The effect of clofibrate with phototherapy in late pre-term newborns with non-hemolytic jaundice.

Background : Despite an understanding of the enzymatic pathways leading to bilirubin production and degradation, very few pharmacologic interventions are utilized and the mainstay of treatment remains phototherapy. Aims : To evaluate the efficacy of clofibrate in reducing total serum bilirubin levels in late pre-term neonates with non-hemolytic jaundice. Design and Setting : Double-blind, placebo-controlled, randomized trial; tertiary level neonatal unit. Materials and Methods : A randomized controlled study was carried out in the neonatal ward of Children's Hospital, Tabriz, Iran, over a 1-year period. Sixty-eight healthy late pre-term infants readmitted with non-hemolytic hyperbilirubinemia were randomized to receive phototherapy and clofibrate (n= 35) or phototherapy and placebo (n= 33). Statistical Analysis Used : Chi-square test and independent sample 't' test. Results : There were no significant differences in the weight, gender, modes of delivery and age of neonates between the two groups. Similarly the mean total serum bilirubin (TSB) level at the time of admission was not significantly different between the two groups [mean± SD: 19.72 ± 1.79 (95% confidence interval: 19.12-20.54 mg/dL) vs. 20.05 ± 2.82 (95% confidence interval, 19.54-22.04 mg/dL), P= 0.57]. The mean TSB 48 hours after phototherapy [mean± SD: 8.06± 1.34 (95% confidence interval: 7.94-10.18 mg/dL) vs.10.94 ± 2.87 (95% confidence interval: 9.92-12.16 mg/dL), P= 0.02] and the mean duration of phototherapy [mean± SD: 64.32 ± 12.48 (95% confidence interval: 60-81.6 hours) vs. 87.84 ± 29.76 (95% confidence interval: 79.2-108 hours), P< 0.001] were significantly lower in the clofibrate-treated group. Conclusions : Clofibrate is an effective adjunctive drug in neonatal hyperbilirubinemia, which results in decreased TSB level and reduced duration of phototherapy in late pre-term newborns.

Efficacy of clofibrate on severe neonatal jaundice associated with glucose-6-phosphate dehydrogenase deficiency (a randomized clinical trial).

Glucose-6-phosphate dehydrogenase (G6PD) deficiency may cause severe hyperbilirubinemia with bilirubin encephalopathy unless intervention is initiated. The aim of this study was to assess the efficacy of clofibrate in full term G6PD deficient neonates with jaundice. A randomized clinical trial study was performed in two groups of full-term G6PD deficient jaundiced neonates (clofibrate treated group, n = 21; control group, n = 19). Infants in the clofibrate group received a single oral dose of 100 mg/kg clofibrate, whereas control group received nothing. Both groups were treated with phototherapy. Serum total and direct bilirubin levels were measured at the onset of treatments, 16, 24 and 48 hours later. On enrollment, the mean total serum bilirubin (TSB) level in the clofibrate treated group was 18.40 +/- 2.41 and in the control group was 17.49 +/- 1.03 (p = 0.401). At 16, 24 and 48 hours of treatment, the mean TSB in the clofibrate group were 15.2 +/- 1.9, 12.6 +/- 2.4, and 10.1 +/- 2.4 and in the control group were 16.5 +/- 1.2, 13.3 +/- 2.2 and 11.4 +/- 2.4, respectively (p = 0.047). At 48 hours, 7 (33%) cases in the clofibrate group and one (5%) case in the control group were discharged with a TSB < 10 mg/dl (p = 0.031). No side effects were observed on serial examinations during hospitalization, or on the 1st and 7th days after discharge. The results show that clofibrate induces a faster decline in serum total bilirubin level, a shorter duration of phototherapy, and hospitalization with no side effects in full-term G6PD deficient neonates with jaundice.

Fototerapia causa danos ao DNA de leucócitos mononucleares periféricos em recém-nascidos a termo / Phototherapy causes DNA damage in peripheral mononuclear leukocytes in term infants

OBJETIVO: Determinar se a fita de DNA de leucócitos mononucleares endógenos é alvo de fototerapia. MÉTODOS: O estudo incluiu 65 recém-nascidos a termo com idades entre 3 e 10 dias que haviam sido expostos a fototerapia intensiva (n = 23) ou convencional (n = 23) por pelo menos 48 horas devido à icterícia neonatal, além de um grupo controle (n = 19). Dano ao DNA foi avaliado por eletroforese alcalina em gel de célula única (ensaio cometa). A capacidade antioxidante total plasmática e os níveis de estado oxidativo total também foram medidos, e a correlação entre danos ao DNA e estresse oxidativo foi investigada. RESULTADOS: Os valores médios de escores de danos ao DNA nos grupos de fototerapia intensiva e convencional foram significativamente maiores do que os do grupo controle (p < 0,001). Os valores médios e desvio padrão foram 32 (9), 28 (9), 21 (7) unidades arbitrárias, respectivamente. Os níveis de estado oxidativo nos grupos de fototerapia intensiva e convencional foram significativamente maiores do que os do grupo controle (p < 0,005). Os valores médios (desvio padrão) foram 18, 1 (4,2), 16.9 (4,4), 13,5 (4,2) µmol H2O2 equivalente/L, respectivamente. De maneira semelhante, os níveis de estresse oxidativo nos grupos de fototerapia intensiva e convencional foram significativamente maiores do que os do grupo controle (p = 0,041). A capacidade antioxidante total plasmática e os níveis de bilirrubina total não diferiram entre os grupos (p > 0,05). Não houve correlações significativas entre escores de danos ao DNA e bilirrubina, estado oxidante total e níveis de estresse oxidativo entre os grupos de fototerapia (p > 0,05). CONCLUSÕES: Tanto a fototerapia intensiva quanto a convencional causam danos ao DNA dos leucócitos mononucleares endógenos em recém-nascidos a termo com icterícia.

OBJECTIVE: Our aim was to determine whether endogenous mononuclear leukocyte DNA strand is a target of phototherapy. METHODS: The study included 65 term infants aged between 3-10 days that had been exposed to intensive (n = 23) or conventional (n = 23) phototherapy for at least 48 hours due to neonatal jaundice, and a control group (n = 19). DNA damage was assayed by single-cell alkaline gel electrophoresis (comet assay). Plasma total antioxidant capacity and total oxidant status levels were also measured, and correlation between DNA damage and oxidative stress was investigated. RESULTS: Mean values of DNA damage scores in both the intensive and conventional phototherapy groups were significantly higher than those in the control group (p < 0.001). Mean values and standard deviation were 32 (9), 28 (9), 21 (7) arbitrary unit, respectively. Total oxidant status levels in both the intensive and conventional phototherapy groups were significantly higher than those in the control group (p = 0.005). Mean (standard deviation) values were 18.1 (4.2), 16.9 (4.4), 13.5 (4.2) µmol H2O2 equivalent/L, respectively. Similarly, oxidative stress index levels in both the intensive and conventional phototherapy groups were significantly higher than those in the control group (p = 0.041). Plasma total antioxidant capacity and total bilirubin levels did not differ between the groups (p > 0.05). There were no significant correlations between DNA damage scores and bilirubin, total oxidant status and oxidative stress levels in either phototherapy group (p > 0.05). CONCLUSIONS: Both conventional phototherapy and intensive phototherapy cause endogenous mononuclear leukocyte DNA damage in jaundiced term infants.

Effects of chichorium intybus on bilirubin.

OBJECTIVE: To evaluate the in vitro effects of chichorium intybus on bilirubin levels. METHODS: In this study the bilirubin levels in the serum of thirty neonates staying in the NICU and suffering from clinical jaundice was determined three times: first without any alterations, second after adding chichorium intybus extract and third after adding the same amount of distilled water. The results were compared using SPSS statistical software. RESULTS: Of the patients evaluated 76.7% were male and 23.3% were female. The average age was 7.35 days. The mean difference observed in unconjugated bilirubin levels in the specimens containing chichorium intybus extract was 3.84 +/- 2.38 mg/dl and in the ones containing distilled water was 2.85 +/- 2.00 mg/dl. The mean difference observed in conjugated bilirubin levels was 0.29 +/- 0.32 mg/dl in specimens containing distilled water and 0.35 +/- 0.26 in the ones containing chichorium intybus. In none of the cases the results were found to be significant. CONCLUSION: In this study chichorium intybus was found to have no significant in vitro effect on the bilirubin level reported by the laboratory. The in vivo effects of this herbal medicine must be evaluated more closely.

Jaundice in the newborns.

Hyperbilirubinemia is the commonest morbidity in the neonatal period and 5-10% of all newborns require intervention for pathological jaundice. Neonates on exclusive breast-feeding have a different pattern and degree of jaundice as compared to artificially fed babies. Latest guidelines from the American Academy of Pediatrics (AAP) for management of jaundice in a normal term newborn have been included in the protocol. Separate guidelines have been provided for the management of jaundice in sick term babies, preterm and low birth weight babies, for hemolytic jaundice and prolonged hyperbilirubinemia.

Acompanhamento da icterícia neonatal em recém-nascidos de termo e prematuros tardios / Follow-up of neonatal jaundice in term and late premature newborns

OBJETIVO: Relatar os resultados de um projeto de acompanhamento de recém-nascidos de termo e próximos ao termo ictéricos no período neonatal. MÉTODOS: Foram encaminhados a ambulatório especializado neonatos com peso > 2.000 g e/ou idade gestacional > 35 semanas, cuja icterícia na alta foi avaliada inicialmente com o icterômetro de Ingram, Bilicheck® e, se indicado, com bilirrubinômetro Unistat (Leica). A bilirrubinemia destes recém-nascidos situava-se no ou acima do percentil 40 do nomograma elaborado por Bhutani. Todos recém-nascidos tratados com fototerapia durante internação foram reavaliados laboratorialmente 24 horas após suspensão do tratamento. A indicação de reinternação para tratamento fototerápico intensivo foi para paciente com nível > 20 mg/dL. RESULTADOS: De um total de 11.259 neonatos, 2.452 (21,8 por cento) foram encaminhados para acompanhamento, dos quais 87,2 por cento (2.140) retornaram. Oitenta neonatos retornados foram reinternados. Dos 2.452 encaminhados para retorno, 180 (7,3 por cento) tinham bilirrubinemia > 15 mg/dL na alta. Destes, 151 retornaram para acompanhamento. Vinte (13,2 por cento) foram reinternados para tratamento. Do total de reinternados, dois recém-nascidos apresentaram nível > 25 mg/dL e nenhum > 30 mg/dL. Todos responderam rapidamente à fototerapia intensiva, e não houve necessidade de utilizar exsangüinotransfusões. CONCLUSÕES: Nossos resultados sugerem que o esquema adotado é eficiente na detecção e prevenção de hiperbilirrubinemias de risco para produzir encefalopatia bilirrubínica em recém-nascidos de termo e próximos ao termo.

OBJECTIVE: To report on the results of a project following term and near term newborn infants who were jaundiced during the neonatal period. METHODS: Neonates were referred to the follow-up clinic with weight > 2,000 g and/or gestational age > 35 weeks, and jaundice at discharge was initially assessed with an Ingram icterometer or Bilicheck and, if indicated, with a Unistat bilirubinometer (Leica). These newborn infants had bilirubinemia at or above the 40th percentile on the nomogram developed by Bhutani. All infants treated with phototherapy while in hospital were reassessed by laboratory methods 24 hours after withdrawal of treatment. Patients were rehospitalized for intensive phototherapy if their level was greater than or equal to 20 mg/dL. RESULTS: From a total sample of 11,259 neonates, 2,452 (21.8 percent) were referred to the follow-up clinic, 87.2 percent (2,140) of whom did return. Eighty returned neonates were readmitted. Return appointments were set for 2,452 patients, 180 (7.3 percent) of whom had bilirubinemia > 15 mg/dL at discharge. Of these 180, 151 returned for follow-up. Twenty (13.2 percent) were readmitted for treatment. Of the total number of readmitted patients, two newborn infants had levels > 25 mg/dL and none > 30 mg/dL. All responded rapidly to intensive phototherapy, and there was no need for exchange transfusions. CONCLUSIONS: Our results suggest that the regime adopted is effective for detecting and preventing hyperbilirubinemia at risk of causing bilirubin-induced encephalopathy in term and near term newborn infants.

Estado oxidante/antioxidante total em recém-nascidos ictéricos antes e depois da fototerapia / Total oxidant/antioxidant status in jaundiced newborns before and after phototherapy

OBJETIVO: Avaliar o efeito da fototerapia no estado oxidante e antioxidante no soro de recém-nascidos a termo com hiperbilirrubinemia. MÉTODO: Trinta e quatro recém-nascidos a termo com idades entre 3 e 10 dias submetidos a fototerapia foram avaliados. O estado antioxidante do soro foi determinado pela capacidade antioxidante total e por componentes antioxidantes individuais: vitamina C, ácido úrico, albumina, concentração de tiol e bilirrubina total. O estado oxidante foi avaliado através do estado oxidante total, índice de estresse oxidativo e componentes oxidantes individuais: malondialdeído e níveis de hidroperóxido lipídico. RESULTADOS: As concentrações de vitamina C, ácido úrico, bilirrubina total e malondialdeído foram significativamente mais baixas, enquanto que o estado oxidante total, níveis de hidroperóxido lipídico e o índice de estresse oxidativo foram significativamente maiores após a fototerapia (p < 0,05). Houve correlações positivas significativas entre a bilirrubina sérica total e a concentração de malondialdeído (r = 0,434, p = 0,001). CONCLUSÕES: Embora a concentração de malondialdeído tenha diminuído após a fototerapia, esta exerce um efeito negativo sobre as diversas partes do sistema de defesa oxidante/antioxidante em recém-nascidos a termo ictéricos, expondo-os a um possível estresse oxidativo.

OBJECTIVE: To assess the effect of phototherapy on serum oxidant and antioxidant status in hyperbilirubinemic full-term newborns. METHOD: Thirty-four full-term infants from 3 to 10 days of age exposed to phototherapy were studied. The serum antioxidant status was assessed by measuring the total antioxidant capacity (TAC) and individual antioxidant components: vitamin C, uric acid, albumin, thiol contents and total bilirubin. The oxidant status was assessed by determining the total oxidant status (TOS), oxidative stress index (OSI) and individual oxidant components: malondialdehyde (MDA), and lipid hydroperoxide levels. RESULTS: Vitamin C, uric acid, total bilirubin and MDA concentration were significantly lower, whereas serum TOS, lipid hydroperoxide and OSI levels were significantly higher after phototherapy (p < 0.05). There were significant positive correlations between serum total bilirubin and MDA (r = 0.434, p = 0.001). CONCLUSIONS: Although the MDA level was reduced after phototherapy, phototherapy has a negative impact on numerous parts of the oxidant/antioxidant defense system in jaundiced full-term newborns, exposing them to potential oxidative stress.

Maternal and neonatal factors affecting physiological jaundice in western U.P.

Several maternal and fetal factors are responsible for neonatal jaundice, which is a common observation in large number of newborns. However, role of these factors in causation of this condition is not well established. Fifty pregnant mothers and their fifty two newborns were studied in the present study. Mothers with complicated pregnancy or septicemia at the time of delivery were excluded. In addition newborns with congenital or chromosomal abnormalities were excluded. Serum concentrations of bilirubin of all neonates were measured on days 1, 3 and 5. It was found to be lower on day 1, with a peak at day 3. The area under serum bilirubin level-time curve (AUC) for each neonate was also calculated. Fetal sex and birth weight were not found to significantly affect the neonatal hyperbilirubinemia. Newborn of bipara mothers were found to have significantly lower (P < 0.05) serum bilirubin level on day 1 as compared to primipara mothers only but higher (P < 0.05) on day 3 as compared to either primi or multipara mothers. Yet, AUC of serum bilirubin curve was significantly higher (P < 0.05) in newborns of bipara mothers than others. Significantly (P < 0.05) higher serum bilirubin on day 1 was also observed in preterm neonates than full term ones. However, maternal haemoglobin and mode of delivery were not shown to affect the neonatal bilirubin levels in these newborns.

Red cell pyruvate kinase deficiency in neonatal jaundice cases in India.

OBJECTIVE: Pyruvate Kinase (PK) deficiency is the most common enzymopathy of the glycolytic pathway in erythrocytes. It constitutes one of the common causes of hereditary non-spherocytic hemolytic anemia. The aim of this study was to screen newborns in India for pyruvate kinase (PK) deficiency in relation to unconjugated hyperbilirubinemia. METHODS: Laboratory investigations done included complete blood counts, reticulocyte counts, direct and indirect bilirubin, assay of G6PD and PK activity, ATP and 2,3 DPG levels. All variables were studied in 50-cord blood samples from normal deliveries and 218 neonates with hyperbilirubinemia. RESULTS: 7 of the 218 cases of neonatal jaundice were PK deficient with 30-40% reduction in PK activity. These cases also had a 3-4-fold increase in 2,3 DPG:ATP ratios, which is one of the additional indicators for PK deficiency. Six of the 7 infants had a severe clinical course. CONCLUSION: This study shows that the prevalence of PK deficiency in Indian neonatal jaundice cases is 3.21%, which is relatively high. This emphasizes the need for screening neonatal hyperbilirubinemia cases in India for PK deficiency.

Hiperbilirrubinemia neonatal prolongada devido à associação entre síndrome de Gilbert e doença hemolítica por incompatibilidade RhD / Persistent neonatal hyperbilirubinemia resulting from Gilbert's syndrome in association with RhD hemolytic disease

OBJETIVO: Relatar associação infreqüente de patologia que cause aumento considerável de produção de bilirrubina e outra diminuição importante na sua excreção. DESCRIÇÃO: Mãe tercigesta, Rh negativo. Na primeira gestação, gerou recém-nascido normal, de termo, não tendo recebido imunoglobulina humana anti-RhD. A segunda gestação complicou-se por isoimunização Rh, dando à luz neonato de termo, o qual necessitou três exsanguinotransfusões e faleceu com 8 dias de vida. Na gestação atual, conseguiu dar à luz a termo recém-nascido tipo ORh positivo, Coombs direto positivo, bilirrubina de cordão 6,5 mg/dl e hematócrito 44 por cento. Com 5 horas de vida, estava ictérico, tendo sido iniciados fenobarbital (por 3 dias) e fototerapia intensiva. A hiperbilirrubinemia foi logo controlada, porém ascendia rapidamente sempre que a fototerapia era suspensa. No 10° dia de vida, a criança foi transfundida por anemia importante. Em vista da persistência da icterícia, no 13° dia de vida pensou-se em associação com síndrome de Gilbert, e o seqüenciamento de DNA foi solicitado. O resultado mostrou genótipo mutante homozigoto UDPT1A1[TA]7TAA. Permaneceu em fototerapia até o 17° dia de vida. Recebeu alta no dia seguinte, após controle de bilirrubinemia. Voltou para acompanhamento ambulatorial e apresentou desenvolvimentos pondo-estatural e neurológico normais. COMENTARIOS: O caso ressalta a importância da associação do aumento de produção/diminuição de excreção de bilirrubina na gênese de hiperbilirrubinemias prolongadas, intensas e passíveis de causar kernicterus, se não tratadas vigorosamente. Demonstra, ainda, a eficácia da fototerapia intensiva, reduzindo os riscos de tratamentos mais agressivos. Ressalta, também, a importância do acompanhamento das icterícias neonatais até a completa remissão dos sintomas.

Relationship between serum bilirubin and coagulation test results in 1-month-old infants.

OBJECTIVE: Although the connection between cholestasis and conjugated hyperbilirubinemia is well known, mild hepatic dysfunction or cholestasis may also be associated with unconjugated hyperbilirubinemia in some infants with prolonged jaundice. The aim of this study was to investigate the relationship between serum bilirubin levels and alanine aminotransferase levels, aspartate aminotransferase levels, prothrombin time, activated partial thromboplastin time, and international normalization ratio findings in a group of infants. METHODS: The study included 77 healthy, term, breast-fed infants with jaundice and 56 age-matched, healthy, term, non-jaundiced controls. The 133 babies were divided into three subgroups according to their total bilirubin levels [group I (controls) < 50 micromol/L, group II = 50-100 micromol/L, and group III > 100 micromol/L, and the findings for the noted parameters were compared]. RESULTS: The mean conjugated bilirubin level was significantly higher, and the mean activated partial thromboplastin time significantly longer in group III than in group I. A significant positive correlation was found between bilirubin levels and PT and APTT results. CONCLUSION: Clinical vitamin K deficiency appeared unlikely to develop in this group of infants with prolonged unconjugated hyperbilirubinemia. However, a significant positive correlation between bilirubin levels and PT and APTT suggest that a higher bilirubin load to the liver may cause some degree of vitamin K deficiency due to mild cholestasis. The importance of this finding, and the possible benefits of vitamin K supplementation in 1-month-old breast-fed infants with bilirubin levels higher than 100 micromol/L require further investigation.

Neonatal cholestasis

Neonatal cholestasis is caused by impaired excretion of biliary substances resulting in their accumulation in blood. Neonatal cholestasis should be ruled out in infants presenting with jaundice that persists after 2 weeks of life. It is important to check fractionated serum bilirubin levels in these patients and immediately refer the patients with conjugated hyperbilirubinemia to a pediatric gastroenterologist for further evaluation. Conjugated hyperbilirubinemia, pale stools and dark urine are the cardinal features of neonatal cholestasis. Early recognition and a stepwise diagnostic evaluation of the infant with cholestasis are essential in successfully treating or managing the complications of the metabolic and infectious liver diseases of the infant as well as surgically relieving obstruction in patients who have biliary atresia. Biliary atresia is the most common cause of neonatal cholestasis and the prognosis is directly related to the age at the time of surgery, with better prognosis if surgery is done before 60 days of age. Cholestasis in premature infants is multifactorial and should have a modified approach to the evaluation of cholestasis. Medical management of cholestasis is mostly supportive, consisting of management of complications of chronic cholestasis like pruritus and nutritional support for malabsorption and vitamin deficiency

Avaliação de dois esquemas de manejo da hiperbilirrubinemia em recém-nascidos com peso menor que 2.000 g / Evaluation of two guidelines for the management of hyperbilirubinemia in newborn babies weighing less than 2, 000 g

OBJETIVO: Avaliar o uso de dois esquemas de fototerapia na hiperbilirrubinemia de recém-nascidos com peso menor que 2.000 g. MÉTODOS: Foram estudados 81 recém-nascidos com peso de nascimento menor que 2.000 g, divididos em dois grupos: "precoce", que iniciou fototerapia com 12 horas de vida e foi tratado por pelo menos 96 horas, e "tardio", que recebeu fototerapia quando a bilirrubina transcutânea atingia 8 mg/dl, sendo retirada quando caísse para 5 mg/dl. Foi analisada a manutenção dos níveis de bilirrubina transcutânea abaixo de 10 mg/dl, o valor médio de bilirrubina transcutânea diária, o valor do pico de bilirrubina transcutânea e época do seu aparecimento e a duração do tratamento. RESULTADOS: No grupo precoce, 20 por cento dos pacientes ultrapassaram 10 mg/dl de bilirrubina transcutânea, contra 60 por cento no tardio. A maior média diária de bilirrubina transcutânea no grupo precoce foi de 6,6 mg/dl, no sétimo dia; no grupo tardio, foi de 8,6 mg/dl no segundo dia de vida. A mediana das horas de fototerapia usadas no grupo precoce foi de 96 (mínimo de 96 e máximo de 156 horas), e no tardio, de 51 horas (mínimo de 0 e máximo de 120 horas). Nenhum paciente necessitou de mudança de tratamento (fototerapia dupla ou exsangüineotransfusão). CONCLUSAO: O uso da fototerapia precoce para neonatos com peso abaixo de 2.000 g é mais seguro que o tratamento tardio se considerada a manutenção de níveis abaixo de 10 mg/dl como satisfatórios.

Bilirubin dosage in cord blood: could it predict neonatal hyperbilirubinemia?

CONTEXTO: A alta hospitalar precoce vem sendo responsabilizada pelo reaparecimento de casos de kernicterus, ou icterícia nuclear. Assim, pesquisas que visem o encontro de parâmetros que ajudem o neonatologista a prevenir a ocorrência de hiperbilirrubinemia grave são bem-vindas. OBJETIVO: Avaliar se os níveis de bilirrubina no funículo umbilical podem predizer a hiperbilirrubinemia neonatal que necessita de tratamento em recém-nascidos no termo até o terceiro dia de vida. TIPO DE ESTUDO: Estudo prospectivo. LOCAL: Unidade Neonatal do Hospital Israelita Albert Einstein, São Paulo, Brasil. PARTICIPANTES: 380 recém-nascidos no termo considerados normais, com ou sem incompatibilidade sangüínea materno-fetal ABO/Rh e sem nenhuma outra complicação. PRINCIPAIS PROCEDIMENTOS: Amostra de sangue do funículo umbilical colhida logo após o nascimento e submetida a dosagem de bilirrubinas totais, conjugada e não conjugada. Esses recém-nascidos foram acompanhados até a alta e a ocorrência de níveis de hiperbilirrubinemia não conjugada indicativa de tratamento foi estudada em relação aos níveis do funículo umbilical. Uma análise discriminante foi utilizada para classificar os recém-nascidos em dois grupos, com e sem risco de necessitarem de fototerapia até o terceiro dia de vida (usando o programa Statistical Package for Social Science, versão 9,0) considerando-se o nível de significância menor que 5%. VARIAVEIS ESTUDADAS: Bilirrubinas de sangue de funículo umbilical; grupo sangüíneo materno e do recém-nascido; indicações de fototerapia. RESULTADOS: O valor médio da bilirrubina não conjugada no sangue do funículo umbilical foi significativamente maior entre os recém-nascidos que atingiram níveis séricos de bilirrubina não conjugada indicativos de fototerapia. A presença de incompatibilidade sangüínea materno-fetal foi estatisticamente significativa para a ocorrência de níveis séricos de bilirrubina não conjugada indicativos de fototerapia, até o terceiro dia de vida. O ponto de corte de bilirrubina não conjugada do funículo umbilical que se mostrou mais útil foi 2.0 mg/100 ml. DISCUSSAO: O sangue do cordão poderia ser coletado e usado para análise dos níveis de bilirrubina conjugada como uma maneira de se considerar ou não a alta de uma criança moderadamente anêmica, em associação com outros recursos. CONCLUSÕES: A incompatibilidade sangüínea materno-fetal...

Neonatal hyperbilirubinemia and its association with thyroid hormone levels and urinary iodine excretion.

OBJECTIVE: To investigate, if, urinary iodine contents as a marker of iodine deficiency and hypothyroidism are associated with the incidence of neonatal hyperbilirubinemia. METHODS: One hundred neonates with total serum bilirubin > or = 15 mg/dl and with no known cause of jaundice were included in the study as a jaundice group. An equal number (n = 100) of non-jaundiced neonates (bilirubin < or = 14.9 mg/dl) with matching for age, gestation period and weight were enrolled in the study as a control group. RESULTS: Thirteen neonates (13%) in the study group had urinary iodine levels < 100 mg/dl as against only 2 (2%) in the control group (p < 0.05). Thirty-four (34/200-17%) neonates i.e. 17 each in the study and control groups had serum TSH > 5 mU/ml and hence an indirect indicator of iodine deficiency in the study population. The mean serum levels of total T3, T4 and TSH in the study neonates were 1.52 +/- 1.23 ng/ml, 15.8 +/- 12.0 micrograms/dl & 3.13 +/- 3.0 mU/ml respectively and did not differ significantly from the mean levels in the control group. Only one neonate in the study group had serum TSH > 20 mU/ml which was suggestive of hypothyroidism, but had normal T3 & T4. Seven neonates in the study group and 8 in the control group had low T4. There was no significant correlation between the maternal and neonatal urine iodine levels, thyroid functions and the bilirubin levels (p > 0.01). CONCLUSION: The jaundiced babies had lower urine oidine levels than the control population. Since, there was no significant difference in the levels of the thyroid hormones, no cause and effect relationship could be inferred between iodine deficiency and jaundice.

A new look on neonatal jaundice.

Out of 6586 live born babies, 736 babies with jaundice were studied from 1st July 1996 to 30th June, 1997, in a city based medical college nursery. Physiological jaundice was present in 8.92% of all live born babies and accounted for 79.89% of babies with jaundice. Breast milk jaundice and prematurity were next common causes responsible for 5.29% each of all cases with neonatal jaundice. Septicaemia caused jaundice in 4.75% cases. Among the babies with jaundice appearing between day 4 and day 7 of life, breast milk jaundice was the commonest cause occurring in 49.25% cases. The last entity surfaced probably due to exclusive breastfeeding recently initiated in the baby friendly hospital nursery.