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Background: Neonatal hyperbilirubinemia continues to be the most common cause of hospital admissions and readmissions in the neonatal population worldwide and this pattern continues despite attempts to identify neonates at risk of pathological hyperbilirubinemia. The aim of the study was to determine the clinical profile and etiology in neonates who were treated with double volume exchange transfusion (DVET).Methods: This was a hospital based prospective observational study in neonates ?35 weeks of gestation who were treated with DVET for severe hyperbilirubinemia in a tertiary care centre over a period of six months.Results: In our study 110 neonates with severe hyperbilirubinemia were treated with DVET. Majority of the neonates were males (59.1%). Lower segment caesarean section (LSCS) was the common mode of delivery observed in 66.4% of the study subjects. Rh incompatibility (36.4%) was the commonest cause of exchange transfusion followed by ABO incompatibility (20%). The mean age of neonates at admission and mean age at DVET in days were 4.03�46 and 4.25�44 respectively. The mean birth weight of neonates treated with DVET was found to be 2.81�57. The mean total serum bilirubin at pre-exchange and post exchange were 26.13�58 mg/dl and 11.63�24 mg/dl respectively.Conclusions: Rh incompatibility was the most common cause in neonates with severe hyperbilirubinemia requiring double volume exchange transfusion.
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Background: Neonatal jaundice is the most common problem in the first week of life leading to delayed hospital discharges and readmissions. Recognizing early neonatal hyperbilirubinemia plays a pivotal role in preventing serious complications. The aim of this study was to study the clinical profile and etiological factors leading to neonatal jaundice.Methods: This prospective observational study was conducted in the neonatal intensive care unit (NICU), department of pediatrics, government medical college, Srinagar, Jammu and Kashmir, India over a period of 6 months (August 2023 to January 2024). A total of 400 cases were enrolled for the study. Data collection was done by history taking, clinical examination and relevant laboratory investigations.Results: In this study, out of 400 jaundiced neonates, 236 (59%) were males and 164 (41%) were females, 342 (85.5%) were born at term and remaining 58 (14.5%) were preterm babies. Among 400 neonates studied, majority (80%) had birth weight ?2500 gm. Only 80 (20%) had birth weight less than 2500 gm. Physiological jaundice was seen in 162 (40.5%) of the total cases. This was followed by ABO incompatibility (20%), Rh incompatibility (16.5%), sepsis (8%), idiopathic (5%), prematurity (4%), cephalhematoma (4%) and breastfeeding jaundice (2%).Conclusions: This study concludes that physiological jaundice is the most common cause of neonatal jaundice in our hospital. This was followed by ABO incompatibility, Rh incompatibility and sepsis. This highlights the importance of appropriate monitoring of neonates with these underlying risk factors.
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Hyperbilirubinemia is one of the most widely seen causes of neonatal morbidity. Haemolytic disease of fetus and newborn is caused by maternal alloantibodies to the fetal RBCs. It is responsible for incompatibility between maternal and fetal blood groups, which results in destruction of fetal red blood cells causing hyperbilirubinemia. ABO and Rh incompatibility are the most common causes of severe indirect hyperbilirubinemia. Besides ABO and Rh isoimmunization, minor blood group incompatibilities such as anti-Kell, anti-C, anti-c, anti-E, anti MNS, Duffy, KIDD, P, Lutheran and Lewis have also been identified as causes of severe neonatal jaundice with an incidence of 385/1,00,000 live births in South-East Asia. We, hereby report a rare case of a full term 2.2 kg newborn presented with severe anemia with reticulocytosis and neonatal hyperbilirubinemia at second hour of life. In view of strongly positive DCT and no Rh negative or ABO setting, minor blood group incompatibility screening test was performed in the mother which revealed presence of multiple alloantibodies; however, the red cell phenotyping confirmed the presence of anti-c antibodies in maternal sera responsible for neonatal alloimmune haemolytic anemia. The baby was offered intensive phototherapy with intravenous immunoglobulin.
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Background: Neonatal hyperbilirubinemia (NH) is the most common abnormality seen during the neonatal period. It affects nearly 60% of term and 80% of preterm neonates during the first week of life. Early discharge of healthy term and late preterm newborns after normal vaginal delivery is a common practice however there are reports of bilirubin induced brain damage (kernicterus) occurring in these infants. Therefore, to ascertain whether cord albumin can be used as a reliable indicator for predicting neonatal hyperbilirubinemia.Methods: A tertiary care hospital-based cross-sectional study was conducted in 142 healthy late preterm and term newborns of either gender with icterus appearing only after 24 hour of life with no other illness using a non-probability sampling method. Data analysis was done using statistical package for the social sciences (SPSS) version 16. Chi-square was used to determine the association between cord albumin and hyperbilirubinemia.Results: There is a significant negative correlation between cord albumin and serum bilirubin at 72-96 hours of life (p=0.001). A total of 142 healthy late preterm and term neonates included. The study group based on Cord serum albumin (CSA) levels ?2.8 g/dl, 2.9-3.3 g/dl, and ?3.4 g/dl shows 77.27%, 22.7% and none respectively developed NH requiring phototherapy. According to receiver operating curve (ROC) analysis, the cutoff point of 2.75 g/dl provides the best sensitivity and specificity result.Conclusions: Cord serum albumin level ?3.4 g/dl are probably safe for early discharge whereas cord serum albumin level <3.4 g/dl will need a close follow-up to check for the development of jaundice.
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El shunt portosistémico congénito es una anomalía vascular venosa que comunica circulación portal y sistémica, por la que se deriva el flujo sanguíneo, salteando el paso hepático. Es una entidad poco frecuente, cuya incidencia varía entre 1/30 000 y 1/50 000 recién nacidos. Puede cursar de forma asintomática o presentarse con complicaciones en la edad pediátrica o, menos frecuente, en la edad neonatal. Ante el diagnóstico, se deberá definir la necesidad de intervención quirúrgica o intravascular para el cierre. Esta decisión depende de las características anatómicas de la malformación, de las manifestaciones clínicas y complicaciones presentes. Se presenta el caso de un paciente de un mes de vida derivado a nuestro centro para estudio de hepatitis colestásica neonatal, con diagnóstico de shunt portosistémico extrahepático. Se realizó cierre intravascular de la lesión con mejoría significativa posterior.
Congenital portosystemic shunt is a venous vascular abnormality that connects portal and systemic circulation, resulting in diversion of the blood flow, bypassing the hepatic passage. It is a rare malformation; its incidence varies from 1:30 000 to 1:50 000 newborns. It may be asymptomatic or present with complications in the pediatric age or, less frequently, in the neonatal age. Upon diagnosis, the need for a surgical or an intravascular intervention for closure should be defined. This decision depends on the malformation anatomical characteristics, clinical manifestations, and complications. We present the case of a 1-month-old patient referred to our center for the study of neonatal cholestatic hepatitis, with a diagnosis of extrahepatic portosystemic shunt. Intravascular closure of the defect was performed with significant subsequent improvement.
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Humanos , Masculino , Recién Nacido , Derivación Portosistémica Intrahepática Transyugular , Malformaciones Vasculares/complicaciones , Procedimientos Endovasculares , Hepatitis/diagnóstico , Hepatitis/etiología , Vena Porta/anomalíasRESUMEN
Abstract Objective: This study aimed to describe the effect of prophylactic phototherapy in the treatment of infants with Neonatal Hemolytic Disease. Method: A retrospective cohort study was carried out with 199 RhD-positive infants, born to RhD-negative mothers, alloimmunized for RhD antigen, between January 2009 and December 2018. Results: The incidence of exchange transfusions in the study population was 9.5%, with a mean maximum bilirubin value of 11.3 mg % (± 4.3mg %). Bilirubin's maximum peak was achieved with a mean of 119.2 life hours (± 70.6h). Conclusions: The low incidence of exchange transfusion, the extended maximum bilirubin peak for later ages, and the low mean of the maximum bilirubin values may indicate a positive effect of prophylactic phototherapy in the treatment of this disease. Further studies must be carried out to confirm these findings.
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Objectives: Neonatal hyperbilirubinemia leads to neurological damages including encephalopathy and hearing loss. This study aimed to screen and evaluate the hearing loss in neonates after recovery from hyperbilirubinemia using the Brainstem evoked response audiometry (BERA) test. Materials and Methods: This cross-sectional comparative study was conducted in Physiology Department at Chitwan Medical College, Nepal. It included 20 age and sex-matched neonates recently recovered from hyperbilirubinemia and 20 normal healthy controls. The external acoustic canals of subjects were checked for any blockage or collapse before BERA testing. The BERA recordings were performed after the neonate’s natural sleep following a standard lab protocol explained by Taylor’s Evoked Potential in Clinical Testing. Results: The BERA wave latencies were delayed with a higher number of case group neonates I (IL-75%, IR-80%), III (IIIL-70%, III R-80%), and V (VL- 80%, VR-85%) than those of controls. The percentage of neonates with delayed interwave latencies was comparable between groups. The neonate’s hearing sensitivity assessed using the grades of hearing impairment by WHO revealed slight (threshold of hearing left ear [THL]-25% and threshold of hearing right ear [THR]-30%) and moderate (THL-40% and THR-35%) grades among cases whereas no impairment (THL-60% and THR-55%) in controls. The hearing thresholds were more in cases. Conclusion: The auditory pathway is highly sensitive to elevated serum bilirubin. BERA detects even a minute degree of hearing damage seen after complete treatment of hyperbilirubinemia. Therefore, BERA is a helpful tool in the early screening of hearing impairment in neonates. This improves prognosis by early management so that the neurosensory systems develop to their full extent and one can enjoy a normal social life.
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Background: Hyperbilirubinemia in a neonate is one of the most common problems that may occur in 60-70 % of term and 80% of preterm babies. It is known to be associated with significant morbidity like neonatal bilirubin encephalopathy and even death. Clinically, and almost exclusively ABO incompatibility occurs in 'A' and 'B' blood group babies of O '+ve' mothers. These babies are reported to be at high risk of severe hyperbilirubinemia. So early intervention, at proper time, is mandatory to prevent these sequelae Methods: The aim is to determine the frequency of ABO and Rh blood group incompatibilities and associated incidence of hyperbilirubinemia for the purpose of instituting intervention for better neonatal outcomes. It was a descriptive cross-sectional study that includes 102 neonates born to mother with O or Rh-negative blood group admitted in the post-natal ward for routine newborn care. Serum bilirubin was documented in icteric neonates. Results: The incidence of ABO incompatibility in our study was 33.33% and of Rh incompatibility was 4.9%. In ABO and Rh incompatibility group, 41.17% and 20% new born respectively developed clinical jaundice. In ABO incompatibility group, majority, 64.28% did not require treatment, whereas in Rh incompatibility group 100% required treatment. In both ABO and Rh incompatibility exchange transfusion was not required. In ABO and Rh incompatibility, all new-born treated well and no kernicterus was seen. Conclusions: In ABO incompatibility, if jaundice develops, it remains in physiological limits. In presence of some aggravating conditions may present as pathological jaundice. It results in significant morbidity but no mortality, so prevention of aggravating factors is very important, in case of ABO and Rh incompatibility
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Objective:To compare the differences of hemolysis between OA and OB blood type in ABO hemolytic disease of the newborn (ABO-HDN), to study the clinical features of ABO hemolytic disease in different type.Methods:From January 2015 to June 2020, full-term ABO-HDN neonates born to blood type O mothers admitted to our hospital were enrolled in this retrospective study. The neonates were assigned into OA group and OB group. SPSS 25.0 software were used to analyze the clinical data.Results:A total of 755 cases were enrolled, including 364 cases of OA group and 391 cases of OB group. On hour-specific bilirubin nomogram, no significant differences existed in high intermediate risk zone between the two groups ( P>0.05). In the low risk zone and the low intermediate risk zone, the proportion of newborns in OA group was higher than the OB group ( P<0.05). In the high risk zone, the proportion of newborns in the OB group was higher than the OA group ( P<0.05). The age of admission of the OB group was younger than the OA group ( P<0.05). The incidences of immunoglobulin usage and blood transfusion in the OB group were higher than the OA group ( P<0.05). No significant differences existed between the two groups in Coombs? test, antibody elution test, free antibody test, platelet count, reticulocyte percentage, the onset time of jaundice, the median serum total bilirubin level, the average hemoglobin level and the incidence of anemia on admission ( P>0.05). No significant differences existed in the incidence of exchange transfusion, the duration of phototherapy and hospitalization between the two groups ( P>0.05). Conclusions:Compared with OA incompatibility, newborns with OB incompatibility have higher incidences of hyperbilirubinemia, blood transfusion and younger age of admission. However, the two groups have similar rate of exchange transfusion and phototherapy and hospitalization duration.
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Background: Neonatal Hyperbilirubinemia is one of the leading causes for admission in NICU in the first week of life. This condition if left untreated may lead to irreversible neurological damage hence increasing mortality and morbidity in newborns. Neonatal Hyperbilirubinemia is treated with phototherapy which employs blue wavelengths of light to change unconjugated bilirubin in the skin. The bilirubin is then converted to less toxic water-soluble photo-isomers that are excreted in the bile and urine. There are several toxic effects to the use of this treatment, one of them being hypocalcemia.Methods: This study has been done at Mahatma Gandhi Institute of Medical Sciences in 2016-2018 on 100 new-borns to prove the effect of phototherapy on serum calcium levels in neonates with hyperbilirubinemia. New-born who were admitted in NICU for Hyperbilirubinemia were screened according to inclusion and exclusion criteria, their sample for serum calcium and serum bilirubin levels were taken as pre and post phototherapy samples.Results: It was observed that the mean Serum calcium level before phototherapy in neonates was 9.31 mg/dl with standard deviation of 0.69 mg/dl. Whereas after phototherapy mean serum calcium level in neonates was 8.88 mg/dl with standard deviation of 0.73 mg/dl. There was statistically significant mean difference in serum calcium level at before and after phototherapy in neonates (p<0.0001).Conclusions: This study proves the hypothesis that phototherapy can cause hypocalcemia in neonates with hyperbilirubinemia.
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Background: Neonatal jaundice is the most commonly observed clinical condition of early neonatal period. It remains a common cause of readmission and important cause of concern for the parents and clinicians. Therefore, appropriate management of neonatal hyperbilirubinemia is of paramount importance. Phototherapy plays a significant role in its management but this modality is not devoid of complications. Authors studied electrolyte changes in the neonates, who received phototherapy.Methods: This perspective hospital based observational study conducted over the period of one year on 90 eligible admitted neonates who received phototherapy as per AAP guideline. Serum bilirubin, sodium, potassium and calcium were determined before and after termination of phototherapy. The first samples were considered as controls and compared with the samples collected after termination of phototherapy.Results: The incidence of LBW babies in this study was 21.9%, while mean birth weight and gestational age was2.76±0.38 kg and 38.34±0.88 weeks respectively. Mean duration of phototherapy was 38.48±09.34 hours. The mean sodium, potassium and calcium level before therapy were 146.6±6.2 mg/dl, 4.7±0.47 mg/dl and 9.4±0.73 mg/dl respectively. Authors found statistically significant changes in the electrolyte’s levels (Na+ 141.3±6.1, K+ 4.2±0.51 and Ca+2 8.4±0.68 respectively), after phototherapy however none of any neonate shown any clinical signs of dyselectolytemia.Conclusions: Neonates undergoing phototherapy are at greater risk of dyselectrolytemia especially in preterm babies therefore close clinical and biochemical monitoring is required for the prompt management of any significant electrolyte imbalance.
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Background: NH affects nearly 60% of term and 80% of preterm neonates during first week of life. 6.1% of well term newborn have a serum bilirubin over 12.9 mg%. Serum bilirubin over 15 mg% is found in 3% of normal term newborns. Neonatal Hyperbilirubinemia (NH) is a cause of concern for the parents as well as for the paediatricians. Aim of study to find out the association between various levels of cord serum albumin (CSA) and significant neonatal hyperbilirubinemia requiring interventions like phototherapy or exchange transfusion and whether it can be used as a risk indicator for subsequent development of significant jaundice.Methods: The present study was conducted on 150 randomly selected eligible term neonates delivered at Department of Pediatrics, Rajkiya Mahila Chikitsalaya, JLN Medical College and Associated Group of Hospitals, Ajmer, India.Results: Authors conducted a prospective study on 150sequentially born term babies. Cord blood was collected at birth and cord serum albumin estimation was done within 4-6 hours of collection of the blood. Cohort was grouped into Group 1, Group 2 and Group 3 based on CSA level ≤ 2.8g/dl, 2.9-3.3g/dl and ≥ 3.4 g/dl respectively. Knowledge of risk factors of NH in neonates could influence decision of early discharge vs. prolonged observation cord serum albumin level of ≤ 2.8g/dl has a correlation with incidence of significant hyperbilirubinemia in term newborns. So this ≤ 2.8g/dl of cord serum albumin level can be used as risk indicator to predict the development of significant hyperbilirubinemia. Whereas cord serum albumin level ≥3.4g/dl is considered safe.Conclusions: Term neonates with hyperbilirubinemia with a total serum bilirubin level ≥17 mg/dl had levels of cord serum albumin of ≤ 2.8 g/dl, and this can be used as a risk indicator to predict the development of NH.
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Introducción: Se ha establecido que la fototerapia con tecnología LED es más efectiva que la fototerapia convencional para el tratamiento de hiperbilirrubinemia neonatal al reducir el número de horas de tratamiento requerido en los recién nacidos a término y pretérmino. El objetivo del presente estudio fue realizar un estudio clínico aleatorizado con tres tipos de lámparas incluida una de prototipo. Métodos: En el presente estudio clínico con un diseño paralelo de tres grupos, participaron recién nacidos con necesidad de tratamiento por hiperbilirrubinemia, ingresados en la Unidad de Neonatología del Hospital Homero Castanier Crespo en Azogues-Ecuador. Fueron distribuidos en 3 grupos: Grupo 1 (G1) Fototerapia con lámpara fluorescente, Grupo 2 (G2) fototerapia LED comercializada (Medix®, Mediled®), Grupo 3 (G3) con Fototerapia LED de prototipo. Se mide la concentración de bilirrubinas y la diferencia de medias de su reducción en cada grupo para demostrar no inferioridad. Resultados: El peso en G1 (n=30) fue 3050 ±134 gr, en G2 (n=30): 3200 ±186; G3 (n=30): 3034 ±234 (P=0.70). La edad gestacional en G1: 39 ±1 semanas, en G2 39.1±1.1, en G3 39 ±1.1 (P=0.80). Bilirrubina en G1: 15.8 ±6.2, en G2: 14. 93 ±5.9 y en G3: 15.62 ±5.9 mg/dl. (P=0.60). Las diferencias de bilirrubina (Delta 1) pre-tratamiento y a las 24 horas de tratamiento fueron -2.4 en G1, -2.4 en G2 y -2.25 mg/dl en G3 (P=0.60). Delta 2 a las 48 horas: -4.5 en G1, -4.26 en G2 y -4.42 mg/dl en G3 (P=0.62). Conclusión: los tres tratamientos demostraron No inferioridad en el tratamiento de hiperbilirrubinemia neonatal
Introduction: It has been established that phototherapy with LED technology is more effective than conventional phototherapy for the treatment of neonatal hyperbilirubinemia by reducing the number of hours of treatment required in term and preterm newborns. The objective of the present study was to carry out a randomized clinical study with three types of lamps, including a prototype. Methods: In the present clinical study with a parallel design of three groups, newborns with need of treatment for hyperbilirubinemia, admitted to the Neonatology Unit of the Homero Castanier Crespo Hospital in Azogues-Ecuador, participated. They were divided into 3 groups: Group 1 (G1) Phototherapy with fluorescent lamp, Group 2 (G2) commercialized LED phototherapy (Medix®, Mediled®), Group 3 (G3) with prototype LED phototherapy. The bilirubin concentration and the mean difference of its reduction in each group are measured to demonstrate non-inferiority. Results: The weight in G1 (n = 30) was 3050 ± 134 gr, in G2 (n = 30): 3200 ± 186; G3 (n = 30): 3034 ± 234 (P = 0.70). Gestational age in G1: 39 ± 1 weeks, in G2 39.1 ± 1.1, in G3 39 ± 1.1 (P = 0.80). Bilirubin in G1: 15.8 ± 6.2, in G2: 14. 93 ± 5.9 and in G3: 15.62 ± 5.9 mg / dl. (P = 0.60). The differences in bilirubin (Delta 1) pre-treatment and at 24 hours of treatment were -2.4 in G1, -2.4 in G2 and -2.25 mg / dl in G3 (P = 0.60). Delta 2 at 48 hours: -4.5 in G1, -4.26 in G2 and -4.42 mg / dl in G3 (P = 0.62). Conclusion: the three treatments demonstrated non-inferiority in the treatment of neonatal hyperbilirubinemia
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Humanos , Fototerapia , Terapia PUVA , Recién Nacido , Hiperbilirrubinemia NeonatalRESUMEN
Background: The most commonly used light sources in the conventional phototherapy units are compact fluorescent lamp (CFL), halogen spotlights and fiberoptic blankets. Recently light emitting diodes (LED) has emerged as better light source for phototherapy and almost replacing all the available conventional light sources. Comparative studies on the efficacy of LED versus conventional phototherapy are limited from India. That is why; this study was undertaken.Methods: 48 neonates of ≥35 weeks gestational age with hyperbilirubinemia were participated in this study. Among them, 24 neonates received conventional phototherapy and rest of them received LED phototherapy. The rate of fall of bilirubin levels at 6 hours and at completion along with total duration of phototherapy in both groups was measured. Results analysed by standard statistical methods.Results: LED phototherapy units showed higher rate of fall in bilirubin at six hrs (LED group: 0.38±0.05 mg/dl/hr versus conventional group: 0.30±0.04 mg/dl/hr, p<0.05) and after completion of therapy (LED group: 0.32±0.03 mg/dl/hr versus conventional group: 0.26±0.03 mg/dl/hr, p<0.05) compared to conventional group. Significant difference was documented in total duration of phototherapy in LED group (30.8±1.8 hours) when compared to conventional group (34.6±0.7 hours). None of the neonate showed phototherapy failure. Side effects were minimal and comparable in both the groups.Conclusions: The LED phototherapy units are more efficacious in terms of higher rate of fall of bilirubin levels and lesser duration of phototherapy compared to conventional phototherapy units.
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Background: Hyperbilirubinemia is one of the common causes of neonatal admission. As clinical evaluation may cause a delay in identification and subsequent initiation of medical therapy, there is a need for the sensitive and inexpensive predictive marker for hyperbilirubinemia in neonates. Measurement of cord albumin and its correlation with the serum bilirubin is one of the noninvasive predictive markers for Hyperbilirubinemia. The present study carried out to know the significance of umbilical cord albumin level as a predictor of neonatal hyperbilirubinemia.Methods: It is a hospital-based prospective cohort study, total 100 healthy term new-borns admitted in the Neonatal Intensive Care Unit, were included in the study as per study protocol over a period of one year. The blood sample was collected from umbilical cord blood for the analysis of bilirubin and albumin, and post 72 hours of life venous blood obtained for estimation of serum bilirubin and albumin along with direct and indirect Coombs test.Results: In this study most of the patients were in the gestational age of 37-38 weeks (71%) followed by 38-40 weeks (27%) and only 1% are >40 weeks. A positive correlation was observed between cord blood bilirubin, serum bilirubin, serum albumin, and cord blood albumin levels. Cord blood albumin was a better marker for neonatal hyperbilirubinemia with a sensitivity of 83%, and a specificity of 48%; as compared to cord blood bilirubin with a sensitivity and specificity of 73% and 39% respectively.Conclusions: From this study, cord blood albumin level was demonstrated as a good predictive marker for neonatal hyperbilirubinemia with a sensitivity of 83.1%. and specificity 48.8%. Hence, cord blood albumin may be used as a non-invasive predictor for neonatal hyperbilirubinemia.
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Background: Measuring the Cord blood Albumin level and predicting neonatal hyperbilirubinemia.Methods: Prospective study was performed on 160 healthy term neonates. Relevant maternal history was collected. Cord blood was collected from the healthy term neonates at birth and cord serum albumin measured. Neonate was assessed for jaundice every day using transcutaneous bilirubinometer. Total Serum Bilirubin (TSB) was assessed if the Transcutaneous Bilirubin (TCB) values were found high and treated according to NICU protocol.Results: Study cohort was grouped as Group A, Group B and Group C based on Cord Serum Albumin (CSA) level ?3.3 g/dl, 3.3-3.8 g/dl and ?3.8 g/d respectively. Statistical analysis was done for correlation of CSA with Neonatal Hyperbilirubinemia (NH). It showed that cord serum albumin level ?3.8 g/dl is critical, as it was seen in 9.1% of neonates who developed neonatal hyperbilirubinemia (p value-0.032).Conclusions: There is a correlation between cord serum albumin level and neonatal hyperbilirubinemia. Cord serum albumin level of ?3.8 g/dl is a risk indicator in predicting the development of neonatal hyperbilirubinemia.
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@#Haemoglobin Constant Spring (Hb CoSp) and Haemoglobin Adana (Hb Adana), are two non-deletion type of α-thalassemia reported in Malaysia. Owing to their structural instability, they cause hemolysis and hyperbilirubinemia. This observational study was part of a large study investigating multiple factors associated with severe neonatal jaundice. In this part we aimed to determine the prevalence of Hb CoSp and Hb Adana and their association with clinically significant neonatal hyperbilirubinemia (SigNH, total serum bilirubin (TSB>290µmol/L)) among jaundiced Malaysian term neonates. Materials and Methods: The inclusion criteria were normal term-gestation neonates admitted consecutively for phototherapy. PCR-restriction fragment length polymorphism method was applied on DNA extracted from dry blood spot specimens of each neonate to detect for Hb CoSp and Hb Adana gene. Positive samples were verified by gene sequencing. Results: Of the 1121 neonates recruited (719 SigNH and 402 no-SigNH), heterozygous Hb CoSp gene was detected in only two (0.27%) neonates. Both were SigNH neonates (0.3% or 2/719). No neonate had Hb Adana variant. Conclusion: Hb CoSp was not common but could be a risk factor associated with SigNH. No Hb Adana was detected.
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Background: As Indian women has increased risk of developing GDM, screening for GDM is essential for early diagnosis and treatment and hence to reduce the adverse neonatal outcomes.Methods: The antenatal women are screened for GDM by administering 50g GCT and the screening test value of >130mg/dl measured at 1 hours were considered screening test positive and subjected to standard 2 hour 75gm OGTT and the neonatal outcome were observed in relation to neonatal birth weight, Apgar, and the occurrence of complications like hypoglycemia, hypocalcemia, hyperbilirubenemia.Results: The average neonatal birth weight in the study population was 3kg. The women with GDM who required diet alone had average neonatal birth weight of 2.9kgs and the GDM women who were on diet and insulin therapy had average neonatal birth weight of 3.4kg. There was increased incidence of hyperbilirubinemia 33.3% .There was only 1 preterm birth.Conclusions: There is association with neonatal Complications like hyperbilirubenemia and hypoglycemia with women who had screening positive for GDM.
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Background: Neonatal Hyperbilirubinemia (NH) is the commonest abnormal physical finding during the first week of life and also the most common cause for readmission during the early neonatal period is a cause of concern for the parents as well as for the Pediatricians. Hence appropriate management of Neonatal Hyperbilirubinemia is of paramount importance. Phototherapy plays a significant role in prevention and treatment of hyperbilirubinemia. However, this treatment modality may itself result in inherent complications. The present study was carried out with the objective of evaluating the sodium and potassium changes in neonates receiving phototherapy for neonatal hyperbilirubinemia.Methods: A prospective hospital based observational comparative study conducted on 96 eligible term neonates admitted in the neonatal intensive care unit receiving phototherapy at a teaching Hospital from October 1st to December 31st 2018. A predesigned proforma has aided the enrolment of new-borns into the study according to AAP guidelines. Serum bilirubin, sodium and potassium were determined before and after termination of phototherapy. The first samples were considered as controls. A comparative study was made between before and after phototherapy groups to determine the incidence of sodium and potassium changes.Results: The study group included 96 term neonates that were managed with phototherapy. Incidence of low birth weight babies was 21.9%. Mean birth weight and gestational age was 2.76'0.38 kg and of 38.34'0.88 weeks respectively. Mean duration of phototherapy was 38.48'09.34 hours. The incidence of Sodium and potassium changes were found to be statistically significant after phototherapy (p<0.01) but neonates didn't develop any signs of hyponatremia and hypokalemia.Conclusions: The study shows that neonates undergoing phototherapy are at a higher risk of sodium and potassium changes. This risk is greater in LBW babies and hence this group of babies should be closely monitored for changes in sodium, potassium and should be managed accordingly.
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Background: Acute Bilirubin Encephalopathy and kernicterus is an important cause of cerebral palsy, developmental delay and hearing impairment in low-middle income countries. Interventions such as universal screening for neonatal jaundice, Rhesus immunoglobulins, intensive phototherapy and exchange transfusion have made kernicterus rare in high income countries, but in our set up such cases continue to be reported. Methods: Retrospective observational study where case records of term neonates brought to the neonatal ICU with signs and symptoms of acute bilirubin encephalopathy during the years 2016 and 2017 were sought and analysed.Results: A total of ten term babies reported to the neonatal unit with severe hyperbilirubinemia along with signs and symptoms of bilirubin encephalopathy of which 60% were females. 90% had a birth weight of more than 2.5 kg and mean birth weight was 2.7±0.25 kgs. All the babies were out born. A 4 babies were born at home of which 3 pregnancies were completely unsupervised during the antenatal period. 90% of the babies were from the rural areas, 6 of the cases were from the districts Rajouri, Poonch and Reasi where the terrain is hilly, 2 from rural areas of Jammu and 1 from Kathua. Only 1 was from the Jammu city. The age at admission ranged from 3-9 days and serum bilirubin from 24 to 43.3 mg %. A 5 babies had ABO incompatibility, 1 Rh incompatibility, 1 sepsis, while no cause could be found in 3.Conclusions: Neonatal jaundice is often not easily appreciated by mothers and caregivers in the home setting until it becomes severe enough, at which point neurological damage may have already occurred. There is an urgent need to train the primary health care personnel in assessment and early identification of risk factors for severe neonatal hyperbilirubinemia. They can help the families to seek prompt treatment for this preventable cause of cerebral palsy and mental retardation.