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Ochigbo S, Ekpebe P, Nyong EE, Ikechukwu O, Ibeawuchi A, Eigbedion A, Adeyemi OO, Abasiattai A, Orazulike N, Ekott M, Omo-Aghoja L, Ande B, Uwagboe C, Igbarumah S, Idemudia E, Okagua J, Lavin T, Gibbons L, Settecase E, Njoku A, Ibrahim IA, Etuk S. Neonatal jaundice incidence, risk factors and outcomes in 54 referral-level facilities in Nigeria. BJOG 2024. [PMID: 38853758 DOI: 10.1111/1471-0528.17865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/26/2024] [Accepted: 05/04/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE To determine the incidence, risk factors and outcomes of babies with neonatal jaundice in a network of referral-level hospitals in Nigeria. DESIGN A cross-sectional analysis of perinatal data collected over a 1-year period. SETTING Fifty-four referral-level hospitals (48 public and 6 private) across the six geopolitical zones of Nigeria. POPULATION A total of 77 026 babies born at or admitted to the participating facilities (67 697 hospital live births; plus 9329 out-born babies), with information on jaundice between 1 September 2019 and 31 August 2020. METHODS Data were extracted and analysed to calculate incidence and sociodemographic and clinical risk factors for neonatal jaundice. MAIN OUTCOME MEASURES Incidence and risk factors of neonatal jaundice in the 54-referral hospitals in Nigeria. RESULTS Of 77 026 babies born in or admitted to the participating facilities, 3228 had jaundice (41.92 per 1000 live births). Of the 67 697 hospital live births, 845 babies had jaundice (12.48 per 1000 live births). The risk factors associated with neonatal jaundice were no formal education (adjusted odds ratio [aOR] 1.68, 95% CI 1.11-2.52) or post-secondary education (aOR 1.17, 95% CI 0.99-1.38), previous caesarean section (aOR 1.68, 95% CI 1.40-2.03), booked antenatal care at <13 weeks or 13-26 weeks of gestation (aOR 1.58, 95% CI 1.20-2.08; aOR 1.15, 95% CI 0.93-1.42, respectively), preterm birth (aOR 1.43, 95% CI 1.14-1.78) and labour more than 18 hours (aOR 2.14, 95% CI 1.74-2.63). CONCLUSIONS Hospital-level and regional-level strategies are needed to address newborn jaundice, which include a focus on management and discharge counselling on signs of jaundice.
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Affiliation(s)
- Sunny Ochigbo
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Patrick Ekpebe
- Department of Paediatrics, Delta State University Teaching Hospital, Abraka, Nigeria
| | - Eno Etim Nyong
- Department of Paediatrics, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Okonkwo Ikechukwu
- Department of Paediatrics, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Amarabia Ibeawuchi
- Department of Paediatrics, Faith Mediplex Hospital, Benin City, Edo State, Nigeria
| | - Andrew Eigbedion
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Oyedeji Oladele Adeyemi
- Department of Paediatrics, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Aniekan Abasiattai
- Department of Obstetrics and Gynaecology, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Ngozi Orazulike
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Mabel Ekott
- Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Lawrence Omo-Aghoja
- Department of Obstetrics and Gynaecology, Delta State University Teaching Hospital, Abraka, Nigeria
| | - Babatunde Ande
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Charles Uwagboe
- Department of Obstetrics and Gynaecology, Faith Mediplex Hospital, Benin City, Edo State, Nigeria
| | - Solomon Igbarumah
- Department of Obstetrics and Gynaecology, Saint Philomena Hospital, Benin City, Edo State, Nigeria
| | - Ebenovbe Idemudia
- Department of Obstetrics and Gynaecology, Saint Philomena Hospital, Benin City, Edo State, Nigeria
| | - Joyce Okagua
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Luz Gibbons
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Eugenia Settecase
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Anthonia Njoku
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Isa Ayuba Ibrahim
- Department of Obstetrics and Gynaecology, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Saturday Etuk
- Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Nigeria
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Boskabadi H, Sadr SH, Darabi A. Evaluating the relationship between aEEG findings and two-year prognosis in neonates with severe hyperbilirubinemia. Early Hum Dev 2024; 193:106031. [PMID: 38729065 DOI: 10.1016/j.earlhumdev.2024.106031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Identifying factors that can better predict the prognosis of neonates with hyperbilirubinemia is important. In this study, we aimed to evaluate the relationship between electroencephalography (EEG) findings and two-year prognosis in neonates with severe hyperbilirubinemia. METHODS & MATERIALS In a cohort prospective study, we studied neonates with a total serum bilirubin level of higher than 18 mg/dL, who were admitted to the neonatal intensive care unit (NICU) of Ghaem hospital, Mashhad, Iran. EEG was recorded upon admission, for all neonates. Patients' data, including demographic characteristics, admission information, and pregnancy and birth data were gathered by obtaining history from parents and studying case files. Also, the relationship between initial EEG findings and final developmental status was assessed. RESULTS Mean and standard deviation age of patients were 5.46 ± 3.13 days and average serum total bilirubin level was 23.97 ± 4.34 mg/dL at admission. Our findings revealed a significant correlation between the presence of trace alternant on EEG and developmental delay (P = .001). Presence of trace alternant waves on initial EEG at admission was significantly associated with developmental delay in the two year (P = .005). CONCLUSION These results indicate a relationship between developmental prognosis and the severity of hyper bilirubinemia in neonates. Also, our findings show that the presence of trace alternate waves on the initial EEG is significantly associated with developmental delay of the neonate in the future.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Susan Hashemi Sadr
- Department of Pediatrics, Student of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azadeh Darabi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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3
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Li S, Gao X, Han Y, Song Y, Wu W, Fan Y, Ren C, Hao L. Dynamic whole-transcriptome landscape of acute bilirubin encephalopathy in newborns. J Pharm Biomed Anal 2024; 247:116250. [PMID: 38850848 DOI: 10.1016/j.jpba.2024.116250] [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: 01/02/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/10/2024]
Abstract
Hyperbilirubinemia in newborns may progress to acute bilirubin encephalopathy (ABE), posing short- and long-term health risks. Despite extensive research identifying numerous mRNAs, lncRNAs, circRNAs, and miRNAs associated with brain injury, their roles in neonatal bilirubin-induced brain injury remain elusive. This study employed whole-transcriptome sequencing to ascertain the differentially expressed (DE) RNA profiles in a newborn ABE rat model, followed by bioinformatic analysis. A time-series competing endogenous RNA (ceRNA) regulatory network was established, and the expression trends of 9 arbitrarily chosen RNAs were verified through quantitative real-time polymerase chain reaction(qRT-PCR). In comparison with the control group, we identified 595, 888, and 1448 DE mRNAs; 22, 37, and 37 DE miRNAs; 1945, 1869, and 1997 DE lncRNAs; and 31, 28, and 36 DE circRNAs at 6 h, 12 h, and 24 h, respectively. Predominantly, these DERNAs contribute to biological functions and pathways associated with inflammation, immunity, metabolism, cell death, and neurodevelopmental regulation. Moreover, we constructed ceRNA networks of DE lncRNA/circRNA-DE miRNA-DE mRNA based on time series. The qRT-PCR expression trends for the selected 9 RNAs were generally similar to the RNA-seq outcomes. This investigation uniquely delineated the temporal expression patterns of mRNA and non-coding RNA in ABE, establishing ceRNA networks and identifying potential molecular mechanisms underlying bilirubin-induced hippocampal damage. Nonetheless, further studies are warranted to corroborate these findings in humans.
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Affiliation(s)
- Shangbin Li
- Department of Pediatrics, First Affiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang 050000, China
| | - Xiong Gao
- Department of Pediatrics, First Affiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang 050000, China
| | - Yiwei Han
- Department of Pediatrics, First Affiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang 050000, China
| | - Yankun Song
- Department of Pediatrics, First Affiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang 050000, China
| | - Wenhui Wu
- Department of Pediatrics, First Affiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang 050000, China
| | - Yuqing Fan
- Department of Pediatrics, First Affiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang 050000, China
| | - Changjun Ren
- Department of Pediatrics, First Affiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang 050000, China.
| | - Ling Hao
- Department of Pediatrics, First Affiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang 050000, China.
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Chawanpaiboon S, Titapant V, Pooliam J. Neonatal complications and risk factors associated with assisted vaginal delivery. Sci Rep 2024; 14:11960. [PMID: 38796580 PMCID: PMC11127920 DOI: 10.1038/s41598-024-62703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
To investigate neonatal injuries, morbidities and risk factors related to vaginal deliveries. This retrospective, descriptive study identified 3500 patients who underwent vaginal delivery between 2020 and 2022. Demographic data, neonatal injuries, complications arising from vaginal delivery and pertinent risk factors were documented. Neonatal injuries and morbidities were prevalent in cases of assisted vacuum delivery, gestational diabetes mellitus class A2 (GDMA2) and pre-eclampsia with severe features. Caput succedaneum and petechiae were observed in 291/3500 cases (8.31%) and 108/3500 cases (3.09%), respectively. Caput succedaneum was associated with multiparity (adjusted odds ratio [AOR] 0.36, 95% confidence interval [CI] 0.22-0.57, P < 0.001) and assisted vacuum delivery (AOR 5.18, 95% CI 2.60-10.3, P < 0.001). Cephalohaematoma was linked to GDMA2 (AOR 11.3, 95% CI 2.96-43.2, P < 0.001) and assisted vacuum delivery (AOR 16.5, 95% CI 6.71-40.5, P < 0.001). Scalp lacerations correlated with assisted vacuum and forceps deliveries (AOR 6.94, 95% CI 1.85-26.1, P < 0.004; and AOR 10.5, 95% CI 1.08-102.2, P < 0.042, respectively). Neonatal morbidities were associated with preterm delivery (AOR 3.49, 95% CI 1.39-8.72, P = 0.008), night-time delivery (AOR 1.32, 95% CI 1.07-1.63, P = 0.009) and low birth weight (AOR 7.52, 95% CI 3.79-14.9, P < 0.001). Neonatal injuries and morbidities were common in assisted vacuum delivery, maternal GDMA2, pre-eclampsia with severe features, preterm delivery and low birth weight. Cephalohaematoma and scalp lacerations were prevalent in assisted vaginal deliveries. Most morbidities occurred at night.Clinical trial registration: Thai Clinical Trials Registry 20220126004.
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Affiliation(s)
- Saifon Chawanpaiboon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
| | - Vitaya Titapant
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Julaporn Pooliam
- Clinical Epidemiological Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
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Endesfelder S, Schmitz T, Bührer C. Bilirubin Exerts Protective Effects on Alveolar Type II Pneumocytes in an In Vitro Model of Oxidative Stress. Int J Mol Sci 2024; 25:5323. [PMID: 38791361 PMCID: PMC11121655 DOI: 10.3390/ijms25105323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Newborn infants face a rapid surge of oxygen and a more protracted rise of unconjugated bilirubin after birth. Bilirubin has a strong antioxidant capacity by scavenging free radicals, but it also exerts direct toxicity. This study investigates whether cultured rat alveolar epithelial cells type II (AEC II) react differently to bilirubin under different oxygen concentrations. The toxic threshold concentration of bilirubin was narrowed down by means of a cell viability test. Subsequent analyses of bilirubin effects under 5% oxygen and 80% oxygen compared to 21% oxygen, as well as pretreatment with bilirubin after 4 h and 24 h of incubation, were performed to determine the induction of apoptosis and the gene expression of associated transcripts of cell death, proliferation, and redox-sensitive transcription factors. Oxidative stress led to an increased rate of cell death and induced transcripts of redox-sensitive signaling pathways. At a non-cytotoxic concentration of 400 nm, bilirubin attenuated oxidative stress-induced responses and possibly mediated cellular antioxidant defense by influencing Nrf2/Hif1α- and NFκB-mediated signaling pathways. In conclusion, the study demonstrates that rat AEC II cells are protected from oxidative stress-induced impairment by low-dose bilirubin.
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Affiliation(s)
- Stefanie Endesfelder
- Department of Neonatology, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (T.S.); (C.B.)
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Ercin S, Coskun Y, Kayas K, Kavas N, Gursoy T. Positive Direct Antiglobulin Test: Is It a Risk Factor for Significant Hyperbilirubinemia in Neonates with ABO Incompatibility? Am J Perinatol 2024; 41:505-510. [PMID: 34847590 DOI: 10.1055/a-1709-5036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE ABO blood group (ABO) incompatibility is a common cause of neonatal indirect hyperbilirubinemia. The direct antiglobulin test (DAT) can identify infants developing hemolytic disease. This study aims to evaluate the significance of DAT positivity among neonates with ABO incompatibility. STUDY DESIGN This retrospective study included 820 neonates with blood group A or B who were born to blood group O mothers. The study group consisted of neonates (n = 79) who had positive DAT, and the control group consisted of infants (n = 741) who had negative DAT. Demographic and clinical data of the neonates regarding jaundice were collected and compared statistically. RESULTS The bilirubin level at 24 hours of life (study group: 8 ± 2.6 mg/dL, control group: 6 ± 2.2 mg/dL, p < 0.001) and the highest bilirubin level (study group: 12.7 ± 3.6 mg/dL, control group: 10.4 ± 4.2 mg/dL, p < 0.001) were higher in infants with positive DAT. A total of 37 (46.8%) infants in the study group and 83 (11.2%) infants in the control group received phototherapy (PT) in the nursery (p < 0.001). In neonates with positive DAT, direct bilirubin level, duration of hospitalization, and PT in the nursery were higher (p = 0.002, <0.001, and <0.001, respectively), whereas hemoglobin level was lower (p < 0.001). CONCLUSION In neonates with ABO incompatibility, a positive DAT is a risk factor for developing significant hyperbilirubinemia. Close follow-up of newborn infants with ABO incompatibility is crucial for early detection and treatment of neonatal jaundice to avoid early and late complications. KEY POINTS · The clinical spectrum of ABO incompatibility varies widely.. · The ABO incompatibility with positive DAT are at greater risk for high bilirubin levels.. · Infants with blood group incompatibilities must be monitored closely..
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Affiliation(s)
- Secil Ercin
- Division of Neonatology, Department of Pediatrics, Koc University Hospital, Istanbul, Turkey
| | - Yesim Coskun
- Department of Pediatrics, Koc University Hospital, Istanbul, Turkey
| | - Kalender Kayas
- Department of Pediatrics, Koc University Hospital, Istanbul, Turkey
| | - Nazan Kavas
- Division of Neonatology, Department of Pediatrics, Koc University Hospital, Istanbul, Turkey
| | - Tugba Gursoy
- Division of Neonatology, Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
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Ayalew T, Molla A, Kefale B, Alene TD, Abebe GK, Ngusie HS, Zemariam AB. Factors associated with neonatal jaundice among neonates admitted at referral hospitals in northeast Ethiopia: a facility-based unmatched case-control study. BMC Pregnancy Childbirth 2024; 24:150. [PMID: 38383399 PMCID: PMC10880319 DOI: 10.1186/s12884-024-06352-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/15/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Neonatal jaundice is a significant contributor to illness and death in newborns, leading to frequent admissions to neonatal intensive care units. To better understand this issue, a study was conducted to identify the factors contributing to neonatal jaundice among newborns admitted to Dessie and Woldia comprehensive specialized hospitals in northeast Ethiopia. METHODS The study took place from April 1 to May 30, 2022, using unmatched case-control design. A total of 320 neonates paired with their mothers were involved, including 64 cases and 256 controls. Data were collected through a structured interviewer-administered questionnaire and a review of medical records. The collected data were analyzed using SPSS Version 23, and a multivariate logistic regression model was employed to understand the relationship between independent factors and the occurrence of neonatal jaundice. Statistical significance was determined at a threshold of P value less than 0.05. RESULTS The study findings revealed that maternal age over 35 years, residing in urban areas [adjusted odds ratio (AOR) = 2.4, 95% confidence interval (CI): 1.23, 4.82], male gender (AOR = 4.3, 95% CI: 1.90, 9.74), prematurity (AOR = 3.9, 95% CI: 1.88, 8.09), and ABO incompatibility (AOR = 2.6, 95% CI: 1.16, 5.96) were significant determinants of neonatal jaundice. Conversely, the study indicated that cesarean birth was associated with a 76% lower likelihood of infant jaundice compared to vaginal delivery (AOR = 0.24, 95% CI: 0.08, 0.72). CONCLUSION To prevent, diagnose, and treat neonatal jaundice effectively, efforts should primarily focus on managing ABO incompatibility and early detection of prematurity. Additionally, special attention should be given to neonates born through vaginal delivery, those with mothers over 35 years old, and those residing in urban areas, as they are at higher risk of developing newborn jaundice. Close monitoring of high-risk mother-infant pairs during the antenatal and postnatal periods, along with early intervention, is crucial for reducing the severity of neonatal jaundice in this study setting.
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Affiliation(s)
- Tsedale Ayalew
- School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asressie Molla
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tilahun Dessie Alene
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Gebremeskel Kibret Abebe
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Habtamu Setegn Ngusie
- Department of Health informatics, School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Alemu Birara Zemariam
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
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Mao YX, Chen ZP, Wang L, Wang J, Zhou CZ, Hou WT, Chen Y. Transport mechanism of human bilirubin transporter ABCC2 tuned by the inter-module regulatory domain. Nat Commun 2024; 15:1061. [PMID: 38316776 PMCID: PMC10844203 DOI: 10.1038/s41467-024-45337-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
Bilirubin is mainly generated from the breakdown of heme when red blood cells reach the end of their lifespan. Accumulation of bilirubin in human body usually leads to various disorders, including jaundice and liver disease. Bilirubin is conjugated in hepatocytes and excreted to bile duct via the ATP-binding cassette transporter ABCC2, dysfunction of which would lead to Dubin-Johnson syndrome. Here we determine the structures of ABCC2 in the apo, substrate-bound and ATP/ADP-bound forms using the cryo-electron microscopy, exhibiting a full transporter with a regulatory (R) domain inserted between the two half modules. Combined with substrate-stimulated ATPase and transport activity assays, structural analysis enables us to figure out transport cycle of ABCC2 with the R domain adopting various conformations. At the rest state, the R domain binding to the translocation cavity functions as an affinity filter that allows the substrates of high affinity to be transported in priority. Upon substrate binding, the R domain is expelled from the cavity and docks to the lateral of transmembrane domain following ATP hydrolysis. Our findings provide structural insights into a transport mechanism of ABC transporters finely tuned by the R domain.
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Affiliation(s)
- Yao-Xu Mao
- Department of Endocrinology, Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, and Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China
- Biomedical Sciences and Health Laboratory of Anhui Province, University of Science and Technology of China, Hefei, Anhui, 230027, China
| | - Zhi-Peng Chen
- Department of Endocrinology, Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, and Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China
| | - Liang Wang
- Department of Endocrinology, Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, and Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China
| | - Jie Wang
- Department of Endocrinology, Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, and Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China
| | - Cong-Zhao Zhou
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China.
- Biomedical Sciences and Health Laboratory of Anhui Province, University of Science and Technology of China, Hefei, Anhui, 230027, China.
| | - Wen-Tao Hou
- Department of Endocrinology, Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, and Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China.
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China.
- Biomedical Sciences and Health Laboratory of Anhui Province, University of Science and Technology of China, Hefei, Anhui, 230027, China.
| | - Yuxing Chen
- Department of Endocrinology, Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, and Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China.
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China.
- Biomedical Sciences and Health Laboratory of Anhui Province, University of Science and Technology of China, Hefei, Anhui, 230027, China.
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Fan J, He HY, Li HH, Wu PL, Tang L, Deng BY, Dong WH, Wang JH. Associations between UGT1A1, SLCO1B1, SLCO1B3, BLVRA and HMOX1 polymorphisms and susceptibility to neonatal severe hyperbilirubinemia in Chinese Han population. BMC Pediatr 2024; 24:82. [PMID: 38279097 PMCID: PMC10811893 DOI: 10.1186/s12887-024-04537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Severe neonatal hyperbilirubinemia could lead to kernicterus and neonatal death. This study aimed to analyze the association between single nucleotide polymorphisms in genes involved in bilirubin metabolism and the incidence of severe hyperbilirubinemia. METHODS A total of 144 neonates with severe hyperbilirubinemia and 50 neonates without or mild hyperbilirubinemia were enrolled in 3 institutions between 2019 and 2020. Twelve polymorphisms of 5 genes (UGT1A1, SLCO1B1, SLCO1B3, BLVRA, and HMOX1) were analyzed by PCR amplification of genomic DNA. Genotyping was performed using an improved multiplex ligation detection reaction technique based on ligase detection reaction. RESULTS The frequencies of the A allele in UGT1A1-rs4148323 and the C allele in SLCO1B3-rs2417940 in the severe hyperbilirubinemia group (30.2% and 90.6%, respectively) were significantly higher than those in the controls (30.2% vs.13.0%, 90.6% vs. 78.0%, respectively, both p < 0.05). Haplotype analysis showed the ACG haplotype of UGT1A1 were associated with an increased hyperbilirubinemia risk (OR 3.122, p = 0.001), whereas the GCG haplotype was related to a reduced risk (OR 0.523, p = 0.018). CONCLUSION The frequencies of the A allele in rs4148323 and the C allele in rs2417940 are highly associated with the incidence of severe hyperbilirubinemia in Chinese Han neonates. TRIAL REGISTRATION Trial registration number:ChiCTR1800020424; Date of registration:2018-12-29.
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Affiliation(s)
- Juan Fan
- Department of Neonatology , Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Hua-Yun He
- Department of Neonatology , Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Huan-Huan Li
- Department of Neonatology, Chongqing Jiulongpo People's Hospital, Chongqing, China
| | - Pi-Liu Wu
- Department of Neonatology, Bishan Maternity & Child Hospital of Chongqing, Chongqing, China
| | - Lei Tang
- Department of Pediatrics, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Bo-Yin Deng
- Department of Neonatology , Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Wen-Hui Dong
- Department of Neonatology , Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China.
| | - Jian-Hui Wang
- Department of Neonatology , Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
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Guan X, Guo J, Xiao D, Wu Z. The effect of different dose of heparin using in peripheral arteriovenous synchronous blood exchange transfusion for neonatal hyperbilirubinemia. J Med Biochem 2024; 43:126-132. [PMID: 38496024 PMCID: PMC10943456 DOI: 10.5937/jomb0-45223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/19/2023] [Indexed: 03/19/2024] Open
Abstract
Background To explore the optimal dosage of heparin in peripheral arteriovenous automatic synchronous exchange transfusion therapy for neonatal hyperbilirubinemia. Methods A total of 185 neonates received peripheral arteriovenous synchronous blood exchange transfusion for hyperbilirubinemia were enrolled from pediatric department of the Ganzhou People's Hospital between January 2018 and June 2020, which were randomly divided into four groups. On the basis of exchange transfusion, different dose of heparin was pumping at the bleeding site of artery (A: no heparin; B: 100 U/h heparin; C: 200 U/h heparin; D: 300 U/h heparin). The indexes of exchange transfusion efficacy, including total bilirubin conversion rate, indirect bilirubin conversion rate, hemoglobin concentration, the platelet number and APTT value was measured before and after therapy. The sites of artery puncture, the sites and rate of vascular occlusion were counted and analyzed.
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Affiliation(s)
- Xueyun Guan
- Ganzhou People's Hospital, Department of Pediatric, Ganzhou, China
| | - Jing Guo
- Ganzhou People's Hospital, Department of Pediatric, Ganzhou, China
| | - Dongsu Xiao
- Ganzhou People's Hospital, Department of Pediatric, Ganzhou, China
| | - Zhong Wu
- Ganzhou People's Hospital, Department of Gastrointestinal Surgery, Ganzhou, China
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Moosa AS, Ngeow AJH, Yang Y, Poon Z, Ng DX, Yi Ling EK, Tan NC. A Novel Smartphone App for Self-Monitoring of Neonatal Jaundice Among Postpartum Mothers: Qualitative Research Study. JMIR Mhealth Uhealth 2023; 11:e53291. [PMID: 38153797 PMCID: PMC10766163 DOI: 10.2196/53291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Background Neonatal jaundice (NNJ) or hyperbilirubinemia is a ubiquitous condition in newborn infants. Currently, the transcutaneous bilirubinometer is used to screen for NNJ in health care facilities, where neonates need to be physically present (ie, a centralized model of care for NNJ screening). Mobile health (mHealth) apps present a low-cost, home-based, and noninvasive system that could facilitate self-monitoring of NNJ and could allow mothers the convenience of screening for NNJ remotely. However, end users' acceptability of such mHealth apps is of fundamental importance before the incorporation of such apps into clinical practice. Objective The study aimed to explore the perception of postpartum mothers toward self-monitoring of NNJ using a novel mHealth app. Methods Mothers attending video consultations for early postpartum care at 2 Singapore primary care clinics watched an instructional video for a hyperbilirubinemia-screening mHealth app (HSMA). An independent researcher used a semistructured topic guide to conduct in-depth interviews with 25 mothers, assessing their views on HSMAs. All interviews were audio recorded, transcribed verbatim, and checked for accuracy before data analysis. Two researchers independently analyzed the transcripts via thematic analysis. Data were managed using NVivo qualitative data management software. Results The identified themes were grouped under perceived usability and utility. Mothers valued the convenience and utility of HSMAs for remote monitoring of NNJ. They appreciated the objectivity the app readings provided compared to visual inspection. However, they perceived that the app's applicability would be restricted to severe jaundice, were concerned about its accuracy and restriction to the English language, and lacked confidence in using it. Nevertheless, they were willing to use it once its accuracy was proven and when they received adequate guidance from health care professionals. They also suggested including an action plan for the measured readings and clinical signs within the app. Mothers proposed pairing teleconsultations with HSMAs to boost their confidence and enhance adoption. Conclusions Mothers were receptive to using HSMAs but had concerns. Multiple languages, proof of accuracy, and resources to guide users should be incorporated into the app in the next phase to increase its successful adoption. Complementing such apps with a teleconsultation service presents a plausible and pragmatic NNJ care delivery model in general practice.
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Affiliation(s)
- Aminath Shiwaza Moosa
- SingHealth Polyclinics, Primary Care Research Institute, Singapore, Singapore
- Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Alvin Jia Hao Ngeow
- Department of Neonatology, Singapore General Hospital, Singapore, Singapore
- Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Department of Paediatrics, Yong Loo Ling School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yuhan Yang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Zhimin Poon
- SingHealth Polyclinics, Primary Care Research Institute, Singapore, Singapore
- Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Ding Xuan Ng
- SingHealth Polyclinics, Primary Care Research Institute, Singapore, Singapore
| | - Eileen Koh Yi Ling
- SingHealth Polyclinics, Primary Care Research Institute, Singapore, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Primary Care Research Institute, Singapore, Singapore
- Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
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12
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Liu X, Dong Y, Qin Y, Xue C, Lyu W. Clinical value of combined predictors of RET%, γ-GT, LDH in the ABO neonatal hemolytic disease. Front Pediatr 2023; 11:1265739. [PMID: 38105791 PMCID: PMC10725244 DOI: 10.3389/fped.2023.1265739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
Objective The purpose of this study is to examine the prognostic significance of the amalgamated indicators, reticulocyte percentage (RET%), lactate dehydrogenase (LDH), and γ-Glutamyltransferase (γ-GT), in neonatal ABO hemolytic disease. Methods A total of 137 hospitalized children with pathological jaundice were included. Based on their medical conditions, they were categorized into two groups, hemolytic (67 cases) and non-hemolytic (70 cases). Pearson linear correlation and binary logistic multivariate analysis were used to analyze LDH, γ-GT, RET% and hemolysis. Furthermore, the predictive value of the combined predictors of RET%, LDH, and γ-GT on ABO neonatal hemolytic disease was evaluated using the ROC curve analysis. Results The laboratory indexes of the two groups were subject to analysis using binary logistic regression to identify suspicious influencing factors. The study revealed that RET%, LDH, and γ-GT were independent risk factors for hemolysis. Pearson linear correlation analysis indicated a positive correlation between LDH and γ-GT with RET% (r = 0.529, P < 0.01; r = 0.526, P = <0.01, respectively). Furthermore, the predictive value of each combined predictor was obtained using the ROC curve, and it was observed that combined predictor L (RET% + LDH + γ-GT)>L1 (RET% + LDH)>L2 (RET% + γ-GT). Conclusion Combined predictor L (RET% + LDH + γ-GT)demonstrate its optimal diagnostic efficacy, offering a novel approach towards diagnosing early-onset ABO hemolytic disease of the newborn.
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Affiliation(s)
| | | | | | | | - Wei Lyu
- Department of Pediatrics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Foley A, Dodge T. Neonatal Triage Red Flags. J Emerg Nurs 2023; 49:811-813. [PMID: 37777929 DOI: 10.1016/j.jen.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/23/2023] [Accepted: 08/18/2023] [Indexed: 10/02/2023]
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左 爽, 李 景, 华 子. [Global disease burden of neonatal jaundice from 1990 to 2019]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1008-1015. [PMID: 37905756 PMCID: PMC10621063 DOI: 10.7499/j.issn.1008-8830.2303063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/21/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES To examine the global, regional, and national disease burden of neonatal jaundice. METHODS The 2019 Global Burden of Disease database was searched to collect incident cases/incidence and deaths/mortality of neonatal jaundice, as well as global socio-demographic index (SDI) and universal health coverage index (UHCI). The epidemiological trend of neonatal jaundice from 1990 to 2019 was analyzed. The correlations between incidence/mortality of neonatal jaundice and SDI and UHCI were evaluated. RESULTS From 601 681 in 1990 to 626 005 in 2019, with a 4.04% increase in global incident cases of neonatal jaundice. The overall age-standardized incidence rate exhibited an increase [estimated annual percent change=0.13 (95%CI: 0.03 to 0.23)] during this period. Additionally, deaths due to neonatal jaundice decreased by 58.83%, from 128 119 in 1990 to 52 742 in 2019. The overall age-standardized mortality rate showed a decrease [estimated annual percent change=-2.78 (95%CI: -3.00 to -2.57)] over the same period. Countries with lower SDI, such as India, Pakistan, and Nigeria, reported a higher proportion of neonatal morbidity and mortality. In 2019, a negative correlation was observed between estimated annual percent change in age-standardized mortality rate and SDI (ρ=-0.320, P<0.05) or UHCI (ρ=-0.252, P<0.05). CONCLUSIONS The global incidence of neonatal jaundice is on the rise, while the mortality rate is declining. The burden of neonatal jaundice is influenced by social development, economic factors, and the level of medical care.
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Daunhawer I, Schumacher K, Badura A, Vogt JE, Michel H, Wellmann S. Validating the early phototherapy prediction tool across cohorts. Front Pediatr 2023; 11:1229462. [PMID: 37876524 PMCID: PMC10593448 DOI: 10.3389/fped.2023.1229462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023] Open
Abstract
Background Hyperbilirubinemia of the newborn infant is a common disease worldwide. However, recognized early and treated appropriately, it typically remains innocuous. We recently developed an early phototherapy prediction tool (EPPT) by means of machine learning (ML) utilizing just one bilirubin measurement and few clinical variables. The aim of this study is to test applicability and performance of the EPPT on a new patient cohort from a different population. Materials and methods This work is a retrospective study of prospectively recorded neonatal data from infants born in 2018 in an academic hospital, Regensburg, Germany, meeting the following inclusion criteria: born with 34 completed weeks of gestation or more, at least two total serum bilirubin (TSB) measurement prior to phototherapy. First, the original EPPT-an ensemble of a logistic regression and a random forest-was used in its freely accessible version and evaluated in terms of the area under the receiver operating characteristic curve (AUROC). Second, a new version of the EPPT model was re-trained on the data from the new cohort. Third, the predictive performance, variable importance, sensitivity and specificity were analyzed and compared across the original and re-trained models. Results In total, 1,109 neonates were included with a median (IQR) gestational age of 38.4 (36.6-39.9) and a total of 3,940 bilirubin measurements prior to any phototherapy treatment, which was required in 154 neonates (13.9%). For the phototherapy treatment prediction, the original EPPT achieved a predictive performance of 84.6% AUROC on the new cohort. After re-training the model on a subset of the new dataset, 88.8% AUROC was achieved as evaluated by cross validation. The same five variables as for the original model were found to be most important for the prediction on the new cohort, namely gestational age at birth, birth weight, bilirubin to weight ratio, hours since birth, bilirubin value. Discussion The individual risk for treatment requirement in neonatal hyperbilirubinemia is robustly predictable in different patient cohorts with a previously developed ML tool (EPPT) demanding just one TSB value and only four clinical parameters. Further prospective validation studies are needed to develop an effective and safe clinical decision support system.
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Affiliation(s)
- Imant Daunhawer
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Kai Schumacher
- Department of Neonatology, Hospital St. Hedwig of the Order of St. John, University Children’s Hospital Regensburg (KUNO), Regensburg, Germany
| | - Anna Badura
- Department of Neonatology, Hospital St. Hedwig of the Order of St. John, University Children’s Hospital Regensburg (KUNO), Regensburg, Germany
| | - Julia E. Vogt
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Holger Michel
- Department of Neonatology, Hospital St. Hedwig of the Order of St. John, University Children’s Hospital Regensburg (KUNO), Regensburg, Germany
| | - Sven Wellmann
- Department of Neonatology, Hospital St. Hedwig of the Order of St. John, University Children’s Hospital Regensburg (KUNO), Regensburg, Germany
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White R, Kilgour Venables H. The significance of ultrasound features of sub-chorionic haemorrhage as a predictor of adverse perinatal outcome: A retrospective review. Eur J Obstet Gynecol Reprod Biol 2023; 289:23-28. [PMID: 37619520 DOI: 10.1016/j.ejogrb.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION This retrospective single centre study considers the predictive value of specific ultrasound features of sub-chorionic haemorrhage (SCH) as potential indicators of adverse pregnancy outcome. METHODS Ultrasound reports and images were reviewed for 160 participants presenting to an early pregnancy assessment unit from January 2018 to January 2019. Participants were selected based upon the presence of SCH within the first trimester. The outcome of each pregnancy and the features of SCH, including the size, location and echogenicity were recorded and multinominal logistic regression was used to establish predictive value. RESULTS The majority of participants were asymptomatic and delivered healthy babies. 24% miscarried prior to delivery or had stillborn babies; the features of bleed within this group revealed an increased prevalence of adverse outcome in the presence of moderate sized haemorrhage (p = 0.02). 61% of miscarried pregnancies presented with "wrapping" SCH, in which haemorrhage encased the gestation sac, suggesting wrapping posed a probable risk (p = 0.01). 71% of miscarriages occurred within 5 + 0-10 + 0 weeks gestation. Persistent SCH was of greater incidence within those participants with adverse outcome (57%). There was no association between fetal abnormality and miscarriage. Jaundice babies and premature delivery occurred more frequently (p = 0.001) and may be a secondary finding following SCH. CONCLUSION There was a strong correlation between presence of SCH in early pregnancy and rate of miscarriage. Specific ultrasound features of SCH, most notably a wrapping location with moderate size, may be indicative of increased risk of miscarriage or post-natal complications. Jaundice and premature births may have an association with placental compromise.
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He Z, Zhang B, Zhang J, Xiao Z, He L, Yang G. A wireless physiological parameter monitoring system with a treatment feedback function during neonatal phototherapy. Physiol Meas 2023; 44:095002. [PMID: 37625435 DOI: 10.1088/1361-6579/acf43c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/25/2023] [Indexed: 08/27/2023]
Abstract
Objective. Neonatal jaundice is a common condition in the early stages of newborns, and phototherapy is a fast, safe and effective method that is used to treat it. However, recent studies have shown that phototherapy may elicit side effects in infants, such as hypothermia, hyperthermia and dehydration. To improve the quality of phototherapy and the prognosis of patients, the changes in neonatal physiological parameters during phototherapy should be monitored to give better feedback to pediatricians or the phototherapy system. However, the current standard of clinical care during neonatal phototherapy with hard-wired devices limits this realization.Approach. Here, we developed a prototype of a neonatal wearable device, which can wirelessly potentially monitor the jaundice value, transepidermal water loss, skin wettedness factor and body orientation during phototherapy, and conducted prototype validation experiments. We also set up user-friendly interfaces and an analysis system on custom software, all designed to make the future addition of data interfaces for treatment feedback functions easier.Main results. The preliminaryin vitroexperiment demonstrated the effectiveness of simultaneous monitoring of the required physiological parameters. And further suggestions and specific operations are discussed in terms of optimization of the treatment of neonatal jaundice.Significance. It is believed that the established system has the potential to provide a basis for future phototherapy nursing guidelines and physiological monitoring standards.
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Affiliation(s)
- Ziliang He
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Benjin Zhang
- Department of Pediatrics, Dazhou Central Hospital, Dazhou, People's Republic of China
| | - Jing Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Zhenghua Xiao
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Ling He
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Gang Yang
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
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Sun S, Yu S, Yu H, Yao G, Guo X, Zhao F, Li J, Wang P. The pyroptosis mechanism of ototoxicity caused by unconjugated bilirubin in neonatal hyperbilirubinemia. Biomed Pharmacother 2023; 165:115162. [PMID: 37467648 DOI: 10.1016/j.biopha.2023.115162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
When activated by unconjugated bilirubin (UCB), inflammatory mediators such as IL - 18 and TNF contribute to the neurotoxicity and ototoxicity observed in severe neonatal hyperbilirubinemia. However, in cell and molecular level, the regulation and mechanism of UCB-induced ototoxicity are remained unclear. In this study, 7-day-old mammary rats were exposed to various concentrations of UCB to imitate the infant auditory damage. The auditory brainstem response result (ABR) indicated severe hearing loss, which occurred with increasing concentration. Morphological analysis of organotypic cochlear cultures treated with different concentrations of UCB indicated that auditory nerve fibers (ANF) were demyelinated and the density of spiral ganglion neurons (SGN) were decreased. In addition, HEI-OC1 cells treated with different concentrations of UCB showed severe necrosis by Flow Cytometry. The morphologic feature of pyroptosis has been observed by scanning electronic microscope. Cleaved Caspase-1, GSDMD and NLRP3 expression were significantly increased in cochlear explants with UCB-induced. To further clarify the molecular mechanism of UCB-induced inner ear cell pyroptosis, specific inhibitors of pyroptosis were applied, the protein associated with pyrotosis such as Cleaved Caspase-1, GSDMD, ASC, IL-18 and NLRP3 were significantly lower than the group with UCB alone. All the data above indicated that ERK /NLRP3/GSDMD signaling pathway involved in UCB-induced ototoxicity.
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Affiliation(s)
- Shihan Sun
- Department of Otolaryngology-Head and Neck Surgery, First Hospital of Jilin University, Changchun 130021, China; Bethune First Clinical Medical College, Jilin University, Changchun, Jilin, China
| | - Shuyuan Yu
- Department of Otolaryngology-Head and Neck Surgery, First Hospital of Jilin University, Changchun 130021, China
| | - Hong Yu
- Department of Otolaryngology-Head and Neck Surgery, First Hospital of Jilin University, Changchun 130021, China
| | - Gang Yao
- Department of Neurology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xinyi Guo
- Department of Otolaryngology-Head and Neck Surgery, First Hospital of Jilin University, Changchun 130021, China
| | - Fengyang Zhao
- Bethune First Clinical Medical College, Jilin University, Changchun, Jilin, China
| | - Jiannan Li
- Bethune First Clinical Medical College, Jilin University, Changchun, Jilin, China
| | - Ping Wang
- Department of Otolaryngology-Head and Neck Surgery, First Hospital of Jilin University, Changchun 130021, China.
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Alfaifi JA, Alqahtani YA, Alqahtani MM, Alqarni A, Alshahrani A, Alshomrani RA. Knowledge and Attitudes of Parents Regarding Neonatal Jaundice in Bisha City, Saudi Arabia. Cureus 2023; 15:e44916. [PMID: 37814740 PMCID: PMC10560542 DOI: 10.7759/cureus.44916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/11/2023] Open
Abstract
Background Neonatal jaundice (NNJ) is one of the most common neonatal illnesses around the world. It continues to be a leading cause of avoidable brain damage, physical and mental impairment, and death in neonates. Neonatal morbidity due to NNJ has a significant impact and cost on families and healthcare resources. The majority of instances are addressed without intervention, but others require assessment and assistance in the form of follow-up or treatment. Inadequate family awareness and understanding of this frequent newborn condition can contribute to delays and difficulties. Aim This study aimed to assess the knowledge and attitudes of parents regarding NNJ in Bisha City, Saudi Arabia. Methodology A cross-sectional study involving 242 participants was carried out. Data were collected using an online questionnaire. The knowledge score differences between groups were analyzed using a Wilcoxon rank sum test and the Kruskal-Wallis rank test. Results In this study of 242 participants from Bisha, we found that the majority were female (155, 64.0%), employed (129, 53.3%), and held a postgraduate degree (150, 62.0%). Regarding knowledge of NNJ, 109 (45.0%) have correctly defined it as yellow pigmentation in the sclera and 64 (26.4%) as yellow pigmentation of the skin. Of most participants, 132 (54.5%) recognized that NNJ could cause complications, but 53 (40.2%) of these were unaware of what these complications might be. Notably, only 89 (36.8%) of respondents believed they had sufficient knowledge about NNJ. The median knowledge score was 3.0 (IQR, 1.0-4.0), and higher scores were significantly associated with being female and reporting sufficient knowledge about the disease. Strategies suggested for improving awareness included campaigns (98, 40.5%) and social networking programs (81, 33.5%). The data suggest a need for enhanced public education regarding NNJ. Conclusion The study highlights the need for increased awareness and education among parents in Bisha, Saudi Arabia, about NNJ. The findings suggest that campaigns and social networking programs could effectively educate people about the condition. Additionally, the study provides insights into the factors associated with higher knowledge scores, such as gender and having a child with NNJ. The results of this study may help healthcare professionals develop effective educational programs and interventions to improve parents' knowledge and attitudes toward NNJ.
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Affiliation(s)
| | | | | | - Anas Alqarni
- College of Medicine, University of Bisha, Bisha, SAU
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20
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Wang N, Jia Y, Zhou X, Wang X, Zhou H, Xiao N. Effects of Repetitive Transcranial Magnetic Stimulation on Pallidum GABAergic Neurons and Motor Function in Rat Models of Kernicterus. Brain Sci 2023; 13:1252. [PMID: 37759853 PMCID: PMC10526431 DOI: 10.3390/brainsci13091252] [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: 06/22/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Kernicterus is a serious complication of hyperbilirubinemia, caused by neuronal injury due to excessive unconjugated bilirubin (UCB) in specific brain areas. This injury induced by this accumulation in the globus pallidus can induce severe motor dysfunction. Repetitive transcranial magnetic stimulation (rTMS) has shown neuroprotective effects in various neurological diseases. This study aimed to investigate the effects of rTMS on pallidal nerve damage and motor dysfunction in a rat model of kernicterus. Rats were divided into a sham group (n = 16), a model group (bilirubin with sham rTMS; n = 16) and an rTMS group (bilirubin with rTMS; n = 16). High-frequency rTMS (10 Hz) was applied starting from 24 h postmodeling for 7 days. The rotarod test, western blotting and immunohistochemical staining were performed to measure motor function and protein expression levels. The rTMS mitigated the negative effects of UCB on the general health of kernicterus-model rats and improved their growth and development. Furthermore, the rTMS alleviated UCB-induced motor dysfunction and increased the expression of GABAergic neuronal marker GAD67 in the globus pallidus. Notably, it also inhibited apoptosis-related protein caspase-3 activation. In conclusion, rTMS could alleviate motor dysfunction by inhibiting apoptosis and increasing globus pallidus GAD67 in kernicterus rat models, indicating that it may be a promising treatment for kernicterus.
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Affiliation(s)
| | | | | | | | | | - Nong Xiao
- Department of Rehabilitation, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing 400010, China; (N.W.); (Y.J.); (X.Z.); (X.W.); (H.Z.)
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Xiong Z, Liu X, Li X. Efficacy of single-and double-volume exchange transfusion for neonatal hyperbilirubinemia. J Med Biochem 2023; 42:484-491. [PMID: 37790206 PMCID: PMC10543125 DOI: 10.5937/jomb0-42668] [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: 01/25/2023] [Accepted: 02/20/2023] [Indexed: 10/05/2023] Open
Abstract
Background To investigate the efficacy and safety of singleand double-volume exchange transfusion for neonatal hyperbilirubinemia (HB) and compare their effects on the internal environment of newborns. Methods The clinical data of 96 HB newborns admitted to and treated in our hospitals from January 2016 to October 2021 were retrospectively analyzed. Then, these newborns were divided into single volume group (80-110 mL/kg, n=48) and double volume group (150-180 mL/kg, n=48) by the exchange volume per unit body mass. The hematological indicators total serum bilirubin (TSB), peripheral blood red blood cell (RBC) count, white blood cell (WBC) count, platelet (PLT) count, serum albumin (ALB), prothrombin time (PT) and activated partial thromboplastin time (APTT), and changes in inner-environment indexes (blood gas, blood glucose, acid-base and electrolyte levels) were compared between the two groups of newborns before treatment and after once treatment. Additionally, the adverse reactions of exchange transfusion in the two groups of newborns were recorded.
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Affiliation(s)
- Zhongzheng Xiong
- Dian Jiang People's Hospital of Chongqing, Department of Medical Laboratory, Chongqing, China
| | - Xianchuan Liu
- Bishan Maternity & Child Hospital of Chongqing, Laboratory Medicine, Chongqing, China
| | - Xiangzhu Li
- Medical University, Bishan Hospital of Chongqing, Department of Blood Transfusion, Chongqing, China
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22
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Ng Y, Maul T, Viswanathan S, Chua C. The Accuracy of Transcutaneous Bilirubin as a Screening Test in Preterm Infants. Cureus 2023; 15:e42793. [PMID: 37538974 PMCID: PMC10394481 DOI: 10.7759/cureus.42793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To determine the accuracy of transcutaneous bilirubin (TcB) to predict total serum bilirubin (TSB) in preterm infants across gestational age (GA) ranges and to calculate the cost-effectiveness of TcB as the primary screening test of choice for neonatal jaundice in neonatal intensive care unit (NICU) settings. METHODS Single-center retrospective study of infants aged ≤ seven days admitted to the NICU over a six-month period with a paired TSB and TcB, with or without phototherapy as part of their routine clinical care. Infants were divided into GA-specific groups as term, late preterm, moderate preterm, and very preterm. Measurement bias (bias=TSB-TcB) was calculated on the paired TSB and TcB values, and a Bland-Altman analysis was carried out. The impacts of additional infant-specific variables on the bias were assessed with univariate and multivariate linear regression techniques. The potential direct cost savings associated with the use of TcB as the primary screening test were calculated. RESULTS A total of 263 paired TSB and TcB samples from 95 patients were included (130 paired samples from term (n=60), 75 from late preterm (n=21), 27 from moderate preterm (n=7), and 31 from very preterm (n=7)). The mean paired measurement bias across all the GA groups was -0.9 ± 2.9 mg/dL. The sensitivity and specificity of TcB in GA < 35 weeks were 92% and 62%, respectively. A conservative estimate of a one-third reduction in TSB measurement by using TcB as the primary screening test will have a direct cost saving of $3,148 over a six-month period. CONCLUSION Our data suggest that TcB is a safe and potentially cost-effective screening test for jaundice across GA groups.
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Affiliation(s)
- Yunfai Ng
- College of Medicine, University of Central Florida College of Medicine, Orlando, USA
- Emergency Medicine, Mount Sinai Hospital, New York, USA
| | - Timothy Maul
- Cardiac Center, Nemours Children's Health, Orlando, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
| | - Sreekanth Viswanathan
- Division of Neonatology, Nemours Children's Health, Orlando, USA
- Department of Pediatrics, University of Central Florida College of Medicine, Orlando, USA
| | - Caroline Chua
- Division of Neonatology, Nemours Children's Health, Orlando, USA
- Department of Pediatrics, University of Central Florida College of Medicine, Orlando, USA
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23
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Kebede C, Fentie B, Tigabu B. Treatment Outcome of Jaundice and Its Associated Factors Among Neonates Treated in Neonatal Intensive Care Unit of Comprehensive and Specialized Hospitals of Southern Nations Nationalities and Peoples Region, Ethiopia 2022. Pediatric Health Med Ther 2023; 14:237-247. [PMID: 37525755 PMCID: PMC10387238 DOI: 10.2147/phmt.s405453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023] Open
Abstract
Introduction Jaundice is a common problem that affects up to 50-60% of full-term babies and 80% of preterm babies. It is a benign condition, but sometimes it can cause profound complications and eventually death. Identifying the treatment outcome of jaundice and the factors affecting it is crucial to preventing the death associated with it. Objective To determine the treatment outcome of jaundice and its associated factors among neonates treated in neonatal intensive care unit of comprehensive and specialized hospitals of SNNPR, Ethiopia, 2022. Methods An institution-based retrospective follow up study was conducted from April 2018 to April 2022. The data was checked for completeness and then entered into Epi-data version 4.6 and exported to STATA version 17. The results were presented in frequencies and percentages for categorical variables as well as mean and median for continuous variables. A binary logistic regression model was used to estimate the effect of an independent variable and the outcome variable. Results A total of 423 charts were reviewed, and 416 (98%) were included in the final analysis. Almost 91.3% (95% CI: 88.2, 93.7) of neonates had improved. Factors significantly associated with the treatment outcome were: residence (AOR = 0.36, 95% CI: 0.2, 0.8); origin of admission (AOR = 0.35, 95% CI: 0.2, 0.8); gestational age (AOR = 0.26, 95% CI: 0.1, 0.8); and total serum bilirubin level (AOR = 0.40, 95% CI: 0.2, 0.9). Conclusion and Recommendation Improvement was lower compared to other low and middle-income countries; more emphasis should be given to improving treatment outcomes in hospitals.
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Affiliation(s)
- Christian Kebede
- Department of Pediatrics and Neonatology Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Beletech Fentie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Health science and Medicine, University of Gondar, Gondar, Ethiopia
| | - Bethelihem Tigabu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Health science and Medicine, University of Gondar, Gondar, Ethiopia
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24
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Xie L, Ding L, Tang L, Yang Z, Wu D, Wang W, Mao J, Shi L, Liu C, Duan L, Xu J, Zhou Q, Sun J, Ding X. A real-world cost-effectiveness study of vancomycin versus linezolid for the treatment of late-onset neonatal sepsis in the NICU in China. BMC Health Serv Res 2023; 23:771. [PMID: 37468855 PMCID: PMC10357666 DOI: 10.1186/s12913-023-09628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/31/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Currently, the detection rates of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS) in the blood cultures of neonates with sepsis exceed the national average drug resistance level, and vancomycin and linezolid are the primary antibacterial drugs used for these resistant bacteria according to the results of etiological examinations. However, a comprehensive evaluation of their costs and benefits in late-onset neonatal sepsis in a neonatal intensive care unit (NICU) has not been conducted. This study aimed to compare the cost and effectiveness of vancomycin and linezolid in treating neonatal sepsis in the NICU. METHODS A cost-effectiveness analysis of real-world data was carried out by retrospective study in our hospital, and the cost and effectiveness of vancomycin and linezolid were compared by establishing a decision tree model. The drug doses in the model were 0.6 g for linezolid and 0.5 g for vancomycin. The cost break down included cost of medical ward, NICU stay, intravenous infusion of vancomycin or linezolid, all monitoring tests, culture tests and drugs. The unit costs were sourced from hospital information systems. The effectiveness rates were obtained by cumulative probability analysis. One-way sensitivity analysis was used to analyze uncertain influencing factors. RESULTS The effectiveness rates of vancomycin and linezolid in treating neonatal sepsis in the NICU were 89.74% and 90.14%, respectively, with no significant difference. The average cost in the vancomycin group was ¥12261.43, and the average cost in the linezolid group was ¥17227.96. The incremental cost effectiveness was ¥12416.33 cost per additional neonate with treatment success in the linezolid group compared to vancomycin group at discharge. Factors that had the greatest influence on the sensitivity of the incremental cost-effectiveness ratio were the price of linezolid and the effectiveness rates. CONCLUSIONS The cost for treatment success of one neonate in linezolid group was ¥5449.17 more than that in vancomycin group, indicating that vancomycin was more cost-effective. Therefore, these results can provide a reference for a cost effectiveness treatment scheme for neonatal sepsis in the NICU.
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Affiliation(s)
- Linjun Xie
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Leyun Ding
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Lian Tang
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Zuming Yang
- Department of Neonatology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Dan Wu
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Wenjuan Wang
- Children's Hospital of Soochow University, Medical College of Soochow University, Soochow University, Suzhou, China
| | - Juehui Mao
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Lu Shi
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Chun Liu
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Lufen Duan
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Jinhui Xu
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Qin Zhou
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
| | - Jiantong Sun
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
| | - Xinyuan Ding
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
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25
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Ung B, Suils H, Cohen C, Autret F, Walter-Nicolet E. Implementation of neonatal phototherapy with the BiliCocoon Bag® device in the maternity ward and impact on mother-infant separation. Arch Pediatr 2023:S0929-693X(23)00084-2. [PMID: 37321947 DOI: 10.1016/j.arcped.2023.05.006] [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: 10/31/2022] [Revised: 04/03/2023] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Free bilirubin jaundice is a frequent pathology in the neonatal period. The major complication is neurological toxicity, the most severe form of which is kernicterus. Overall, 5%-10% of jaundiced neonates require treatment. The first-line treatment is phototherapy, with intensive phototherapy being the gold standard. Other equipment is also available, including the BiliCocoon Bag®. It is a safe and controlled therapy that can be performed in the mother's room in the maternity ward, thereby avoiding separation and allowing for breast- or bottle-feeding during treatment. It is easy to install and does not require protective glasses, thus no scope or hospitalization. In our maternity ward, all neonates requiring intensive phototherapy are hospitalized in the neonatology ward. OBJECTIVE The objective of our study was to evaluate the number of avoided hospitalizations in neonatology for free bilirubin jaundice since the introduction, according to a strict protocol, of the BiliCocoon Bag® device. MATERIAL AND METHOD This was a single-center retrospective cohort study using data of newborns usually collected as part of standard care. Children born in our maternity ward during an 18-month period (August 1, 2020 to January 31, 2022) were included. Causes of jaundice, age at the beginning and mode of treatment, number of sessions for each device, and length of stay were compared. Results are presented as number and percentage with median (25th-75th) or mean (extremes) values for categorical and continuous variables, respectively. A t-test was used to compare the means of the independent groups. RESULTS A total of 316 newborns were included. Physiological jaundice was the main cause of jaundice. The median age for the first phototherapy treatment was 54.5 h (30-68). The 316 neonates needed 438 phototherapy sessions: 235 (74%) neonates required only one phototherapy session, 85 (36%) of them were treated with the BiliCocoon Bag®. For the 81 children who needed two or more phototherapy sessions, 19 children (23.5%) were treated by tunnel phototherapy and then the BiliCocoon Bag®, and eight children (10%) by BiliCocoon Bag® alone. The BiliCocoon Bag® enabled a relative reduction in the hospitalization rate of 38% and avoided hospitalization for approximately one third of the newborns treated. The BiliCocoon Bag® failure rate was 3.6% and the average length of stay was comparable between the two types of treatment. CONCLUSION Following a strict protocol of use, the BiliCocoon Bag® is a reliable method and a good alternative to intensive phototherapy for newborns in the maternity ward, as it avoids hospitalization and mother-infant separation.
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Affiliation(s)
- Bunhong Ung
- Paris Saint Joseph Hospital Group 185 rue Raymond Losserand 75014 Paris, France
| | - Hélène Suils
- Paris Saint Joseph Hospital Group 185 rue Raymond Losserand 75014 Paris, France
| | - Carole Cohen
- Paris Saint Joseph Hospital Group 185 rue Raymond Losserand 75014 Paris, France
| | - Fanny Autret
- Paris Saint Joseph Hospital Group 185 rue Raymond Losserand 75014 Paris, France
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26
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Belay G, Gerbi A, Gebremariam T, Tilahun T, Chimdi E, Etefa T. Jaundice and its associated factors among neonates admitted to selected referral hospitals in southwest oromia, Ethiopia: Multi-center cross-sectional study. Heliyon 2023; 9:e16019. [PMID: 37206029 PMCID: PMC10189262 DOI: 10.1016/j.heliyon.2023.e16019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
Background Jaundice is a common clinical problem during the first month of birth throughout the world. Mainly, it is the leading cause of neonatal morbidity and mortality in developing countries. Objectives The aimed of this studied was to assess predictors of jaundice among neonates admitted to selected referral hospitals in southwest Oromia, Ethiopia, 2021. Methods An Institutional based cross-sectional study was implemented among 205 admitted neonates at selected referral hospitals in southwest Oromia, Ethiopia from October 05 to November 5, 2021. Jimma medical center (JMC), Wollega University referral hospital (WURH), and Ambo University Referral hospital (AURH) were selected by simple random sampling technique. A pretested structured interviewer-administered questionnaire and medical record review was used to collect data. Both binary and multivariable logistic regression analyses were performed to identify factors associated with neonatal jaundice. Logistic regression analyses were performed to identify factors associated with neonatal jaundice. Statistical Significance was declared at P-value less than 0.05 in the final model, and if the confidence interval does not include the null hypothesis value. Results The prevalence of neonatal jaundice was 20.5% (95%CI: 1.74-1.85). The mean age of neonates was 8.6 ± 7.8 days. Traditional medicine use during current pregnancy (AOR: 5.62, 95%CI: 1.07, 9.52), Rh incompatibility (AOR: 0.045, 95%CI: 0.01, 0.21), gestational age (AOR: 4.61, 95%CI: 1.05, 10.3), premature rupture of membrane (AOR: 3.76, 95%CI: 1.58, 8.93) and hypertension (mother) (AOR: 3.99, 95%CI: 1.13, 14.02) were factors significantly associated with neonatal jaundice. Conclusion Neonatal jaundice was relatively higher in the current study. Traditional medicine use, Rh incompatibility, premature ruptures of membrane, hypertension, and preterm gestational age were factors associated with neonatal jaundice.
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Affiliation(s)
- Gutu Belay
- Department of Medical Sciences, College of Medical and Health Sciences, Ambo University, Ethiopia
| | - Asfaw Gerbi
- Department of Biomedical Sciences (Anatomy), College of Medical Sciences, Institute of Health, Jimma University, Ethiopia
| | - Teka Gebremariam
- Department of Biomedical Sciences (Anatomy), College of Medical Sciences, Institute of Health, Jimma University, Ethiopia
| | - Tsion Tilahun
- Department of Pediatrics and Child Health, College of Medical Sciences, Institute of Health, Jimma University, Ethiopia
| | - Emebet Chimdi
- Department of Medical Sciences, College of Medical and Health Sciences, Ambo University, Ethiopia
| | - Tesema Etefa
- Department of Biomedical Sciences (Anatomy), College of Medical Sciences, Institute of Health, Jimma University, Ethiopia
- Corresponding author.
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27
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Zhang H, Zhuang Y, Xia S, Jiang H. Deep Learning Network with Spatial Attention Module for Detecting Acute Bilirubin Encephalopathy in Newborns Based on Multimodal MRI. Diagnostics (Basel) 2023; 13:diagnostics13091577. [PMID: 37174968 PMCID: PMC10178403 DOI: 10.3390/diagnostics13091577] [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: 04/05/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Acute bilirubin encephalopathy (ABE) is a significant cause of neonatal mortality and disability. Early detection and treatment of ABE can prevent the further development of ABE and its long-term complications. Due to the limited classification ability of single-modal magnetic resonance imaging (MRI), this study aimed to validate the classification performance of a new deep learning model based on multimodal MRI images. Additionally, the study evaluated the effect of a spatial attention module (SAM) on improving the model's diagnostic performance in distinguishing ABE. METHODS This study enrolled a total of 97 neonates diagnosed with ABE and 80 neonates diagnosed with hyperbilirubinemia (HB, non-ABE). Each patient underwent three types of multimodal imaging, which included T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and an apparent diffusion coefficient (ADC) map. A multimodal MRI classification model based on the ResNet18 network with spatial attention modules was built to distinguish ABE from non-ABE. All combinations of the three types of images were used as inputs to test the model's classification performance, and we also analyzed the prediction performance of models with SAMs through comparative experiments. RESULTS The results indicated that the diagnostic performance of the multimodal image combination was better than any single-modal image, and the combination of T1WI and T2WI achieved the best classification performance (accuracy = 0.808 ± 0.069, area under the curve = 0.808 ± 0.057). The ADC images performed the worst among the three modalities' images. Adding spatial attention modules significantly improved the model's classification performance. CONCLUSION Our experiment showed that a multimodal image classification network with spatial attention modules significantly improved the accuracy of ABE classification.
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Affiliation(s)
- Huan Zhang
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou 310027, China
| | - Yi Zhuang
- Department of Radiology, Affiliated Children's Hospital of Jiangnan University, Wuxi 214036, China
| | - Shunren Xia
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou 310027, China
| | - Haoxiang Jiang
- Department of Radiology, Affiliated Children's Hospital of Jiangnan University, Wuxi 214036, China
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28
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Santos C, Burnay C, Button C, Cordovil R. Effects of Exposure to Formal Aquatic Activities on Babies Younger Than 36 Months: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5610. [PMID: 37107892 PMCID: PMC10138400 DOI: 10.3390/ijerph20085610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
This systematic review investigated the possible effects of exposing infants to formal activities in aquatic environments. A literature search of eight databases was concluded on 12 December 2022. Studies were eligible if they: (i) focused on 0-36 months of age infants, (ii) addressed the exposure of infants to formal aquatic activities, and (iii) compared the 'same condition of aquatic exposure with the control' or 'before and after exposure'. The PRISMA protocol was used. Articles considered for inclusion (n = 18) were clustered in the health, development, and physiological outcome domains. The results show that research is focused on indoor activities, mainly in baby swimming programs and baby aquatic therapy interventions. Swimming and aquatic therapy practices are generally safe for babies' health, and there are benefits to preterm and newborns exposed to aquatic therapy once the physiological parameters are maintained in normal and safe patterns. A positive effect is also suggested in general gross and fine motor skills, visual motion perception, cognitive flexibility, and response selection accuracy for infants who participated in aquatic programs. Further investigation with high-quality experimental designs is required to establish the effect of exposure of infants to formal aquatic activities (Systematic Review Registration: CRD42021248054).
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Affiliation(s)
- Carlos Santos
- Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, 1499-002 Cruz Quebrada, Portugal
| | - Carolina Burnay
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, 1499-002 Cruz Quebrada, Portugal
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin 9016, New Zealand
| | - Chris Button
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin 9016, New Zealand
| | - Rita Cordovil
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, 1499-002 Cruz Quebrada, Portugal
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29
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Li Y, Zhao J, Yu X. Feasibility analysis of TCB, hs-CRP, and UCB/ALB as outcome measures for dynamic assessment during phototherapy of neonates with Hyperbilirubinemia. Biotechnol Genet Eng Rev 2023:1-14. [PMID: 37035928 DOI: 10.1080/02648725.2023.2199245] [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: 04/11/2023]
Abstract
Hyperbilirubinemia (HY) is a common condition in neonates that requires phototherapy treatment. This study aimed to evaluate the effectiveness of transcutaneous bilirubin measurements (TCB), hypersensitive C-reactive protein (hs-CRP), and unconjugated bilirubin (UCB)/albumin (ALB) as indicators of HY during neonatal phototherapy. A research group of 67 neonates with pathological HY and a control group of 55 healthy neonates were selected from a hospital between June 2020 and May 2021. TCB, hs-CRP, and UCB/ALB tests were performed before, during (at 3 days of treatment), and after (at 6 days of treatment) phototherapy in the research group and at admission in the control group. The study also included a 1-year prognostic follow-up on the research group. The study observed the difference in TCB, hs-CRP, and UCB/ALB test results between both groups and their assessment effect on adverse reactions, treatment effects, and poor prognosis in phototherapy. TCB, hs-CRP, and UCB/ALB levels were higher in the research group than in the control group and gradually decreased during phototherapy (P < 0.05). The combined TCB, hs-CRP, and UCB/ALB assay had 100.0% sensitivity and 64.58% specificity (P < 0.001) for predicting adverse reactions, 88.24% sensitivity and 80.00% specificity (P < 0.001) for predicting the effect of phototherapy, and 90.91% sensitivity and 88.89% specificity (P < 0.001) for predicting poor prognosis. The combined TCB, hs-CRP, and UCB/ALB assay showed superior assessment of adverse effects, clinical outcomes, and poor prognosis in HY neonates treated with phototherapy. TCB, hs-CRP, and UCB/ALB could be used as dynamic disease assessment indicators for HY to better prevent and treat the occurrence of HY.
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Affiliation(s)
- Yanbi Li
- Department of Paediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Jihua Zhao
- Department of Paediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Xinqiao Yu
- Department of Paediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
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30
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Doğan E, Kaya HD, Günaydin S. The effect of massage on the bilirubin level in term infants receiving phototherapy. Explore (NY) 2023; 19:209-213. [PMID: 35660270 DOI: 10.1016/j.explore.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/13/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Massage has positive physiological effects on infants. Infant massage increases the excretion of waste products such as bilirubin from the body by accelerating the flow of the blood, lymph, and tissue fluids. PURPOSE The aim of the study is to investigate the effect of infant massage on hyperbilirubinemia in newborns receiving phototherapy. METHODS The study population consisted of infants admitted to the neonatal intensive care unit of a public hospital in Istanbul between October 2021 and January 2022 with a need for phototherapy. Sixty-one newborns who met the study criteria were randomized and divided into two as the experimental (n=30) and control (n=31) groups. All infants were followed up for 3 days, and phototherapy was applied twice a day. In addition to phototherapy, infant massage was applied to the experimental group for 10 min just before the phototherapy. The bilirubin level was measured 2 h after the end of phototherapy for both groups. Moreover, diapers were changed 8 times a day, every 3 h, in both groups. RESULTS The groups were homogeneous in terms of descriptive data, and no significant difference was observed between the groups (p>0.05). When bilirubin levels were compared, there was a significant decrease in bilirubin levels in the experimental group starting from the third day (p =.000). The frequency of defecation on the second and third days increased significantly in the experimental group (p =.000). CONCLUSION Infant massage can increase the frequency of defecation and help decrease bilirubin levels in newborns diagnosed with hyperbilirubinemia.
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Affiliation(s)
- Elif Doğan
- Faculty of Health Science, Department of Midwifery, Istanbul University-Cerrahpasa, Turkey
| | - Hüsniye Dinç Kaya
- Faculty of Health Science, Department of Midwifery, Istanbul University-Cerrahpasa, Turkey.
| | - Sevil Günaydin
- Faculty of Health Science, Department of Midwifery, Istanbul University-Cerrahpasa, Turkey
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31
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Perkov S, Gorin D. Noninvasive, continuous fluorescence monitoring of bilirubin photodegradation. Phys Chem Chem Phys 2023; 25:4460-4466. [PMID: 36723008 DOI: 10.1039/d2cp03733e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Nowadays phototherapy is widely used for treatment of various diseases. However, efficient application of phototherapy requires an understanding of light interactions with main endogenous chromophores (e.g., hemoglobin, bilirubin, and water) in tissue. In particular, bilirubin is the target chromophore in the treatment of neonatal jaundice, which is the most common disease affecting up to 80% of preterm infants. The most frequently recommended treatment technique for this disease is phototherapy with blue light in combination with conventional drug therapy. To follow threshold total serum bilirubin (TSB) concentration guidelines, it is essential to estimate TSB concentration accurately. The gold standard biochemical analysis is invasive and bulky. Moreover, noninvasive methods do not provide sufficient reproducibility and accuracy. In this research, the fluorescence sensing of bilirubin with human serum albumin complexes was studied. The fluorescence time course during light irradiation (central wavelength: 467 nm and power density: 12.13 mW cm-2) was demonstrated to depend on the initial concentration. Specifically, for the bilirubin concentration C = 18.65 μM, an insignificant fluorescence signal increase was observed during the first 30 minutes of light irradiation, while for bilirubin concentration C = 373 μM, the fluorescence signal did not reach maximum during 2.5 hours of light irradiation. Thus, fluorescence sensing might show increased accuracy when used with other noninvasive bilirubin sensing methods.
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Affiliation(s)
- Sergei Perkov
- Center for Photonic Science and Engineering, Skolkovo Institute of Science and Technology, Bolshoy Boulevard 30, bld. 1, Moscow, 121205, Russia.
| | - Dmitry Gorin
- Center for Photonic Science and Engineering, Skolkovo Institute of Science and Technology, Bolshoy Boulevard 30, bld. 1, Moscow, 121205, Russia.
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32
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Sankar MN, Ramanathan R, Joe P, Katheria AC, Villosis MFB, Cortes M, Bhatt DR, Truong H, Paje V, Tan RC, Arora V, Nguyen M, Biniwale M. Transcutaneous bilirubin levels in extremely preterm infants less than 30 weeks gestation. J Perinatol 2023; 43:220-225. [PMID: 35931798 DOI: 10.1038/s41372-022-01477-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The primary objective of this study was to determine the relationship between transcutaneous bilirubin (TcB) levels and total serum bilirubin (TSB) levels in extremely preterm infants. STUDY DESIGN We conducted a prospective multicenter study of extremely preterm infants less than 30 weeks gestation in California. Difference between paired TcB and TSB values were compared based on gestational age, birth weight, maternal race/ethnicity, chronological age as well as during and after phototherapy. RESULTS TSB values ranged from 0 to 12.6 mg/dl and the TcB values ranged from 0 to 14.2 mg/dl. TSB was predicted with a high degree of accuracy at TSB = 2.37 + 0.54 (TcB) with r = 0.786. There was good correlation across gestational age, birth weight, race/ethnic, chronological age subgroups as well as during and after phototherapy. CONCLUSION Our study supports the use of TcB as a screening tool for monitoring jaundice in extremely preterm infants.
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Affiliation(s)
- Meera N Sankar
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA.
| | - Rangasamy Ramanathan
- Division of Neonatology, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Priscilla Joe
- Neonatology, UCSF Benioff Children's Oakland, Oakland, CA, USA
| | - Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | | | - Maria Cortes
- Department of Pediatrics/Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Dilip R Bhatt
- Neonatology, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA
| | - Huy Truong
- Neonatology, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA
| | - Virna Paje
- Neonatology, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA
| | - Rosemarie C Tan
- Neonatology, Miller Children's Hospital, Long Beach, CA, USA
| | - Vasudha Arora
- Neonatology, Kaiser Foundation Hospital, Downey, CA, USA
| | - Marielle Nguyen
- Neonatology, Kaiser Permanente Southern California Orange County, Anaheim, CA, USA
| | - Manoj Biniwale
- Division of Neonatology, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Krishnegowda S, Thandaveshwara D, Doreswamy SM. Determination of intensity and spread of light to the surrounding in conventional phototherapy and comparison with novel converging photo unit — an observational study. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2023. [DOI: 10.1186/s43054-022-00151-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Abstract
Background
Blue light phototherapy used extensively in the management of hyperbilirubinemia has many side effects like dry eyes, blurring, headache, and altered circadian rhythm. Healthcare providers working around the phototherapy are unduly exposed to these side effects. Altered circadian rhythm results in disruption in the sleep-wake cycle affecting healthcare providers particularly working during the night shift. The constant glare of the blue light interrupts in clinical observation of the baby on phototherapy. With the intent of providing effective phototherapy with minimal exposure of blue light to healthcare providers, a light source called the photo unit was designed and developed.
The objective of this study was to estimate the intensity and spread of blue light to the surrounding in conventional phototherapy and to compare the same with newly developed converging photo unit.
Results
The therapeutic range of irradiance was noted up to 22 inch in diameter with conventional phototherapy compared to only 7 inch with our photo unit. The light spread with a conventional phototherapy unit was seen beyond 50 inch in all directions whereas was confined to 19-inch diameter with photo unit.
Conclusion
Photo unit developed by the authors has minimal divergence of light to the surrounding, thereby mitigating the side effects of blue light exposure to the people working in the vicinity. Multiple of these photo units can be used to make a phototherapy device.
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Chen LW, Zhang Y, Xu DD, Wang Y, Gao H. Causal relationships of neonatal jaundice, direct bilirubin and indirect bilirubin with autism spectrum disorder: A two-sample Mendelian randomization analysis. Front Public Health 2023; 11:1137383. [PMID: 37124814 PMCID: PMC10133461 DOI: 10.3389/fpubh.2023.1137383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Background Multiple systematic reviews and meta-analyses have examined the association between neonatal jaundice and autism spectrum disorder (ASD) risk, but their results have been inconsistent. This may be because the included observational studies could not adjust for all potential confounders. Mendelian randomization study can overcome this drawback and explore the causal relationship between the both. Methods We used the data of neonatal jaundice, direct bilirubin (DBIL), indirect bilirubin (IBIL), and ASD collected by genome-wide association study (GWAS) to evaluate the effects of neonatal jaundice, DBIL and IBIL on ASD by using a two-sample Mendelian randomized (MR). The inverse variance-weighted method (IVW) was the main method of MR analysis in this study. Weighted median method, MR-Egger regression and mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) test were used for sensitivity analysis. Results There was no evidence of an effect of neonatal jaundice (OR, 1.002, 95% CI, 0.977-1.027), DBIL (OR, 0.970, 95% CI, 0.884-1.064) and IBIL (OR, 1.074, 95% CI, 0.882-1.308) on ASD risk by IVW test. In the weighted median method, MR-Egger regression and leave-one-out analysis, the results were robust and no heterogeneity or pleiotropy was observed. Conclusions We found that neonatal jaundice, DBIL and IBIL were not associated with ASD in this study. However, this paper did not explore the effect of severity and duration of jaundice on ASD in different ethnic populations, which may require further research.
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Affiliation(s)
- Li-wen Chen
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yi Zhang
- Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People's Republic of China, Anhui Medical University, Hefei, Anhui, China
| | - Dou-dou Xu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yang Wang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- *Correspondence: Yang Wang
| | - Hui Gao
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Ministry of Education Key Laboratory for Full Life Cycle Population Health, Anhui Medical University, Hefei, Anhui, China
- Hui Gao
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Gonzalez-Suarez AM, Long A, Huang X, Revzin A. A Compact Control System to Enable Automated Operation of Microfluidic Bioanalytical Assays. BIOSENSORS 2022; 12:1160. [PMID: 36551127 PMCID: PMC9775492 DOI: 10.3390/bios12121160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 06/17/2023]
Abstract
We describe a control system for operating valve-enabled microfluidic devices and leverage this control system to carry out a complex workflow of plasma separation from 8 μL of whole blood followed by on-chip mixing of plasma with assay reagents for biomarker detection. The control system incorporates pumps, digital pressure sensors, a microcontroller, solenoid valves and off-the-shelf components to deliver high and low air pressure in the desired temporal sequence to meter fluid flow and actuate microvalves. Importantly, our control system is portable, which is suitable for operating the microvalve-enabled microfluidic devices in the point-of-care setting.
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Affiliation(s)
| | - Alexander Long
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
- Department of Biology, St. Olaf College, Northfield, MN 55057, USA
| | - XuHai Huang
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Alexander Revzin
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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Assessment of phytochemicals, antioxidants and in-silico molecular dynamic simulation of plant derived potential inhibitory activity of Thalictrum foliolosum DC. and Cordia dichotoma G. Forst. against jaundice. Biomed Pharmacother 2022; 156:113898. [DOI: 10.1016/j.biopha.2022.113898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
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Yan Q, Gong Y, Luo Q, Yin X, Yang L, Wang H, Feng J, Xing K, Huang Y, Huang C, Fan L. Effects of a Smartphone-Based Out-of-Hospital Screening App for Neonatal Hyperbilirubinemia on Neonatal Readmission Rates and Maternal Anxiety: Randomized Controlled Trial. J Med Internet Res 2022; 24:e37843. [DOI: 10.2196/37843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background
Neonatal hyperbilirubinemia is one of the leading causes of neonatal readmission—especially severe hyperbilirubinemia and its complications—and it influences disease burden as well as neonatal and maternal health. Smartphones have been shown to have satisfactory accuracy in screening neonatal bilirubin levels, but the impact of this technology on neonatal health care service and maternal health outcomes is still unknown.
Objective
The aim of this study was to evaluate the impact of a smartphone-based out-of-hospital neonatal jaundice screening program on neonatal readmission rates for jaundice and related maternal anxiety.
Methods
This was a 2-arm, unblinded, randomized controlled trial with 30 days of intervention and follow-up periods. From August 2019 to August 2020, healthy mother-infant dyads were recruited on-site from 3 public hospitals in Hainan, China. Intervention group mothers used the smartphone app to routinely monitor neonatal jaundice at home under the web-based guidance of pediatricians. Control group participants received routine care. The primary study outcome was the neonatal readmission rate due to jaundice within 30 days of the first hospital discharge. The secondary outcome was the maternal anxiety score associated with neonatal jaundice. The data were collected through a self-assessed questionnaire. All participants were included in the analysis (intention-to-treat).
Results
In this study, 1424 mother-infant dyads were recruited, comprising 1424 mothers and 1424 newborns. The median age
of the mothers was 29 (IQR 26-32) years, and there were 714 (50.1%) male neonates. These mother-infant dyads were randomly
assigned to the intervention group and the control group, with 712 dyads in each group; only 1187 of these dyads completed the
follow-up. We found that the adjusted 30-day neonatal readmission rate due to jaundice reduced by 10.5% (71/605, 11.7% vs
141/582, 24.2%; 95% CI 5%-15.9%; odds ratio 0.4, 95% CI 0.3-0.5; P<.001) and the relevant maternal anxiety mean score
decreased by 3.6 (95% CI –4.4 to –2.8; β=–3.6, 95% CI –4.5 to –2.8; P<.001) in the intervention group compared to those in the
routine care group.
Conclusions
Our study shows that the smartphone-based out-of-hospital screening method for neonatal hyperbilirubinemia decreased the neonatal readmission rate within 30 days from the first discharge and improved maternal mental health to some degree, thus demonstrating the usefulness of this screening app for follow-up in pediatric care.
Trial Registration
China Clinical Trial Registration Center, ChiCTR2100049567; http://www.chictr.org.cn/showproj.aspx?proj=64245
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Tsai ML, Lin WY, Chen YT, Lin HY, Ho HH, Kuo YW, Lin JH, Huang YY, Wang HS, Chiu HY, Lin HC. Adjuvant probiotic Bifidobacterium animalis subsp. lactis CP-9 improve phototherapeutic treatment outcomes in neonatal jaundice among full-term newborns: A randomized double-blind clinical study. Medicine (Baltimore) 2022; 101:e31030. [PMID: 36397441 PMCID: PMC9666203 DOI: 10.1097/md.0000000000031030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Probiotics had been used to decreased bilirubin level in neonatal jaundice (NJ) without being further studied mechanism and stratification. The intestinal pathogen Escherichia coli produced β-glucuronidase would increase enterohepatic circulation and elevate serum bilirubin levels (SBLs) which might worsen the disease process of NJ. STUDY OBJECTIVE We hypothesized that some probiotics could decrease bilirubin level through inhibiting the growth of E. coli. It's assumed that adjuvant probiotic intervention might accelerate the phototherapy for NJ and alleviate the severity of the NJ. Besides, it's further study the efficacy of the probiotic intervention in NJ among the full-term and preterm newborns. MATERIALS AND METHODS Firstly, the Bifidobacterium animalis subsp. lactis CP-9 was screened for its anti-E. coli activity. Then, it was orally administered to newborns with NJ in combination with conventional phototherapy (wavelength 425-457 nm) to determine its efficacy. 83 neonatal patients whose serum bilirubinemia was at a concentration of ≥ 15 mg/dL were participated the double-blind randomized trial and conducted in the neonatal ward of China Medical University Children's Hospital (CMUCH, Taichung, Taiwan). The test was conducted in 2 groups: experimental group: phototherapy + B. animalis subsp. lactis CP-9 (n = 43; 5 × 109 CFU/capsule) and control group: phototherapy + placebo (n = 40). The SBL and total phototherapy duration were measured. RESULTS The experimental group showed improved serum bilirubin decline rate (-0.16 ± 0.02 mg/dL/h; P = .009, 95% CI -0.12 to -0.2), particularly in the first 24 hour of in-hospital care, and reduced total phototherapy duration (44.82 ± 3.23 h; P = .011, 95% CI: 51.3-38.2) compared with the control group. Especially, probiotics had a significant therapeutic effect (serum bilirubin decline rate: -0.18 ± 0.02 mg/dL/h, 95% CI -0.12 to -0.23, P = .014; phototherapy duration: 43.17 ± 22.72 h, 95% CI 51.9-34.3, P = .019) in the low-risk subgroup (full-term newborns). CONCLUSIONS In conclusion, B. animalis subsp. lactis CP-9 synergistically improves treatment outcomes of NJ during in-hospital phototherapy including reduced total phototherapy duration and improved serum bilirubin decline rate, particularly in full-term newborns.
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Affiliation(s)
- Ming-Luen Tsai
- Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Yang Lin
- Research and Development Department, Glac Biotech Co., Ltd., Tainan, Taiwan
| | - Yin-Ting Chen
- Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiang-Yu Lin
- Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsieh-Hsun Ho
- Research and Development Department, Glac Biotech Co., Ltd., Tainan, Taiwan
| | - Yi-Wei Kuo
- Research and Development Department, Glac Biotech Co., Ltd., Tainan, Taiwan
| | - Jia-Hung Lin
- Research and Development Department, Glac Biotech Co., Ltd., Tainan, Taiwan
| | - Yen-Yu Huang
- Research and Development Department, Glac Biotech Co., Ltd., Tainan, Taiwan
| | - Hui-Shan Wang
- Research and Development Department, Glac Biotech Co., Ltd., Tainan, Taiwan
| | - Hsiao-Yu Chiu
- Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- *Correspondence: Hung-Chih Lin and Hsiao-Yu Chiu, Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, No. 2, Yude Rd., North Dist., Taichung City 404, Taiwan (R.O.C.) (e-mail: ; )
| | - Hung-Chih Lin
- Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Asia University Hospital, Asia University, Taichung, Taiwan
- *Correspondence: Hung-Chih Lin and Hsiao-Yu Chiu, Division of Neonatology, Department of Pediatrics, China Medical University Children’s Hospital, China Medical University, No. 2, Yude Rd., North Dist., Taichung City 404, Taiwan (R.O.C.) (e-mail: ; )
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Determinants of neonatal jaundice in Ethiopia: a systematic review and meta-analysis. World J Pediatr 2022; 18:725-733. [PMID: 36114364 DOI: 10.1007/s12519-022-00597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/19/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Neonatal jaundice is a common condition characterized by a yellowish discoloration of the skin, conjunctiva, and sclera caused by elevated serum or plasma bilirubin levels during the newborn period. The condition is usually not dangerous, but it can progress to severe hyperbilirubinemia, which can lead to acute bilirubin encephalopathy and kernicterus, a bilirubin-induced neurological damage. Therefore, this study aimed to assess the pooled prevalence of neonatal jaundice and its determinants in Ethiopia. METHODS Scopus, PubMed, Google Scholar, Embase, and CINAHL databases were searched for studies published between January 1, 2010 and July 30, 2021. A weighted DerSimonian Laird random-effects model was used to estimate the pooled prevalence of neonatal jaundice and its associated factors. The I2 was used to calculate the degree of heterogeneity. The funnel plot and Egger's regression test were used to assess publication bias. RESULTS Totally 697 articles were generated from various databases, and the review included a total of eight articles. The pooled prevalence of neonatal jaundice was 30.96% [95% confidence interval (CI) 16.61%-45.31%)] in Ethiopia. This review showed that prolonged labor [adjusted odd ratio (AOR) = 3.39; 95% CI 2.41-4.77), low birth weight (AOR = 5.12; 95% CI 3.11-8.72), birth asphyxia (AOR = 3.75; 95% CI 2.11-6.66), cephalohematoma (AOR = 7.07; 95% CI 2.72-18.38), ABO incompatibility (AOR = 6.05; 95% CI 2.95-12.42), Rhesus (RH) incompatibility (AOR = 3.77; 95% CI 2.04-6.96), male sex (AOR = 4.53; 95% CI 3.39-6.07), and neonatal sepsis (AOR = 2.47; 95% CI 1.49-4.08) were identified as a determining factor for neonatal jaundice in Ethiopia. CONCLUSIONS In low- and middle-income countries, neonatal jaundice is a significant healthcare burden, accounting for a significant portion of global childhood mortality and morbidity. However, some low-cost, effective, practical, and dependable solutions have been implemented. Prolonged labor, ABO incompatibility, RH incompatibility, birth asphyxia, neonatal sepsis, low birth weight, cephalohematoma, and male sex were identified as risk factors for neonatal jaundice in Ethiopia.
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Vizcarra-Jiménez D, Copaja-Corzo C, Hueda-Zavaleta M, Parihuana-Travezaño EG, Gutierrez-Flores M, Rivarola-Hidalgo M, Benites-Zapata VA. Predictors of Death in Patients with Neonatal Sepsis in a Peruvian Hospital. Trop Med Infect Dis 2022; 7:tropicalmed7110342. [PMID: 36355884 PMCID: PMC9697646 DOI: 10.3390/tropicalmed7110342] [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: 08/17/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Reducing neonatal mortality is a global challenge. This study’s objective was to determine the predictors of mortality in patients with neonatal sepsis. The study was a retrospective cohort study in a Peruvian hospital from January 2014 to April 2022. Neonates diagnosed with sepsis were included. To find predictors of mortality, we used Cox proportional regression models. We evaluated 288 neonates with sepsis; the median birth weight and hospitalization time were 3270 g and seven days, respectively. During follow-up, 18.4% did not survive, and the most common complications were jaundice (35.42%), respiratory distress syndrome (29.51%), and septic shock (12.5%). The most isolated bacteria were Klebsiella pneumoniae. The risk factors associated with higher mortality were prematurity (aHR = 13.92; 95% CI: 1.71−113.51), platelets <150,000 (aHR = 3.64; 1.22−10.88), creatinine greater than 1.10 (aHR = 3.03; 1.09−8.45), septic shock (aHR = 4.41; 2.23−8.74), and admission to IMV (aHR = 5.61; 1.86−16.88), On the other hand, breastfeeding was associated with a lower risk of death (aHR = 0.25; 0.13−0.48). In conclusion, we report a high incidence of death and identify clinical (prematurity, septic shock, admission to IMV) and laboratory characteristics (elevated creatinine and thrombocytopenia) associated with higher mortality in patients with neonatal sepsis. Breastfeeding was a factor associated with survival in these patients.
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Affiliation(s)
| | - Cesar Copaja-Corzo
- Facultad de Ciencias de la Salud, Universidad Privada de Tacna, Tacna 23003, Peru
- Red Asistencial Ucayali EsSalud, Ucayali 25003, Peru
- Correspondence: (C.C.-C.); (V.A.B.-Z.)
| | - Miguel Hueda-Zavaleta
- Facultad de Ciencias de la Salud, Universidad Privada de Tacna, Tacna 23003, Peru
- Hospital III Daniel Alcides Carrion EsSalud, Tacna 23000, Peru
| | | | - Maykel Gutierrez-Flores
- Facultad de Ciencias de la Salud, Universidad Privada de Tacna, Tacna 23003, Peru
- Hospital Hipólito Unanue de Tacna, Tacna 23003, Peru
| | | | - Vicente A. Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15024, Peru
- Correspondence: (C.C.-C.); (V.A.B.-Z.)
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Neonatal and Maternal Risk Factors for Indirect Hyperbilirubinemia: A Cross-Sectional Study from Bahrain. Int J Pediatr 2022; 2022:5199423. [PMID: 36119547 PMCID: PMC9481389 DOI: 10.1155/2022/5199423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/20/2022] [Accepted: 08/27/2022] [Indexed: 11/28/2022] Open
Abstract
Results Out of 555 records, 404 neonates were included. Among those, 209 (51%) were males and 275 (68.1%) were Bahraini. The median indirect bilirubin level at presentation was 218 (interquartile range, 174-270) μmol/L. ABO incompatibility was the commonest risk factor for neonatal indirect hyperbilirubinemia (n = 152, 37.6%) followed by glucose-6-phosphate dehydrogenase (G6PD) deficiency (n = 130/400, 32.5%). Age (>25 years) was the commonest maternal risk factor (n = 331, 81.9%) followed by cesarean delivery (n = 137, 33.9%). Neonates with ABO incompatibility had a significantly higher mean indirect bilirubin level compared to those with other risk factors (234.9 ± 68.5 versus 225 ± 82.2 mmol/L, respectively) (P = 0.04). Phototherapy use significantly increased along with the rise of bilirubin level (P < 0.0001). Intravenous immunoglobulins (IVIG) and exchange transfusion were used in 44 (10.9%) and 14 (3.5%) patients, respectively. Neonates who received IVIG had significantly higher bilirubin levels than those who did not (P = 0.005). Male newborns (P = 0.008), Bahrainis (P = 0.001), those with reticulocytosis (P = 0.001), and those who received IVIG (P = 0.001) were more prone to have associated risk factors. Conclusion ABO incompatibility, G6PD deficiency, and older maternal age were the commonest neonatal and maternal risk factors for developing neonatal indirect hyperbilirubinemia. Bahraini, male newborns, reticulocytosis, and IVIG use were associated with these factors. Early detection of such factors through screening can aid in immediate management to prevent serious complications of this common condition.
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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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Eghbalian F, Karimi L, Raeisi R, Dehkordi AH, Bouraghi H. Effect of clofibrate on reducing neonatal jaundice: a systematic review and meta-analysis. Osong Public Health Res Perspect 2022; 13:174-183. [PMID: 35820666 PMCID: PMC9263335 DOI: 10.24171/j.phrp.2021.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
In neonates, bilirubin tends to be deposited in body tissues, especially the skin and mucous membranes. Jaundice is an early symptom of bilirubin excretion disorders. Therefore, the aim of this study was to investigate the effect of clofibrate on reducing neonatal jaundice. In this systematic review, international databases, including PubMed, Scopus, Web of Science, Embase, Cochrane, and Google Scholar, were searched without time and language restrictions. The reference lists of all studies ultimately included were manually searched. In the 17 articles reviewed, with a sample size of 665 people published between 2005 and 2019, the average weight of the neonates varied from 2,186 g to 4,000 g. Furthermore, the average age of neonates varied from 2 days to 9 days. Four doses of clofibrate (25, 30, 50, 100 mg/kg of neonatal body weight) were used. The bilirubin level of neonates significantly decreased in the intervention group 24, 36, 48, and 72 hours after the start of treatment. Clofibrate administration decreased total serum bilirubin, especially from the second day onwards, and also reduced hospitalization time, hospital costs, and side effects from hospitalization.
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Feng Q, Huang Z, Su L, Fan Y, Guan Y, Zhang G. Therapeutic efficacy and safety of Yinzhihuang granules with phototherapy in neonatal pathologic jaundice: An updated systematic review and meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 100:154051. [PMID: 35325827 DOI: 10.1016/j.phymed.2022.154051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/17/2022] [Accepted: 03/12/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Yinzhihuang granule, consisting of extracts of Artemisia capillaris Thunb., Gardenia jasminoides Ellis, Lonicera japonica Thunb., and Scutellaria baicalensis Georgi is a well-known traditional Chinese patent medicine for patients with liver injury in China. However, the effects and safety of its use for pathologic jaundice in newborns require further systematic evaluation. PURPOSE To systematically evaluate the efficacy and safety of Yinzhihuang granules for the treatment of neonatal pathologic jaundice and to provide clinical evidence. METHODS Chinese databases (China Network Knowledge Infrastructure, Wan Fang Database, and VIP Database) and English databases (PubMed, EmBase, and the Cochrane Library) were thoroughly investigated through screening randomized controlled trials on Yinzhihuang granules for neonatal pathologic jaundice from the establishment of all databases to November 18, 2021. A meta-analysis was performed for selected data using STATA software. TSA software was used for trial sequential analyses of the total effective rate and adverse reactions. RESULTS A total of 19 trials and 2,221 newborns with pathologic jaundice were included in this study. Outcome measures of clinical efficacy in the experimental group were higher than in controls, including total bilirubin (WMD = -30.34, 95% CI = -35.44 to -25.23, p < 0.001), direct bilirubin (WMD = -15.03, 95% CI = -23.54 to -6.52, p < 0.001), indirect bilirubin (WMD = -11.22, 95% CI = -17.50 to -4.95, p < 0.001), recovery time (WMD = -2.96, 95% CI = -3.92 to -2.00, p < 0.001), hospitalization time (WMD = -3.83, 95% CI = -4.89 to -2.76, p < 0.001), and liver function indices. There were statistically significant differences between the two groups. Likewise, the incidence of adverse reactions, including diarrhea, erythra, and fever decreased remarkably in the trial group (RR = 0.44, 95% CI = 0.33 to 0.59, p < 0.001). Publication bias did not exist. We verified the efficacy and safety of Yinzhihuang granules with phototherapy for pathologic jaundice in newborns according using TSA analysis. CONCLUSION Yinzhihuang granules with phototherapy for neonatal pathologic jaundice are more effective than phototherapy alone. The incidence of ADRs does not increase with the application of Yinzhihuang granules. Due to the heterogeneity across the included studies, additional multicenter clinical trials with follow-ups are needed to confirm our findings.
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Affiliation(s)
- Qun Feng
- Lunan Pharmaceutical Group Co., Ltd., State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Linyi 276006, China.
| | - Zhiyan Huang
- Lunan Hope Pharmaceutical Co., Ltd., Linyi 276006, China
| | - Lingjin Su
- Linyi Fourth People's Hospital, Linyi 276005, China
| | - Yulan Fan
- Linyi Fourth People's Hospital, Linyi 276005, China
| | - Yongxia Guan
- Lunan Pharmaceutical Group Co., Ltd., State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Linyi 276006, China
| | - Guimin Zhang
- Lunan Pharmaceutical Group Co., Ltd., State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Linyi 276006, China.
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The outcomes of favipiravir exposure in pregnancy: a case series. Arch Gynecol Obstet 2022; 307:1385-1395. [PMID: 35622152 PMCID: PMC9136192 DOI: 10.1007/s00404-022-06615-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/06/2022] [Indexed: 12/26/2022]
Abstract
Purpose As in vitro and in vivo studies reported antiviral efficacy against RNA viruses, favipiravir, a pyrazinecarboxamide derivative, has become one of the treatment options for COVID-19 in some countries including Turkey. Preclinical studies demonstrated the risk for teratogenicity and embryotoxicity. Hence, the drug is contraindicated during pregnancy. Although limited in numbers, case-based evaluations indicate that favipiravir might not be a major teratogen in human pregnancies. This study aimed to present and analyze the outcomes of favipiravir exposure during pregnancy. Methods In this case series, the outcomes of nine pregnancies that were referred to the Teratology Information Service of Dokuz Eylul University Faculty of Medicine, Department of Medical Pharmacology between 01 April 2020 and 30 November 2021 were retrospectively evaluated. Results One spontaneous abortion, two elective terminations, one preterm live delivery and five term live deliveries were detected. The premature newborn was reported dead on the 5th day of neonatal intensive care unit admission. Physiological jaundice and transient respiratory distress were recorded in two term infants. One term infant was antenatally diagnosed with renal pelviectasis, but the findings resolved postnatally without requiring intervention. Conclusion The data indicate that favipiravir is not likely to be a major teratogen. Yet, it is not possible to draw a definite conclusion due to methodological limitations. Favipiravir exposures during pregnancy should be followed up closely and the outcomes should be reported consistently.
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Abstract
PURPOSE OF REVIEW Hyperbilirubinemia is commonly seen in neonates. Though hyperbilirubinemia is typically asymptomatic, severe elevation of bilirubin levels can lead to acute bilirubin encephalopathy and progress to kernicterus spectrum disorder, a chronic condition characterized by hearing loss, extrapyramidal dysfunction, ophthalmoplegia, and enamel hypoplasia. Epidemiological data show that the implementation of universal pre-discharge bilirubin screening programs has reduced the rates of hyperbilirubinemia-associated complications. However, acute bilirubin encephalopathy and kernicterus spectrum disorder are still particularly common in low- and middle-income countries. RECENT FINDINGS The understanding of the genetic and biochemical processes that increase the susceptibility of defined anatomical areas of the central nervous system to the deleterious effects of bilirubin may facilitate the development of effective treatments for acute bilirubin encephalopathy and kernicterus spectrum disorder. Scoring systems are available for the diagnosis and severity grading of these conditions. The treatment of hyperbilirubinemia in newborns relies on the use of phototherapy and exchange transfusion. However, novel therapeutic options including deep brain stimulation, brain-computer interface, and stem cell transplantation may alleviate the heavy disease burden associated with kernicterus spectrum disorder. Despite improved screening and treatment options, the prevalence of acute bilirubin encephalopathy and kernicterus spectrum disorder remains elevated in low- and middle-income countries. The continued presence and associated long-term disability of these conditions warrant further research to improve their prevention and management.
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Affiliation(s)
- Shuo Qian
- Department of Neurology and Rehabilitation, University of Illinois at Chicago College of Medicine, 912 S Wood St, Chicago, IL, 60612, USA.
| | - Prateek Kumar
- Department of Neurology and Rehabilitation, University of Illinois at Chicago College of Medicine, 912 S Wood St, Chicago, IL, 60612, USA
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago College of Medicine, 912 S Wood St, Chicago, IL, 60612, USA
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Zhang Y, Zhang C, Shu JB, Zhang F. Atypical infantile-onset Pompe disease with good prognosis from mainland China: A case report. World J Clin Cases 2022; 10:3278-3283. [PMID: 35603335 PMCID: PMC9082720 DOI: 10.12998/wjcc.v10.i10.3278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/29/2022] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pompe disease has a broad disease spectrum, including infantile-onset Pompe disease (IOPD) and late-onset Pompe disease (LOPD) forms. It is a type of glycogen storage disorder belonging to autosomal recessive genetic disease, for an estimated incidence of 1/40000 among the neonatal population. In severe cases, the natural course is characterized by death due to cardiopulmonary failure in the first year after birth. However, the clinical outcomes have improved since the emergence of enzyme replacement therapy (ERT) was widely used. CASE SUMMARY The reported female case in China was an atypical IOPD, which demonstrates an unusual presentation of glycogen accumulation syndrome type II without obvious skeletal muscle involvement, and reviewed physical examination, biochemical examinations, chest radiograph, and acid α-glucosidase (GAA) mutation analysis. After 4-mo specific ERT, the case received 12-mo follow-up. Moreover, the patient has obtained a very good prognosis under ERT. CONCLUSION For the atypical IOPD patients, early diagnosis and treatment may contribute to good prognosis.
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Affiliation(s)
- Ying Zhang
- Department of Neonatal, Tianjin Children’s Hospital (Tianjin University Children's Hospital), Tianjin 300134, China
| | - Cheng Zhang
- Department of Neonatal, Tianjin Children’s Hospital (Tianjin University Children's Hospital), Tianjin 300134, China
| | - Jian-Bo Shu
- Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin Pediatric Research Institute, Tianjin Children’s Hospital (Tianjin University Children's Hospital), Tianjin 300134, China
| | - Fang Zhang
- Department of Neonatal, Tianjin Children’s Hospital (Tianjin University Children's Hospital), Tianjin 300134, China
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Guedalia J, Farkash R, Wasserteil N, Kasirer Y, Rottenstreich M, Unger R, Grisaru Granovsky S. Primary risk stratification for neonatal jaundice among term neonates using machine learning algorithm. Early Hum Dev 2022; 165:105538. [PMID: 35026695 DOI: 10.1016/j.earlhumdev.2022.105538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neonatal jaundice occurs in approximately 60% of term newborns. Although risk factors for neonatal jaundice have been studied, all the suggested strategies are based on various newborn tests for bilirubin levels. We aim to stratify neonates into risk groups for clinically significant neonatal jaundice using a combined data analysis approach, without serum bilirubin evaluation. STUDY DESIGN Term (gestational week 37-42) neonates born in a single medical center, 2005-2018 were identified. Anonymized data were analyzed using machine learning. Thresholds for stratification into risk groups were established. Associations were evaluated statistically using neonates with and without clinically significant neonatal jaundice from the study population. RESULTS A total of 147,667 consecutive term live neonates were included. The machine learning diagnostic ability to evaluate the risk for neonatal jaundice was 0.748; 95% CI 0.743-0.754 (AUC). The most important factors were (in order of importance) maternal blood type, maternal age, gestational age at delivery, estimated birth weight, parity, CBC at admission, and maternal blood pressure at admission. Neonates were then stratified by risk: 61% (n = 90,140) were classed as low-risk, 39% (n = 57,527) as higher-risk. Prevalence of jaundice was 4.14% in the full cohort, and 1.47% and 8.29% in the low- and high-risk cohorts, respectively; OR 6.06 (CI: 5.7-6.45) for neonatal jaundice in high-risk group. CONCLUSION A population tailored "first step" screening policy using machine learning model presents potential of neonatal jaundice risk stratification for term neonates. Future development and validation of this computational model are warranted.
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Affiliation(s)
- Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat-Gan, Israel
| | - Rivka Farkash
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Netanel Wasserteil
- Department of Pediatrics, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Yair Kasirer
- Department of Pediatrics, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel.
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat-Gan, Israel
| | - Sorina Grisaru Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
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Tanimizu N. The neonatal liver: Normal development and response to injury and disease. Semin Fetal Neonatal Med 2022; 27:101229. [PMID: 33745829 DOI: 10.1016/j.siny.2021.101229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The liver emerges from the ventral foregut endoderm around 3 weeks in human and 1 week in mice after fertilization. The fetal liver works as a hematopoietic organ and then develops functions required for performing various metabolic reactions in late fetal and neonatal periods. In parallel with functional differentiation, the liver establishes three dimensional tissue structures. In particular, establishment of the bile excretion system consisting of bile canaliculi of hepatocytes and bile ducts of cholangiocytes is critical to maintain healthy tissue status. This is because hepatocytes produce bile as they functionally mature, and if allowed to remain within the liver tissue can lead to cytotoxicity. In this review, we focus on epithelial tissue morphogenesis in the perinatal period and cholestatic liver diseases caused by abnormal development of the biliary system.
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Affiliation(s)
- Naoki Tanimizu
- Department of Tissue Development and Regeneration, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, S-1, W-17, Chuo-ku, Sapporo, 060-8556, Japan.
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The incidence rate and influence factors of hemolysis, lipemia, icterus in fasting serum biochemistry specimens. PLoS One 2022; 17:e0262748. [PMID: 35045128 PMCID: PMC8769349 DOI: 10.1371/journal.pone.0262748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Hemolysis, icterus, and lipemia (HIL) of blood samples have been a concern in hospitals because they reflect pre-analytical processes’ quality control. However, very few studies investigate the influence of patients’ gender, age, and department, as well as sample-related turnaround time, on the incidence rate of HIL in fasting serum biochemistry specimens. Methods A retrospective, descriptive study was conducted to investigate the incidence rate of HIL based on the HIL index in 501,612 fasting serum biochemistry specimens from January 2017 to May 2018 in a tertiary university hospital with 4,200 beds in Sichuan, southwest China. A subgroup analysis was conducted to evaluate the differences in the HIL incidence rate by gender, age and department of patients, and turnaround time of specimens. Results The incidence rate of hemolysis, lipemia and icterus was 384, 53, and 612 per 10,000 specimens. The male patients had a significantly elevated incidence of hemolysis (4.13% vs. 3.54%), lipemia (0.67% vs. 0.38%), and icterus (6.95% vs. 5.43%) than female patients. Hemolysis, lipemia, and icterus incidence rate were significantly associated with the male sex with an odds ratio (OR) of 1.174 [95% confidence interval (CI), 1.140–1.208], 1.757 (95%CI: 1.623–1.903), and 1.303 (95%CI: 1.273–1.333), respectively, (P<0.05). The hospitalized patients had a higher incidence of hemolysis (4.03% vs. 3.54%), lipemia (0.63% vs. 0.36%), and icterus (7.10% vs. 4.75%) than outpatients (P<0.001). Specimens with relatively longer transfer time and/or detection time had a higher HIL incidence (P<0.001). The Pediatrics had the highest incidence of hemolysis (16.2%) with an adjusted OR (AOR) of 4.93 (95%CI, 4.59–5.29, P<0.001). The Neonatology department had the highest icterus incidence (30.1%) with an AOR of 4.93 (95%CI: 4.59–5.29, P<0.001). The Neonatology department (2.32%) and Gastrointestinal Surgery (2.05%) had the highest lipemia incidence, with an AOR of 1.17 (95%CI: 0.91–1.51) and 4.76 (95%CI: 4.70–5.53), both P-value <0.001. There was an increasing tendency of hemolysis and icterus incidence for children under one year or adults aged more than 40. Conclusion Evaluation of HIL incidence rate and HIL-related influence factors in fasting serum biochemistry specimens are impartment to interpret the results more accurately and provide better clinical services to patients.
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