Hyperbilirubinemia in term and near-term infants: Kernicterus on the rise?

Case study on the use of intensive pediatric neurorehabilitation in the treatment of kernicterus

Background

Kernicterus Spectrum Disorder (KSD) is the result of prolonged bilirubin toxicity resulting in widespread neurological injury. Once the bilirubin levels are normalized the encephalopathy becomes static, however the consequences of the injury can have life-long effects. The sequelae of KSD include motor impairments, auditory deficits, dental dysplasia, and potentially cognitive impairments. While KSD is a rare diagnosis, particularly in developed countries, there is evidence that there may be a global increase in incidence (Hansen, Semin Neonatol 7:103–9, 2002; Johnson, J Perinatol 29:S25–45, 2009; Kaplan etal. Neonatology 100:354–62, 2011; Maisels, Early Hum Dev 85:727–32, 2009; Olusanya etal., Arch Dis Child 99:1117–21, 2014; Steffensrud, Newborn Infant Nurs Rev 4:191–200, 2004). The literature on the treatment of various specific sequelae of KSD is varied, but in general specific therapeutic efforts to improve motor skills are not evidenced-based. The following is a case report on the use of Acquire therapy, an intensive neuromotor intervention, to ameliorate some of the motor-function deficits secondary to KSD.

Case presentation

This case-report presents the results of two intensive therapeutic intervention sessions in one male child with KSD. Treatments occurred at 28 and 34 months. The child presented with fine and gross motor deficits as well as communication delays. Each session consisted of daily therapy for 4 h each weekday for 3 weeks. The child was assessed before and after treatment with 2 standardized measures, the Gross Motor Function Measure (GMFM) and The Bayley Scales of Infant and Toddler Development (Bayley).

Conclusions

The GMFM at the 1st assessment was 34, 74at the 2nd assessment (after intervention 1), and 64 at the third assessment and 104 at the 4th assessment (after intervention 2). The Bayley at the 3rd assessment was 18, and 38 at the 4th assessment (after intervention 2).

Efficacy of double and triple phototherapy in term newborns with hyperbilirubinemia: the first clinical trial

BACKGROUND

Icterus is the most common medical problem in neonates and phototherapy is the standard treatment for neonatal hyperbilirubinemia. This study aimed to compare the efficacy and length of hospital stay of double and triple phototherapy in newborns with indirect hyperbilirubinemia.

METHODS

In a clinical trial, 40 healthy term newborns (gestational age >37 weeks) with bilirubin > or =12 and > or =15 mg/dL in the second and third day, respectively, were randomly assigned to triple (n=20) or double phototherapy (n=20) groups. Total and direct serum bilirubin were measured at admission, 8, 16, and 24 hours after beginning of phototherapy, and every 12 hours thereafter until discharge (when bilirubin levels reached < or =10 mg/dL).

RESULTS

There were 21 male (52%) and 19 female (48%) term neonates, with significant difference between patients' age, weight, and age of icterus. There was no significant difference in the rate of bilirubin decline between the two groups within the first 8, 16 and 24 hours. There was no significant difference in mean length of hospital stay between the two groups. Analysis of complications showed no difference between triple and double groups.

CONCLUSION

Triple phototherapy failed to reduce total serum bilirubin and shorten length of hospitalization more rapidly than double phototherapy.

Toward understanding the connections between infant jaundice and infant feeding

Parents face a paradox when they are told: Breast is best; bottle-feeding is hazardous to health. But breast-fed babies are more likely to become severely jaundiced than bottle-fed babies, and severe jaundice can lead to brain damage. This article will explore the natural physiology of jaundice with a focus on breast-feeding-associated jaundice, primary prevention of hyperbilirubinemia, and current evidence-based recommendations about feeding jaundice breast-fed infants.