RESUMO
Objective: To determine clinical features, etiology and risk factors in term and near term newborns with severe hyperbilirubinemia
Methods: During ten years period [2000 - 2009], infants of > 35 gestational weeks who received phototherapy were evaluated retrospectively. The study population was divided into two groups and clinical features, etiology and risk factors were compared. Group 1 defined by those who had bilirubin level >25 mg/dl [severe hyperbilirubinemia] and group 2 defined by bilirubin level <25 mg/dl
Results: During the study period 1335 babies were evaluated. Severe hyperbilirubinemia was found in 137 [10.3%] patients
Total serum bilirubin level was 29.7+/-4.7 mg/dl in group 1 and 18.9+/-3.5 mg/dl in group 2. Pathological weight loss, vaginal delivery and supplementary feeding were identified as significant risk factors for development of severe hyperbilirubinemia [p < 0.001, p < 0.001 and p = 0.04, respectively]
The time at recognition of jaundice by family and postnatal age at admission were significantly higher in group 1
The ratios of previous sibling received phototherapy and being the second child or after were found higher in group 1
Conclusion: Pathological weight loss, vaginal delivery and supplementary feeding were determined as risk factors for development of severe hyperbilirubinemia. The newborns with severe hyperbilirubinemia had late recognition of jaundice and admission to hospital by their families
RESUMO
To evaluate early aggressive vs. conservative nutrition and its effect on Retinopathy of Prematurity [ROP] in <32 weeks of gestation neonates. A prospective, randomized, clinical study was conducted in NICU with a total of 75 preterm infants. In the intervention group, infants received early aggressive nutrition immediately after birth, in the control group infants were started on conventional parenteral nutrition [PN]. Blood samples were obtained for Insulin-like growth factor 1 [IGF-1] and insulin-like growth factor binding protein 3 [IGFBP3] levels before commencement of PN on the first postnatal day, and from week 1 to 6 every week. All the infants were examined for ROP. Infants in the early aggressive group had a reduction in the risk of ROP of 5% [2 from 40]; the number of infants needed treatment averaged 3.7 [2.7 to 5.2]. A total of 11 neonates in the conventional group were detected having ROP [P<0.05]. Overall, IGF-I levels were higher in the aggressive PN [APN] vs the conventional PN [CPN]. ROP development was higher in the CPN compared to the APN. IGF-1levels were lower in ROP developers compared with non-ROP in the APN group. There was no difference in IGF-I levels in ROP developers versus non-ROP in the CPN group. IGF-1 levels were lower in the CPN group compared with the APN group in the third week in ROP developers. There was a correlation between ROP and IGF-1 levels. Through ROC analysis, IGF-1 was demonstrated as being a sensitive marker for ROP. IGF-1 levels were higher in the APN group versus the CPN group. This may indicate that IGF-1 levels simply being higher is not enough; rather, that being higher above a cutoff value may prevent ROP