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Banerjee B, Olajide OJ, Bortolussi G, Muro AF. Activation of Alternative Bilirubin Clearance Pathways Partially Reduces Hyperbilirubinemia in a Mouse Model Lacking Functional Ugt1a1 Activity. Int J Mol Sci 2022; 23:ijms231810703. [PMID: 36142606 PMCID: PMC9505366 DOI: 10.3390/ijms231810703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/21/2022] Open
Abstract
Bilirubin is a heme catabolite and Ugt1a1 is the only enzyme involved in the biological elimination of bilirubin. Partially functional or non-functional Ugt1a1 may result in neuronal damage and death due to the accumulation of unconjugated bilirubin in the brain. The understanding of the role of alternative bilirubin detoxification mechanisms that can reduce bilirubin toxicity risk is crucial for developing novel therapeutic strategies. To provide a proof-of-principle showing whether activation of alternative detoxification pathways could lead to life-compatible bilirubin levels in the absence of Ugt1a1 activity, we used Ugt1−/− hyperbilirubinemic mice devoid of bilirubin glucuronidation activity. We treated adult Ugt1−/− mice with TCPOBOP, a strong agonist of the constitutive androstane receptor (CAR). TCPOBOP treatment decreased plasma and liver tissue bilirubin levels by about 38%, and resulted in the transcriptional activation of a vast array of genes involved in bilirubin transport and metabolism. However, brain bilirubin level was unaltered. We observed ~40% degradation of bilirubin in the liver microsomes from TCPOBOP treated Ugt1−/− mice. Our findings suggest that, in the absence of Ugt1a1, the activation of alternative bilirubin clearance pathways can partially improve hyperbilirubinemic conditions. This therapeutic approach may only be considered in a combinatorial manner along with other treatments.
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Lee ZM, Yang YH, Chang LS, Chen CC, Yu HR, Kuo KC. Increased Total Serum Bilirubin Level Post-Ibuprofen Use Is Inversely Correlated with Neonates' Body Weight. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081184. [PMID: 36010074 PMCID: PMC9406485 DOI: 10.3390/children9081184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022]
Abstract
Backgrounds: Drugs with the ability to displace bilirubin from albumin-binding sites subsequently leading to an increased bilirubin level may cause hyperbilirubinemia in neonates. Ibuprofen is commonly used to treat patent ductus arteriosus (PDA) in neonates, yet the use of ibuprofen has drawn mixed conclusions. We performed a retrospective study to determine how ibuprofen use influences the total serum bilirubin (TSB) level in neonates of differing birth weight (BW). Materials and methods: Neonates (including premature infants) born at Chang Gung Memorial Hospital, Taiwan during January 2004 to July 2020 were entered into this study. We recorded the phototherapy duration, including the initial day and end day, and determined the average influence of one-day phototherapy on TSB level. The highest monitored TSB level post-ibuprofen use minus the one measured prior to ibuprofen use was considered the TSB change following ibuprofen administration in this study, and the above-mentioned influence of daily phototherapy on the TSB level was used to correlate the results. Neonates with any of the following conditions were excluded: those who received ceftriaxone, those with intraventricular hemorrhage, and those infected with TORCH. Results: The average daily influence of phototherapy on the TSB level of neonates was −0.20 (−0.57~0.05) mg/dL, −0.28 (−0.84~0.13) mg/dL, −0.75 (−1.77~0.10) mg/dL, and −1.60 (−2.70~−0.50) mg/dL in neonates with BWs of <1 kg, 1−1.49 kg, 1.5−2.49 kg, and ≥2.5 kg, respectively, indicating that neonates with a BW ≥ 1.5 kg experienced a greater reduction in TSB level following phototherapy as compared with those with a BW < 1.5 kg. The average TSB increase following ibuprofen use in neonates was 3.38 ± 2.77 mg/dL, 2.04 ± 2.53 mg/dL, and 1.34 ± 2.24 mg/dL in neonates with BWs of <1 kg, 1−1.49 kg, and ≥1.5 kg, respectively, i.e., an elevated TSB change with a decreased neonate BW was noted post-ibuprofen use (p = 0.026, one-way analysis of variance (ANOVA)). Conclusions: As ibuprofen use is correlated with an apparent increase in TSB level in neonates with a lower BW, especially in those with a BW < 1 kg, iv acetaminophen can be an appropriate alternative to ibuprofen for ELBW neonates for the treatment of PDA if they are experiencing severe unconjugated hyperbilirubinemia.
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Affiliation(s)
- Zon-Min Lee
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Department of Pharmacy, Tajen University, Pingtung 90741, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 61344, Taiwan
- Health Informatics and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 61344, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chih-Cheng Chen
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi 61344, Taiwan
- College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan
- Section of Neonatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Department of Early Childhood Care and Education, Cheng-Shiu University, Kaohsiung 83301, Taiwan
| | - Hong-Ren Yu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Kuang-Che Kuo
- College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Correspondence: ; Tel.: +886-7-7317123; Fax: +886-7-7338009
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Hajjaj OI, Clarke G, Lieberman L. Immunohematology testing using umbilical cord blood: review of the literature, survey of practice and guidance development. Transfusion 2022; 62:871-886. [PMID: 35322408 DOI: 10.1111/trf.16834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Following delivery, blood tests are performed on umbilical cord blood (CB) to avoid neonatal venipuncture. Despite widespread and longstanding CB testing, no guidelines exist to suggest which immunohematology tests should be performed on CB. STUDY DESIGN AND METHODS We performed a scoping review, surveyed national practice, and developed guidance statements concerning CB testing. Database searches identified relevant articles. A survey was sent to all Canadian hospitals and transfusion laboratories that perform perinatal testing. A national panel of experts was convened to develop guidance statements. RESULTS A total of 116 articles met the inclusion criteria and were summarized. Literature on CB testing is limited; few studies have investigated laboratory testing methodologies or validated CB test results with peripheral samples. The survey was completed by 580/597 institutions (97%); 85% were community hospitals and 16% had a neonatal intensive care unit. There is diversity in the types of CB tests performed and variability in practice. While most centers order appropriately, some laboratories routinely perform CB tests that are not clinically indicated (e.g., direct antiglobulin testing for all neonates) and other do not perform CB tests when results would be beneficial (e.g., phenotype on CB when mother has a clinically significant antibody). Fifteen guidance statements were developed. DISCUSSION This study highlights variability in CB testing, likely reflecting evidence gaps, methodology differences between studies, and lack of guidelines. CB tests should only be performed when indicated and validated on this sample type. The presented guidance statements aim to standardize practice and encourage judicious CB sampling.
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Affiliation(s)
- Omar I Hajjaj
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
| | - Gwen Clarke
- Canadian Blood Services, Laboratory Services, Ottawa, Ontario, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Lani Lieberman
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada.,Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Thomas M, Greaves RF, Tingay DG, Loh TP, Ignjatovic V, Newall F, Oeum M, Tran MTC, Rajapaksa AE. Current and emerging technologies for the timely screening and diagnosis of neonatal jaundice. Crit Rev Clin Lab Sci 2022; 59:332-352. [PMID: 35188857 DOI: 10.1080/10408363.2022.2038074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Neonatal jaundice is one of the most common clinical conditions affecting newborns. For most newborns, jaundice is harmless, however, a proportion of newborns develops severe neonatal jaundice requiring therapeutic interventions, accentuating the need to have reliable and accurate screening tools for timely recognition across different health settings. The gold standard method in diagnosing jaundice involves a blood test and requires specialized hospital-based laboratory instruments. Despite technological advancements in point-of-care laboratory medicine, there is limited accessibility of the specialized devices and sample stability in geographically remote areas. Lack of suitable testing options leads to delays in timely diagnosis and treatment of clinically significant jaundice in developed and developing countries alike. There has been an ever-increasing need for a low-cost, simple to use screening technology to improve timely diagnosis and management of neonatal jaundice. Consequently, several point-of-care (POC) devices have been developed to address this concern. This paper aims to review the literature, focusing on emerging technologies in the screening and diagnosing of neonatal jaundice. We report on the challenges associated with the existing screening tools, followed by an overview of emerging sensors currently in pre-clinical development and the emerging POC devices in clinical trials to advance the screening of neonatal jaundice. The benefits offered by emerging POC devices include their ease of use, low cost, and the accessibility of rapid response test results. However, further clinical trials are required to overcome the current limitations of the emerging POC's before their implementation in clinical settings. Hence, the need for a simple to use, low-cost POC jaundice detection technology for newborns remains an unsolved challenge globally.
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Affiliation(s)
- Mercy Thomas
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Australia
| | - Ronda F Greaves
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Victorian Clinical Genetics Services, Melbourne, Australia.,International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy
| | - David G Tingay
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
| | - Tze Ping Loh
- International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy.,Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Hematology, Murdoch Children's Research Institute, Melbourne, Australia
| | - Fiona Newall
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Australia
| | - Michelle Oeum
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | - Mai Thi Chi Tran
- International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy.,National Children's Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - Anushi E Rajapaksa
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Think Project Global, Melbourne, Australia
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Bortolussi G, Shi X, ten Bloemendaal L, Banerjee B, De Waart DR, Baj G, Chen W, Oude Elferink RP, Beuers U, Paulusma CC, Stocker R, Muro AF, Bosma PJ. Long-Term Effects of Biliverdin Reductase a Deficiency in Ugt1-/- Mice: Impact on Redox Status and Metabolism. Antioxidants (Basel) 2021; 10:antiox10122029. [PMID: 34943131 PMCID: PMC8698966 DOI: 10.3390/antiox10122029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Accumulation of neurotoxic bilirubin due to a transient neonatal or persistent inherited deficiency of bilirubin glucuronidation activity can cause irreversible brain damage and death. Strategies to inhibit bilirubin production and prevent neurotoxicity in neonatal and adult settings seem promising. We evaluated the impact of Bvra deficiency in neonatal and aged mice, in a background of unconjugated hyperbilirubinemia, by abolishing bilirubin production. We also investigated the disposal of biliverdin during fetal development. In Ugt1−/− mice, Bvra deficiency appeared sufficient to prevent lethality and to normalize bilirubin level in adults. Although biliverdin accumulated in Bvra-deficient fetuses, both Bvra−/− and Bvra−/−Ugt1−/− pups were healthy and reached adulthood having normal liver, brain, and spleen histology, albeit with increased iron levels in the latter. During aging, both Bvra−/− and Bvra−/−Ugt1−/− mice presented normal levels of relevant hematological and metabolic parameters. Interestingly, the oxidative status in erythrocytes from 9-months-old Bvra−/− and Bvra−/−Ugt1−/− mice was significantly reduced. In addition, triglycerides levels in these 9-months-old Bvra−/− mice were significantly higher than WT controls, while Bvra−/−Ugt1−/− tested normal. The normal parameters observed in Bvra−/−Ugt1−/− mice fed chow diet indicate that Bvra inhibition to treat unconjugated hyperbilirubinemia seems safe and effective.
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Affiliation(s)
- Giulia Bortolussi
- International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy; (G.B.); (B.B.)
| | - Xiaoxia Shi
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (X.S.); (L.t.B.); (D.R.D.W.); (R.P.O.E.); (U.B.); (C.C.P.)
- Key Laboratory of Protein Modification and Disease, School of Bioengineering, Dalian University of Technology, Dalian 116024, China
| | - Lysbeth ten Bloemendaal
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (X.S.); (L.t.B.); (D.R.D.W.); (R.P.O.E.); (U.B.); (C.C.P.)
| | - Bhaswati Banerjee
- International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy; (G.B.); (B.B.)
| | - Dirk R. De Waart
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (X.S.); (L.t.B.); (D.R.D.W.); (R.P.O.E.); (U.B.); (C.C.P.)
| | - Gabriele Baj
- Light Microscopy Imaging Center, Department of Life Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Weiyu Chen
- Heart Research Institute, Sydney, NSW 2042, Australia; (W.C.); (R.S.)
| | - Ronald P. Oude Elferink
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (X.S.); (L.t.B.); (D.R.D.W.); (R.P.O.E.); (U.B.); (C.C.P.)
| | - Ulrich Beuers
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (X.S.); (L.t.B.); (D.R.D.W.); (R.P.O.E.); (U.B.); (C.C.P.)
| | - Coen C. Paulusma
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (X.S.); (L.t.B.); (D.R.D.W.); (R.P.O.E.); (U.B.); (C.C.P.)
| | - Roland Stocker
- Heart Research Institute, Sydney, NSW 2042, Australia; (W.C.); (R.S.)
| | - Andrés F. Muro
- International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy; (G.B.); (B.B.)
- Correspondence: (A.F.M.); (P.J.B.); Tel.: +39-040-3757369 (A.F.M.); +31-20-566-8850 (P.J.B.)
| | - Piter J. Bosma
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (X.S.); (L.t.B.); (D.R.D.W.); (R.P.O.E.); (U.B.); (C.C.P.)
- Correspondence: (A.F.M.); (P.J.B.); Tel.: +39-040-3757369 (A.F.M.); +31-20-566-8850 (P.J.B.)
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6
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Okolie F, South-Paul JE, Watchko JF. Combating the Hidden Health Disparity of Kernicterus in Black Infants: A Review. JAMA Pediatr 2020; 174:1199-1205. [PMID: 32628268 DOI: 10.1001/jamapediatrics.2020.1767] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Kernicterus is a devastating, permanently disabling neurologic condition resulting from bilirubin neurotoxicity. Black neonates account for more than 25% of kernicterus cases in the US, despite making up only approximately 14% of all births. This is a largely overlooked health disparity. OBSERVATIONS The black kernicterus health disparity exists despite a lower overall incidence of clinically significant hyperbilirubinemia among black neonates, a paradox recently explained by a previously unrecognized risk for hazardous hyperbilirubinemia. Aligned with national and global health initiatives to reduce or eliminate health disparities, this review highlights the multiple biologic and nonbiologic factors contributing to kernicterus risk in black infants and approaches to reduce this health disparity. This includes both parent-level and clinician-level kernicterus prevention strategies, with an emphasis on improving parental health literacy on neonatal jaundice and acute bilirubin encephalopathy and clinician awareness of the key factors that contribute to hazardous hyperbilirubinemia risk in this vulnerable group. Parent-level prevention strategies include efforts to improve their health literacy on neonatal jaundice and acute bilirubin encephalopathy and empower care seeking for jaundice. Clinician-level prevention strategies include efforts to eliminate community and institutional barriers that impede access to care, heighten clinician awareness of the factors that contribute to kernicterus risk in this vulnerable patient group, and strengthen newborn hyperbilirubinemia management and bilirubin surveillance. CONCLUSIONS AND RELEVANCE There are multiple opportunities for intervention to reduce black kernicterus risk. Although kernicterus is a rare disorder, the incidence among black infants is not a trivial matter nor are efforts to prevent kernicterus. While the multiple interacting biologic and nonbiologic contributors to increased kernicterus risk among black infants pose a considerable challenge to clinicians, there are opportunities for intervention to reduce this risk and health disparity. Continued study is imperative to understand the current scope of kernicterus and its occurrence in black neonates.
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Affiliation(s)
- Francesca Okolie
- Division of Neonatology, Department of Pediatrics, Columbia University, New York, New York
| | - Jeannette E South-Paul
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jon F Watchko
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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[An investigation of severe neonatal hyperbilirubinemia in 13 hospitals of Jiangsu Province, China]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22. [PMID: 32669162 PMCID: PMC7389622 DOI: 10.7499/j.issn.1008-8830.2001050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To investigate the incidence of severe neonatal hyperbilirubinemia and the management on the treatment and follow-up of this disease in Jiangsu Province, China. METHODS The neonates with severe hyperbilirubinemia who were admitted to 13 hospitals in Jiangsu Province from January to December, 2018, were enrolled as subjects. A retrospective analysis was performed on their mediacal data and follow-up data. RESULTS In 2018, 740 neonates with severe hyperbilirubinemia were reported from the 13 hospitals in Jiangsu Province, accounting for 2.70% (740/27 386) of the total number of neonates admitted to the department of neonatology. Among these neonates, 620 (83.8%) had severe hyperbilirubinemia, 106 (14.3%) had extremely severe hyperbilirubinemia, and 14 (1.9%) had hazardous hyperbilirubinemia. Four neonates (0.5%) were diagnosed with acute bilirubin encephalopathy. A total of 484 neonates (65.4%) were readmitted due to severe hyperbilirubinemia after discharge from the delivery institution, with a median age of 7 days, among whom 214 (44.2%) were followed up for jaundice at the outpatient service before readmission, with a median age of 6 days at the first time of outpatient examination. During hospitalization, 211 neonates (28.5%) underwent cranial MRI examinations, among whom 85 (40.3%) had high T1WI signal in the bilateral basal ganglia and the globus pallidus; 238 neonates (32.2%) underwent brainstem auditory evoked potential examinations, among whom 14 (5.9%) passed only at one side and 7 (2.9%) failed at both sides. The 17 neonates with acute bilirubin encephalopathy or hazardous hyperbilirubinemia were followed up. Except one neonate was lost to follow-up, and there were no abnormal neurological symptoms in the other neonates. CONCLUSIONS Neonates with severe hyperbilirubinemia account for a relatively high proportion of the total number of neonates in the department of neonatology. Jaundice monitoring and management after discharge from delivery institutions need to be strengthened. For neonates with severe hyperbilirubinemia, relevant examinations should be carried out more comprehensively during hospitalization and these neonates should be followed up comprehensively and systematically after discharge.
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Zhang L, Liu W, Hou K, Lin J, Song C, Zhou C, Huang B, Tong X, Wang J, Rhine W, Jiao Y, Wang Z, Ni R, Liu M, Zhang L, Wang Z, Wang Y, Li X, Liu S, Wang Y. Air pollution exposure associates with increased risk of neonatal jaundice. Nat Commun 2019; 10:3741. [PMID: 31431616 PMCID: PMC6702167 DOI: 10.1038/s41467-019-11387-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 07/09/2019] [Indexed: 12/25/2022] Open
Abstract
Clinical experience suggests increased incidences of neonatal jaundice when air quality worsens, yet no studies have quantified this relationship. Here we reports investigations in 25,782 newborns showing an increase in newborn's bilirubin levels, the indicator of neonatal jaundice risk, by 0.076 (95% CI: 0.027-0.125), 0.029 (0.014-0.044) and 0.009 (95% CI: 0.002-0.016) mg/dL per μg/m3 for PM2.5 exposure in the concentration ranges of 10-35, 35-75 and 75-200 μg/m3, respectively. The response is 0.094 (0.077-0.111) and 0.161 (0.07-0.252) mg/dL per μg/m3 for SO2 exposure at 10-15 and above 15 μg/m3, respectively, and 0.351 (0.314-0.388) mg/dL per mg/m3 for CO exposure. Bilirubin levels increase linearly with exposure time between 0 and 48 h. Positive relationship between maternal exposure and newborn bilirubin level is also quantitated. The jaundice-pollution relationship is not affected by top-of-atmosphere incident solar irradiance and atmospheric visibility. Improving air quality may therefore be key to lowering the neonatal jaundice risk.
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Affiliation(s)
- Liqiang Zhang
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, 100875, Beijing, China.
| | - Weiwei Liu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 100006, Beijing, China
| | - Kun Hou
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, 100875, Beijing, China
| | - Jintai Lin
- Laboratory for Climate and Ocean-Atmosphere Studies, Department of Atmospheric and Oceanic Sciences, School of Physics, Peking University, 100871, Beijing, China.
| | - Changqing Song
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, 100875, Beijing, China.
| | - Chenghu Zhou
- State Key Laboratory of Resources and Environment Information System, Institute of Geographical Science and Natural Resources, Chinese Academy of Sciences, 100101, Beijing, China.
| | - Bo Huang
- Department of Geography and Resource Management, The Chinese University of Hong Kong, 999077, Hong Kong, China
| | - Xiaohua Tong
- School of Surveying and Geo-informatics, Tongji University, 200092, Shanghai, China
| | - Jinfeng Wang
- State Key Laboratory of Resources and Environment Information System, Institute of Geographical Science and Natural Resources, Chinese Academy of Sciences, 100101, Beijing, China
| | - William Rhine
- Division of Neonatology, Lucile Packard Children's Hospital Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Ying Jiao
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 100006, Beijing, China
| | - Ziwei Wang
- Laboratory for Climate and Ocean-Atmosphere Studies, Department of Atmospheric and Oceanic Sciences, School of Physics, Peking University, 100871, Beijing, China
| | - Ruijing Ni
- Laboratory for Climate and Ocean-Atmosphere Studies, Department of Atmospheric and Oceanic Sciences, School of Physics, Peking University, 100871, Beijing, China
| | - Mengyao Liu
- Laboratory for Climate and Ocean-Atmosphere Studies, Department of Atmospheric and Oceanic Sciences, School of Physics, Peking University, 100871, Beijing, China
| | - Liang Zhang
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, 100875, Beijing, China
| | - Ziye Wang
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, 100875, Beijing, China
| | - Yuebin Wang
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, 100875, Beijing, China
| | - Xingang Li
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, 100875, Beijing, China
| | - Suhong Liu
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, 100875, Beijing, China
| | - Yanhong Wang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 100006, Beijing, China
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9
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Aprillia Z, Gayatri D, Waluyanti FT. Sensitivity, Specificity, and Accuracy of Kramer Examination of Neonatal Jaundice: Comparison with Total Bilirubin Serum. Compr Child Adolesc Nurs 2018; 40:88-94. [PMID: 29166181 DOI: 10.1080/24694193.2017.1386975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Zesi Aprillia
- a Faculty of Nursing , Universitas Indonesia, Jalan Bahder Djohan Campus , Depok , Indonesia
| | - Dewi Gayatri
- a Faculty of Nursing , Universitas Indonesia, Jalan Bahder Djohan Campus , Depok , Indonesia
| | - Fajar Tri Waluyanti
- a Faculty of Nursing , Universitas Indonesia, Jalan Bahder Djohan Campus , Depok , Indonesia
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Khurshid F, Medves J. Effectiveness of universal hyperbilirubinemia screening on newborn health: a systematic review protocol. ACTA ACUST UNITED AC 2018; 16:287-290. [PMID: 29419612 DOI: 10.11124/jbisrir-2016-003338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to assess the effectiveness of the universal hyperbilirubinemia screening program on common newborn health outcomes.Specifically, the review will assess: the incidence of severe hyperbilirubinemia/kernicterus/exchange transfusion, rate of readmission due to jaundice, length of hospital stay on birth admission, rate and utilization of phototherapy during birth hospitalization, and jaundice related emergency visits.
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Affiliation(s)
- Faiza Khurshid
- Department of Pediatrics, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Jennifer Medves
- School of Nursing, Faculty of Health Sciences, Queen's University
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Kumra T, Weaver SJ, Prather K, Garnepudi L, Bartlett EL, Crocetti M. Correlation of Transcutaneous and Serum Bilirubin Measurements in the Outpatient Setting. Clin Pediatr (Phila) 2018; 57:231-234. [PMID: 28952368 DOI: 10.1177/0009922817693302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tina Kumra
- 1 Johns Hopkins Community Physicians, Baltimore, MD, USA
| | - Sallie J Weaver
- 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Albumin administration prevents neurological damage and death in a mouse model of severe neonatal hyperbilirubinemia. Sci Rep 2015; 5:16203. [PMID: 26541892 PMCID: PMC4635426 DOI: 10.1038/srep16203] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/12/2015] [Indexed: 11/12/2022] Open
Abstract
Therapies to prevent severe neonatal unconjugated hyperbilirubinemia and kernicterus are phototherapy and, in unresponsive cases, exchange transfusion, which has significant morbidity and mortality risks. Neurotoxicity is caused by the fraction of unconjugated bilirubin not bound to albumin (free bilirubin, Bf). Human serum albumin (HSA) administration was suggested to increase plasma bilirubin-binding capacity. However, its clinical use is infrequent due to difficulties to address its potential preventive and curative benefits, and to the absence of reliable markers to monitor bilirubin neurotoxicity risk. We used a genetic mouse model of unconjugated hyperbilirubinemia showing severe neurological impairment and neonatal lethality. We treated mutant pups with repeated HSA administration since birth, without phototherapy application. Daily intraperitoneal HSA administration completely rescued neurological damage and lethality, depending on dosage and administration frequency. Albumin infusion increased plasma bilirubin-binding capacity, mobilizing bilirubin from tissues to plasma. This resulted in reduced plasma Bf, forebrain and cerebellum bilirubin levels. We showed that, in our experimental model, Bf is the best marker to determine the risk of developing neurological damage. These results support the potential use of albumin administration in severe acute hyperbilirubinemia conditions to prevent or treat bilirubin neurotoxicity in situations in which exchange transfusion may be required.
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Polley N, Saha S, Adhikari A, Banerjee S, Darbar S, Das S, Pal SK. Safe and symptomatic medicinal use of surface-functionalized Mn3O4 nanoparticles for hyperbilirubinemia treatment in mice. Nanomedicine (Lond) 2015; 10:2349-63. [DOI: 10.2217/nnm.15.83] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: Testing the potential of citrate-capped Mn3O4 nanoparticles (NPs) as a therapeutic agent for alternative rapid treatment of hyperbilirubinemia through direct removal of bilirubin (BR) from blood in mice. Materials & methods: NPs were synthesized and the mechanism of BR degradation in presence and absence of biological macromolecules were characterized in vitro. To test the in vivo BR degradation ability of NPs, CCl4-intoxicated mice were intraperitoneally injected with NPs. Results: We demonstrated ultrahigh efficacy of the NPs in symptomatic treatment of hyperbilirubinemia for rapid reduction of BR in mice compared with conventional medicine silymarin without any toxicological implications. Conclusion: These findings may pave the way for practical clinical use of the NPs as safe medication of hyperbilirubinemia in human subjects.
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Affiliation(s)
- Nabarun Polley
- Department of Chemical, Biological & Macromolecular Sciences, S N Bose National Centre for Basic Sciences, Block JD, Sector III, Salt Lake, Kolkata 700 098, India
| | - Srimoyee Saha
- Department of Physics, Jadavpur University, 188, Raja Subodh Chandra Mullick Road, Jadavpur, Kolkata 700032, India
| | - Aniruddha Adhikari
- Department of Chemical, Biological & Macromolecular Sciences, S N Bose National Centre for Basic Sciences, Block JD, Sector III, Salt Lake, Kolkata 700 098, India
| | - Somtirtha Banerjee
- Department of Physics, Jadavpur University, 188, Raja Subodh Chandra Mullick Road, Jadavpur, Kolkata 700032, India
| | - Soumendra Darbar
- Research & Development Division, Dey's Medical Stores (Mfg.) Ltd, 62, Bondel Road, Ballygunge, Kolkata 700019, India
| | - Sukhen Das
- Department of Physics, Jadavpur University, 188, Raja Subodh Chandra Mullick Road, Jadavpur, Kolkata 700032, India
| | - Samir Kumar Pal
- Department of Chemical, Biological & Macromolecular Sciences, S N Bose National Centre for Basic Sciences, Block JD, Sector III, Salt Lake, Kolkata 700 098, India
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Abstract
The National Institute for Health and Clinical Excellence neonatal jaundice guidelines recommend checking the bilirubin level in all infants with visible jaundice. The gold standard for this measurement is total serum bilirubin (TSB). Transcutaneous bilirubinometry (TcB) is an alternative to TSB that has been validated for clinical use through extensive study. TcB provides many advantages over TSB including instantaneous measurements without requiring a painful lab draw. For infants >35 weeks gestation, TcB can reliably identify infants at risk for severe hyperbilirubinaemia and can decrease the number of TSB measurements obtained. However, paediatric providers should be aware of limitations in clinical use of TcB including decreasing accuracy at higher bilirubin levels, lack of independently validated nomograms for interpretation and limited research regarding its use during phototherapy.
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Affiliation(s)
- Matthew C O'Connor
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
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Maisels MJ. Neonatal transcutaneous bilirubin measurements: an opportunity to enhance laboratory utilization and improve patient care. Clin Chem 2012; 58:1395-6. [PMID: 22554553 DOI: 10.1373/clinchem.2012.183616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M Jeffrey Maisels
- Department of Pediatrics, Oakland University William Beaumont School of Medicine, Division of Neonatology, Beaumont Children's Hospital, Royal Oak, MI 48073, USA.
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Flaherman VJ, Kuzniewicz MW, Escobar GJ, Newman TB. Total serum bilirubin exceeding exchange transfusion thresholds in the setting of universal screening. J Pediatr 2012; 160:796-800.e1. [PMID: 22133423 DOI: 10.1016/j.jpeds.2011.09.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 08/26/2011] [Accepted: 09/29/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the incidence and predictors of total serum bilirubin (TSB) levels that meet or exceed American Academy of Pediatrics (AAP) exchange transfusion (ET) thresholds in the setting of universal screening. STUDY DESIGN We conducted a retrospective cohort analysis of electronic data on 18 089 newborns ≥35 weeks gestation born at Northern California Kaiser Permanente Medical Care Program hospitals implementing universal TSB screening in 2005 to 2007, with chart review for subjects with TSB levels reaching the AAP threshold for ET. RESULTS The outcome developed in 22 infants (0.12%); 14 (63.6%) were <38 weeks gestation. Only one infant received an ET; none of the infants had documented sequelae. The first TSB was at least high-intermediate risk on the AAP risk-nomogram for all 22 infants and high-risk for those ≥38 weeks, but was less than the phototherapy level in 15 infants (68%). Of these 15 infants, 2 failed phototherapy and 13 did not have a TSB repeated in <24 hours. However, re-testing all infants at high-intermediate risk or greater would have required 2166 additional bilirubin tests. CONCLUSION Screening was sensitive but not specific for predicting exchange threshold.
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