Oxidative stress, phototherapy and the neonate.

Phototherapy is the most widely used form of therapy for unconjugated hyperbilirubinaemia. Its non-invasive nature and few side effects reported earlier have led to the assumption that it is innocuous. Recent research has revealed that phototherapy is a photodynamic stress and can induce lipid peroxidation. There is increasing evidence that many severe diseases of the neonate are caused by oxidative injury and lipid peroxidation. In the present communique, we review the oxidative susceptibility of the neonate and the evidence now available that phototherapy induces oxidative stress. Although intensive phototherapy (up to 40 mwatt/cm2/nm) has been reported to be increasingly effective, a little caution, we believe is warranted, till more definite data in the human neonate, help resolve the issue.

Abordagem clinica, laboratorial e terapeutica do recém-nascido icterico / Clinical, laboratorial and therapeutic management of the neonatal jaundice

O objetivo desta revisäo/atualizaçäo a respeito da abordagem clinica, laboratorial e terapeutica do recém-nascido icterico foi apresentar um roteiro didático, com a finalidade de se tentar esclarecer algumas dúvidas sobre a conduta na hiperbilirrubinemia neonatal, dando enfase aos pontos polêmicos da terapeutica

Patologías del recién nacido en relación con la edad materna / The pathology of the born according to the mother ly age

Las patologías de recién nacido según la edad materna es una problemática vigente en nuestros hospitales. Se realizó un estudio prospectivo con una muestra de 500 recién nacidos, seleccionados al azar, atendidos en el Hospital General del Oeste "Dr. José Gregorio Hernández", quienes posteriormente fueron trasladados a retén de niño sano o patológico, dependiendo de las condiciones del mismo posterior al nacimiento, y los datos maternos fueron recopilados de las historias obstétricas. El mayor porcentaje de nacimientos se registró en madres con edades conprendidas entre 16-20 años, representando 36,6 por ciento coincidiendo a su vez con el mayor número de patologías más frecuentes: ictericia del recién nacido (23,4 por ciento) y síndrome de dificultad respiratoria (22,8 por ciento). Con este estudio se trata de resaltar la importancia que tiene el llevar a cabo un buen control prenatal y adecuada educación sexual, logrando disminuir la incidencia de embarazos en gestantes jóvenez y las complicaciones neonatales que ello acarrea

Clinical significance of serum and cerebro spinal fluid bilirubin indices in neonatal jaundice.

To assess the value of unbound bilirubin (UB) and saturation index (SI) in serum and CSF as indicators of Kernicterus, we studied 50 icteric neonates (serum indirect bilibrubin (IB) greater than or equal to 7 mg/dl) and 20 controls (IB less than 7 mg/dl) during the first week of life. Serum and CSF were obtained simultaneously in all neonates. Of 36 neonates with IB greater than 12 mg/dl 19 had evidence of kernicterus. UB was estimated by Sephadex gel filtration and SI by salicylate displacement technique. Positive correlation (r = +0.85) was obtained between serum and CSF UB levels. There was a significant difference (p less than 0.05) between mean serum and CSF UB levels in kernicterus and non-kernicterus neonates (kernicterus serum UB = 0.71 +/- 0.22) mg/dl, CSF UB = 0.16 +/- 0.06 mg/dl: non-kernicteric serum UB = 0.40 +/- 0.10 mg/dl, CSF UB = 0.10 +/- 0.03 mg/dl). A critical serum UB level 0.5 mg/dl and a danger zone of CSF UB (0.1 to 0.15 mg/dl) was observed in presence of kernicterus. Neonates with kernicterus and 30% non-kernicteric had serum SI greater than or equal to 8. Mean values of serum and CSF SI were comparable in all neonates. The serum and CSF UB and SI, and the mean percentage cross over of UB from serum to CSF when statistically compared were not significantly influenced by risk factors.

Effect of phototherapy on nutrients utilization in newborn infants with jaundice.

The effect of phototherapy on digestion and absorption of nutrients was performed in 25 male, newborn infants with hyperbilirubinemia. The infants were divided into 2 groups; one group was fed with lactose formula whereas the other group received the non-lactose formula. The quantities of daily volume, fat and energy intakes of both groups were similar. Protein intake was significantly higher in the latter group. During 72-hours of phototherapy, there were decreases in serum bilirubin in all infants and mean weight change was decreased in infants fed with non-lactose formula. Treatment by phototherapy in jaundiced infants did not affect protein, fat and energy absorption. The presence of loose stool, lower stool pH and trace in reducing substances in some subjects fed with lactose formula suggests mild lactose intolerance. Prospective study in clinical trial needs to be further assessed and clarified on other nutrients such as amino acids and riboflavin status in these infants during phototherapy.