Infecciones del tracto urinario en neonatos sin explicación. Hiperbilirrubinemia: Prevalencia y predictivo factores de riesgo / Urinary tract infections in unexplained neonatal hyperbilirubinemia: Prevalence and predictive risk factors

Introduction: Urinary tract infections (UTIs) are widespread clinical disorder among early neonates. Neonates with UTIs were susceptible to higher rates of morbidity and mortality, particularly when presented with hyperbilirubinemia. Early diagnosis may help in complete recoveryrather than being threatened in terms of complications. The study aimed at determining the prevalence and predictive risk factors of UTIs in neonates with an unexplained hyperbilirubinemia. Method: A cross-sectional study was carried out in the NICU of Aswan University Hospital, Egypt from August 2018 to February 2019. The study was conducted on 140 newborns who were diagnosed with indirect hyperbilirubinemia in the first 4 weeks of life after exclusion of unrelated criteria. Demographic and clinical data were collected by an interview questionnaire. Biochemical markers including bilirubin level, CBC, urine analysis and urine cultures and sensitivity were determined. Results: The prevalence rate of UTIs in the studied newborns was 25%. Escherichia -coli was the dominant organism isolated. Amikacin was the most common antibiotic sensitive to the isolates. There was a significant difference between the UTI positive and negative neonates in the univariate analysis regarding some studied variables. While, an increase in the number of WBCs in the blood (OR = 6.90, P = 0.001), small for gestational age (OR = 4.07, P = 0.021), prolonged phototherapy (OR = 3.50, P = 0.034), and presence of maternal complications (OR = 2.92, P = 0.001) were statistically associated with a positive urine culture in multivariate analysis. Conclusions and recommendations: The prevalence rate of UTIs was 25%. The study indicated the importance of routine screening of UTI (urine culture) as part of the clinical assessment of unexplained hyperbilirubinemia in neonates with an increase in the number of WBCs in their blood, small for gestational age, prolonged duration of phototherapy, and neonates born from mothers who had a history of obstetric complications

Auditory evoked potentials in a newborn Wistar rat model of hyperbilirubinemia / Potenciais evocados auditivos em um modelo de rato Wistar neonato com hiperbilirrubinemia

ABSTRACT INTRODUCTION: Hyperbilirubinemia is a common health problem in newborns. Its effects can be different according to the level and duration of the hyperbilirubinemia. The toxic effect of bilirubin on the auditory system can be seen as a sensory neural hearing loss or auditory neuropathy spectrum disorder (ANSD). OBJECTIVE: The purpose of our study was to determine the effects of toxic bilirubin level on the auditory system by using Auditory Brainstem Response audiometry. METHODS: Rats are used as animal models due to their low cost and easy attainability. Auditory Brainstem Response was used for auditory assessment. In this study, three groups were established: experimental, control and placebo groups. RESULTS: In the experimental group, which consists of rats with hyperbilirubinemia, sensory neural hearing loss was found bilaterally in 4 rats (66.67%) and unilaterally in 2 rats (16.67%) and auditory neuropathy spectrum disorder was found unilaterally in 1 rat (8.33%). Auditory Brainstem Response thresholds were significantly elevated compared to control and placebo groups (p < 0.05). CONCLUSION: Hyperbilirubinemia of newborn rats may result both in sensory neural hearing loss and auditory neuropathy spectrum disorder.

RESUMO INTRODUÇÃO: A hiperbilirrubinemia é um problema de saúde comum em neonatos. Seus efeitos podem variar, dependendo do nível e da duração da hiperbilirrubinemia. O efeito tóxico da bilirrubina no sistema auditivo pode ser observado na forma de deficiência auditiva sensorioneural ou de distúrbio do espectro da neuropatia auditiva. OBJETIVO: A finalidade de nosso estudo foi determinar os efeitos de nível tóxico de bilirrubina no sistema auditivo, com o uso da audiometria da resposta auditiva evocada de tronco cerebral. MÉTODO: Os ratos são empregados como modelos animais graças a seu baixo custo e fácil obtenção. Utilizamos a resposta auditiva evocada de tronco cerebral para avaliação da audição. No estudo, foram estabelecidos três grupos: experimental, controle e placebo. RESULTADOS: No grupo experimental, constituído de ratos com hiperbilirrubinemia, disacusia auditiva neurosensorial foi diagnosticada bilateralmente em quatro ratos (66,67%), e unilateralmente em dois (16,67%); e distúrbio do espectro da neuropatia auditiva foi observado unilateralmente em um rato (8,33%). Os limiares da resposta evocada de tronco cerebral estavam significantemente elevados, em comparação com os grupos controle e placebo (p < 0,05). CONCLUSÃO: A hiperbilirrubinemia de ratos neonatos pode resultar tanto em disacusia auditiva neurosensorial como em distúrbio do espectro da neuropatia auditiva.

Hipoacusia neurosensorial e hiperbilirrubinemia neonatal / Hearing loss, sensorineural and neonatal hyperbilirubinemia neonatal

INTRODUCCION: Hasta el 60 por ciento de los recién nacidos a término presentan hiperbilirrubinemia. La hiperbilirrubinemia es un factor de riesgo neonatal que tiene probada asociación con la hipoacusia neurosensorial. OBJETIVO: Identificar la prevalencia y características de la hipoacusia neurosensorial en recién nacidos a término con hiperbilirrubinemia neonatal. MATERIAL y METODOS: Estudio descriptivo, retrospectivo de corte transversal, se incluyen todos los recién nacidos a término con hiperbilirrubinemia sin otro factor de riesgo conocido para hipoacusia nacidos en el Servicio de Neonatología del Hospital Santa Rosa durante el período 2004-2011 con evaluación audiológica mediante Potenciales evocados auditivos de tallo cerebral (PEATC). RESULTADOS: Se estudiaron 36 pacientes. Hubo un predominio del sexo femenino (61.1 por ciento), el peso promedio al nacer fue 3149.4±558 gramos, la edad promedio al alta fue 2.186±1.99 días, la edad promedio al momento del reingreso fue 6.46±3.46, el valor promedio de bilirrubina total fue de 23.6±5.25. Se encontraron 5 pacientes (13,9 por ciento) con hiperbilirrubinemia moderada, 15 pacientes (41.7 por ciento) con hiperbilirrubinemia severa, 9 casos (25 por ciento) con hiperbilirrubinemia extrema y 5 casos (13.9 por ciento) con hiperbilirrubinemia fulminante. En 16 (44.4 por ciento) se reportó incompatibilidad sanguínea. El tipo más común de incompatibilidad fue ABO, con 8 casos de tipo OA (22.2 por ciento) y 8 casos OB (22.2 por ciento). Se utilizó fototerapia en 34 (94.4 por ciento) y fenobarbital en 19 (52.8 por ciento) pacientes. En 7 (19.4 por ciento) pacientes se practicó exanguinotransfusión. A ningún paciente se le administró albúmina. La tasa de prevalencia de hipoacusia en recién nacidos hiperbilirrubinémicos fue de 72.2 por ciento en el primer control de PEATC y de 29 por ciento en el segundo control. CONCLUSIONES: La tasa de prevalencia de hipoacusia en recién nacidos hiperbilirrubinémicos fue de 72.2...

INTRODUCTION: Up to 60 per cent of term infants have hyperbilirubinemia. Hyperbilirubinemia is a risk factor that has proven neonatal association with sensorineural hearing loss. OBJECTIVE: Identify the prevalence and characteristics of sensorineural hearing Ioss in term infants with neonatal hyperbilirubinemia. MATERIAL AND METHODS: A descriptive, retrospective cross section, including all term infants with hyperbilirubinemia without other known risk factors for hearing Ioss born Neonatology Service of Santa Rosa Hospital during the period 2004-2011 with audiological evaluation by auditory evoked potentials brainstem (ABR). RESULTS: There was a predominance of females (61.1 per cent), the average birth weight was 3149.4±558 grams, the average age at discharge was 2186±1.99 days, the average age at the time of readmission was 6.46±3.46, the average value of total bilirubin was 23.6±5.25. We found 5 patients (13.9 per cent) with moderate hyperbilirubinemia, 15 patients (41.7 per cent) with severe hyperbilirubinemia, 9 cases (25 per cent) with extreme hyperbilirubinemia and 5 cases (13.9 per cent) with fulminant hyperbilirubinemia. In 16 (44.4 per cent) reported blood incompatibility. The most common type was ABO incompatibility with OA type 8 cases (22.2 per cent) and OB 8 cases (22.2 per cent). Phototherapy was used in 34 (94.4 per cent) and phenobarbital in 19 (52.8 per cent) patients in 7 (19.4 per cent) patients underwent exchange transfusion. No patient was given albumin. The prevalence of hearing loss in newborns hyperbilirubinaemic was 72.2 per cent in the first control of ABR and 29 per cent in the second control. CONCLUSIONS: The prevalence of hearing los s in newborns Hyperbilirubinaemic was 72.2 per cent in the first control of ABR, and 29 per cent in the second control.

Caracterização da triagem auditiva neonatal da Clínica Limiar em Porto Velho - Rondônia / Newborn hearing screening in the Limiar Clinic in Porto Velho - Rondônia

Triagem auditiva neonatal de rotina é capaz de detectar precocemente alterações auditivas que poderão interferir na vida do indivíduo. OBJETIVO: Caracterizar o programa de triagem auditiva neonatal em uma população de neonatos. MATERIAL E MÉTODO: Estudo de coorte histórico longitudinal. Levantamento no banco de dados da clínica responsável pela triagem auditiva neonatal na cidade Porto Velho-RO do período de fevereiro de 2004 a outubro de 2006. RESULTADOS: Dos 6889 recém-nascidos cadastrados, 5700 (82,7 por cento) passaram e 1189 (17,3 por cento) falharam na primeira etapa da triagem. Dos que falharam 900 (75,7 por cento) compareceram para o reteste. Dentre estes, 15 (0,22 por cento) recémnascidos tiveram deficiência auditiva confirmada. A deficiência auditiva mais prevalente foi à perda auditiva neural com 46,7 por cento dos casos confirmados, tendo como indicador de risco mais prevalente a hiperbilirrubinemia. CONCLUSÃO: A hiperbilirrubinemia apresentou maior prevalência dentre os indicadores de risco encontrados nos recém-nascidos com deficiência auditiva confirmada. A prevalência de perda auditiva observada é de dois recém-nascidos para cada 1000 nascidos. Observa-se ainda uma correlação estatisticamente significante entre a perda auditiva neural com o indicador de risco hiperbilirrubinemia e perda auditiva neurossensorial com a etiologia desconhecida.

With the universal hearing screening we can prevent auditory disorders in children. AIM: To characterize the program of neonatal auditory screening into a population of neonates. MATERIALS AND METHODS: longitudinal cohort study. We surveyed the clinic's database on neonatal auditory screening in the city of Porto Velho, Rondônia. RESULTS: Among the 6,889 newborns in the database, 5,700 (82.7 percent) passed and 1,189 (17.3 percent) failed the first screening. Of the group which failed 900 (75.7 percent) returned for retesting. Among these, 15 (0.22 percent) newborns had hearing loss confirmed. The most prevalent was neural hearing loss with 46.7 percent confirmed cases; they had hyperbilirubinemia as the most prevalent risk factor. CONCLUSION: hyperbilirubinemia was the most prevalent risk factor found in the group of hearing impaired children. The prevalence of hearing loss was of 2 in 1,000 newborns. It is important to highlight the relevant association between neural hearing loss caused by hyperbilirubinemia and sensorineural hearing loss of unknown causes.

Icterícia como causa de internação neonatal: a experiência em um serviço terciário de Porto Alegre, RS / Jaundice in healthy term newborns treated at a tertiary center in Porto Alegre, RS

Introdução: Cerca de 60-80% dos recém-nascidos (RN) tornam-se ictéricos durante os primeiros dias de vida. Apesar de geralmente representar um fenômeno transitório, alguns pacientes necessitam de tratamento hospitalar. O objetivo deste estudo foi determinar a causa principal de icterícia neonatal em recém-nascidos saudáveis internados no Hospital Luterano e possíveis associações com diversas variáveis clínicas. Metodologia: Estudo retrospectivo em que foram estudados todos os casos de RN com icterícia neonatal internados para tratamento de hiperbilirrubinemia na UTI Neonatal do Hospital Luterano da ULBRA, no período de abril de 2007 a dezembro de 2008. Os resultados foram expressos em estatística descritiva e foi utilizado o teste exato de Fischer e o teste Qui-quadrado. O limite alfa considerado foi de 5%, com nível de significância de 0,05. Resultados: Dentre os RNs estudados (74), 52,7% eram do sexo masculino e 45,9% eram do sexo feminino. 14,8% dos pacientes nasceram de parto vaginal, enquanto que 85,1% nasceram de cesárea. A maioria dos recém-nascidos estudados (74,3%) foi considerada a termo. O diagnóstico mais frequente (37,8%) de icterícia dos pacientes internados para tratamento no serviço foi o de baixo aporte. Os pacientes do sexo masculino necessitaram de maior tempo de fototerapia do que as pacientes do sexo feminino (p=0,056). Conclusão: O diagnóstico de baixo aporte recebido pelos pacientes foi a causa mais frequente de icterícia. Os meninos necessitaram de um tempo significativamente maior de fototerapia para o tratamento da icterícia do que as meninas; também houve associação positiva da hiperbilirrubinemia com a baixa idade.

Introduction: About 60-80% of the newborns (NB) experience jaundice in the first days of life. Although jaundice is often a transitory phenomenon, some infants require hospital care. The aim of this study was to determine the main cause of neonatal jaundice among healthy newborns admitted to the Hospital Luterano and the possible associations with a number of clinical variables. Methods: A retrospective study in which all cases of NB with neonatal jaundice admitted for treatment of hyperbilirubinemia at the Neonatal ICU of the Hospital Luterano of ULBRA were studied, from Apr 2007 to Dec 2008. The results were expressed as descriptive statistics, and Fisher’s exact test and the Chi-square test were applied. The alpha limit considered was 5%, with level of significance at 0.05. Results: Among the 74 NB studied, 52.7% were males and 45.9% were females. 14.8% of the infants had a vaginal birth, while 85.1% had a cesarean delivery. Most of the studied infants (74.3%) were born full term. The most frequent cause for (37.8%) jaundice among these patients was inadequate intake. The male patients needed to stay longer on phototherapy than female patients (p=0.056). Conclusion: Low intake by the patient was the most frequent cause of jaundice in this series. The boys needed significantly more time on phototherapy than females, and there was a positive association of hyperbilirubinemia with low age.

Analysis of transient otoacoustic emissions and brainstem evoked auditory potentials in neonates with hyperbilirubinemia / Análise das emissões otoacústicas transientes e dos potenciais evocados auditivos do tronco encefálico em neonatos com hiperbilirrubinemia

Hyperbilirubinemia is toxic to the auditory pathways and to the central nervous system, leaving sequelae such as hearing loss and encephalopathy. AIM: to assess the hearing of neonates with hyperbilirubinemia, using transient evoked otoacoustic emissions (TOAEs) and brainstem evoked auditory potentials (BEAP). Prospective study. MATERIALS AND METHODS: we had two groups: GI (n-25), neonates with hyperbilirubinemia; GII (n-22), neonates without hyperbilirubinemia and without risk factors for hearing loss. All the neonates had up to 60 days of life and were submitted to TOAE and BEAP. RESULTS: 12 neonates from GI and 10 from GII were girls and 13 from GI and 12 from GII were boys. TOAEs were present in all the children, however with lower amplitudes in GI, especially in the frequencies of 2 and 3KHz (p < 0.05). Regarding the BEAP, we observed a mild PV and LI-V increase in BI. The alterations observed in these tests do not correlate to the serum levels of bilirubin. CONCLUSIONS: in neonates with hyperbilirubinemia, we noticed lower TOAE amplitudes and mild PV and LI-V increase, indicating cochlear and retrocochlear disorders, stressing the importance of using both tests and carefully reading them in these evaluations.

A hiperbilirrubinemia é tóxica às vias auditivas e ao sistema nervoso central, deixando sequelas como surdez e encefalopatia. OBJETIVOS: avaliar a audição de neonatos portadores de hiperbilirrubinemia, utilizando-se a pesquisa das emissões otoacústicas evocadas transientes (EOAET) e dos potenciais evocados auditivos do tronco encefálico (PEATE). Estudo prospectivo. CASUÍSTICA E MÉTODOS: Constituíram-se dois grupos: GI (n-25), neonatos com hiperbilirrubinemia; GII (n-22), neonatos sem hiperbilirrubinemia e sem fatores de risco para surdez. Todos os neonatos tinham até 60 dias de vida e foram submetidos à EOAET e ao PEATE. RESULTADOS: 12 neonatos de GI e 10 de GII eram meninas e 13 de GI e 12 de GII eram meninos. As EOAET estavam presentes em todas as crianças, porém com amplitudes menores em GI, especialmente nas frequências de 2 e 3KHz (p < 0,05). No PEATE, observou-se discreto prolongamento de PV e de LI-V em GI. As alterações observadas nesses testes não se correlacionaram aos níveis séricos da bilirrubinemia. CONCLUSÕES: Em neonatos portadores de hiperbilirrubinemia, menores amplitudes das EOAET e discreto prolongamento de PV e de LI-V foram constatados indicando comprometimento coclear e retrococlear das vias auditivas, salientando-se a importância da utilização e da interpretação minuciosa de ambos os testes nessas avaliações.

Auditory brainstem responses in autisnc children in comparison with normal children

One of the most important problems of children who suffer from autism is abnormality in receiving and integrating sensory inputs, especially hearing input. It has been shown that brainstem has a key role in receiving, encoding and integrating hearing input. Auditory brainstem response [ABR] is a tool by which we can evaluate this function. The purpose of this study was to assess and to compare autistic and normal children brainstem hearing function. This case-control study was conducted on thirty [58 ears] autistic and thirty [57 ears] normal 6-12 years old children. The children with autism were divided into slight and severe subgroups according to Autism Diagnostic Interview-Revised questionnaire. Clickevoked ABR was recorded and compared between groups. There was significant difference between two groups V and III wave latencies and I-III and I-V interpeak latencies [p < 0.05]. In fact, comparison of the results of autism subgroups with normal children indicated that the latencies of the severe subgroup significantly prolonged. Increasing latencies of ABR waves in severe subgroup maybe due to abnormality in low level of brainstem. Brainstem abnormality may result in exacerbating the symptom of autism. It is therefore suggested that ABR is included in diagnostic test batteries for these patients

Auditory evaluation of high risk newborns by automated auditory brain stem response

The objective of this study was to assess the prevalence of hearing impairment by automated auditory brain stem response [AABR] in newborns admitted to an intensive and intermediate care unit and to analyze the associated risk factors. An observational cross-sectional study was conducted between January 2005 and January 2006. 834 newborns [62% boys and 38% girls] were assessed. Newborns had a mean [SD] gestational age of 36 [2.1] weeks with a mean [SD] birth weight of 2950 [1250] grams. The presence of the following neonatal pathologies was investigated: craniofacial malformations, hyperbilirubinemia [total bilirubin 20 mg/dl for all newborns], neonatal asphyxia, congenital infections, septicemia, birth weight [

Egreso precoz del recién nacido: [revisión] / Early newborn discharge: [review]

El egreso precoz del recién nacido, definido como el alta de las 48 horas del nacimiento, se ha convertido en una práctica clínica rutinaria, motivada en parte por la presión familiar de convertir el acto de nacer en un acontecimiento natural, y fomentada por la escasez de camas maternas en los institutos públicos de salud. A pesar de su frecuente aplicación, no existen estudios bien diseñados que demuestren la seguridad del egreso precoz cuando se emplea de manera colectiva. Aunque ofrece beneficios biológicos y sociales, el alta temprana puede ser un procedimiento riesgoso, debido a situaciones no detectadas que pueden amenazar el bienestar del neonato en el ambiente del hogar, cuando el niño no está siendo supervisado por personal de salud. Las complicaciones neonatales asociadas al egreso precoz son más frecuentes cuando el alta no se complementa con una visita temprana programada a las 48 horas del alta, y cuando se aplica de manera masiva, sin individualizar las necesidades particulares de cada pareja madre-niño. La condición neonatal más importante relacionada al alta precoz es la hiperbilirrubinemia excesiva, especialmente en el neonato prematuro tardío. La Academia Americana de Pediatría ha establecido un conjunto de criterios mínimos a cumplir para que el neonato se vaya al hogar antes de 48 horas, el seguimiento de los cuales es variable entre los pediatras. Estas normas son dificiles de cumplir en los hospitales públicos venezolanos, debido a la alta densidad de nacimientos y a características demográficas particulares. Es factible que se requiera la formulación de requisitos propios de egreso que se puedan aplicar en grupos bien seleccionados de nuestra población.

Early newborn discharge has progressively become a common clinical practice in many institutions, due to the mothers’ wish to demedicalize the childbirth process and to the scarcity of maternal beds in public hospitals. Although early discharge provides social and biological benefits, its collective application may be associated with risks for the mother and the newborn, since immediate postnatal recovery has shifted from the hospital to the home, where the infant is not being supervised by health professionals. These risks are more relevant when short stays are not complemented with a follow-up visit within 48 hours, and when early discharge is massively applied without consideration for particular needs of mothers and infants. The most common neonatal complication seen after early newborn discharge is extreme hyperbilirubinemia, most notorious in late preterm infants. A list of minimal criteria for early discharge has been published by the American Academy of Pediatrics. The compliance with these guidelines is highly variable among pediatricians, and its suitability in our maternity wards is not warranted. Formulation of particular criteria adjusted to the demographic and behavioral characteristics of our perinatal population seems mandatory.

Early onset conjugated hyperbilirubinemia in newborn infants.

OBJECTIVES: To determine the causes and related outcomes of early onset conjugated hyperbilirubinemia in a group of newborn infants and to determine the incidence of sepsis in these neonates. METHODS: The charts of 42 babies with conjugated hyperbilirubinemia were retrospectively reviewed. RESULTS: The mean gestational age was 37 weeks and the mean postnatal age at presentation was 10 days. Culture-proven sepsis was identified in 15 babies (35.7% of total). Gram-negative bacteria were isolated in 10 cases and E. coli was the most common of these agents (7 cases). Perinatal hypoxia-ischemia was the second most frequent etiology (7 patients; 16.7% of total). The other diagnoses were blood group incompatibility (n=5), Down syndrome (n=3), cholestasis associated with parenteral nutrition (n=3), neonatal hepatitis (n=2), metabolic liver disease (n=1), biliary atresia (n=1), portal venous thrombosis (n=1) and unknown (n=4). Thirteen babies with sepsis recovered completely with treatment, whereas the prognosis for those with perinatal hypoxia-ischemia was grave (six of seven died). CONCLUSIONS: The findings suggest that early onset cholestatic jaundice in newborn infants is more commonly from non-hepatic causes, so it is reasonable to monitor these infants carefully for a period of time before undertaking time-consuming or invasive investigations towards a primary liver disease.

Thai healthy newborns have a higher risk.

Kernicterus is a preventable but devastating neurologic disorder with life long complications. It is caused by severe and inadequately treated hyperbilirubinemia during the newborn period. In the present paper potential causes and risk factors for the occurrence of kernicterus related to the Thai health system that are responsible for the care of newborn infants before and after discharge are discussed. Potential risk reduction strategies for the Thai health system are purposed Some efforts to improve the quality of Thai newborn care particularly newborns with jaundice that have been made are mentioned. An adherence to the American Academy of Pediatrics clinical guideline for management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation for those strategies that are feasible to follow will help reduce the prevalence of severe hyperbilirubinemia and bilirubin encephalopathy.