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Neonatal hyperbilirubinaemia, clinically presenting as jaundice, is a ubiquitous and commonly a benign metabolic condition in newborn infants.It is a leading cause of hospitalization of neonates in the first week of life.Serum bilirubin has been considered as the most potent superoxide with the peroxyl radical scavenger activity.However, uncontrolled hyperbilirubinaemia or rapidly rising bilirubin can reach a neurotoxic concentration, potentially leading to central nervous system sequelae.Thus, the health status of jaundiced newborn infants is dependent on striking an appropriate balance between the protective effects of serum bilirubin and the risk of bilirubin neurotoxicity.In order to standardize the management of neonatal hyperbilirubinemia (jaundice), many countries have developed clinical practice management guidelines.This review sorted out and briefly interpreted the main contents of clinical management guidelines for neonatal hyperbilirubinemia drafted by the American Academy of Pediatrics and other countries, aiming to provide references of clinical diagnosis and treatment practice to domestic pediatrician.
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Aims: This study aimed at examining the oxidative stress level of sickle cell anaemia subjects using glutathione and bilirubin levels as markers as well as the red cell parameters. Study Design: Case-control study. Place and Duration of Study: University of Calabar Teaching Hospital, Calabar-Nigeria, between August 2018 and July 2019. Methodology: Subjects comprised 45 SCA patients (27 females, 18 males; age range 10-45 years) attending clinic at University of Calabar Teaching Hospital Calabar, Nigeria and equal number of age and sex-matched control subjects with Hb AA. Blood samples were collected and analyzed by standard methods. The red cell parameters were analysed by automation using FY-Smart-1 auto haematology analyzer. Bilirubin assay was performed using the colorimetric method, while glutathione was performed by enzyme-linked immunosorbent assay technique. Results: The red blood cell count, haemoglobin concentration, and haematocrit values of SCA subjects were significantly lower (p=0.001) compared to values from control subjects, while the red cell indices and red cell distribution width values were increased in SCA subjects (p=0.001). The Total bilirubin, conjugated bilirubin and unconjugated bilirubin were significantly increased (p=0.001) among SCA subjects, while the glutathione concentration values were reduced (p=0.001) when compared to values obtained from control subjects. Conclusion: SCA subjects have marked red cell size variation, lymphocytosis and thrombocytosis. The haemolytic events that occur in sickle cell anaemia results in glutathione depletion.
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Background: The incidence of jaundice in first week of life is very common affecting about 55% of term and 82% of preterm neonates. There should be specific guidelines for the early prediction of neonatal hyperbilirubinaemia by different available techniques. This will not only decrease the social, financial and medical burden but will also help in minimising the extent of brain damage. The aim of the present study is to confirm that umbilical cord blood bilirubin level is an important predictor of neonatal hyperbilirubinaemia. Besides this, the safe cut off value of bilirubin is also studied for early diagnosis of jaundice. Methods: It is an observational, prospective study in which the umbilical cord blood was collected for the estimation of serum bilirubin level and then again after 72 hours of life for estimation of serum total bilirubin. Statistical test using chi-square test of significance was applied and the predictive values (Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were calculated using the conventional formulae. Results: Various maternal factors (age, parity and mode of delivery) and neonatal factors (sex, gestational age and birth weight) can influence the incidence of neonatal jaundice. It was an interesting finding that the neonates who had high umbilical cord bilirubin level, developed neonatal jaundice in the first week of life. The sensitivity and specificity of the test were highest in case of group 4 (96.5%) and (96.2%) respectively. The positive predictive value was highest in group 4 (42%) and negative predictive value was highest in group 3 (94%). Conclusion: The bilirubin estimation of umbilical cord blood can be an important indicator of neonatal jaundice and helps in planning the management of neonate.
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Background: Jaundice is very common in the neonatal period of life. Although it is not a major cause of mortality, it is an important cause of morbidity. So, assessment of the causes and risk factors of neonatal jaundice is very important. Objectives: The objectives of the study were to find out the causes of jaundice, its clinical features, evaluation of the outcome of current management strategy and complications encountered by the participating subjects following treatment. Materials and Methods: This prospective study was conducted in the Neonatal Unit of Rangpur Medical College Hospital (RpMCH) during July to December 2006. A total of 100 neonates having jaundice on admission or who developed jaundice following admission were included in the study. A number of investigations were done for the purpose of assessment of neonates and their icteric condition. The test statistics used to analyse the data were descriptive statistics, Chi-square (c2) and correlation tests. Results: In the present study the median age of the jaundiced newborns on admission was 5 days, while the median age of appearance of jaundice was 3.5 days. Most of the newborns exhibited jaundice 24 hours after birth and peaked by 3–4 days. Majority of the subjects (77%) had pathological jaundice and only 23% had physiological jaundice. This study shows septicemia was in 28% cases followed by asphyxia (20%), prematurity (18%), Rh incompatibility (15%), IUGR (11%) etc. Half of the newborns (51%) had serum bilirubin (indirect) >10 mg/dL. Gestational age and serum bilirubin was found to exhibit a negative correlation. Preterm babies also tend to develop severe to very severe jaundice more than their term counterparts (p<0.001). Birth weight was also found to bear a negative correlation with serum bilirubin. Low birth weight (LBW) babies also had a significantly higher tendency to develop severe to very severe jaundice (p<0.001). Of the 77 patients who were treated, about 64% received phototherapy, 61% received antibiotics and very few (5.2%) received exchange transfusion. Majority of the patients developed some sorts of complications. The predominant complications of phototherapy were irritability (40.8%) followed by skin rashes (26.5%), loose motion (20.4%) and dehydration (16.3%). Very few newborns (4%) had hyperthermia. All four babies who received exchange transfusion suffered from hypovolaemia, one developed hypoglycaemia and one exhibited anaemia. Conclusion: Neonatal jaundice is a leading cause of hospitalisation in the first few weeks of life throughout the world. Though management of unconjugated hyperbilirubinaemia in newborns has undergone changes based on emerging evidences, phototherapy and exchange blood transfusion are still the most commonly used effective modalities for lowering serum bilirubin level.
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Objective To investigate the interference of hyperlipidemia and hyperbilirubinaemia to HbA1c measurements by ion‐exchange high‐performance liquid chromatography(IE‐HPLC) method .Methods Fresh whole‐blood samples collected with EDTA‐K2 anticoagulant tubes were divided into four groups :control group(HbA1c<6 .2% ) ,diabetes group(HbA1c≥6 .2% ) ,hyperlipi‐demia group(TG 3 -20 mmol/L);hyperbilirubinaemis group (TBIL 21 -549 μmol/L) .HbA1c of these samples were measured with affinity chromatography(AC‐HPLC) and IE‐HPLC respectively .Results When HbA1c≤18 .7% ,r=0 .993 ;95% confidence interval(CI) of HbA1c results by using IE‐HPLC method was -0 .71 -0 .89 ;coefficient of variation was -5 .8% -6 .8% ;P=0 .198 and the difference was not statistically significant .When HbA1c< 16 .3% ,r= 0 .997;95% CI of HbA1c results with IE‐HPLC method is -0 .31-0 .67;coefficient of variation was -5 .8% -4 .3% .P=0 .000 and the difference was statistically signifi‐cant .No interference was detectded with the results ;When HbA1c was 16 .3% -18 .7% ,positive bias was observed with the re‐sults .When TG≤20 .78 mmol/L ,r=0 .995;95% CI of HbA1c results with IE‐HPLC method was -0 .26-0 .50 ;coefficient of var‐iation was -5 .5% -5 .8% .P=0 .000 and the difference was statistically significant .No interference was detectded with the re‐sults;When TBIL≤549 .3 μmol/L ,r=0 .990 ;95% CI of HbA1c results with IE‐HPLC method was -0 .08 -0 .63;coefficient of variation was -14% -4 .1% .P=0 .000 and the difference was statistically significant .When TBIL≤342 .1 μmol/L ,r= 0 .994 ;95% CI of HbA1c results with IE‐HPLC method was -0 .09-0 .50;coefficient of variation was -5 .5% -4 .1% .No interference was detectded with the results .When TBIL was 380 .7-549 .3 μmol/L ,negative bias was observed with the results .Conclusion Our data indicated that HbA1c measurement with IE‐HPLC method could resist the interference of hyperlipidemia;When TBIL≤380 .7 μmol/L and HbA1c<16 .3% ,the results could meet the needs of general clinical detection .Clinical staff should choose more specific HbA1c measurement method according to the patient's condition .
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Objective: The study was aimed to evaluate the attributes related to hyperbilirubinaemia among neonates. Materials and methods: A total number of 120 neonates with hyperbilirubinemia included in the study. Data were collected using hospital records and by face-to-face interview of mother of those neonates using a predesigned questionnaire. Data were expressed as mean±SD and number (percent) as appropriate. Both descriptive and inferential statistics were considered in data analysis. Statistical analyses were performed using SPSS Software. Result: Of the total neonates, 57% were baby boys. In age group of 2nd to 7th days were 59.2% of neonates. According to the birth weight, neonates distribution was 38.3% in very low (<2000g), 42.5% low (2001-2500g) and 19.2% normal (>2500g) birth weight group. ABO incompatibility was found in 14.2% and Rh 8.3% cases of hyperbilirubinaemia. Birth trauma was found in 7.5% and congenital anomalies 3.3% neonates. Pre-maturity (gestational age <37 wks) was found in 73.3% cases. Normal vaginal delivery was performed in 59.2% of cases. Exclusive breast feeding was given by 43.33% mothers. Of the mothers 93.4% were housewives. Thirty percent (30%) of mothers were adolescents (<20 years) and 27.5% young adults (20 to 25 years). Of the 120 mothers 56.7% had primary level education. Low birth weight (<2000g to 2500g) neonates had significantly higher (p<0.005) serum bilirubin than the normal birth weight counterpart. Among the neonates of the mothers with GDM, 9.2% had serum bilirubin level above 20mg/dl and the distribution showed significant association (p<0.005). Conclusions: It is concluded that low birth weight and prematurity remained to the major causes of neonatal hyperbilirubinemia in neonates. Other common causes, particularly ABO and Rh incompatibility, are also present which could be avoided by meticulous clinical practice and burden of neonatal morbidity and mortality related to hyperbilirubinemia can be reduced.
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Objective To determine the efifcacy of exchange transfusion (ECT) with whole blood and reconstituted blood in neonatal hyperbilirubinaemia. Methods The clinical data of hyperbilirubinaemic neonates who had undergone ECT was reviewed. The neonates were categorized into three groups based on their ECT, whole blood (n=17), 1:1 ball-oplasm ratio reconstituted blood (n=18) and 2:1 ball-oplasm ratio reconstituted blood (n=20). Results There was no signiifcant difference in the demographic characteristics and causes of jaundice among the three groups. ABO blood incompatibility was the most com-mon cause of hyperbilirubinaemia in all groups. ECT with reconstituted or whole blood had no signiifcant effect on biochemi-cal indices of serum in patients. The levels of hemoglobin and hematocrit of 2:1 ball-oplasm ratio group were higher than those of other groups (P<0.05). The rates of hypocalcaemia and thrombocytopenia were similar in three groups after ECT. Conclu-sion ECT with 2:1 ball-oplasm ratio reconstituted blood can reduce the occurrence of anemia, and is more effective to treat neonatal hyperbilirubinaemia.
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Gilbert syndrome (GS) is a hereditary relatively common benign unconjugated hyperbilirubinaemia. The promoter region of uridine diphosphate glycosyltransferase 1 (UGT1A1) gene contains a normal A(TA)6 TAA element; variations in this motif (A(TA)7/8 TAA) are generally associated with this disorder. This is a report of the varied effects of GS in a Mexican Mestizo family with a non-common (TA)8 repeat in this population. T he proposita and her mother showed (TA)7 /(TA)8 genotype, while her father and sister were (TA)6 /(TA)7 , but only the proposita showed clinical manifestations. This report supports that the (TA)7 and (TA)8 are necessary, but not enough to explain the features of GS. There are probably additional genetic variations ie, the presence of "modifier" genes or one can speculate that an oligogenetic trait can contribute to the expression of the final phenotype.
El síndrome de Gilberto (SG) es un hiperbilirubinemia no conjugada, benigna, relativamente común y hereditaria. La región promotora del gen (UGT1A1) de la uridina difosfato glicosiltransferasa 1, contiene un elemento normal A (TA)6 TAA. Las variaciones en este motivo (A (TA)7/8 TAA) se encuentran por lo general asociadas con este desorden. Éste es un reporte de los variados efectos del SG en una familia mestiza mexicana con una repetición (TA)8 no común en esta población. La probando y su madre mostraron el genotipo (TA)7 /(TA)7 , mientras su padre y hermana eran (TA)6 /(TA)7 , pero sólo la probando mostró manifestaciones clínicas. Este informe sostiene que el (TA)7 y (TA)8 son necesarios, pero no suficientes para explicar los rasgos del SG. Probablemente hay variaciones genéticas adicionales, es decir, la presencia de genes "modificadores", o se puede especular que un rasgo oligogenético puede contribuir a la expresión del fenotipo final.
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Adulto , Feminino , Humanos , Adulto Jovem , Doença de Gilbert/genética , Glucuronosiltransferase/genética , Alelos , Polimorfismo Genético , Regiões Promotoras GenéticasRESUMO
Objective To invesgate the influence of mild hepatic macrovesicular steatosis to liver function recoveration and liver regeneration after right hemihepatectomy of the living liver donor.Methods The Medical record of 95 cases of living donor liver transplantation in our hospital between Oct 2008 to May 2009 were retrospectively analyzed, 15 donors were decteded have light macrovesicularsteatosis(20%～30%, 5 donors; 10%～19%, 10 donors) (group A),80donors have no hepatic steatosis(group B). Clinical date before operation and outcome after operation were compered. Results The average age, sex ratio,remmnent liver volume ratio, and with middle hepatic vein/without middle hepatic vein ratio had no significant differences between two groups(P=0. 870,P=0. 608,P=0. 928,P=0.196), but the body mass index(BMI) was significantly higher in group A than group B ( P = 0.013). After operation , the peak total bilirubin (TBIL) level and alanine aminotransferase(AST)were was significantly higher in group 1 than in group 2 (P=0. 039) ,the liver regeneration ratio had no significant difference after 15days of operation(P=0. 939). Multivariable analysis showed mild macrovesicular steatosis to be an independent risk factor for hyperbilirubinaemia (odds ratio 5.375(95%confidence interva 1.467-19. 6961); P=0. 011). Conclusions light macrovesicular steatosis is an independent risk factor for hyperbilirubinaemia. For the safe of the living liver donor, attentive evaluation should be done before operation to the living liver donors.
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0.05).Compared with the normal(P0.05).In the control group with G-6-PD deficieney,ROS,MDA of phototherapy of 24 hours were higher,the index of phototherapy was larger significantly than in the the G-6-PD normal.Conclusion Phototherapy can alleviate the ability of anti-oxgenize,it can be more extruding for the patients who are deficient for the G-6-PD by the damage of lipid over oxygenizing,the interference of vitamin E is more efficient.