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Jaundice in infants is one of the most common diseases at birth. In preterm infants, the risk is more than 80%, and in term infants, the rate is reduced to about 60%. One of the most effective and low-risk ways to treat neonatal jaundice is the use of light therapy or phototherapy. Fluorescent lamps, tungsten halogen lamps, LEDs, optical fibers and etc are used in these devices. Bilirubin reacts to green light and blue light. The green light's wavelength is in the range of 570-495 nm. The blue light has a wavelength of 495-450 nm and an absorption range of 450 nm. Studies have found that the best light for phototherapy devices is a light that has the wavelength of 400 to 520 nm, and because the blue light absorption rate is about 450 nm, so it is used in phototherapy. In addition to its proper absorption rate, it also has antimicrobial activity against bacteria. It is difficult to determine the exact duration of the phototherapy, because each infant has his/her specific conditions and the exact duration cannot be determined generally. Phototherapy should be continued until the bilirubin level in the baby's blood is sufficiently reduced, monitored by the supervision, and does not pose a threat to the baby. Phototherapy devices have different types, each with advantages over their predecessors. In existing models, because of their unique features like high sensitivity to bilirubin reduction, higher power, and efficiency, lighter, lower heat generation, lower cost and longer life devices, LED light sources are widely used in phototherapy devices. According to all the studies, we are looking for a device with proper coverage, portability, and moving the baby with the device without separating the baby from the baby as well as providing a quiet space for the mother and baby away from the hospital environment.

Diffuse reflectance spectroscopy is a non-destructive method to obtain biochemical and physiological information by investigating the optical properties of skin. Transcutaneous bilirubin (TcB) measurement utilizes reflectance spectroscopy to determine the jaundice level in newborns. Although TcB measurement has some advantages over total serum bilirubin (TSB) measurement such as being non-invasive, noninfectious, painless, and instantaneous, the existing TcB devices cannot yet replace TSB devices due to the inaccuracy of measurements. In this paper, we propose the use of reflectance spectroscopy in conjunction with regression tools such as multiple polynomial regression (MPR), artificial neural network (ANN), and support vector regression (SVR) to predict the jaundice level. The proposed methods were tested on TcB measurement data obtained from 314 babies. TcB measurements were collected by two devices: a commercially available product, Draeger JM-103, and a prototype device on which we can implement the proposed algorithms. The results are encouraging towards increasing the clinical usage of transcutaneous bilirubinometers as all the three methods accurately predict the jaundice level with a correlation value between 0.932 and 0.943. The proposed use of ANN improves the non-invasive transcutaneous approach, with results converging to more accurate invasive serum bilirubin measurements by blood sampling.

Background Neonatal jaundice is a common condition occurring in 60%-80% of all healthy-term and late-preterm neonates. In the majority of cases, neonatal jaundice resolves spontaneously and causes no harm; however, in some neonates, significant hyperbilirubinemia can develop and lead to kernicterus jaundice, a serious neurological disease. Phototherapy (PT) is the preferred treatment for jaundice; however, to be effective, PT devices need to have a broad light emission surface to generate no or little heat and to provide an optimal wavelength and light intensity (420-490 nm and ≥30 µW/cm²/nm, respectively). Objective This study aimed to investigate the feasibility, safety, and level of satisfaction of parents and health care teams with the BUBOlight device, an innovative alternative to conventional hospital PT, in which luminous textiles have been incorporated in a sleeping bag. Methods This interventional, exploratory, simple group, nonrandomized, single-center trial will be conducted at Lille Hospital. In total, 10-15 neonates and their parents will be included to obtain evaluable data from 10 parent-neonate pairs. Neonates weighing more than 2500 g at birth and born with ≥37 weeks of amenorrhea that required PT in accordance with the guidelines of the National Institute For Health and Clinical Excellence will receive one 4-hour session of illumination. Total serum bilirubin and transcutaneous bilirubin levels were obtained at the start and 2 hours after the end of PT. Cutaneous and rectal temperatures, heart rate, and oxygen saturation will be measured at the beginning and during PT. The number of subjects is therefore not calculated on the basis of statistical assumptions. We aim to obtain a minimum proportion of 90% (ie, 9 of 10) of the neonates included, who have been able to undergo 4-hour PT without unacceptable and unexpected toxicities. We will calculate the mean, median, quartiles, minimum and maximum values of the quantitative parameters, and the frequency of the qualitative parameters. The rate of patients with no unacceptable and unexpected toxicities (ie, the primary endpoint) will be calculated. Results The first patient is expected to be enrolled at the end of 2020, and clinical investigations are intended for up to June 2021. The final results of this study are expected to be available at the end of 2021. Conclusions Our findings will provide insights into the safety and feasibility of a new PT device based on light-emitting fabrics for the treatment of newborn jaundice. This new system, if proven effective, will improve the humanization of neonatal care and help avoid mother-child separation. Trial Registration ClinicalTrials.gov NCT04365998; https://clinicaltrials.gov/ct2/show/NCT04365998 International Registered Report Identifier (IRRID) PRR1-10.2196/24808

Introduction: Newborn jaundice is a common outpatient problem. Transcutaneous bilirubin (TcB) measurements correlate well with total serum bilirubin (SB) measurements below 15 mg/dl and are efficient and noninvasive. Some concern exists that TcB measurement may subsequently lead to an increase in the number of SB measurements performed in the outpatient setting. We aimed to implement the use of a TcB device in an outpatient clinic. By doing so, we sought to increase the number of newborns screened solely by TcB as opposed to SB, by 30%, within 12 months. Methods: We conducted plan-do-study-act cycles with targeted interventions to promote the use of TcB in an outpatient clinic for eligible newborns older than 35 weeks gestational age, aged 1–20 days, and without a history of transfusion, phototherapy, extensive bruising, or risk of hemolysis. We used statistical process control methods to measure proportions of newborns evaluated with TcB (run chart) and patients-between SB measurements (G-chart) over time in the outpatient clinic. Results: We collected preintervention data for 18-months and intervention data for 12 months. For newborns attending the outpatient clinic, the proportion of TcB measurements increased after implementation of the use of TcB measurement. There was an increase in patients-between SB measurements. At project inception, SB was drawn for every 8 eligible patients. By the end of the project, there were 98 eligible newborns between instances of SB testing. Conclusion: Implementation of a quality-improvement initiative to measure TcB in the outpatient clinic was feasible and reduced the number of SB tests.

Yenidoğan sarılığı, yenidoğanlarda bilirubin metabolizmasında ortaya çıkan değişiklikler ve bilirubin yapımının artması (hiperbilirubinemi)'dır. Hiperbilirubinemide erken tanı ve tedavide gerçekleşmediğinde bilirubin ensefalopatisi oluşabilmektedir. Bu durum yenidoğan sarılığının en ciddi ve ağır komplikasyonudur. Bu nedenle yenidoğan hemşireleri yenidoğan sarılığının tanı ve tedavisini bilmelidir. Bu çalışma ile Yenidoğan Yoğun Bakım (YYB) hemşirelerinin yenidoğan sarılığı ve tedavisi ile ilgili bilgi düzeylerini belirlemek amaçlanmıştır. Bu araştırma, tanımlayıcı ve kesitsel olup, Ocak - Haziran 2019 tarihleri arasında İç Anadolu Bölgesindeki bir il ve ilçelerinde bulunan sekiz hastanede yer alan YYB ünitelerinde çalışan YYB hemşireleri (F=88) ile yapılmıştır. Araştırmanın örneklemini ise örneklem seçim kriterlerine uyan, çalışmaya katılmayı kabul eden (f=66) YYB hemşireleri oluşturmuştur. Araştırmada veriler "Tanıtıcı Bilgi Formu" ve "YYB Hemşirelerinin Yenidoğan Sarılığı ve Tedavisi ile İlgili Bilgi Düzeylerini Belirleme Formu" ile toplanmıştır. Bu bilgi formu 40 maddeden oluşmuş, formdan alınabilecek en düşük puan 0, en yüksek puan 40'tır. İstatistiksel analizler SPSS (Version 22.0) paket programı ile yapılmış, uygun istatistiksel değerlendirmeler kullanılmış, istatistiksel olarak p

Background: Neonatal jaundice is a prevalent disease that causes many complications, including kernicterus and even death. Previous studies have shown that clofibrate as an aryloxy isobutyric acid derivate can be effectively applied for the treatment of neonatal jaundice. Thus, this review was carried out to investigate the effects and mechanism of action of clofibrate on neonatal jaundice. Methods: The keywords such as “Clofibrate” in combination with “Neonatal jaundice” or “Neonatal hyperbilirubinemia” or “Newborn Jaundice” were used to search for relevant publications indexed in the Institute for Scientific Information (ISI), Scopus, PubMed, and Google Scholar databases. Finally, after reviewing the studies, 24 papers were included in this study. Results: Results showed that the processes of albumin-bound bilirubin transfer to the hepatocytes, hepatic uptake, and storage via ligandin, hepatic conjugation via uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1), conjugation into the bile via MRP2 represent the main action mechanism of clofibrate that turns it into the bilirubin conjugates and expels it from the bile. Besides, clofibrate has been shown to reduce the level of Total Serum Bilirubin (TSB) in infants even at a dosage of 25 mg/kg without leaving side effects. Conclusions: The results of this review revealed that clofibrate effectively reduces TSB in short-term usage and can even have a promising effect at the dosage of 25 mg/kg in full-term infants. Most studies have shown this property over a short period in term infants, and there is no evidence about long-term usage in this regard.

BACKGROUND Leading authorities in North America recommend universal screening via total serum bilirubin (TSB) measurement or transcutaneous bilirubinometry (TcB) for kernicterus prevention. We assessed costs associated with these 2 screening methods in hospital and in urban and rural community settings. METHODS Our tertiary care centre in Saskatoon, with about 5600 births per year, serves the local population of 300 000; in addition, 30% of patients are referred from outside the local community and surrounding area. We obtained health administrative data for two 6-month periods: before (June 1 to Nov. 30, 2015 [TSB program]) and after (June 1 to Nov. 30, 2016 [TcB-TSB program]) implementation of universal screening with TcB. Data on nurses' time and mileage were collected to assess the mean time for screening and sample transportation. We performed a cost-minimization analysis. RESULTS The observed requirement for TSB blood draws decreased by 71.4% after implementation of TcB (1383.2/1000 live births to 397.8/1000 live births), whereas the overall number of screens increased from 1383.2 to 2758.6/1000 live births. The mean time per screen decreased from 12.52 (95% confidence interval [CI] 10.44-14.59) minutes with TSB to 2.94 (95% CI 2.55-3.33) minutes with TcB (p < 0.001). The estimated cost per TcB screen in hospital and community (urban and rural) settings was $3.54 and $3.76, respectively, and the estimated cost per TSB screen in hospital and in urban and rural community settings was $15.82, $50.21 and $65.03, respectively. The estimated overall 6-month savings with the TcB-TSB hospital and community programs were $19 760 and $6417, respectively. INTERPRETATION The TcB-TSB program reduced nurses' time to screen and provided immediate results at the point of care. Transcutaneous bilirubinometry reduced the requirement for painful heel pokes while improving access to screening and decreasing the overall program cost.

Jaundice in newborns is the most common symptom and in the vast majority of cases reflects the characteristics of bilirubin metabolism in the neonatal period. In healthy newborns there are two kinds of jaundice that do not require treatment and are caused by hyperbilirubinemia: physiologic and breastfeeding ones. Transient disturbance of the bilirubin clearance (indirect bilirubin conjugation) not affecting the child development lies at the core of a healthy newborn jaundice. Jaundice of breastfeeding differs by prolonged course (up to 2-3 months) while physical and psychomotor development of the child is not affected. However prolonged course (over 14 days of life) of jaundice requires determination of bilirubin and its fractions in dynamics to rule out more serious causes of hyperbilirubinemia.

DOI : 10.26650/electrica.2019.18022 Today, phototherapy devices are used to treat newborn jaundice. However, there are some cases that the commercial phototherapy devices are inadequate. Most of the device are controlled only at the certain interval that prevents instantaneous monitoring the newborn’s vital parameters. For other cases, devices are one-way lighting. In addition, when the baby is taken away from the device, unnecessary lighting causes the decrease in LED’s lifetime. In the scope of the study, intensive phototherapy device was developed to eliminate deficiencies that are mentioned above. Properties of the developed phototherapy device are; Automatic detection of newborn's presence, double-sided illumination, continuous monitoring with IP webcam, temperature measurement of the environment and also newborn’s body temperature. The light intensity of the device was measured with a photometer as 28.6 μW/cm²/nm that was obtained from 460nm wavelength LED illumination in both top and bottom in accordance with the American Academy of Pediatrics (AAP) guideline. Cite this article as: Aksahin M. Multifunctional Phototherapy Device Design. Electrica, 2019; 19(1): 65-71.

Background Transcutaneous (TcB) meters support clinical decision making at point-of-care, reduces nurses’ time to screen, decreases the frequency of painful blood draws and minimizes health care costs. Best practice for TcB screening is unknown and international guidelines vary. Meter bias may result in over- or underestimation of TSB in a Canadian population. The Canadian Paediatric Society suggests screening between 24 and by 72 hours of age and reducing total serum bilirubin (TSB) action thresholds by the 95th confidence interval of the meter. To support point-of-care decision making, a tertiary center and community follow-up program uses universal screening and follow-up protocols. ​ Objectives The aim of this analysis is to develop a locally validated TcB nomogram with action thresholds based on age and risk for clinical use at point-of-care. ​ Design/Methods This prospective cross-sectional study includes newborns ≥35 weeks gestation Results The study population includes 498 newborns that received 620 visits and 705 meter readings with thirteen JM-105 with mean birth weight 3.38 kilograms (SD=0.51) with thirteen JM-105. Along with the clinical screening protocol, nomograms for newborns 35-37 weeks gestation (high and medium risk thresholds) and 38+ weeks gestation medium and low risk thresholds) are presented. Newborns with TcB that plots in a potential treatment range will receive a TSB to determine if intensive phototherapy is required. Conclusion To support point-of-care decision making, a tertiary center and community follow-up program uses universal screening and follow-up protocols. TcB nomograms with action thresholds based on age and risk support point-of-care decision making.

Creating a legacy is something few can accomplish. Former Editor-in-Chief of Pediatrics Dr Jerold F. (Jerry) Lucey, MD, FAAP, did so most admirably. Sadly, on December 10, 2017, Jerry Lucey died in Sarasota, Florida. With his passing, we lost a champion who led our journal for three-and-a-half decades. Jerry’s influence on all of us fortunate to know him and work with him is apparent in every issue we publish. Jerry Lucey grew up in Holyoke, Massachusetts, graduated from Dartmouth College in 1948, and received his doctor of medicine degree at New York University College of Medicine in 1952. He did his internship at Bellevue Hospital and residency at Columbia-Presbyterian Medical Center, and conducted research in newborn jaundice there and then at Harvard Medical School, triggering the start of his career as a neonatologist before formal fellowships existed in the field. Jerry joined the faculty of the University of Vermont College of Medicine (now the University of Vermont Robert Larner, MD, College of Medicine) in 1956, rose to the rank of professor in 1967, and was named the Harry Wallace Professor of Neonatology in 1995. He was an active member of the department until his retirement in 2009, when he was named professor emeritus. His contributions … Address correspondence to Lewis R. First, MD, MS, University of Vermont Robert Larner, MD College of Medicine, 89 Beaumont Ave, Given Courtyard S250, Burlington, VT 05405-0068. E-mail: lewis.first{at}med.uvm.edu

Background and aims Kernicterus is a significant problem in low income countries (LICs) and measurement of total serum bilirubin (TSB) is often restricted by cost or lack of laboratory facilities. Near patient testing through the use of transcutaneous bilirubinometry (TcB) may be of benefit in LICs. Therefore, the aim of this study was to determine agreement between (TcB) and TSB in a LIC (Haiti). Methods With approval the Ministry of Health, we conducted a single centre prospective study (February-May 2017) in a NGO funded neonatal unit in northern Haiti. Babies with clinically detected jaundice, Results Paired TcB/TSB measurements were obtained from 35 infants. 19 (54.3%) were male; 23 (65.7%) were ≥35 weeks, 12 (34.3%) 200 µmol/L), TcB tended to underestimate bilirubin in comparison to TSB and the magnitude of the difference increased. The mean difference between TcB and TSB was increased in babies 35 weeks 8.4µmol/L (95% CI −18.5, 35.3). Conclusion Our data indicate good agreement between TcB and TSB levels in Haitian newborns receiving phototherapy. Implementing TcB measurement for the management of newborn jaundice is both feasible and convenient as an alternative to laboratory TSB measurements in preterm and term babies during phototherapy in a LIC setting.

Resumen: La hiperbilirrubinemia representa la causa más común de reingreso hospitalario en la primera semana de vida. Su detección continúa siendo un desafío, debido especialmente al alta precoz que puede asociarse con un retraso en el diagnóstico.La identificación de los niños con riesgo de desarrollar hiperbilirrubinemia significativa es una de las principales prioridades de la sanidad pública.En este documento, se presenta un enfoque para el manejo de la ictericia del recién nacido, según recomendaciones basadas en la evidencia médica y en la opinión del Comité de Estándares de la Sociedad Española de Neonatología. Abstract: Hyperbilirubinaemia is one of the most frequent causes of hospital readmission during the first week of life. Its detection is still a big challenge, mainly due to the early discharge from the hospital that can be associated with a delay of the diagnosis.The identification of those newborns at risk of developing significant hyperbilirubinaemia is one of the main priorities in the public health care system.An approach to the management of newborn jaundice is presented in this article, following the recommendations based on the medical evidence and on the opinion of the Standards Committee of the Spanish Society of Neonatology.

Hyperbilirubinaemia is one of the most frequent causes of hospital readmission during the first week of life. Its detection is still a big challenge, mainly due to the early discharge from the hospital that can be associated with a delay of the diagnosis.The identification of those newborns at risk of developing significant hyperbilirubinaemia is one of the main priorities in the public health care system.An approach to the management of newborn jaundice is presented in this article, following the recommendations based on the medical evidence and on the opinion of the Standards Committee of the Spanish Society of Neonatology. Resumen: La hiperbilirrubinemia representa la causa más común de reingreso hospitalario en la primera semana de vida. Su detección continúa siendo un desafío, debido especialmente al alta precoz que puede asociarse con un retraso en el diagnóstico.La identificación de los niños con riesgo de desarrollar hiperbilirrubinemia significativa es una de las principales prioridades de la sanidad pública.En este documento, se presenta un enfoque para el manejo de la ictericia del recién nacido, según recomendaciones basadas en la evidencia médica y en la opinión del Comité de Estándares de la Sociedad Española de Neonatología.

Background: Newborn jaundice has remained one of the leading causes of neonatal morbidity and mortality in sub-Saharan Africa. It is believed that delays in detection and/or inappropriate treatment may largely be responsible for this. Given that most mothers are now discharged home 24 hours after a normal delivery, the responsibility to detect jaundice in the new-born and take appropriate decision now rest with the mothers. This study therefore sought to evaluate the knowledge and perception of newborn jaundice among parturient mothers. Method: This study was a descriptive cross-sectional study carried out among 255 parturient mothers at the lying-in ward of Mariere Memorial Central Hospital. A structured, pre-tested, interviewer administered questionnaire was used to obtain information from the mothers. SPSS version 16 was employed in the analysis of the data. Results: Of the 255 parturient mothers interviewed, only 156 (61.2%) affirmed their awareness of newborn jaundice and only these mothers were further analysed. Their mean age was 30.2±5.4 and a median parity of 2. Thirty-seven (23.7%) of the mothers had tertiary education and just about half (50.6%) of the mothers knew that newborn jaundice presents with yellowish discoloration of the body and sclera. Three (1.9%) of the mothers knew that haemolysis is an underlying cause of jaundice and four (2.6%) mothers each correctly mentioned phototherapy and exchange blood transfusion as treatment modalities. Health talk given at the antenatal clinic was the source of information by 81 (51.9%) of the mothers. Conclusion: This study showed that the knowledge of risk factors/causes, treatment and complication of newborn jaundice by mothers is unsatisfactory. DOI: http://dx.doi.org/10.3329/bjms.v13i3.16521 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.292-297

This study investigated the effectiveness of simple-to-implement adjustments of phototherapy devices on irradiance levels in a cross-section of Nigerian hospitals. A total of 76 phototherapy devices were evaluated in 16 hospitals while adjustments were implemented for a subset of 25 devices for which consent was obtained. The mean irradiance level was 7.6 ± 5.9 µW/cm(2)/nm for all devices prior to adjustments. The average irradiance level improved from 9.0 µW/cm(2)/nm to 27.3 µW/cm(2)/nm for the adjusted group (n = 25) compared with 6.8 ± 5.4 µW/cm(2)/nm for the unadjusted group (n = 51). Simple, inexpensive adjustments to phototherapy devices with sub-optimal irradiance levels can significantly improve their effectiveness to acceptable international standards and should be widely promoted in resource-constrained settings.

Usually, all newborns demonstrate high serum unconjugated bilirubin (UCB) level. UCB may induce adverse effects in the central nervous system. We aimed to evaluate the cytotoxic effects of UCB and the protective effects of docosahexaenoic acid (DHA) on astrocyte cell cultures. The viability of astrocyte cells decreased after UCB treatment in a dose-dependent manner. Pre-incubation of DHA prevents the cells from UCB-mediated neurotoxicity. Our results shown that UCB leads to inhibition of antioxidant enzymes superoxide dismutase (SOD), catalase and GPx activity and induction of apoptosis. But only 4-h pretreatment of DHA can suppress of UCB-mediated inhibition of antioxidant enzymes SOD, catalase and GPx activity and induction of apoptosis in astrocytes. Our results strongly indicated that DHA has a protective effect on UCB-mediated neurotoxicity through inhibition apoptosis and antioxidant enzymes activity of SOD, CAT and GPx in rat primer astrocyte cell line © 2013 Informa UK, Ltd.

Neonatal jaundice (hyperbilirubinemia), extremely common in neonates, can be associated with neurotoxicity. A safe level of bilirubin has not been defined in either premature or term infants. Emerging evidence suggest that the level of unbound (or “free”) bilirubin has a better sensitivity and specificity than total serum bilirubin for bilirubin-induced neurotoxicity. Although recent studies suggest the usefulness of free bilirubin measurements in managing high-risk neonates including premature infants, there currently exists no widely available method to assay the serum free bilirubin concentration. To keep pace with the growing demand, in addition to reevaluation of old methods, several promising new methods are being developed for sensitive, accurate, and rapid measurement of free bilirubin and bilirubin binding capacity. These innovative methods need to be validated before adopting for clinical use. We provide an overview of some promising methods for free bilirubin and binding capacity measurements with the goal to enhance research in this area of active interest and apparent need.

Objectives To assess the effects of sample dilution, peroxidase concentration, and chloride ion (Cl − ) on plasma unbound bilirubin ( B f ) measurements made using a commercial peroxidase methodology (UB Analyzer) in a study population of ill, premature newborns. Design and methods B f was measured with a UB Analyzer in 74 samples at the standard 42-fold sample dilution and compared with B f measured at a 2-fold sample dilution using a FloPro Analyzer. B f was measured at two peroxidase concentrations to determine whether the peroxidase steady state B f ( B fss ) measurements were significantly less than the equilibrium B f ( B feq ), in which case it was necessary to calculate B feq from the two B fss measurements. B f was also measured before and after adding 100 mmol/L Cl − to the UB Analyzer assay buffer. Results B feq at the 42-fold dilution was nearly 10-fold less than but it correlated significantly with B feq at the 2-fold dilution (mean 8.2 ± 5.2 nmol/L versus 73.5 ± 70 nmol/L, respectively, p r = 0.6). The two UB Analyzer B fss measurements were significantly less than B feq in 42 of 74 (57%) samples, and Cl − increased B feq in 66 of 74 (89%) samples by a mean of 82 ± 67%. Conclusions B fss measured by the UB Analyzer at the standard 42-fold sample dilution using assay buffer without Cl − and a single peroxidase concentration is significantly less than the B feq in undiluted plasma. Accurate B f measurements can be made only in minimally diluted serum or plasma.

Rapunzel syndrome is a variety of trichobezoar which has a tail extending down through pylorus to small intestine. Most reported cases were female with underlying psychiatric problem. We are reporting 7 years old girl presented with history of chronic abdominal pain (discomfort), progressive in nature, abdominal distention and weight loss. Radiological work-up is consistent with huge filling defect in stomach. Laparatomy and gastrotomy was done, a huge trichobezoar with a long tail extending to proximal part of small intestine was removed. Post- surgical hospital course was smooth with no complications and she was discharged in the 2nd week, given a follow up with psychiatrist and psychologist for evaluation and management to prevent recurrence

Context: Phototherapy is the mainstay of treatment for about 3% of neonates in India who develop significant jaundice in phototherapy range. New devices have been introduced in the market over the past few years. Aims: To compare the efficacy of three types of phototherapy machines, namely Blue and White, Compact Fluorescent Lamp, and Light Emitting Diode type. Settings and Design: A non-randomized prospective interventional study conducted in a tertiary care hospital of Western India. Material and Methods: Ninety neonates with phototherapy range hyperbilirubinemia were assigned into three groups of 30 neonates each to receive phototherapy using one of the three types of phototherapy machines. Need for exchange transfusion, total serum bilirubin (TSB) at 24 hours post-phototherapy and side effect profile were recorded. Decision to stop phototherapy was based on acceptable reduction of serum bilirubin to below phototherapy range. Statistical analysis used: Medcalc® Version 11.4.2.0 Software was utilised. Comparison of mean TSB was done using one way ANOVA. P-value of

Background In many resource-limited settings, the availability of effective phototherapy for jaundiced infants is frequently hampered by lack of, or inadequate resources to acquire and maintain conventional electric-powered phototherapy devices. This study set out to ascertain maternal experience and satisfaction with a novel treatment of infants with significant hyperbilirubinemia using filtered sunlight phototherapy (FSPT) in a tropical setting with irregular access to effective conventional phototherapy. Methods A cross-sectional satisfaction survey was conducted among mothers of jaundiced infants treated with FSPT in an inner-city maternity hospital in Lagos, Nigeria from November 2013 to March 2014. Mothers’ experience during treatment was elicited with a pretested questionnaire consisting of closed and open-ended items. Satisfaction was rated on a five-point Likert scale. Correlates of overall maternal satisfaction were explored with descriptive and inferential non-parametric statistics. Results A total of 191 mothers were surveyed, 77 (40%) of whom had no prior knowledge of neonatal jaundice. Maternal satisfaction was highest for quality of nursing care received (mean: 4.72 ± 0.55, median: 5[IQR: 5–5]) and lowest for physical state of the test environment (mean: 3.85 ± 0.74, median: 4[IQR: 3–4]). The overall rating (mean: 4.17 ± 0.58, median: 4[IQR: 4–5]) and the observed effect of FSPT on the babies (mean: 4.34 ± 0.58, 4[IQR: 4–5]) were quite satisfactory. FSPT experience was significantly correlated with the adequacy of information received (p

We aimed to determine the role of exchange transfusion related complications, treatment, and etiology as well as subgroup incompatibility in patients subject to ET (exchange transfusion) due to newborn jaundice. 82 patients hospitalized due to newborn jaundice and exposed to exchange transfusion between August 2007 and August 2011 were retrospectively studied. Before ET mean total serum bilirubin was 29,2±9,83. The most frequent cause of ET was ABO incompatibility (31%) followed by Rh incompatibility (19%) and subgroup incompatibility (17%), respectively. In 46% of all patients and in 71% of the patients presenting with subgroup incompatibility , direct combs test was detected to be (+). 49% of the patients were administrated with intravenous immunoglobulin. 5 of the patients who were exposed to ET presented with hydrops fetalis. Of these patients 3 had Rh, 1 had ABO while the other had subgroup incompatibility. Although ABO and Rh incompatibility are substantial underlying reasons of severe jaundice requiring exchange transfusion, particularly widespread use of RhoGAM thereby enabling the prior identification and precautions, ET need was reduced compared to previous cases. On the contrary, SGU related severe hemolytic jaundice relatively enhanced, however., Bu çalışmada yenidoğan sarılığı nedeniyle kan değişimi (KD) yapılan hastalarda etiyoloji, tedavi, KD ile ilgili komplikasyonlar ve subgrup uyuşmazlığının rolünü belirlemeyi amaçladık. Dört yıl boyunca yenidoğan sarılığı nedeniyle yatırılarak 89 KD yapılan toplam 82 hasta retrospektif olarak değerlendirildi. KD öncesi ortalama total serum bilirubin düzeyi 29,2±9,83 mg/dl idi. En sık KD sebebi ABO uyuşmazlığı (%31), bunu Rh uyuşmazlığı (%19) ve subgrup uyuşmazlığı (SGU) (%17) izliyordu. Tüm hastaların %46’sında ve SGU olan hastaların %71’inde direkt coombs testi (+) idi. Hastaların %49’una İVİG verildi. KD yapılan hastalardan 5’inde hidrops fetalis tablosu mevcuttu. Bunların 3’ünde Rh, 1’inde ABO ve diğerinde SGU mevcuttu. KD gereksinimi gösteren ciddi sarılığın en önemli sebebi ABO ve Rh uyuşmazlığı olsa da özellikle Rhogamın yaygın kullanılması, bu risk nedenlerinin önceden tanımlanarak gerekli öneriler ve önlemler sayesinde KD ihtiyacı eskiye oranla azaltılmıştır. Ancak bunun aksine SGU’na bağlı ciddi hemolitik sarılık ve KD ihtiyacı rölatif olarak artmıştır. Kaldi ki SGU hidrops fetalis, kernikterus ve ölüme yol açabilmektedir. Riskli grupların önceden bilinmesi ve erken yoğun fototerapi sayesinde hiperbilirubineminin komplikasyonları ve KD oranı önemli ölçüde azaltılabilecektir

We aimed to determine the role of exchange transfusion related complications, treatment, and etiology as well as subgroup incompatibility in patients subject to ET (exchange transfusion) due to newborn jaundice. 82 patients hospitalized due to newborn jaundice and exposed to exchange transfusion between August 2007 and August 2011 were retrospectively studied. Before ET mean total serum bilirubin was 29,2±9,83. The most frequent cause of ET was ABO incompatibility (31%) followed by Rh incompatibility (19%) and subgroup incompatibility (17%), respectively. In 46% of all patients and in 71% of the patients presenting with subgroup incompatibility, direct combs test was detected to be (+). 49% of the patients were administrated with intravenous immunoglobulin. 5 of the patients who were exposed to ET presented with hydrops fetalis. Of these patients 3 had Rh, 1 had ABO while the other had subgroup incompatibility. Although ABO and Rh incompatibility are substantial underlying reasons of severe jaundice requiring exchange transfusion, particularly widespread use of RhoGAM thereby enabling the prior identification and precautions, ET need was reduced compared to previous cases. On the contrary, SGU related severe hemolytic jaundice relatively enhanced, however.

This resource is a part of a seven-module curriculum intended to provide teaching faculty caring for well newborns with accessible, approachable, easily delivered, hands-on tools for bedside teaching in the newborn nursery. The seven modules are linked. This module focuses on newborn jaundice. Jaundice is an exceedingly common problem in the early newborn period, yet the approach to the physical examination and evaluation of jaundiced infants will vary depending on infant age, condition, and risk factors. The appropriate management of neonatal jaundice depends on one's ability to distinguish infants at risk for developing jaundice from those at risk for developing neurotoxicity from jaundice. In addition, the physician must be able to recognize the uses and limitations of published guidelines and to correctly interpret findings on the physical examination. This module is designed to review the clinically relevant aspects of neonatal hyperbilirubinemia that presents in the first days of life and then translate that knowledge into informed management of a jaundiced infant. It has been used in the newborn nursery setting to stimulate thought and discussion about jaundice. It has primarily been used by attending physicians who are teaching pediatric residents and medical students, but could also be used by a senior resident who is functioning in a supervisory or teaching role. Medical students and resident physicians have given very positive feedback about the material presented, and attending physicians have found it easy to use. Third-year medical students and pediatric residents were evaluated using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Results are as follows: “Presentation was well-organized and presented clearly.” (4.57 average); “Audiovisual aids were helpful.” (4.43); “Topic was important and useful.” (4.71); “Presentation was appropriate for my level of training.” (4.71); “Presenter achieved stated objectives.” (4.71); “Overall, teaching was effective.” (4.43); and “This presentation should be continued.” (4.71).

Objective: Whether the G71R mutation contributes to the high incidence of neonatal indirect hyperbilirubinemia in Turkey remains unknown. In this study we screened for G71R mutation of the UGT1A1 gene in prolonged and pathological hyperbilirubinemia with unexplained etiology in newborns in Turkey. Method: In this study, we screened the G71R mutation of the UGT1A1 gene in 70 Turkish newborn infants: 23 infants with pathologic hyperbilirubinemia, 24 infants with prolonged hyperbilirubinemia and 23 infants without pathologic and prolonged hyperbilirubinemia. Mutations were detected by non-radioactive dye terminator cycle sequencing. Results: In these seventy infants enrolled in this study, there were 62 with G/G (88.5 %), 8 with G/R (11.5%), and none with R/R. Two (8.7%) infants in the pathologic jaundice group and 5 (20.8 %) infants in the prolonged indirect hyperbilirubinemia, one (4.3%) infant in the control group had G/R genotype. Although G/R mutation is higher in the prolonged indirect hyperbilirubinemia group, genotypic distributions among the three groups were not statistically significant. The allele frequency of the G71R mutation was found 4.3%, 10.4%, and 2.2% in the pathologic jaundice group, in the prolonged indirect hyperbilirubinemia group, and in the control group respectively. When we compared the peak serum total bilirubin concentrations of neonates according to their genotypes, the peak bilirubin concentration was higher in G/R genotype than G/G genotype. Conclusions: G71R mutation of UGT1A1 gene is also present in Turkish population and the presence of this mutation is associated with otherwise unexplained pathological or prolonged neonatal hyperbilirubinemia in a Turkish population. ©2010 Dustri-Verlag Dr. K. Feistle.

Background: The serum or plasma total bilirubin concentration (BT) has long been the standard clinical laboratory test for evaluating neonatal jaundice, despite studies showing that BT correlates poorly with acute bilirubin encephalopathy (ABE) and its sequelae including death, classical kernicterus, or bilirubin-induced neurological dysfunction (BIND). The poor correlation between BT and ABE is commonly attributed to the confounding effects of comorbidities such as hemolytic diseases, prematurity, asphyxia, or infection. Mounting evidence suggests, however, that BT inherently performs poorly because it is the plasma non–protein-bound (unbound or free) bilirubin concentration (Bf), rather than BT, that is more closely associated with central nervous system bilirubin concentrations and therefore ABE and its sequelae.Content: This article reviews (a) the complex relationship between serum or plasma bilirubin measurements and ABE, (b) the history underlying the limited use of Bf in the clinical setting, (c) the peroxidase method for measuring Bf and technical and other issues involved in adapting the measurement to routine clinical use, (d) clinical experience using Bf in the management of newborn jaundice, and (e) the value of Bf measurements in research investigating bilirubin pathochemistry.Summary: Increasing evidence from clinical studies, clinical experience, and basic research investigating bilirubin neurotoxicity supports efforts to incorporate Bf expeditiously into the routine evaluation of newborn jaundice. .