Neonatal Jaundice.

Hyperbilirubinemia is a common occurrence in neonates; it may be physiological or pathological. Conjugated hyperbilirubinemia may result from medical or surgical causes, and can result in irreversible liver damage if untreated. The aim of imaging is the timely diagnosis of surgical conditions like biliary atresia and choledochal cysts. Abdominal ultrasound is the first line imaging modality, and Magnetic resonance cholangiopancreatography (MRCP) also has a role, especially in pre-operative assessment of choledochal cysts (CDCs). For biliary atresia, the triangular cord sign and gallbladder abnormalities are the two most useful ultrasound features, with a combined sensitivity of 95%. Liver biopsy has an important role in pre-operative evaluation; however, the gold standard for diagnosis of biliary atresia remains an intra-operative cholangiogram. Choledochal cysts are classified into types according to the number, location, extent and morphology of the areas of cystic dilatation. They are often associated with an abnormal pancreaticobiliary junction, which is best assessed on MRCP. Caroli's disease or type 5 CDC comprises of multiple intrahepatic cysts. CDCs, though benign, require surgery as they may be associated with complications like cholelithiasis, cholangitis and development of malignancy. Severe unconjugated hyperbilirubinemia puts neonates at high risk of developing bilirubin induced brain injury, which may be acute or chronic. Magnetic resonance imaging of the brain is the preferred modality for evaluation, and shows characteristic involvement of the globus pallidi, subthalamic nuclei and cerebellum - in acute cases, these areas show T1 hyperintensity, while chronic cases typically show hyperintensity on T2 weighted images.

Ictericia neonatal / Neonatal jaundice

Tipos de ictericia. Origen de la bilirrubina. Toxicidad de la bilirrubina. Tratamiento

Sensitivity, Specificity, and Accuracy of Kramer Examination of Neonatal Jaundice: Comparison with Total Bilirubin Serum.

Neonatal jaundice often occurs in the first week after birth. Early detection of neonatal jaundice can prevent kernicterus as a complication of high levels of bilirubin in neonates. Visual assessment is one of the examinations introduced by Kramer to assess the presence of neonatal jaundice. The purpose of this study was to determine the sensitivity, specificity, and accuracy of Kramer's visual assessment in the examination of neonatal jaundice. This study used cross-sectional design to examine 102 infants, with the sample selected by the convenience sampling method. A 2 × 2 table diagnostic test was employed in this study to analyze the data. The results of this study showed that visual assessment of neonatal jaundice obtained a sensitivity value of 76.92%, a specificity value of 89.47%, and an accuracy value of 86.27%. This research can contribute to the development of other non-invasive methods for assessing neonatal jaundice, and thereby contribute to a decrease in neonatal morbidity.

N-gram support vector machines for scalable procedure and diagnosis classification, with applications to clinical free text data from the intensive care unit.

BACKGROUND: Existing risk adjustment models for intensive care unit (ICU) outcomes rely on manual abstraction of patient-level predictors from medical charts. Developing an automated method for abstracting these data from free text might reduce cost and data collection times. OBJECTIVE: To develop a support vector machine (SVM) classifier capable of identifying a range of procedures and diagnoses in ICU clinical notes for use in risk adjustment. MATERIALS AND METHODS: We selected notes from 2001-2008 for 4191 neonatal ICU (NICU) and 2198 adult ICU patients from the MIMIC-II database from the Beth Israel Deaconess Medical Center. Using these notes, we developed an implementation of the SVM classifier to identify procedures (mechanical ventilation and phototherapy in NICU notes) and diagnoses (jaundice in NICU and intracranial hemorrhage (ICH) in adult ICU). On the jaundice classification task, we also compared classifier performance using n-gram features to unigrams with application of a negation algorithm (NegEx). RESULTS: Our classifier accurately identified mechanical ventilation (accuracy=0.982, F1=0.954) and phototherapy use (accuracy=0.940, F1=0.912), as well as jaundice (accuracy=0.898, F1=0.884) and ICH diagnoses (accuracy=0.938, F1=0.943). Including bigram features improved performance on the jaundice (accuracy=0.898 vs 0.865) and ICH (0.938 vs 0.927) tasks, and outperformed NegEx-derived unigram features (accuracy=0.898 vs 0.863) on the jaundice task. DISCUSSION: Overall, a classifier using n-gram support vectors displayed excellent performance characteristics. The classifier generalizes to diverse patient populations, diagnoses, and procedures. CONCLUSIONS: SVM-based classifiers can accurately identify procedure status and diagnoses among ICU patients, and including n-gram features improves performance, compared to existing methods.

[Neonatal hyperbilirubinemia and molecular mechanisms of jaundice]. / Vrozené hyperbilirubinemie a molekulární mechanizmy zloutenky.

The introductory summarises the classical path of heme degradation and classification of jaundice. Subsequently, a description of neonatal types of jaundice is given, known as Crigler Najjar, Gilberts, DubinJohnson and Rotor syndromes, emphasising the explanation of the molecular mechanisms of these metabolic disorders. Special attention is given to a recently discovered molecular mechanism of the Rotor syndrome. The mechanism is based on the inability of the liver to retrospectively uptake the conjugated bilirubin fraction primarily excreted into the blood, not bile. A reduced ability of the liver to uptake the conjugated bilirubin contributes to the development of hyperbilirubinemia in common disorders of the liver and bile ducts and to the toxicity of xenobiotics and drugs using transport proteins for conjugated bilirubin.

Early identification and referral of liver disease.

This article aims to review the causes of jaundice, particularly conjugated jaundice in infants and the signs and symptoms of neonatal liver disease. The role of community practitioners in identifying prolonged jaundice in Infants will be discussed and a jaundice protocol and early identification algorithm will be introduced.

Weight loss and hypernatremia in breast-fed babies: frequency in neonates with non-hemolytic jaundice.

OBJECTIVE: The aim of this study was to determine what proportion of newborns admitted with idiopathic non-hemolytic hyperbilirubinemia exhibit severe weight loss and hypernatremia. METHODS: The prospective study involved 115 infants >48 h old who were admitted with jaundice between July 2002 and July 2003, and had unconjugated bilirubin levels >12 mg/dL. Premature babies (gestational age <37 weeks) and those with hemolytic jaundice and other pathologic causes of non-hemolytic jaundice were excluded. Postnatal age (days) at admission, bodyweight at admission, weight change since birth (percentage weight loss calculated at admission) and mode of feeding (breast-feeding, formula feeding, mixed feeding) were recorded. Severe weight loss was defined in babies who showed >10% weight loss or had not regained enough to reach birthweight by postnatal day 10. Serum Na levels and breast-milk Na levels were also measured. RESULTS: Twenty-eight (33%) of the 86 newborns with idiopathic hyperbilirubinemia in the study exhibited severe weight loss. Almost all the 86 babies were exclusively breast-fed, and 10 babies (12%) had severe weight loss combined with hypernatremia. The group with severe weight loss and hypernatremia had higher breast-milk Na levels than the other infants. CONCLUSION: The results indicate that a large proportion of babies with non-hemolytic jaundice have severe weight loss, and that breast-fed newborns with the combination of weight loss and hypernatremia may present with non-hemolytic jaundice.

Non-invasive bilirubinometry in neonatal jaundice.

This chapter will focus on techniques that have been developed to measure transcutaneous bilirubin (TcB). The first electronic TcB device proved to be useful when used as a screening method for identifying newborns who needed a serum bilirubin determination. Newer TcB devices can be used not only as screening tools but also as reliable substitutes for serum bilirubin measurements. The Chromatics Colormate III is still based on the colour of the skin, estimating serum bilirubin from skin-reflectance (skin colour) whereas the BiliCheck measures transcutaneous bilirubin by utilizing the entire spectrum of visible light (380 to 760 nm) reflected by the skin.

Hyperbilirubinemia in the term newborn.

Hyperbilirubinemia is one of the most common problems encountered in term newborns. Historically, management guidelines were derived from studies on bilirubin toxicity in infants with hemolytic disease. More recent recommendations support the use of less intensive therapy in healthy term newborns with jaundice. Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 micromol per L) in infants 25 to 48 hours old, 18 mg per dL (308 micromol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 micromol per L) in infants older than 72 hours. Few term newborns with hyperbilirubinemia have serious underlying pathology. Jaundice is considered pathologic if it presents within the first 24 hours after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 micromol per L) per day or is higher than 17 mg per dL (290 micromol per L), or an infant has signs and symptoms suggestive of serious illness. The management goals are to exclude pathologic causes of hyperbilirubinemia and initiate treatment to prevent bilirubin neurotoxicity.

Recognition of the presence and severity of newborn jaundice by parents, nurses, physicians, and icterometer.

OBJECTIVE: To determine how well parents, nurses, physicians, and an Ingram icterometer can detect the presence and the severity of jaundice in newborns. SETTING: Normal newborn nursery in a 340-bed teaching hospital. PATIENTS OR OTHER PARTICIPANTS: Nurses and physicians caring for nursery infants and parents of the infants. INTERVENTIONS: Physicians and nurses examining newborns documented whether they detected jaundice in the infants and, if so, the estimated bilirubin level and the extent of cephalocaudal progression of the jaundice. An assistant taught the parents how to examine the infants for jaundice and determine its cephalocaudal progression. The assistant also obtained icterometer readings. Bilirubin testing was performed according to usual clinical practice. OUTCOME MEASURES: Nurse and physician estimates of bilirubin levels; parent, nurse, and physician assessment of the presence of jaundice and its cephalocaudal progression; icterometer readings; bilirubin levels. RESULTS: There was moderate agreement about the presence of jaundice in the infants (pairwise kappa, 0.48) However, all infants with bilirubin levels >12 mg/dL were correctly identified as jaundiced by all examiners. The parents' assessment of cephalocaudal progression and the icterometer readings were most highly correlated with serum bilirubin levels (adjusted Pearson correlations, 0.71 and 0.57, respectively). CONCLUSIONS: Many parents can be taught to accurately assess cephalocaudal progression of jaundice in the hospital. The icterometer is a useful tool for assessing jaundice severity. Both parent assessment and the icterometer were more highly correlated with bilirubin levels than physician and nurse estimates in this study. Additional research is needed to determine how accurate these methods of clinical assessment are at the higher bilirubin levels that typically occur after hospital discharge.

Icterícias näo colestáticas do recém-nascido / Non-colestatic neonatal jaundice

Este artigo relembra alguns conceitos básicos e faz uma revisäo do que há de novo no conhecimento e abordagem das icterícias neonatais näo colestáticas

Management of neonatal jaundice.

Jaundice is the most commonly encountered neonatal clinical problem; 80 percent of neonates become clinically jaundiced, while 5 percent develop serum bilirubin levels above currently recommended treatment standards. This article outlines theories about the pathophysiology of neonatal jaundice and presents a logical approach to its management. First, the health care provider must distinguish between physiologic, exaggerated and pathologic jaundice. The treatment modalities of exchange transfusion, phototherapy and cessation of nursing are discussed.