Neonatal hyperbilirubinemia and repercussions on neurodevelopment: A systematic review

The relationship between preoperative serum indirect bilirubin and postoperative delirium in geriatric patients undergoing joint replacement

BACKGROUND

Postoperative delirium (POD) is one of the most common complications in geriatric patients following surgery. Physiological concentration of bilirubin possesses anti-inflammatory, antioxidant and neuroprotective effects, which are important protective mechanisms against POD. This study aimed to explore the relationship between preoperative serum bilirubin and POD in geriatric patients undergoing joint replacement.

METHODS

Geriatric patients who underwent hip or knee joint replacement surgery under intrathecal anesthesia were included. These patients had American Society of Anesthesiologists (ASA) grades I to III. The patients with a history of psychiatric or neurological disorders, infectious diseases or sepsis, hemolytic anemia, liver diseases, performed general anesthesia or intrathecal anesthesia combined with general anesthesia, or insufficient surgical information were excluded. Patients' age, gender, weight, height, ASA classification, liver function and bilirubin within one week before surgery, preoperative Mini-Mental State Examination (MMSE) scores, surgical type, dosage of medications, intraoperative bleeding volume, postoperative average numeric rating scale (NRS) pain scores, the occurrence of POD and Delirium Rating Scale-Revised-98 (DRS-R-98) scores for POD were collected.

RESULTS

A total of 269 patients were eligible for inclusion in the study, with 23.05% (62/207) exhibiting POD. Patients with POD exhibited higher age and ASA classification, and had lower weight, serum total serum bilirubin (TBIL) and indirect bilirubin (IBIL) within one week before surgery, and preoperative MMSE scores (all p < 0.05). Univariate logistic regression analysis showed that the above variables were correlated with the occurrence of POD (all p < 0.05). Multivariate logistic regression analysis revealed that age was a risk factor (p < 0.001, OR = 1.14, 95% CI [1.07-1.21]), while weight (p = 0.041, OR = 0.96, 95% CI [0.92-0.99]), IBIL levels within one week before surgery (p = 0.012, OR = 0.65, 95% CI [0.47-0.91]) and preoperative MMSE scores (p < 0.001, OR = 0.84, 95% CI [0.78-0.91]) served as protective factors against the occurrence of POD. The serum IBIL concentration within one week before surgery was performed receiver operating characteristic (ROC) curve analysis. The estimated cutoff value for predicting the occurrence of POD was 6.65 μmol/L, and area under the curve (AUC) was 0.63. Patients with preoperative serum IBIL concentration below 6.65 μmol/L had a higher incidence of POD.

CONCLUSION

Patients with lower preoperative serum IBIL levels exhibited a higher incidence of POD in geriatric patients undergoing joint replacement. Low serum IBIL was a risk factor and a predictor for the occurrence of POD.

The Relationship between General Movements and Risk Factors in Moderate-Late Preterm Infants: A Prospective Cohort Study

INTRODUCTION

Moderate-late preterm infants constitute the largest segment of preterm births globally. While previously considered to have a low neurological risk, recent research has uncovered an elevated incidence of neurodevelopmental conditions in this group. This study aimed to assess the relationship between the general movement assessment and birth-related risk factor-based tools in moderate-late preterm infants.

METHODS

A prospective cohort study of 65 moderate-late preterm infants in a neonatal intensive care unit involved the evaluation of general movements, the Nursery Neurobiologic Risk Score, and the Perinatal Risk Inventory. Associations were analyzed using Fisher's exact test, Spearman's correlation was used for ordinal variables, and backward stepwise logistic regression was used to identify predictor variables for the assessments.

RESULTS

The findings indicated a high prevalence of normal (41%) and poor (52%) repertoire patterns during the writhing period. While no significant associations were found between the three assessments, a slight approximation emerged between dysmorphic traits and patterns (p = 0.053). Furthermore, an extended period of ventilation correlated with a higher likelihood of developing a cramped synchronized pattern and there was a correlation between both risk factor-based tools (p < 0.001).

CONCLUSIONS

This research enhances our understanding of the early impact on general movement assessments in moderate-late preterm infants. While no clear relationship emerged between general movement assessment and risk factor-based tools, there was a subtle connection noted with dysmorphic traits. A longer ventilation duration was linked to a higher risk of developing cramped synchronized patterns.