OBJECTIVE@#To study the effect of red blood cell (RBC) storage duration on the clinical effect of exchange transfusion (ET) and internal environment in neonates with hyperbilirubinemia.@*METHODS@#A retrospective analysis was performed for the clinical data of 135 neonates with hyperbilirubinemia who received ET between January 2015 and August 2018. According to RBC storage duration, the neonates were divided into short-term storage group (RBCs were stored for ≤7 days) with 56 neonates and long-term storage group (RBCs were stored for >7 days) with 79 neonates. The two groups were compared in terms of serum total bilirubin (TBIL) level and the rate of TBIL reduction at 0 and 12 hours after ET, as well as the duration of continued phototherapy and rate of repeated ET. Routine blood test parameters, electrolytes, blood glucose, and blood gas parameters were measured before ET and at 0 hour after ET.@*RESULTS@#At 0 hour after ET, there were no significant differences in the TBIL level and the rate of TBIL reduction between the two groups (P>0.05). At 12 hours after ET, the long-term storage group had a significantly higher TBIL level and a significantly lower rate of TBIL reduction than the short-term storage group (P7 days in ET for neonates with hyperbilirubinemia does not affect the immediate effect of ET, but these neonates tend to have a poor outcome after continued phototherapy and high risk of hyponatremia, hyperkalemia, and metabolic acidosis.


Subject(s)
Bilirubin , Erythrocytes , Exchange Transfusion, Whole Blood , Humans , Hyperbilirubinemia , Hyperbilirubinemia, Neonatal , Infant, Newborn , Phototherapy , Retrospective Studies
16.
Article in English | WPRIM | ID: wpr-759583

ABSTRACT

BACKGROUND: In pregnant women, the frequency of irregular antibodies that cause hemolytic disease of the fetus and newborn (HDFN) vary between study populations. The clinical manifestations of HDFN differ according to the specificities and degree of irregular antibodies. This study examined the frequency and nature of maternal alloimmunization and neonatal outcomes. METHODS: Pregnant women, who underwent irregular antibody screening for prenatal testing at an obstetrics clinic in a single center, were enrolled. Those who screened positive for irregular antibodies were selected as the test group, and age- and obstetrics history-matched pregnant women were selected as the control group to evaluate the pregnancy outcomes according to irregular antibodies. RESULTS: The prevalence of irregular antibodies was 2.78% (42/1,508). With the exception of an unidentified antibody, anti-D was the most frequently identified antibody, followed in order by anti-E and anti-Le(a). The rate of fetal death was higher in the test group (6/37, 16.2%) than in the control group (1/37, 2.7%) (P=0.047). Eight pregnant women had anti-C or anti-D, one woman had a stillbirth, and four living neonates developed hyperbilirubinemia. Of six pregnant women with anti-E alone or with other alloantibodies, three experienced a spontaneous abortion or stillbirth. Among the six newborns with maternal anti-Le(a) and anti-Jk(a), four developed hyperbilirubinemia, but their mothers did not experience a spontaneous abortion or stillbirth. CONCLUSION: The prevalence of unexpected antibodies among pregnant Korean women was 2.78%. A significant difference in neonatal outcomes was observed, including the death rate, prematurity, and hyperbilirubinemia, depending on the specificity of the unexpected antibody.


Subject(s)
Abortion, Spontaneous , Antibodies , Female , Fetal Death , Fetus , Humans , Hyperbilirubinemia , Infant, Newborn , Isoantibodies , Mass Screening , Mortality , Mothers , Obstetrics , Pregnancy , Pregnancy Outcome , Pregnant Women , Prevalence , Sensitivity and Specificity , Stillbirth
17.
Article in English | WPRIM | ID: wpr-719401

ABSTRACT

Monitoring cerebral oxygenation using a near infrared spectroscopy (NIRS) device is useful for estimating cerebral hypoperfusion and is available during liver transplantation (LT). However, high serum bilirubin concentration can interfere with NIRS because bilirubin absorbs near infrared light. We report a patient who underwent LT with a diagnosis of vanishing bile duct syndrome, whose regional cerebral oxygen saturation (rSO₂) remained below 15% even with alert mental status and SpO2₂ value of 99%. The rSO₂ values were almost fixed at the lowest measurable level throughout the intra- and postoperative period. We report a case of erroneously low rSO₂ values during the perioperative period in a liver transplant recipient which might be attributable to skin pigmentation rather than higher serum bilirubin concentration.


Subject(s)
Bile Ducts , Bile , Bilirubin , Diagnosis , Humans , Hyperbilirubinemia , Hypoxia, Brain , Liver Transplantation , Liver , Oxygen , Perioperative Period , Postoperative Period , Skin Pigmentation , Spectrum Analysis , Transplant Recipients
19.
Rev. Hosp. Niños B.Aires ; 60(271): 328-332, 2018.
Article in Spanish | LILACS | ID: biblio-988165
20.
Article in English | WPRIM | ID: wpr-718955

ABSTRACT

PURPOSE: Subgaleal hemorrhage (SGH) is a rare but potentially fatal condition in newborns; however, few studies have reported on this condition. We aimed to identify the clinical characteristics and prognostic factors of SGH. METHODS: We retrospectively reviewed the medical records of 20 neonates diagnosed with SGH between January 2000 and June 2017. Enrolled neonates were clinically diagnosed when they had tender fluctuant scalp swelling that crossed the suture lines. RESULTS: Among 20 neonates with SGH, 12 were boys and 7 were girls; median hospitalization duration was 9.7±6.9 days. Fourteen neonates (70%) were born via vacuum-assisted vaginal delivery, and 4 via vacuum-assisted cesarean section. Of the neonates enrolled, half of them initially showed unstable vital signs, including apnea, desaturation, and cyanosis. Ten neonates had acidosis and 3 had asphyxia (pH < 7.0). Intracranial lesions associated with SGH were observed in 15 neonates (75%), including subdural hemorrhage (50%), subarachnoid hemorrhage (15%), intraventricular hemorrhage (5%), cerebral infarct (15%), skull fracture (30%), and cephalohematoma (20%). Twelve neonates (60%) required transfusion, 5 (25%) had seizures, and 3 (15%) died. Eight neonates (40%) had hyperbilirubinemia (mean total bilirubin, 13.1±7.4). The mean follow-up period was 8.4±7.5 months. At follow-up, 10 neonates (58.8%) were healthy with normal development, whereas 7 (41.2%) had neurological deficits. CONCLUSION: The morbidity rate was 41.2% due to severe metabolic acidosis. Anemia, hyperbilirubinemia, low Apgar scores, and subdural hemorrhage did not affect the prognosis. The long-term outcomes of neonates with SGH are generally good. Only arterial blood pH was significantly associated with death.


Subject(s)
Acidosis , Anemia , Apnea , Asphyxia , Bilirubin , Cesarean Section , Cyanosis , Female , Follow-Up Studies , Hematoma, Subdural , Hemorrhage , Hospitalization , Humans , Hydrogen-Ion Concentration , Hyperbilirubinemia , Infant, Newborn , Medical Records , Pregnancy , Prognosis , Retrospective Studies , Scalp , Seizures , Skull Fractures , Subarachnoid Hemorrhage , Sutures , Vacuum Extraction, Obstetrical , Vital Signs
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