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Daggle L, Sharma N, Setiady I, Leonard K. Management of Neonatal Hyperbilirubinemia: Shedding Light on the American Academy of Pediatrics 2022 Clinical Practice Guideline Revision. Pediatr Ann 2024; 53:e208-e216. [PMID: 38852082 DOI: 10.3928/19382359-20240407-02] [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: 06/10/2024]
Abstract
Neonatal hyperbilirubinemia is one of the most common conditions managed by pediatricians. Although many infants are affected, most will experience complete resolution without complication. Acute bilirubin encephalopathy and kernicterus are rare yet debilitating sequelae of severe hyperbilirubinemia that can be avoided through careful monitoring and treatment with phototherapy. Appropriate management of neonatal hyperbilirubinemia must balance the risks of these severe conditions with the effects of overtreatment. Released in 2022, the American Academy of Pediatrics revised the clinical practice guideline for the management of hyperbilirubinemia, which aims to provide that balance through updates to the previous guideline. This article will provide the reader with (1) an evidence-based harm and benefit analysis of the guideline, (2) an overview of key changes and clarifications made in the new guideline, and (3) a practical summary of guideline updates. [Pediatr Ann. 2024;53(6):e208-e216.].
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Li J, Ye S, Huang X, Yang G, Wang Y, Zeng J, Lai C. Analysis of the intestinal microbiota and profiles of blood amino acids and acylcarnitines in neonates with hyperbilirubinemia. BMC Microbiol 2024; 24:171. [PMID: 38760685 PMCID: PMC11102171 DOI: 10.1186/s12866-024-03328-y] [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: 01/07/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE This study aimed to discuss the distinctive features of the intestinal microbiota in neonates with hyperbilirubinemia and to comprehensively analyse the composition of the intestinal microbiota as well as the levels of free amino acids and acylcarnitines in the peripheral blood of neonates experiencing hyperbilirubinemia. RESULTS At the phylum level, Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes, and Chloroflexi were the five predominant microbial groups identified in both the hyperbilirubinemia and control groups. Alpha diversity analysis, encompassing seven indices, showed no statistically significant differences between the two groups. However, Beta diversity analysis revealed a significant difference in intestinal microbiota structure between the groups. Linear discriminant analysis effect size (LEfSe) indicated a significant reduction in the abundance of Gammaproteobacteria and Enterobacteriaceae within the hyperbilirubinemia group compared to that in the control group. The heatmap revealed that the control group exhibited increased abundances of Escherichia and Bifidobacterium, while the hyperbilirubinemia group exhibited increased levels of Enterococcus and Streptococcus. Regarding blood amino acids and acylcarnitines, there were greater concentrations of citrulline (Cit), arginine (Arg), ornithine (Orn), and valine (Val) in the hyperbilirubinemia group than in the control group. The hyperbilirubinemia group also exhibited significant increases in medium-chain fatty acids (C6, C8), long-chain fatty acids (C18), and free carnitine (C0). CONCLUSION By comparing neonates with hyperbilirubinemia to those without, a significant disparity in the community structure of the intestinal microbiota was observed. The intestinal microbiota plays a crucial role in the bilirubin metabolism process. The intestinal microbiota of neonates with hyperbilirubinemia exhibited a certain degree of dysbiosis. The abundances of Bacteroides and Bifidobacterium were negatively correlated with the bilirubin concentration. Therefore, the fact that neonates with hyperbilirubinemia exhibit some variations in blood amino acid and acylcarnitine levels may provide, to a certain degree, a theoretical basis for clinical treatment and diagnosis.
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Affiliation(s)
- Junguo Li
- Department of Clinical Laboratory, The Second Nanning People's Hospital, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of Molecular Immunology Research, Nanning, Guangxi, China
| | - Shenglin Ye
- Department of Clinical Laboratory, The Fifth Affiliated Hospital of Guangxi Medical University, The First People's Hospital of Nanning, Nanning, Guangxi, China
| | - Xinyuan Huang
- Department of Clinical Laboratory, The Second Nanning People's Hospital, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of Molecular Immunology Research, Nanning, Guangxi, China
| | - Guolong Yang
- Department of Clinical Laboratory, The Second Nanning People's Hospital, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of Molecular Immunology Research, Nanning, Guangxi, China
| | - Yijin Wang
- Department of Pediatrics, The Second Nanning People's Hospital, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jianghui Zeng
- Department of Clinical Laboratory, The Second Nanning People's Hospital, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
- Guangxi Key Laboratory of Molecular Immunology Research, Nanning, Guangxi, China.
| | - Chunhui Lai
- Department of Clinical Laboratory, The Second Nanning People's Hospital, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
- Guangxi Key Laboratory of Molecular Immunology Research, Nanning, Guangxi, China.
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Smith M, Ridgway A, Mullikin D. Neonatal Hyperbilirubinemia Admissions Following Clinical Practice Guideline Implementation. Mil Med 2024; 189:e1259-e1262. [PMID: 37975240 DOI: 10.1093/milmed/usad427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/08/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Treatment of neonatal hyperbilirubinemia remains one of the most common reasons for readmission following delivery. Revised clinical practice guidelines (CPGs) for the treatment of neonatal hyperbilirubinemia were published on August 5, 2022. This report describes the preliminary outcomes following implementation of the new CPGs at Tripler Army Medical Center. MATERIALS AND METHODS A retrospective chart review was performed for the 12 months prior to implementation and the 5 months post implementation. RESULTS Bilirubin admissions decreased from 15.6% of total admissions during the 12 months prior to the new guidelines (69/441) to 4.1% of admissions (8/194) during the 5 months after implementation of the new guidelines (P < 0.001). This corresponds to a 74% reduction (risk ratio = 0.26, 95% confidence interval [CI] 0.13 to 0.54). The decrease in admissions was found to correlate to greater than $140,000 in annual savings. CONCLUSION Adhering to the revised CPGs has the potential to increase resource availability at a time when nursing shortages and financial instability are impacting health care systems nationwide. No short-term adverse events were noted; however, long-term follow up will be needed.
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Affiliation(s)
- Morgan Smith
- Pediatric Residency Program, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Austin Ridgway
- Pediatric Residency Program, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Dolores Mullikin
- Pediatric Residency Program, Tripler Army Medical Center, Honolulu, HI 96859, USA
- Pediatric Faculty, The University of Uniformed Services, Bethesda, MD 20814, USA
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Bhutani VK, Vidavalur R, Wong RJ. Advances to diminish global newborn kernicterus mortality. J Perinatol 2024; 44:493-500. [PMID: 38151598 DOI: 10.1038/s41372-023-01862-7] [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] [Received: 09/22/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE Initiatives, "Every Newborn Action Plans" and "Sustainable Developmental Goals," are profoundly shaping global infant mortality trends. Concurrently, professional organizations recommended curricula to prevent extreme hyperbilirubinemia (EHB) sequelae. Therefore we assessed if these efforts have successfully decreased EHB-related mortality over time. STUDY DESIGN We used the Global Burden of Diseases 2019 database to determine neonatal and infant mortality and the burden of kernicterus from 1990-2019. RESULTS Globally, kernicterus accounted for 2.8 million infant deaths and trended downwards significantly from 1990 to 2019. By 2019, kernicterus-related mortality was 4 and 293 per million livebirths in high (HICs) and low income countries (LICs), respectively. 82% of deaths occurred in LICs and lower-middle income-countries. Average declines of mortality rates were 6.2% and 3.0% for HICs and LICs, respectively. CONCLUSIONS Kernicterus-related mortality has been effectively reduced to <5 per million in HICs. Skills and knowledge transfer can potentially transform frontline services to bridge discordant kernicteric outcomes worldwide.
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Affiliation(s)
- Vinod K Bhutani
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Ramesh Vidavalur
- Department of Neonatology, Cayuga Medical Center of Ithaca, Ithaca, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Ronald J Wong
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Yuan Y, Huang J, Yu J, Tan JKS, Chng KZ, Lee J, Kim S. Application of machine learning algorithms for accurate determination of bilirubin level on in vitro engineered tissue phantom images. Sci Rep 2024; 14:5952. [PMID: 38467676 PMCID: PMC10928098 DOI: 10.1038/s41598-024-56319-4] [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: 11/16/2023] [Accepted: 03/05/2024] [Indexed: 03/13/2024] Open
Abstract
Neonatal Jaundice is a common occurrence in neonates. High excess bilirubin would lead to hyperbilirubinemia, leading to irreversible adverse damage such as kernicterus. Therefore, it is necessary and important to monitor neonates' bilirubin levels in real-time for immediate intervention. However, current screening protocols have their inherent limitations, necessitating more convenient measurements. In this proof-of-concept study, we evaluated the feasibility of using machine learning for the screening of hyperbilirubinemia in neonates from smartphone-acquired photographs. Different machine learning models were compared and evaluated to gain a better understanding of feature selection and model performance in bilirubin determination. An in vitro study was conducted with a bilirubin-containing tissue phantom to identify potential biological and environmental confounding factors. The findings of this study present a systematic characterization of the confounding effect of various factors through separate parametric tests. These tests uncover potential techniques in image pre-processing, highlighting important biological features (light scattering property and skin thickness) and external features (ISO, lighting conditions and white balance), which together contribute to robust model approaches for accurately determining bilirubin concentrations. By obtaining an accuracy of 0.848 in classification and 0.812 in regression, these findings indicate strong potential in aiding in the design of clinical studies using patient-derived images.
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Affiliation(s)
- Yijia Yuan
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore
- N.1 Institute for Health, National University of Singapore, Singapore, 119276, Singapore
| | - Jiayao Huang
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore
| | - Jiachen Yu
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore
- College of Biomedical Engineering and Instrument, Zhejiang University, Hangzhou, 310027, China
| | - Justin Kok Soon Tan
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore
- N.1 Institute for Health, National University of Singapore, Singapore, 119276, Singapore
| | | | - Jiun Lee
- Department of Neonatology, National University Health System, Singapore, 119228, Singapore
- Department of Paediatrics, National University of Singapore, Singapore, 119228, Singapore
| | - Sangho Kim
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore.
- N.1 Institute for Health, National University of Singapore, Singapore, 119276, Singapore.
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Trasancos C, Horey D. Experiences with neonatal jaundice management in hospitals and the community: interviews with Australian health professionals. BMJ Open 2024; 14:e075896. [PMID: 38355169 PMCID: PMC10868246 DOI: 10.1136/bmjopen-2023-075896] [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: 05/22/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Worldwide, neonatal jaundice accounts for considerable morbidity and mortality. Although severe adverse outcomes, such as hyperbilirubinaemia and kernicterus, are uncommon in high-income countries, these outcomes do occur, have enormous lifelong personal, health and social costs, and may be preventable. Evidence-based practice commonly relies on clinical guidelines; however, their implementation can be difficult. Implementation of neonatal jaundice care has been adversely affected by issues with professional boundaries, competing professional priorities and poor understanding of neonatal jaundice. This paper focuses on the perceptions and experiences of Australian health professionals involved in the management of neonatal jaundice. METHODS Using a qualitative descriptive approach, semistructured interviews were undertaken to gain understanding of the experiences of health professionals in Australia across the scope of care for jaundiced newborns through an interpretivist approach and to identify possible gaps in the delivery of evidence-based care. Health professionals from a range of disciplines and care settings were recruited by purposive maximum variation sampling. Interviews were conducted face-to-face or by telephone with detailed notes taken and a field journal maintained. Interview scripts were verified by participants and imported into NVivo software. Data were analysed for major themes according to type and contexts of practice. RESULTS Forty-one health professionals from six broad discipline areas were interviewed. Two major themes and explanatory subthemes were found. The first theme, falling through the gaps, highlighted gaps in evidence-based care, as described by four explanatory subthemes: professional boundaries, blindness to possibility of adverse outcomes, competing professional development priorities and unintended consequences.The second major theme, we know what should happen-but how?, described participant perceptions that it was known what was required to improve care but how to achieve such changes was unclear. The two subthemes are: improvements in education and training, and standardised policies and protocols. CONCLUSIONS Multiple barriers to the provision of evidence-based care related to neonatal jaundice management are experienced by health professionals in Australia. Clinical guidelines are not sufficient to support health professionals deliver evidence-based care in the complex contexts in which they work. Implementation strategies for evidence-based practice need to take account of the experiences of health professionals and the challenges they face. Such strategies need to focus on improving collaboration between different disciplines for the well-being of those needing care. In the case of neonatal jaundice management, consideration is also needed in how to raise awareness of the importance of avoiding severe adverse outcomes, even when they might be rare, and how this might be done. Addressing issues that lead to disjointed care or poor knowledge of neonatal jaundice among health professionals is essential.
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Affiliation(s)
| | - Dell Horey
- La Trobe University, Melbourne, Victoria, Australia
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Leung-Pineda V, Weinzierl EP, Rogers BB. Preliminary Investigation into the Prevalence of G6PD Deficiency in a Pediatric African American Population Using a Near-Patient Diagnostic Platform. Diagnostics (Basel) 2023; 13:3647. [PMID: 38132231 PMCID: PMC10742488 DOI: 10.3390/diagnostics13243647] [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: 10/25/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is prevalent in the African American population. We identified eighteen G6PD-deficient samples (9%) in a study of residual, de-identified whole blood specimens from 200 African American pediatric patients using a point-of-care instrument. This highlights the possibility of a rapid time to result for G6PD testing, which can be valuable in some clinical scenarios.
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Affiliation(s)
| | | | - Beverly B. Rogers
- Department of Pathology and Laboratory Medicine, Children’s Healthcare of Atlanta, and Emory University School of Medicine, Atlanta, GA 30322, USA; (V.L.-P.); (E.P.W.)
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DeZure C. Updated Clinical Practice Guidelines for Management of Hyperbilirubinemia in Infants Born at 35 Weeks or More Gestation. Pediatr Ann 2023; 52:e436-e439. [PMID: 38049191 DOI: 10.3928/19382359-20231016-07] [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: 12/06/2023]
Abstract
Given the prevalence of jaundice in newborns, and the consequences of untreated hyperbilirubinemia, the long-awaited revised clinical practice guidelines for hyperbilirubinemia were finally released in August 2022 by the American Academy of Pediatrics as an update to the 2004 guidelines on the same topic. As new evidence and data become available, it is important for pediatricians and neonatologists to re-assess their clinical decision-making over time to ensure that patients are receiving the best care possible. With improvements in medical equipment and medical technology, and growing concerns about the overtreatment of hyperbilirubinemia, the newest clinical practice guidelines attempt to tackle the prevention, risk assessment, monitoring, and treatment of hyperbilirubinemia with these things in mind. [Pediatr Ann. 2023;52(12):e436-e439.].
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Duan L, Chen P, Tu N, Hu H. Clinical value of combination detection of direct antiglobulin test and serum albumin globulin ratio in severe hyperbilirubinemia caused by ABO hemolytic disease of the newborn. J Matern Fetal Neonatal Med 2023; 36:2228965. [PMID: 37369373 DOI: 10.1080/14767058.2023.2228965] [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: 07/25/2022] [Revised: 04/11/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023]
Abstract
Background To explore of a combination of antiglobulin test(DAT) and albumin globulin ratio(AGR) could predict the severity of ABO hemolytic disease of the newborn(ABO-HDN).Methods The measurement of DAT, AGR and combination detection of DAT and AGR was done to predict severe ABO-HDN hyperbilirubinemia in 270 full-term infants based on whether the infants received transfusions of blood components. The infants were divided into three groups according to the results of DAT and ARG and compared the differences of phototherapy day and hospitalization day of the three groups.Results Of the 270 cases enrolled in this study, 69 infants were DAT positive. Peak total bilirubin, AGR, and positive DAT were independently associated with the need for blood components transfusion. ROC curve analysis for blood components transfusion showed that DAT cutoff value >± with a sensitivity of 39.4% and a specificity of 83.9%, AGR cutoff value <2.05 with a sensitivity of 54.1% and a specificity of 85.7%, and combination detection of DAT and ARG with a sensitivity of 62.1% and a specificity of 91.2%. The AUCs for DAT, AGR, and combination detection of DAT and AGR were .621, .740, and .750 respectively. The phototherapy day and hospitalization day were significantly longer in group of AGR <2.05 and DAT >± than that of a group of AGR <2.05 and group of DAT >±.Conclusions DAT and ARG could be early predictors for the severity ABO-HDN hyperbilirubinemia and combination detection of DAT and AGR could further increase its predictive value.
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Affiliation(s)
- Ling Duan
- Department of Blood Transfusion, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Ping Chen
- Department of Blood Transfusion, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Na Tu
- Department of Clinical Laboratory, Wuhan Prevention and Treatment Center for Occupational Diseases, Wuhan, Hubei, China
| | - Hongbing Hu
- Department of Blood Transfusion, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
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Abiha U, Banerjee DS, Mandal S. Demystifying non-invasive approaches for screening jaundice in low resource settings: a review. Front Pediatr 2023; 11:1292678. [PMID: 38054187 PMCID: PMC10694303 DOI: 10.3389/fped.2023.1292678] [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: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 12/07/2023] Open
Abstract
All national and international pediatric guidelines universally prescribe meticulous bilirubin screening for neonates as a critical measure to mitigate the incidence of acute bilirubin encephalopathy (ABE) and Kernicterus. The prevailing gold standard for jaundice detection in neonates necessitates invasive blood collection, followed by subsequent biochemical testing. While the invasive procedure provides dependable bilirubin measurements and continues to be the sole gold standard diagnostic method for assessing bilirubin concentration. There exists a pressing need to innovate non-invasive screening tools that alleviate the sampling stress endured by newborns, mitigate iatrogenic anemia, and expedite the turnaround time for obtaining results. The exploration of non-invasive modalities for bilirubin measurements is gaining momentum, driven by the overarching goal of minimizing the number of pricks inflicted upon neonates, thereby rendering screening a swift, efficient, comfortable, and dependable process. This comprehensive review article delves extensively into the array of non-invasive approaches and digital solutions that have been proposed, implemented, and utilized for neonatal bilirubin screening, with a particular emphasis on their application in low-resource settings. Within this context, the review sheds light on the existing methodologies and their practical applications, with a specific focus on transcutaneous bilirubin meters. Moreover, it underscores the prevailing open challenges in this domain and outlines potential directions for future research endeavors. Notably, the review underscores the imperative need for robust educational programs targeted at both families and healthcare personnel to expedite the process of seeking timely care for neonatal jaundice. Additionally, it underscores the necessity for the development of enhanced screening and diagnostic tools that can offer greater accuracy in clinical practice.
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Affiliation(s)
- Umme Abiha
- Department of Smart Healthcare, Indian Institute of Technology, Jodhpur, India
- All India Institute of Medical Science, Jodhpur, India
| | - Dip Sankar Banerjee
- Computer Science and Engineering, Indian Institute of Technology, Jodhpur, India
| | - Saptarshi Mandal
- Transfusion Medicine and Blood Bank, All India Institute of Medical Science, Jodhpur, India
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Tan TJ, Chen WJ, Lin WC, Yang MC, Tsai CC, Yang YN, Yang SN, Liu HK. Early-Term Neonates Demonstrate a Higher Likelihood of Requiring Phototherapy Compared to Those Born Full-Term. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1819. [PMID: 38002910 PMCID: PMC10670379 DOI: 10.3390/children10111819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
Early-term neonates (with a gestational age (GA) of 37 and 0/7 weeks to 38 and 6/7 weeks) face higher morbidities, including respiratory and neurodevelopmental issues, than full-term (39 and 0/7 weeks to 40 and 6/7 weeks) infants. This study explores whether hyperbilirubinemia necessitating phototherapy also differs between these groups. A retrospective study was conducted on neonates born from January 2021-June 2022, excluding those with specific conditions. Evaluated factors included GA, birth weight, bilirubin levels, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and feeding type, with phototherapy given as per AAP guidelines. Of 1085 neonates, 356 met the criteria. When stratifying the neonates based on the need for phototherapy, a higher proportion of early-term neonates required phototherapy compared to full-term (p < 0.05). After factoring in various risks (GA; birth weight; gender; feeding type; G6PD deficiency; transcutaneous bilirubin levels at 24 h and 24-48 h postpartum; maternal diabetes; and the presence of caput succedaneum or cephalohematoma), early-term neonates were more likely to need phototherapy than full-term babies (OR: 2.15, 95% CI: 1.21 to 3.80). The optimal cut-off for transcutaneous bilirubin levels 24-48 h postpartum that were used to predict phototherapy need was 9.85 mg/dl. In conclusion, early-term neonates are at a greater risk for developing jaundice and requiring phototherapy than full-term neonates. Monitoring bilirubin 24-48 h postpartum enhances early prediction and intervention.
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Affiliation(s)
- Teck-Jin Tan
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (T.-J.T.); (M.-C.Y.); (C.-C.T.); (Y.-N.Y.); (S.-N.Y.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Wan-Ju Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
- Department of Pediatrics, E-Da Dachang Hospital, I-Shou University, Kaohsiung 80794, Taiwan
| | - Wan-Chun Lin
- Department of Nurse Practitioners, Yuan’s General Hospital, Kaohsiung 80249, Taiwan;
| | - Ming-Chun Yang
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (T.-J.T.); (M.-C.Y.); (C.-C.T.); (Y.-N.Y.); (S.-N.Y.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Ching-Chung Tsai
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (T.-J.T.); (M.-C.Y.); (C.-C.T.); (Y.-N.Y.); (S.-N.Y.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Yung-Ning Yang
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (T.-J.T.); (M.-C.Y.); (C.-C.T.); (Y.-N.Y.); (S.-N.Y.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - San-Nan Yang
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (T.-J.T.); (M.-C.Y.); (C.-C.T.); (Y.-N.Y.); (S.-N.Y.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Hsien-Kuan Liu
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (T.-J.T.); (M.-C.Y.); (C.-C.T.); (Y.-N.Y.); (S.-N.Y.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
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Sampurna MTA, Pratama DC, Visuddho V, Oktaviana N, Putra AJE, Zakiyah R, Ahmad JM, Etika R, Handayani KD, Utomo MT, Angelica D, Ayuningtyas W, Hendrarto TW, Rohsiswatmo R, Wandita S, Kaban RK, Liem KD. A review of existing neonatal hyperbilirubinemia guidelines in Indonesia. F1000Res 2023; 11:1534. [PMID: 38025296 PMCID: PMC10682606 DOI: 10.12688/f1000research.110550.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the management of this condition were present. This study aimed to compare the existing guidelines regarding prevention, diagnosis, treatment and monitoring in order to create the best recommendation for a new hyperbilirubinemia guideline in Indonesia. Methods Through an earlier survey regarding adherence to the neonatal hyperbilirubinemia guideline, we identified that three main guidelines are being used in Indonesia. These were developed by the Indonesian Pediatric Society (IPS), the Ministry of Health (MoH), and World Health Organization (WHO). In this study, we compared factors such as prevention, monitoring, methods for identifying, risk factors in the development of neonatal jaundice, risk factors that increase brain damage, and intervention treatment threshold in the existing guidelines to determine the best recommendations for a new guideline. Results The MoH and WHO guidelines allow screening and treatment of hyperbilirubinemia based on visual examination (VE) only. Compared with the MoH and WHO guidelines, risk assessment is comprehensively discussed in the IPS guideline. The MoH guideline recommends further examination of an icteric baby to ensure that the mother has enough milk without measuring the bilirubin level. The MoH guideline recommends referring the baby when it looks yellow on the soles and palms. The WHO and IPS guidelines recommend combining VE with an objective measurement of transcutaneous or serum bilirubin. The threshold to begin phototherapy in the WHO guideline is lower than the IPS guideline while the exchange transfusion threshold in both guidelines are comparably equal. Conclusions The MoH guideline is outdated. MoH and IPS guidelines are causing differences in approaches to the management hyperbilirubinemia. A new, uniform guideline is required.
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Affiliation(s)
- Mahendra Tri Arif Sampurna
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Danny Chandra Pratama
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Visuddho Visuddho
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Novita Oktaviana
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Achmad Januar Er Putra
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Rahmi Zakiyah
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Jordy Maulana Ahmad
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Risa Etika
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Kartika Darma Handayani
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Martono Tri Utomo
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Dina Angelica
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Wurry Ayuningtyas
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Toto Wisnu Hendrarto
- Neonatal Intensive Care Unit, Harapan Kita Mother and Child Hospital, Jakarta, 11420, Indonesia
| | - Rinawati Rohsiswatmo
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Setya Wandita
- Neonatology Division, Department of Child Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Risma Karina Kaban
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Kian Djien Liem
- Department of Neonatology, Radboud University Medical Centre, Nijmegen, 6525, Netherlands Antilles
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Tomasini DK, Guindon MG, Vereen RJ, Drumm CM, Ponnapakkam AP. Readmission Reduction for Hyperbilirubinemia in Infants ≥ 35 Weeks Estimated Gestational Age Using a Standardized Protocol. Jt Comm J Qual Patient Saf 2023; 49:613-619. [PMID: 37599136 DOI: 10.1016/j.jcjq.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Most newborns experience hyperbilirubinemia. Monitoring and treatment must be balanced with the risk of unintended harm, including readmission to the birth hospital. From January 2019 to April 2021, the average rate of inborn readmission for all causes was 2.09% at the study hospital; hyperbilirubinemia accounted for 91% of these readmissions. The aim of this project was to decrease readmission rate for hyperbilirubinemia by 60% within eight months of protocol implementation. METHODS The Lean system of quality improvement was used to assess root causes and implement countermeasures. A hyperbilirubinemia protocol was developed, and phototherapy equipment was upgraded. Monthly readmission rates were the main outcome measure. Process measures included hour of life for initial transcutaneous bilirubin measurement. Balance measures included number of serum bilirubin labs obtained per 100 infants, percentage treated with phototherapy, mean length of phototherapy treatment, and length of hospital stay. Statistical process control charts were used to measure changes in quality over time. RESULTS Baseline data showed a monthly readmission rate for hyperbilirubinemia of 1.9%. Following countermeasure implementation, there was a clinically significant downward shift in the monthly readmission rate to 0.64%, representing a 66% decrease from baseline. CONCLUSION Implementation of the project protocol was associated with a clinically significant decrease in readmissions for hyperbilirubinemia with no concurrent clinically significant changes in the number of labs drawn, number of infants started on phototherapy, or average length of hospital stay. For military treatment facilities or institutions with similar staffing models, this protocol may offer a model for improvement.
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14
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Gabbay JM, Agneta EM, Turkington S, Bajaj BM, Sinha B, Geha T. Rates of phototherapy among ABO-incompatible newborns with a negative direct antiglobulin test. J Perinatol 2023; 43:1357-1362. [PMID: 36959468 PMCID: PMC10034253 DOI: 10.1038/s41372-023-01650-3] [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: 11/10/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE We analyze phototherapy rates after implementation of a Hyperbilirubinemia Clinical Pathway (HCP), which placed full-term ABOi DAT negative newborns on the low risk phototherapy nomogram, rather than medium risk, as previously done. STUDY DESIGN A chart review was performed for ABOi newborns born ≥36 weeks gestation between January 2020 and October 2021. Primary outcome measures were rates of phototherapy across pre- and post-intervention groups and among DAT negative newborns. RESULTS There was an increased proportion of newborns assigned to the low risk curve after the intervention. There were no significant differences in phototherapy rates among the intervention groups, although there was a non-significant decrease in phototherapy rates among DAT negative newborns after the intervention. There were no increases in adverse outcomes. CONCLUSIONS Providers adhered to the guidelines after implementation of the HCP. ABOi DAT negative newborns can be viewed as low risk for hyperbilirubinemia requiring phototherapy.
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Affiliation(s)
- Jonathan M Gabbay
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
| | - Elizabeth M Agneta
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | | | - Benjamin M Bajaj
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Bharati Sinha
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
- Department of Newborn Medicine, Boston Medical Center, Boston, MA, USA
| | - Tanya Geha
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
- Department of Newborn Medicine, Boston Medical Center, Boston, MA, USA
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15
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Kaplan M, Hammerman C, Shapiro SM. Grand Rounds Hyperbilirubinemia following Phototherapy in Glucose-6-Phosphate Dehydrogenase-Deficient Neonates: Not Out of the Woods. J Pediatr 2023; 261:113452. [PMID: 37169338 DOI: 10.1016/j.jpeds.2023.113452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/22/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Michael Kaplan
- Department of Neonatology, Shaare Zedek Medical Center (M.K. Emeritus), Jerusalem, Israel; Faculty of Medicine of the Hebrew University, Jerusalem, Israel.
| | - Cathy Hammerman
- Department of Neonatology, Shaare Zedek Medical Center (M.K. Emeritus), Jerusalem, Israel; Faculty of Medicine of the Hebrew University, Jerusalem, Israel
| | - Steven M Shapiro
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
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Ustun H, Oncel MY, Kefeli M, Akar M, Engür D. Bilirubin Measurement Through a Smartphone Application in Preterm Infants. KLINISCHE PADIATRIE 2023; 235:265-269. [PMID: 36539195 DOI: 10.1055/a-1816-5878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKROUND Aim of the present study is to evaluate the feasibility and reliability of an smartphone application for monitore of bilirubin levels in preterm infants. METHODS Preterm infants hospitalized in the neonatal intensive care unit with gestational age of<35 weeks were included. Exclusion criteria were parental reluctance and requirement of phototherapy in the last 12 hours. Measurements were obtained through a smartphone application (BiliScan) along with simultaneous transcutaneous device (Dräger JM 105) and venous blood biochemistry. RESULTS Mean gestational age was 30.8±2.4 weeks and birth weight was 1622±566 g. Measurements were obtained at a median of 4 (1-21) days of life. Twenty-five infants (19.4%) had ABO and/or Rh incompatibility and 39 infants (30.2%) required phototherapy. None of the cases required exchange transfusion. Mean total serum bilirubin (TSB) level was 8.16±2.60 mg/dL, mean transcutaneous bilirubin (TcB) level was 8.60±2.70 mg/dL, and the mean bilirubin level measured by BiliScan was 7.26±2.68 mg/dL. For TSB and TcB measurements, the intraclass correlation coefficient (ICC) was found to be 0.915 (95% confidence interval 0.835-0.951; p<0.001) and a strong positive correlation was found between these two measurements. When TSB and BiliScan measurements were compared, ICC was found to be significant as 0.512 (95% confidence interval 0.353-0.638; p<0.001), with a moderate correlation. CONCLUSIONS In this study, we evaluated the feasibility and reliability of a smartphone application for monitoring bilirubin levels in preterm infants. Although BiliScan measurements reported to display high correlation in term infants, a moderate correlation was found in the preterm infants. It is an emerging low-cost, non-invasive alternative for neonatal jaundice monitoring, however, results should be interpreted with caution in preterm infants.
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Affiliation(s)
- Huseyin Ustun
- Neonatology, Tepecik Training and Research Hospital Clinics, Konak, Turkey
| | | | - Melike Kefeli
- Neonatology, Izmir Tepecik Training and Research Hospital, Konak, Turkey
| | - Melek Akar
- Neonatology, Izmir Tepecik Training and Research Hospital, Konak, Turkey
| | - Defne Engür
- Neonatology, Izmir Tepecik Training and Research Hospital, Konak, Turkey
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Shapiro A, Mtenthaonga P, Mjumira R, Reuben M, Samuel A, Bond M, Carns J, Schwarz R, Johnston R, Mangwiro L, Odedere O, Miros R, McHugh S, Kawaza K, Dube Q, Ezeaka C, Richards-Kortum R. Design and field evaluation of a lateral flow cassette device for point-of-care bilirubin measurement. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002262. [PMID: 37552665 PMCID: PMC10409260 DOI: 10.1371/journal.pgph.0002262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/15/2023] [Indexed: 08/10/2023]
Abstract
Neonatal jaundice is an important cause of morbidity and mortality worldwide, and neonates born in low and middle-income countries bear a disproportionate burden. We previously developed a low-cost, point-of-care system to measure total serum bilirubin (TSB) in neonates. This device was effective at detecting and monitoring jaundice; however, the disposable strips were difficult to produce at scale. Here, we report a new lateral flow cassette design, called BiliDx, that was produced at scale using traditional manufacturing techniques. We evaluated the performance of BiliDx at sites in Nigeria and Malawi. The lateral flow strip consists of plasma separation membranes, nitrocellulose, and a plastic cassette. We evaluated the performance of the strips and reader at two hospitals located in Nigeria and Malawi compared to reference standard TSB. We also assessed performance for samples with high direct bilirubin (DB) and high hematocrit (HCT). We collected 1,144 samples from 758 neonates (TSB ranged from 0.2 to 45.9 mg/dL). The mean bias of BiliDx measurements in the validation set was +0.75 mg/dL, and 95% limits of agreement were -2.57 to 4.07 mg/dL. The mean bias and limits of agreement were comparable for samples with HCT < 60% and HCT ≥ 60%, and for samples with low and intermediate DB levels; the samples with high DB levels had wider 95% limits of agreement (-4.50 to +3.03 mg/dL). Error grid analysis shows that 96.9% of samples measured with BiliDx would have resulted in the same clinical decision as the reference standard. This performance is comparable to previous results that used a handmade two-dimensional strip. Additionally, error grid analysis shows that all 20 samples with high DB levels would have resulted in the same clinical decision as the reference standard. This evaluation supports the use of BiliDx lateral flow cassettes to provide accurate point-of-care measurements in low-resource settings.
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Affiliation(s)
- Alyssa Shapiro
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
| | - Prince Mtenthaonga
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Rowland Mjumira
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Margaret Reuben
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ayodele Samuel
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Meaghan Bond
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
| | - Jennifer Carns
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
| | - Richard Schwarz
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
| | - Ryan Johnston
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
| | | | - Opeyemi Odedere
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
| | - Robert Miros
- 3rd Stone Design, San Rafael, California, United States of America
| | - Sean McHugh
- DCN Dx, Carlsbad, California, United States of America
| | - Kondwani Kawaza
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Queen Dube
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Chinyere Ezeaka
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rebecca Richards-Kortum
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
- Rice360 Institute for Global Health Technologies, Rice University, Houston, Texas, United States of America
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18
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Casnocha Lucanova L, Zibolenova J, Matasova K, Matasova K, Zibolen M. The use of transcutaneous bilirubin nomograms for the prevention of bilirubin neurotoxicity in the neonates. Front Public Health 2023; 11:1212667. [PMID: 37538268 PMCID: PMC10395091 DOI: 10.3389/fpubh.2023.1212667] [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: 04/26/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
Purpose Although neonatal jaundice is a ubiquitous and predominantly benign phenomenon, the risk of neurotoxicity exists in a number of infants with unconjugated hyperbilirubinemia. Plotting bilirubin values on nomograms enables clinicians to employ an anticipatory and individualized approach with the goal of avoiding excessive hyperbilirubinemia and preventing acute bilirubin encephalopathy and its progression to kernicterus. We aimed to construct nomograms for White term infants based on transcutaneous bilirubin (TcB) measurements using a JM-105 device. Methods TcB measurements were taken in infants at ages ranging from 0 to 96 postnatal hours. We then constructed hour-specific TcB nomograms from forehead and sternum measurements in infants who did not require subsequent phototherapy. Results We included 2,981 TcB measurements taken on the forehead and 2,977 measurements taken on the sternum in 301 White term newborn infants. We assessed the predictive abilities of the nomograms at six postnatal time intervals using receiver operating characteristic curves. The areas under the curves indicated reasonable prediction of hyperbilirubinemia requiring phototherapy, except for the forehead measurement taken within the first 12 h of life. Sensitivity tended to rise as postnatal age increased. Conclusion The nomograms illustrate dermal bilirubin dynamics in White term neonates during the first 4 days of life. They may be useful tools to predict individualized risk of hyperbilirubinemia requiring treatment, and to plan optimal follow-up of infants at risk of bilirubin neurotoxicity.
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Affiliation(s)
- Lucia Casnocha Lucanova
- Neonatology Department, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Martin, Slovakia
| | - Jana Zibolenova
- Department of Public Health, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Katarina Matasova
- Neonatology Department, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Martin, Slovakia
| | - Katarina Matasova
- Neonatology Department, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Martin, Slovakia
| | - Mirko Zibolen
- Neonatology Department, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Martin, Slovakia
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Germana S, Shaikh SK. Increasing utilisation of a rebound hyperbilirubinaemia calculator in two newborn nurseries. BMJ Open Qual 2023; 12:e002141. [PMID: 37429640 DOI: 10.1136/bmjoq-2022-002141] [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: 10/03/2022] [Accepted: 06/22/2023] [Indexed: 07/12/2023] Open
Abstract
Neonatal hyperbilirubinaemia requiring phototherapy treatment is a common problem impacting the length of hospital stay and rates of hospital readmission. Previous guidelines included guidance for initiating phototherapy treatment but not for discontinuing phototherapy treatment during initial newborn admission.In response to dissatisfaction from trainees, staff and families regarding the variable approach to discontinuing phototherapy among attending nursery providers, we used quality improvement methodologies to increase utilisation of a rebound hyperbilirubinaemia calculator as a more consistent method for guiding the timing of phototherapy discontinuation. The aim was to increase utilisation of the rebound hyperbilirubinaemia calculator for newborns treated with phototherapy in two newborn nurseries to >90% within 2 years.Sequential interventions focused on increasing provider awareness of the rebound hyperbilirubinaemia calculator and making the calculator simple to access and use.At the university medical centre nursery, the use of the calculator increased from 8.7% to 100%, exceeding the project goal. In the community hospital nursery, there was a statistically significant increase in the rate of utilisation from 3.7% to 79.4%, but this fell slightly below the goal of >90%.Electronic Health Record integration, along with education and addition of prompts to providers, increased utilisation of a rebound hyperbilirubinaemia calculator as a consistent approach for guiding decisions about discontinuing phototherapy treatment in newborns.
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Affiliation(s)
- Sarah Germana
- Pediatrics, Duke University Health System, Durham, North Carolina, USA
| | - Sophie Kay Shaikh
- Pediatrics, Duke University Health System, Durham, North Carolina, USA
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20
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Westenberg LEH, Been JV, Willemsen SP, Vis JY, Tintu AN, Bramer WM, Dijk PH, Steegers EAP, Reiss IKM, Hulzebos CV. Diagnostic Accuracy of Portable, Handheld Point-of-Care Tests vs Laboratory-Based Bilirubin Quantification in Neonates: A Systematic Review and Meta-analysis. JAMA Pediatr 2023; 177:479-488. [PMID: 36912856 PMCID: PMC10012043 DOI: 10.1001/jamapediatrics.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Importance Quantification of bilirubin in blood is essential for early diagnosis and timely treatment of neonatal hyperbilirubinemia. Handheld point-of-care (POC) devices may overcome the current issues with conventional laboratory-based bilirubin (LBB) quantification. Objective To systematically evaluate the reported diagnostic accuracy of POC devices compared with LBB quantification. Data Sources A systematic literature search was conducted in 6 electronic databases (Ovid MEDLINE, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar) up to December 5, 2022. Study Selection Studies were included in this systematic review and meta-analysis if they had a prospective cohort, retrospective cohort, or cross-sectional design and reported on the comparison between POC device(s) and LBB quantification in neonates aged 0 to 28 days. Point-of-care devices needed the following characteristics: portable, handheld, and able to provide a result within 30 minutes. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data Extraction and Synthesis Data extraction was performed by 2 independent reviewers into a prespecified, customized form. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was performed of multiple Bland-Altman studies using the Tipton and Shuster method for the main outcome. Main Outcomes and Measures The main outcome was mean difference and limits of agreement in bilirubin levels between POC device and LBB quantification. Secondary outcomes were (1) turnaround time (TAT), (2) blood volumes, and (3) percentage of failed quantifications. Results Ten studies met the inclusion criteria (9 cross-sectional studies and 1 prospective cohort study), representing 3122 neonates. Three studies were considered to have a high risk of bias. The Bilistick was evaluated as the index test in 8 studies and the BiliSpec in 2. A total of 3122 paired measurements showed a pooled mean difference in total bilirubin levels of -14 μmol/L, with pooled 95% CBs of -106 to 78 μmol/L. For the Bilistick, the pooled mean difference was -17 μmol/L (95% CBs, -114 to 80 μmol/L). Point-of-care devices were faster in returning results compared with LBB quantification, whereas blood volume needed was less. The Bilistick was more likely to have a failed quantification compared with LBB. Conclusions and Relevance Despite the advantages that handheld POC devices offer, these findings suggest that the imprecision for measurement of neonatal bilirubin needs improvement to tailor neonatal jaundice management.
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Affiliation(s)
- Lauren E H Westenberg
- Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jasper V Been
- Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jolande Y Vis
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrei N Tintu
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Peter H Dijk
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Christian V Hulzebos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
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21
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Liang D, Veters MD. Clinical progress note: Revisions to the management of neonatal hyperbilirubinemia. J Hosp Med 2023. [PMID: 36704859 DOI: 10.1002/jhm.13046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 01/28/2023]
Affiliation(s)
- Danni Liang
- Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michelle D Veters
- Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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22
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Wilander M, Sandblom J, Thies-Lagergren L, Andersson O, Svedenkrans J. Bilirubin Levels in Neonates ≥35 Weeks of Gestation Receiving Delayed Cord Clamping for an Extended Time-An Observational Study. J Pediatr 2023:S0022-3476(23)00022-7. [PMID: 36646247 DOI: 10.1016/j.jpeds.2023.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/25/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe bilirubin levels in neonates ≥350/7 gestational weeks, receiving delayed cord clamping (CC), in relation to the updated Bhutani nomogram. STUDY DESIGN This was a retrospective, observational study based on data from medical records and local data sheets. Singleton neonates, born vaginally at a gestational age ≥350/7, and with a registered time to CC and at least one registered bilirubin, were included. We excluded neonates with positive direct antiglobulin test or hemolytic disorders. Adjusted analyses were performed using ANOVA and linear or logistic regression. RESULTS We analyzed 558 neonates, mean gestational age (SD) 39.9 (1.3) weeks. CC was performed at a median (IQR) time of 6 (5-8) minutes. The dataset contained 1330 bilirubin measurements. Median (IQR) age at bilirubin measurement was 37 (22-54) hours. Bilirubin percentiles in neonates with CC time ≥2 minutes were similar, or lower, compared with the Bhutani nomogram between 12 and 72 hours, but with greater 95th percentile at later hours of age. Phototherapy was initiated in 13 (2.3 %) of the neonates. We found no association between time to CC and hyperbilirubinemia (β = -0.05, P = .07). Need for phototherapy was marginally greater in neonates with shorter time to CC. CONCLUSIONS Bilirubin levels were not correlated to time to CC. Our findings indicate that CC beyond 2 minutes can be performed without additional monitoring for jaundice.
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Affiliation(s)
- Maria Wilander
- Department of Clinical Sciences Lund, Pediatrics/Neonatology, Lund University, Lund, Sweden; Department of Pediatrics, Hospital of Halland, Halmstad, Sweden.
| | - Johan Sandblom
- Department of Clinical Sciences Lund, Pediatrics/Neonatology, Lund University, Lund, Sweden; Department of Neonatology, Skåne University Hospital, Malmö/Lund, Sweden
| | - Li Thies-Lagergren
- Department of Midwifery Research - Reproductive, Perinatal and Sexual Health, Lund University, Lund, Sweden
| | - Ola Andersson
- Department of Clinical Sciences Lund, Pediatrics/Neonatology, Lund University, Lund, Sweden; Department of Neonatology, Skåne University Hospital, Malmö/Lund, Sweden
| | - Jenny Svedenkrans
- Department of Clinical Sciences Lund, Pediatrics/Neonatology, Lund University, Lund, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden; Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
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23
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Beal JA. American Academy of Pediatrics' Updated Clinical Guidelines for Managing Neonatal Hyperbilirubinemia. MCN Am J Matern Child Nurs 2023; 48:49. [PMID: 36469895 DOI: 10.1097/nmc.0000000000000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Judy A Beal
- Dr. Judy A. Beal is a Professor and Dean Emerita, Simmons University, Boston, MA. Dr. Beal can be reached via email at
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24
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Satrom KM, Farouk ZL, Slusher TM. Management challenges in the treatment of severe hyperbilirubinemia in low- and middle-income countries: Encouraging advancements, remaining gaps, and future opportunities. Front Pediatr 2023; 11:1001141. [PMID: 36861070 PMCID: PMC9969105 DOI: 10.3389/fped.2023.1001141] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/17/2023] [Indexed: 02/15/2023] Open
Abstract
Neonatal jaundice (NJ) is common in newborn infants. Severe NJ (SNJ) has potentially negative neurological sequelae that are largely preventable in high resource settings if timely diagnosis and treatment are provided. Advancements in NJ care in low- and middle-income countries (LMIC) have been made over recent years, especially with respect to an emphasis on parental education about the disease and technological advancements for improved diagnosis and treatment. Challenges remain, however, due to lack of routine screening for SNJ risk factors, fragmented medical infrastructure, and lack of culturally appropriate and regionally specific treatment guidelines. This article highlights both encouraging advancements in NJ care as well as remaining gaps. Opportunities are identified for future work in eliminating the gaps in NJ care and preventing death and disability related to SNJ around the globe.
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Affiliation(s)
- Katherine M Satrom
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, United States
| | - Zubaida L Farouk
- Department of Pediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria.,Centre for Infectious Diseases Research, Bayero University, Kano, Nigeria
| | - Tina M Slusher
- Department of Pediatrics, Global Health Program, Critical Care Division, University of Minnesota, Minneapolis, MN, United States.,Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
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25
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Walz L, Brooks JC, Newman T. Evidence Suggests a Decrease in the Incidence of Kernicterus in California. J Pediatr 2022; 255:220-223.e1. [PMID: 36563899 DOI: 10.1016/j.jpeds.2022.11.023] [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: 06/23/2022] [Revised: 10/21/2022] [Accepted: 11/07/2022] [Indexed: 12/25/2022]
Abstract
We identified children diagnosed with kernicterus in the California Department of Developmental Services and estimated an incidence of 0.42 per 100 000 births from 1988 to 2014, significantly decreasing to 0.04 per 100 000 births after 2009. We also examined national infant kernicterus mortality from 1979 to 2016 using CDC data. It did not decrease significantly.
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Affiliation(s)
- Lucas Walz
- Life Expectancy Project, San Francisco, CA
| | | | - Thomas Newman
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA; Department of Pediatrics, University of California-San Francisco, San Francisco, CA
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26
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Orringer K, Kileny S, Salada K, Sahloul E, Gebremariam A, Skoczylas M, Yoon E. Biliblanket Utilization for Outpatient Treatment of Newborn Jaundice. Clin Pediatr (Phila) 2022:99228221136446. [PMID: 36476052 DOI: 10.1177/00099228221136446] [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] [Indexed: 12/13/2022]
Abstract
Hyperbilirubinemia is a common neonatal diagnosis. Biliblankets have the potential to reduce readmission for hyperbilirubinemia. The study purpose was to characterize home biliblanket treatment for hyperbilirubinemia using retrospective medical record review of newborns with total serum bilirubin of 0.1 to 3 mg/dL below inpatient threshold seen at 9 pediatric clinics (N = 359). The main outcomes were whether a biliblanket was used and whether the usage impacted readmissions. Home biliblankets were used for 44% of newborns. Nine percent of newborns were readmitted for hyperbilirubinemia. Four percent of newborns treated with a biliblanket were readmitted compared with 13% of those not treated with a biliblanket (P = .002). Newborns treated with a biliblanket (odds ratio [OR] = 0.16; 95% confidence interval [CI] = 0.06-0.44) and newborns 3 days or older (OR = 0.16; 95% CI = 0.06-0.43) were less likely to be readmitted than newborns not treated with a biliblanket and 2-day-old newborns. We found that home biliblanket use was associated with lower odds of hospital readmission for newborn jaundice.
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Affiliation(s)
- Kelly Orringer
- Division of General Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Sharon Kileny
- Division of General Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Katherine Salada
- Division of Pediatric Hospital Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Eman Sahloul
- Division of Hospital Medicine, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Acham Gebremariam
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Maria Skoczylas
- Division of Pediatric Hospital Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Esther Yoon
- Division of General Pediatrics, University of Michigan, Ann Arbor, MI, USA
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27
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Kair LR, Phillipi CA, Wood KE. Long-Awaited AAP Hyperbilirubinemia Guidelines Have Arrived. Hosp Pediatr 2022; 12:e443-e445. [PMID: 36073232 PMCID: PMC9770821 DOI: 10.1542/hpeds.2022-006938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Laura R Kair
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Carrie A Phillipi
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Kelly E Wood
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa
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28
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Abstract
This Viewpoint discusses the complexities of race-conscious medicine and the importance of more explicit and attentive guidance in treatment recommendations.
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Affiliation(s)
- Sharon Ostfeld-Johns
- Section of Hospital Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.,Section of General Internal Medicine Program in Hospital Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elena Aragona
- Section of Hospital Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Louis Hart
- Section of Hospital Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.,Office of Health Equity, Yale New Haven Health System, New Haven, Connecticut
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29
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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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30
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Morgan JM, Peters S, Adusei-Baah C. Hemolytic Disease of the Newborn: A Community Hospitalist Perspective. Clin Pediatr (Phila) 2022; 62:404-408. [PMID: 36324255 DOI: 10.1177/00099228221133175] [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] [Indexed: 11/06/2022]
Abstract
Hemolytic disease of the newborn is commonly diagnosed and managed by pediatric and newborn hospitalists. Severe cases, however, pose unique challenges for community hospitals without higher level neonatal intensive care units. This case highlights the challenges faced by pediatric hospitalists in the community and suggests a focused approach to management.
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Affiliation(s)
- Joy M Morgan
- Children's National Hospital, Washington, DC, USA.,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Summer Peters
- Children's National Hospital, Washington, DC, USA.,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Charity Adusei-Baah
- Children's National Hospital, Washington, DC, USA.,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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31
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Niknam A, Ramezani Tehrani F, Behboudi-Gandevani S, Rahmati M, Hedayati M, Abedini M, Firouzi F, Torkestani F, Zokaee M, Azizi F. Umbilical cord blood concentration of connecting peptide (C-peptide) and pregnancy outcomes. BMC Pregnancy Childbirth 2022; 22:764. [PMID: 36224521 PMCID: PMC9559016 DOI: 10.1186/s12884-022-05081-4] [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: 08/10/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background C-peptide offers potential as a marker to indicate childhood metabolic outcomes. Measuring C-peptide concentration might have better future utility in the risk stratification of neonates born to overweight or diabetic mothers. Prior research has tried to bring this matter into the light; however, the clinical significance of these associations is still far from reach. Here we sought to investigate the associations between fetomaternal metabolic variables and umbilical cord blood C-peptide concentration. Methods For the present study, 858 pregnant women were randomly selected from among a sub-group of 35,430 Iranian pregnant women who participated in a randomized community non-inferiority trial of gestational diabetes mellitus (GDM) screening. Their umbilical cord (UC) blood C-peptide concentrations were measured, and the pregnancy variables of macrosomia/large for gestational age (LGA) and primary cesarean section (CS) delivery were assessed. The variation of C-peptide concentrations among GDM and macrosomia status was plotted. Due to the skewed distribution of C-peptide concentration in the sample, median regression analysis was used to identify potential factors related to UC C-peptide concentration. Results In the univariate model, positive GDM status was associated with a 0.3 (95% CI: 0.06 − 0.54, p = 0.01) increase in the median coefficient of UC blood C-peptide concentration. Moreover, one unit (kg) increase in the birth weight was associated with a 0.25 (95% CI: 0.03 − 0.47, p = 0.03) increase in the median coefficient of UC blood C-peptide concentration. In the multivariate model, after adjusting for maternal age, maternal BMI, and macrosomia status, the positive status of GDM and macrosomia were significantly associated with an increase in the median coefficient of UC blood C-peptide concentration (Coef.= 0.27, 95% CI: 0.13 − 0.42, p < 0.001; and Coef.= 0.34, 95% CI: 0.06 − 0.63, p = 0.02, respectively). Conclusion UC blood concentration of C-peptide is significantly associated with the incidence of maternal GDM and neonatal macrosomia. Using stratification for maternal BMI and gestational weight gain (GWG) and investigating molecular markers like Leptin and IGF-1 in the future might lay the ground to better understand the link between metabolic disturbances of pregnancy and UC blood C-peptide concentration. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05081-4.
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Affiliation(s)
- Atrin Niknam
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Hedayati
- Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Infertility and cell therapy office, Transplant & Disease Treatment Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Faegheh Firouzi
- Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | | | - Mehdi Zokaee
- Senior Executive of Public Health, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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32
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Rustogi D, Yusuf K. Use of Albumin in the NICU: An Evidence-based Review. Neoreviews 2022; 23:e625-e634. [PMID: 36047753 DOI: 10.1542/neo.23-9-e625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Albumin is the most abundant protein in human blood with distinctive functions throughout the human body. Low albumin levels are a predictor of mortality as well as disease outcome in children and adults. However, the clinical significance of hypoalbuminemia and the role of albumin infusions in NICUs remain unclear and controversial.
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Affiliation(s)
- Deepika Rustogi
- Department of Neonatology & Pediatrics, Yashoda Superspeciality Hospital, Kaushambi, Ghaziabad, UP, India
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kamran Yusuf
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
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33
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van der Geest BAM, Rosman AN, Bergman KA, Smit BJ, Dijk PH, Been JV, Hulzebos CV. Severe neonatal hyperbilirubinaemia: lessons learnt from a national perinatal audit. Arch Dis Child Fetal Neonatal Ed 2022; 107:527-532. [PMID: 35091450 DOI: 10.1136/archdischild-2021-322891] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/16/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To describe characteristics of neonates with severe neonatal hyperbilirubinaemia (SNH) and to gain more insight in improvable factors that may have contributed to the development of SNH. DESIGN AND SETTING Descriptive study, based on national Dutch perinatal audit data on SNH from 2017 to 2019. PATIENTS Neonates, born ≥35 weeks of gestation and without antenatally known severe blood group incompatibility, who developed hyperbilirubinaemia above the exchange transfusion threshold. MAIN OUTCOME MEASURES Characteristics of neonates having SNH and corresponding improvable factors. RESULTS During the 3-year period, 109 neonates met the eligibility criteria. ABO antagonism was the most frequent cause (43%). All neonates received intensive phototherapy and 30 neonates (28%) received an exchange transfusion. Improvable factors were mainly related to lack of knowledge, poor adherence to the national hyperbilirubinaemia guideline, and to incomplete documentation and insufficient communication of the a priori hyperbilirubinaemia risk assessment among healthcare providers. A priori risk assessment, a key recommendation in the national hyperbilirubinaemia guideline, was documented in only six neonates (6%). CONCLUSIONS SNH remains a serious threat to neonatal health in the Netherlands. ABO antagonism frequently underlies SNH. Lack of compliance to the national guideline including insufficient a priori hyperbilirubinaemia risk assessment, and communication among healthcare providers are important improvable factors. Implementation of universal bilirubin screening and better documentation of the risk of hyperbilirubinaemia may enhance early recognition of potentially dangerous neonatal jaundice.
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Affiliation(s)
- Berthe A M van der Geest
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC Sophia, Rotterdam, The Netherlands .,Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Ageeth N Rosman
- Department of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Foundation Perined, Utrecht, The Netherlands
| | - Klasien A Bergman
- Department of Neonatology, University Medical Centre Groningen Beatrix Children's Hospital, Groningen, The Netherlands
| | - Bert J Smit
- Directorate Quality and Patient Care, Erasmus MC, Rotterdam, The Netherlands
| | - Peter H Dijk
- Department of Neonatology, University Medical Centre Groningen Beatrix Children's Hospital, Groningen, The Netherlands
| | - Jasper V Been
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC Sophia, Rotterdam, The Netherlands.,Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Christian V Hulzebos
- Department of Neonatology, University Medical Centre Groningen Beatrix Children's Hospital, Groningen, The Netherlands
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34
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Kemper AR, Newman TB, Slaughter JL, Maisels MJ, Watchko JF, Downs SM, Grout RW, Bundy DG, Stark AR, Bogen DL, Holmes AV, Feldman-Winter LB, Bhutani VK, Brown SR, Maradiaga Panayotti GM, Okechukwu K, Rappo PD, Russell TL. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics 2022; 150:188726. [PMID: 35927462 DOI: 10.1542/peds.2022-058859] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Thomas B Newman
- Departments of Epidemiology & Biostatistics and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | | | - M Jeffrey Maisels
- Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Jon F Watchko
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen M Downs
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - Randall W Grout
- Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana
| | - David G Bundy
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Debra L Bogen
- Allegheny County Health Department, Pittsburgh, Pennsylvania
| | - Alison Volpe Holmes
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Lori B Feldman-Winter
- Department of Pediatrics, Division of Adolescent Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Vinod K Bhutani
- Department of Pediatrics, Neonatal and Developmental Medicine Stanford University School of Medicine, Stanford, California
| | | | - Gabriela M Maradiaga Panayotti
- Division of Primary Care, Duke Children's Hospital and Health Center, Duke University Medical Center, Durham, North Carolina
| | - Kymika Okechukwu
- Department of Quality, American Academy of Pediatrics, Itasca, Illinois
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35
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Slaughter JL, Kemper AR, Newman TB. Technical Report: Diagnosis and Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics 2022; 150:188725. [PMID: 35927519 DOI: 10.1542/peds.2022-058865] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Severe hyperbilirubinemia is associated with kernicterus. Informed guidance on hyperbilirubinemia management, including preventive treatment thresholds, is essential to safely minimize neurodevelopmental risk. OBJECTIVE To update the evidence base necessary to develop the 2022 American Academy of Pediatrics clinical practice guideline for management of hyperbilirubinemia in the newborn infant ≥35 weeks' gestation. DATA SOURCE PubMed. STUDY SELECTION English language randomized controlled trials and observational studies. Excluded: case reports or series, nonsystematic reviews, and investigations focused on <35-weeks' gestation infants. DATA EXTRACTION Topics addressed in the previous clinical practice guideline (2004) and follow-up commentary (2009) were updated with new evidence published through March 2022. Evidence reviews were conducted for previously unaddressed topics (phototherapy-associated adverse effects and effectiveness of intravenous immune globulin [IVIG] to prevent exchange transfusion). RESULTS New evidence indicates that neurotoxicity does not occur until bilirubin concentrations are well above the 2004 exchange transfusion thresholds. Systematic review of phototherapy-associated adverse effects found limited and/or inconsistent evidence of late adverse effects, including cancer and epilepsy. IVIG has unclear benefit for preventing exchange transfusion in infants with isoimmune hemolytic disease, with a possible risk of harm due to necrotizing enterocolitis. LIMITATIONS The search was limited to 1 database and English language studies. CONCLUSIONS Accumulated evidence justified narrowly raising phototherapy treatment thresholds in the updated clinical practice guideline. Limited evidence for effectiveness with some evidence of risk of harm support the revised recommendations to limit IVIG use.
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Affiliation(s)
| | - Alex R Kemper
- Departments of Epidemiology & Biostatistics and Pediatrics, University of California, San Francisco, San Francisco, California
| | - Thomas B Newman
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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36
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Wright JL, Trent ME. Applying an Equity Lens to Clinical Practice Guidelines: Getting Out of the Gate. Pediatrics 2022; 150:188724. [PMID: 35927367 DOI: 10.1542/peds.2022-058918] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joseph L Wright
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland
| | - Maria E Trent
- Department of Pediatrics; Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Akuamoah-Boateng G, Stetson RC, Karon BS, Brumbaugh JE. Refining interpretation of transcutaneous bilirubin measurement in newborns born late preterm. Pediatr Neonatol 2022; 63:484-488. [PMID: 35659749 DOI: 10.1016/j.pedneo.2022.05.003] [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: 09/29/2021] [Revised: 03/16/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transcutaneous bilirubin (TCB) monitoring is widely used for jaundice screening in the newborn period. Limited data exists on adjusting TCB for bias in late preterm infants. The objective of this study was to determine the median bias between transcutaneous bilirubin and total serum bilirubin levels in newborns born at 35-36 weeks' gestation. METHODS This was a retrospective cohort study of late preterm infants born at 35-0/7 to 36-6/7 weeks' gestation who were admitted to a level III neonatal intensive care unit from May 2018 to February 2020. Transcutaneous and total serum bilirubin levels were assessed within 2 h of each other during the first 60 h of life. Bland-Altman plots were used to evaluate transcutaneous bilirubin bias. Bilirubin risk stratification based on age (in hours) was done using an adaptation of the Bhutani nomogram for transcutaneous, adjusted transcutaneous, and total serum bilirubin measurements. RESULTS The median bias between transcutaneous and total serum bilirubin bias was 2.4 mg/dL (IQR 1.7-3.4, 95% CI 2.2-2.7). The kappa statistic demonstrated slight agreement between the unadjusted transcutaneous bilirubin and total serum bilirubin (k = 0.033, p = 0.194. The kappa statistic demonstrated fair agreement between an adjusted transcutaneous bilirubin (subtract 1 mg/dL) and total serum bilirubin (k = 0.298, p < 0.0001) and moderate agreement between another adjusted transcutaneous bilirubin (subtract 2 mg/dL) and total serum bilirubin (k = 0.430, p < 0.0001). CONCLUSION In a single center study of late preterm infants, transcutaneous bilirubin systematically overestimated the total serum bilirubin level. Subtracting 1 mg/dL from the transcutaneous bilirubin identified infants with total serum bilirubin levels in the high or high intermediate risk range. Adjusting the transcutaneous bilirubin prior to risk stratification may reduce unnecessary blood draws for total serum bilirubin. Studies of racially and ethnically diverse newborns using various transcutaneous bilirubin meters are needed prior to broad application of the adjusted transcutaneous bilirubin approach.
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Affiliation(s)
- Gloria Akuamoah-Boateng
- Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Raymond C Stetson
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Brad S Karon
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jane E Brumbaugh
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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Thomas DH, Warner JV, Jones GRD, Chung JZY, Macey DJ, Screnci A, Ryan JB. Total bilirubin assay differences may cause inconsistent treatment decisions in neonatal hyperbilirubinaemia. Clin Chem Lab Med 2022; 60:1736-1744. [PMID: 36036565 DOI: 10.1515/cclm-2022-0749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess interlaboratory variability of total serum bilirubin (TSB) results in newborns. Initiated following a clinical incident in which a neonate was transferred to a tertiary hospital for treatment of severe hyperbilirubinemia but on arrival was reclassified into a lower risk category due to a 20% difference in TSB between laboratories. METHODS Fresh residual plasma samples from hospital-born infants were pooled to obtain 11 samples across a range of total bilirubin concentrations. Aliquots were light-protected and measured on 7 commercial platforms at 4 accredited medical laboratories. Data from The Royal College of Pathologists of Australasia Quality Assurance Programs' (RCPAQAP) Neonatal Bilirubin program was analysed. RESULTS Twenty-four to 30% difference in results for individual samples, largely due to calibration differences between assays. When interpreted according to guidelines, results from different platforms would have led to different clinical interventions in some cases. RCPAQAP results showed significant within-method bias but were not shown to be commutable with patient samples. CONCLUSIONS There are clinically significant method-dependent differences in TSB results from neonatal samples, consistent with our clinical incident. The differences are largely due to lack of standardisation of calibrator values. This has implications for healthcare resource use and possibly for the neurodevelopment of infants. Intervention is needed at a number of levels, including clinical reporting of incidents arising from discordant results, commitment by manufacturers to ensure metrological traceability of methods with sufficiently low uncertainty in the final measurements, and availability of commutable quality assurance material to monitor assay performance, especially at the clinical decision points for neonatal jaundice.
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Affiliation(s)
- David H Thomas
- Clinical Chemistry Liverpool Hospital, NSW Health Pathology, NSW Health Pathology, Liverpool, NSW, Australia
| | - Janet V Warner
- Faculty of Medicine, The University of QLD, Saint Lucia, QLD, Australia
| | | | - Jason Z Y Chung
- Department of Biochemistry, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - David J Macey
- Central Automated Laboratory and Biochemistry, Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia
| | - Antonella Screnci
- Department of Chemical Pathology, St Vincent's Pathology, Darlinghurst, NSW, Australia
| | - Joshua B Ryan
- Department of Chemical Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
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van der Geest BAM, de Mol MJS, Barendse ISA, de Graaf JP, Bertens LCM, Poley MJ, Ista E, Kornelisse RF, Reiss IKM, Steegers EAP, Been JV. Assessment, management, and incidence of neonatal jaundice in healthy neonates cared for in primary care: a prospective cohort study. Sci Rep 2022; 12:14385. [PMID: 35999237 PMCID: PMC9399078 DOI: 10.1038/s41598-022-17933-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 08/03/2022] [Indexed: 11/29/2022] Open
Abstract
Jaundice caused by hyperbilirubinaemia is a common phenomenon during the neonatal period. Population-based studies evaluating assessment, management, and incidence of jaundice and need for phototherapy among otherwise healthy neonates are scarce. We prospectively explored these aspects in a primary care setting via assessing care as usual during the control phase of a stepped wedge cluster randomised controlled trial.We conducted a prospective cohort study embedded in the Screening and TreAtment to Reduce Severe Hyperbilirubinaemia in Infants in Primary care (STARSHIP) Trial. Healthy neonates were included in seven primary care birth centres (PCBCs) in the Netherlands between July 2018 and March 2020. Neonates were eligible for inclusion if their gestational age was ≥ 35 weeks, they were admitted in a PCBC for at least 2 days during the first week of life, and if they did not previously receive phototherapy. Outcomes were the findings of visual assessment to detect jaundice, jaundice incidence and management, and the need for phototherapy treatment in the primary care setting.860 neonates were included of whom 608 (71.9%) were visibly jaundiced at some point during admission in the PCBC, with 20 being 'very yellow'. Of the latter, four (20%) did not receive total serum bilirubin (TSB) quantification. TSB levels were not associated with the degree of visible jaundice (p = 0.416). Thirty-one neonates (3.6%) received phototherapy and none received an exchange transfusion. Five neonates did not receive phototherapy despite having a TSB level above phototherapy threshold.Jaundice is common in otherwise healthy neonates cared for in primary care. TSB quantification was not always performed in very jaundiced neonates, and not all neonates received phototherapy when indicated. Quality improvement initiatives are required, including alternative approaches to identifying potentially severe hyperbilirubinaemia.Trial registration: NL6997 (Dutch Trial Register; Old NTR ID 7187), registered 3 May 2018.
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Affiliation(s)
- Berthe A M van der Geest
- Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - Malou J S de Mol
- Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ivana S A Barendse
- Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Johanna P de Graaf
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Loes C M Bertens
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marten J Poley
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Erwin Ista
- Department of Paediatrics, Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Nursing Science, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - René F Kornelisse
- Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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Shapiro A, Anderson J, Mtenthaonga P, Kumwenda W, Bond M, Schwarz R, Carns J, Johnston R, Dube Q, Chiume M, Richards-Kortum R. Evaluation of a Point-of-Care Test for Bilirubin in Malawi. Pediatrics 2022; 150:188493. [PMID: 35799070 DOI: 10.1542/peds.2021-053928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES BiliSpec is a low-cost spectrophotometric reader and disposable paper-based strip to quantify total serum bilirubin from several blood drops. This study was a prospective evaluation of BiliSpec in 2 neonatal wards in Malawi compared with a reference standard bilirubinometer over a large range of bilirubin and hematocrit levels. METHODS The accuracy of BiliSpec and a transcutaneous bilirubinometer were compared with the reference standard of spectrophotometry for 475 blood samples collected from 375 subjects across a range of total serum bilirubin concentrations from 0.0 to 33.7 mg/dL. The development of error grids to assess the clinical effects of measurement differences is reported. RESULTS BiliSpec was found to have a mean bias of -0.48 mg/dL and 95% limits of agreement of -5.09 mg/dL to +4.12 mg/dL. Results show 90.7% of BiliSpec measurements would have resulted in the same clinical decision as the reference standard, whereas 55.0% of transcutaneous bilirubin measurements would have resulted in the same clinical decision as the reference standard. CONCLUSIONS This evaluation supports use of BiliSpec to provide accurate, low-cost, point-of-care bilirubin measurements in low-resource hospitals. Future work is needed to evaluate BiliSpec among a larger number of users.
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Affiliation(s)
- Alyssa Shapiro
- Department of Bioengineering, Rice University, Houston, Texas
| | - Jessica Anderson
- Rice 360° Institute for Global Health, Rice University, Houston, Texas
| | - Prince Mtenthaonga
- Rice 360° Institute for Global Health, Rice University, Houston, Texas.,Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Watson Kumwenda
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Meaghan Bond
- Department of Bioengineering, Rice University, Houston, Texas.,Rice 360° Institute for Global Health, Rice University, Houston, Texas
| | - Richard Schwarz
- Department of Bioengineering, Rice University, Houston, Texas
| | - Jennifer Carns
- Department of Bioengineering, Rice University, Houston, Texas
| | - Ryan Johnston
- Rice 360° Institute for Global Health, Rice University, Houston, Texas
| | - Queen Dube
- Rice 360° Institute for Global Health, Rice University, Houston, Texas.,Department of Pediatrics, University of Malawi College of Medicine, Blantyre, Malawi
| | - Msandeni Chiume
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Rebecca Richards-Kortum
- Department of Bioengineering, Rice University, Houston, Texas.,Rice 360° Institute for Global Health, Rice University, Houston, Texas
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Pandit T, Pandit R, Bhattar K. Possible COVID-19 Maternal-to-Neonate Vertical Transmission in a Case of Early Neonatal Infection. Cureus 2022; 14:e27141. [PMID: 36017288 PMCID: PMC9392985 DOI: 10.7759/cureus.27141] [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] [Accepted: 07/22/2022] [Indexed: 11/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a disease caused by a novel strain of coronavirus and has resulted in a global pandemic. Information regarding the COVID-19 pathophysiology and its long-term impacts on humans is yet to be found. The knowledge about the COVID -19 infection's effects on the fetus is limited. The maternal to fetal transmission during various trimesters is not adequately studied. We present a case concerning maternal-to-fetal vertical transmission focusing on congenital infection.
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Lieberman L, Lopriore E, Baker JM, Bercovitz RS, Christensen RD, Crighton G, Delaney M, Goel R, Hendrickson JE, Keir A, Landry D, La Rocca U, Lemyre B, Maier RF, Muniz‐Diaz E, Nahirniak S, New HV, Pavenski K, dos Santos MCP, Ramsey G, Shehata N. International guidelines regarding the role of IVIG in the management of Rh- and ABO-mediated haemolytic disease of the newborn. Br J Haematol 2022; 198:183-195. [PMID: 35415922 PMCID: PMC9324942 DOI: 10.1111/bjh.18170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/16/2022] [Indexed: 01/08/2023]
Abstract
Haemolytic disease of the newborn (HDN) can be associated with significant morbidity. Prompt treatment with intensive phototherapy (PT) and exchange transfusions (ETs) can dramatically improve outcomes. ET is invasive and associated with risks. Intravenous immunoglobulin (IVIG) may be an alternative therapy to prevent use of ET. An international panel of experts was convened to develop evidence-based recommendations regarding the effectiveness and safety of IVIG to reduce the need for ETs, improve neurocognitive outcomes, reduce bilirubin level, reduce the frequency of red blood cell (RBC) transfusions and severity of anaemia, and/or reduce duration of hospitalization for neonates with Rh or ABO-mediated HDN. We used a systematic approach to search and review the literature and then develop recommendations from published data. These recommendations conclude that IVIG should not be routinely used to treat Rh or ABO antibody-mediated HDN. In situations where hyperbilirubinaemia is severe (and ET is imminent), or when ET is not readily available, the role of IVIG is unclear. High-quality studies are urgently needed to assess the optimal use of IVIG in patients with HDN.
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Affiliation(s)
- Lani Lieberman
- Department of Clinical PathologyUniversity Health NetworkTorontoOntarioCanada
- Department of Laboratory Medicine & PathobiologyUniversity of TorontoTorontoOntarioCanada
- Department of Laboratory Medicine and Molecular DiagnosticsSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Enrico Lopriore
- Division of NeonatologyDepartment of Pediatrics, Leiden University Medical CenterLeidenThe Netherlands
| | - Jillian M. Baker
- Department of PediatricsUnity Health Toronto (St. Michael's Hospital)TorontoOntarioCanada
- Division of Haematology‐OncologyThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Rachel S. Bercovitz
- Division of HematologyOncology, and Stem Cell Transplant, Department of Pediatrics, Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Robert D. Christensen
- Divisions of Neonatology and Hematology/OncologyUniversity of Utah HealthSalt Lake CityUTUSA
- Department of Women and Newborn's ResearchIntermountain HealthcareSalt Lake CityUtahUSA
| | - Gemma Crighton
- Department of HaematologyRoyal Children's HospitalMelbourneAustralia
| | - Meghan Delaney
- Division of Pathology & Laboratory MedicineChildren's National HospitalWashingtonDistrict of ColumbiaUSA
- Department of Pathology & PediatricsThe George Washington University Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Ruchika Goel
- Division of Transfusion MedicineDepartment of Pathology, School of Medicine, Johns Hopkins UniversityBaltimoreMarylandUSA
- Simmons Cancer Institute at SIU School of MedicineSpringfieldIllinoisUSA
| | - Jeanne E. Hendrickson
- Departments of Laboratory Medicine and PediatricsYale UniversityNew HavenConnecticutUSA
| | - Amy Keir
- SAHMRI Women and KidsSouth Australian Health and Medical InstituteNorth AdelaideSouth AustraliaAustralia
- Adelaide Medical School and the Robinson Research Institutethe University of AdelaideNorth AdelaideSouth AustraliaAustralia
| | | | - Ursula La Rocca
- Department of Translational and Precision MedicineSapienza UniversityRomeItaly
- Italian National Blood CentreNational Institute of HealthRomeItaly
| | - Brigitte Lemyre
- Department of PediatricsUniversity of OttawaOttawaOntarioCanada
| | - Rolf F. Maier
- Children's HospitalUniversity Hospital, Philipps UniversityMarburgGermany
| | - Eduardo Muniz‐Diaz
- Department of ImmunohematologyBlood and Tissue Bank of CataloniaBarcelonaSpain
| | - Susan Nahirniak
- Alberta Precision Laboratories and Department of Laboratory Medicine and PathologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Helen V. New
- Clinical DirectorateNHS Blood and TransplantLondonUK
- Centre for HaematologyImperial College LondonLondonUK
| | - Katerina Pavenski
- Department of Laboratory Medicine and PathologyUnity Health Toronto (St. Michael's Hospital)TorontoOntarioCanada
| | | | - Glenn Ramsey
- Department of PathologyFeinberg School of Medicine, Northwestern UniversityChicagoIllinoisUSA
| | - Nadine Shehata
- Departments of MedicineLaboratory Medicine and Pathobiology, Institute of Health, Policy Management and Evaluation, University of Toronto, Mount Sinai HospitalTorontoOntarioCanada
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Evaluation of a mobile application tool (BiliNorm) to improve care for newborns with hyperbilirubinemia in Indonesia. PLoS One 2022; 17:e0269286. [PMID: 35709090 PMCID: PMC9202860 DOI: 10.1371/journal.pone.0269286] [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: 11/22/2021] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Severe hyperbilirubinemia is more frequent in low- and middle-income countries such as Indonesia than in high-income countries. One of the contributing factors might be the lack of adherence to existing guidelines on the diagnosis and treatment of hyperbilirubinemia. We developed a new national guideline for hyperbilirubinemia management in Indonesia. To help healthcare workers use this guideline, a web-based decision support tool application may improve both the adherence to the guideline and the care for infants with hyperbilirubinemia. Methods We developed a web-based application (BiliNorm) to be used on a smartphone that displays the bilirubin level of the patient on the nomogram and advises about the treatment that should be started. Healthcare workers of two teaching hospitals in East Java, Indonesia, were trained on the use of BiliNorm. At 6 months after the introduction, a questionnaire was sent to those who worked with the application enquiring about their experiences. An observational study was conducted in two time epochs. A chart review of infants with hyperbilirubinemia in the two hospitals was sent. The appropriateness of hyperbilirubinemia management during a 6-month period before BiliNorm introduction was compared to that during a 7-month period after its introduction. Results A total of 43 participants filled in the questionnaire, the majority (72%) of them indicated that BiliNorm was well received and easy to use. Moreover, 84% indicated that BiliNorm was helpful for the decision to start phototherapy. Chart review of 255 infants before BiliNorm introduction and that of 181 infants after its introduction indicated that significantly more infants had received treatment according to the guideline (38% vs 51%, p = 0.006). Few infants received phototherapy, but bilirubin level was not measured (14% vs 7%, p = 0.024). There was no difference in the proportion of infants who were over- and under-treated (34% vs 32% and 14% vs 10%, respectively). Conclusions The web-based decision tool BiliNorm appears to be a valuable application. It is easy to use for healthcare workers and helps them adhere to the guideline. It improves the care for infants with hyperbilirubinemia and may help reduce the incidence of severe hyperbilirubinemia in Indonesia.
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Ramezani Tehrani F, Behboudi-Gandevani S, Farzadfar F, Hosseinpanah F, Hadaegh F, Khalili D, Soleymani-Dodaran M, Valizadeh M, Abedini M, Rahmati M, Bidhendi Yarandi R, Torkestani F, Abdollahi Z, Bakhshandeh M, Zokaee M, Amiri M, Bidarpour F, Javanbakht M, Nabipour I, Nasli Esfahani E, Ostovar A, Azizi F. A Cluster Randomized Noninferiority Field Trial of Gestational Diabetes Mellitus Screening. J Clin Endocrinol Metab 2022; 107:e2906-e2920. [PMID: 35325164 DOI: 10.1210/clinem/dgac181] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Although it is well-acknowledged that gestational diabetes mellitus (GDM) is associated with the increased risks of adverse pregnancy outcomes, the optimal strategy for screening and diagnosis of GDM is still a matter of debate. OBJECTIVE This study was conducted to demonstrate the noninferiority of less strict GDM screening criteria compared with the strict International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria with respect to maternal and neonatal outcomes. METHODS A cluster randomized noninferiority field trial was conducted on 35 528 pregnant women; they were scheduled to have 2 phases of GDM screening based on 5 different prespecified protocols including fasting plasma glucose in the first trimester with threshold of 5.1 mmol/L (92 mg/dL) (protocols A, D) or 5.6 mmol/L (100 mg/dL) (protocols B, C, E) and either a 1-step (GDM is defined if one of the plasma glucose values is exceeded [protocol A and C] or 2 or more exceeded values are needed [protocol B]) or 2-step approach (protocols D, E) in the second trimester. Guidelines for treatment of GDM were consistent with all protocols. Primary outcomes of the study were the prevalence of macrosomia and primary cesarean section (CS). The null hypothesis that less strict protocols are inferior to protocol A (IADPSG) was tested with a noninferiority margin effect (odds ratio) of 1.7. RESULTS The percentages of pregnant women diagnosed with GDM and assigned to protocols A, B, C, D, and E were 21.9%, 10.5%, 12.1%, 19.4%, and 8.1%, respectively. Intention-to-treat analyses satisfying the noninferiority of the less strict protocols of B, C, D, and E compared with protocol A. However, noninferiority was not shown for primary CS comparing protocol E with A. The odds ratios (95% CI) for macrosomia and CS were: B (1.01 [0.95-1.08]; 0.85 [0.56-1.28], C (1.03 [0.73-1.47]; 1.16 [0.88-1.51]), D (0.89 [0.68-1.17]; 0.94 [0.61-1.44]), and E (1.05 [0.65-1.69]; 1.33 [0.82-2.00]) vs A. There were no statistically significant differences in the adjusted odds of adverse pregnancy outcomes in the 2-step compared with the 1-step screening approaches, considering multiplicity adjustment. CONCLUSIONS The IADPSG GDM definition significantly increased the prevalence of GDM diagnosis. However, the less strict approaches were not inferior to other criteria in terms of adverse maternal and neonatal outcomes.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | | | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran 1411713139, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran 1411713139, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Masoud Soleymani-Dodaran
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran 1445613113, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Mehrandokht Abedini
- Infertility and cell therapy office, Transplant & Disease Treatment Center, Ministry of Health and Medical Education, Tehran 1419943471, Iran
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Razieh Bidhendi Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran 1985713834, Iran
| | | | - Zahra Abdollahi
- Department of Nutrition, Ministry of Health and Medical Education, Tehran 1419943471, UK
| | - Marzieh Bakhshandeh
- Family Health Department, Ministry of Health and Medical Education, Tehran 1419943471, Iran
| | - Mehdi Zokaee
- Population, family and school health Department, Kurdistan University of Medical Sciences, Sanandaj 6618634683, Iran
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
| | - Farzam Bidarpour
- Kurdistan University of Medical Sciences, Sanandaj 6618634683, Iran
| | | | - Iraj Nabipour
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr 7514763448, Iran
| | - Ensieh Nasli Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran 1411713139, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran 1411713139, Iran
| | - Fereidoun Azizi
- Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
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Watchko JF, Maisels MJ. Management of severe hyperbilirubinemia in the cholestatic neonate: a review and an approach. J Perinatol 2022; 42:695-701. [PMID: 35145210 DOI: 10.1038/s41372-022-01330-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/13/2022] [Accepted: 01/26/2022] [Indexed: 12/11/2022]
Abstract
A review of the literature demonstrates that severe total hyperbilirubinemia (total serum bilirubin ≥ 20 mg/dL [340 µmol/L]) in some cholestatic term (≥37 weeks) and late-preterm (≥340/7-366/7 weeks) gestation neonates poses a risk for bilirubin-induced brain damage. When the direct bilirubin fraction is <50% of the total serum bilirubin this risk is associated with the total serum bilirubin alone and treatment decisions should be based on the total serum bilirubin. On the other hand, there are limited data on the risk of bilirubin-induced brain damage in the neonate with severe total hyperbilirubinemia and a direct bilirubin fraction that is equal to or exceeds 50% of the total serum bilirubin. When this rare combination occurs, efforts to keep the indirect bilirubin fraction from reaching severe levels might, nevertheless, be prudent.
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Affiliation(s)
- Jon F Watchko
- Professor Emeritus Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - M Jeffrey Maisels
- Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.,Department of Pediatrics, Beaumont Children's Hospital, Royal Oak, MI, USA
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Zhang X, Zeng S, Cheng G, He L, Chen M, Wang M, Zhou W, Qiu H, Wang Z. Clinical Manifestations of Neonatal Hyperbilirubinemia Are Related to Alterations in the Gut Microbiota. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050764. [PMID: 35626941 PMCID: PMC9139945 DOI: 10.3390/children9050764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/02/2022] [Accepted: 05/19/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND PURPOSE Neonatal hyperbilirubinemia, also known as neonatal jaundice, is a common and frequent clinical condition with a complex etiology that can lead to brain damage in severe cases. Early recognition of hyperbilirubinemia and timely intervention and treatment can help reduce the occurrence of sequelae. This study was conducted to identify whether the gut microbiota composition can distinguish neonates with hyperbilirubinemia. METHODS Meconium samples were collected from 69 neonates with neonatal jaundice (NJ) and 69 age- and sex-matched neonates without clinically significant jaundice (healthy controls; HCs) for 16S rRNA gene sequencing and microbiome analysis. RESULTS Compared with HCs, the Chao 1 richness index of the gut microbiota was significantly decreased in the NJ group. The relative abundance of the probiotic gut bacterium, Lactobacillus, was significantly lower in the NJ group than in the HC group, whereas the abundances of potentially harmful gut bacteria, such as Escherichia coli and Staphylococcus, were significantly higher in the NJ group than in HCs. Correlation of the gut microbiota and clinical indicators revealed a positive correlation between Escherichia coli/Staphylococcus and serum total bilirubin levels. Finally, the results of a random forest machine-learning method to evaluate the possibility of using NJ-associated gut microbiota compositions as potential NJ biomarkers revealed an area under the curve of 96.88%. CONCLUSIONS The abundances of Escherichia coli and Staphylococcus were positively correlated with serum total bilirubin levels. Hence, the gut microbiota composition is a potential biomarker of NJ.
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Affiliation(s)
- Xueli Zhang
- Division of Neonatology, People’s Hospital of Longhua, Shenzhen 518109, China; (X.Z.); (L.H.); (M.C.)
| | - Shujuan Zeng
- Division of Neonatology, Longgang District Central Hospital of Shenzhen, Shenzhen 518116, China;
| | - Guoqiang Cheng
- Division of Neonatology, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai 201102, China;
| | - Liufang He
- Division of Neonatology, People’s Hospital of Longhua, Shenzhen 518109, China; (X.Z.); (L.H.); (M.C.)
| | - Mingqiu Chen
- Division of Neonatology, People’s Hospital of Longhua, Shenzhen 518109, China; (X.Z.); (L.H.); (M.C.)
| | - Mingbang Wang
- Shanghai Key Laboratory of Birth Defects, Division of Neonatology, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai 201102, China; (M.W.); (W.Z.)
- Microbiome Therapy Center, South China Hospital, Health Science Center, Shenzhen University, Shenzhen 518116, China
| | - Wenhao Zhou
- Shanghai Key Laboratory of Birth Defects, Division of Neonatology, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai 201102, China; (M.W.); (W.Z.)
| | - Huixian Qiu
- Division of Neonatology, Longgang District Central Hospital of Shenzhen, Shenzhen 518116, China;
| | - Zhangxing Wang
- Division of Neonatology, People’s Hospital of Longhua, Shenzhen 518109, China; (X.Z.); (L.H.); (M.C.)
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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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Bhatt P, Parmar N, Ayensu M, Umscheid J, Vasudeva R, Donda K, Doshi H, Dapaah-Siakwan F. Trends and Resource Use for Kernicterus Hospitalizations in the United States. Hosp Pediatr 2022; 12:e185-e190. [PMID: 35578911 DOI: 10.1542/hpeds.2021-006502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the trends in hospitalization for kernicterus in the United States from 2006 through 2016. METHOD Repeated, cross-sectional analysis of the 2006 to 2016 editions of the Kids' Inpatient Database. All neonatal hospitalizations with an International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification code for kernicterus and admitted at age ≤28 days were included. RESULTS Among 16 094 653 neonatal hospitalizations from 2006 to 2016, 20.5% were diagnosed with jaundice with overall incidence of kernicterus 0.5 per 100 000. The rate of kernicterus (per 100 000) was higher among males (0.59), Asian or Pacific Islanders (1.04), and urban teaching hospitals (0.72). Between 2006 and 2016, the incidence of kernicterus decreased from 0.7 to 0.2 per 100 000 (P-trend = .03). The overall median length of stay for kernicterus was 5 days (interquartile range [IQR], 3-8 days). The overall median inflation-adjusted cost of hospitalization was $5470 (IQR, $1609-$19 989). CONCLUSIONS Although the incidence of kernicterus decreased between 2006 and 2016, its continued occurrence at a higher rate among Asian or Pacific Islander and Black race or ethnicity in the United States require further probing. Multipronged approach including designating kernicterus as a reportable event, strengthening newborn hyperbilirubinemia care practices and bilirubin surveillance, parental empowerment, and removing barriers to care can potentially decrease the rate of kernicterus further.
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Affiliation(s)
- Parth Bhatt
- Department of Pediatrics, United Hospital Center, Bridgeport, West Virginia
| | - Narendrasinh Parmar
- Department of Pediatrics, Brookdale University Hospital and Medical Center, Brooklyn, New York
| | - Marian Ayensu
- Outpatient Department, The Trust Hospital, Accra, Ghana
| | - Jacob Umscheid
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas
| | - Rhythm Vasudeva
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas
| | - Keyur Donda
- Section of Neonatology, Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Harshit Doshi
- Neonatal Intensive Care Unit, Golisano Children's hospital of Southwest Florida, Fort Myers, Florida
| | - Fredrick Dapaah-Siakwan
- Neonatal Intensive Care Unit, Department of Medicine, Valley Children's Hospital, Madera, California
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Zhuang J, Hu J, Bei F, Huang J, Wang L, Zhao J, Qian R, Sun J. Exposure to air pollutants during pregnancy and after birth increases the risk of neonatal hyperbilirubinemia. ENVIRONMENTAL RESEARCH 2022; 206:112523. [PMID: 34929187 DOI: 10.1016/j.envres.2021.112523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/02/2021] [Accepted: 12/04/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Exposure to air pollution is associated with increased risks of several adverse conditions in newborns, such as preterm birth. Whether air pollution is associated with neonatal hyperbilirubinemia remains unclear. We aimed to develop and validate an air-quality-based model to better predict neonatal hyperbilirubinemia. METHODS A multicenter, population-based cohort of neonates with a gestational age (GA) ≥35 weeks and birth weight ≥2000 g was enrolled in the study. The study was conducted in Shanghai, China, from July 2017 to December 2018. The daily average concentrations of particulate matter (PM) with aerodynamic diameters≤2.5 μm (PM2.5) and ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2) and carbon monoxide (CO) were measured. Neonatal hyperbilirubinemia was diagnosed according to the American Academy of Pediatrics (AAP) guidelines by trained neonatologists. We used logistic least absolute shrinkage and selection operator (LASSO) regression to screen air pollutant indicators related to neonatal hyperbilirubinemia and build an air-quality signature for each patient. An air-quality-based nomogram was then established to predict the risk of neonatal hyperbilirubinemia. RESULTS A total of 11196 neonates were evaluated. Prenatal PM10, CO and NO2 exposure and postpartum SO2 exposure were significantly associated with neonatal hyperbilirubinemia. The air-quality score was calculated according to the hyperbilirubinemia-related pollutants. The air-quality score of the hyperbilirubinemia group was significantly higher than that of the nonhyperbilirubinemia group (P < .01, odds ratio = 2.97). An air-quality-based logistic regression model was built and showed good discrimination (C-statistic of 0.675 [95% CI (confidence interval), 0.658 to 0.692]) and good calibration. Decision curve analysis showed that the air-quality-based model was better than the traditional clinical model in predicting neonatal hyperbilirubinemia. CONCLUSIONS The findings of this study suggest that ambient air pollution exposure is associated with an increased risk of neonatal hyperbilirubinemia. Our results encourage further exploration of this possibility in future studies.
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Affiliation(s)
- Jialu Zhuang
- Department of Neonatology, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Shanghai, China.
| | - Jie Hu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Shanghai, China.
| | - Fei Bei
- Department of Neonatology, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Shanghai, China.
| | - Jiahu Huang
- Department of Pediatrics,Shanghai Children's Hospital, Shanghai Jiaotong University School of Medicine, 355 Luding Road, Shanghai, China.
| | - Liangjun Wang
- Department of Neonatology, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Shanghai, China.
| | - Junjie Zhao
- Department of Neonatology, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Shanghai, China.
| | - Ruiying Qian
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Bingsheng Road, Hangzhou, China.
| | - Jianhua Sun
- Department of Neonatology, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Shanghai, China.
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