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The study aimed to assess the risk of hearing loss in full-term neonates with hyperbilirubinemia, examining the relationship between bilirubin levels, onset age of hyperbilirubinemia, and hearing impairment. Additionally, it investigated whether hearing loss was transient or late-onset, using a cost-effective double-screening method. The study included 160 full-term neonates aged 0-1 month. Following completion of phototherapy for hyperbilirubinemia, all infants underwent initial screening with otoacoustic emissions (OAEs) and automated auditory brainstem responses (AABR). A second screening was administered to all infants within one month. Infants referred during the second screening, regardless of their first screening results, underwent diagnostic evaluation. For analysis, the infants were categorised into 4 groups, based on their bilirubin levels and onset of jaundice. After the initial screening, 37% of infants were referred, which decreased to 9% after subsequent screening, suggesting transient hearing loss in 76% of initially referred infants. Permanent hearing impairment was confirmed in 2.5% of infants following diagnostic evaluation, with 3 infants diagnosed with ANSD and 1 infant with sensorineural hearing loss, all from categories characterized by elevated bilirubin levels. The findings indicated that even bilirubin levels as low as 12 to 15 mg/dl could lead to hearing loss, particularly when jaundice onset occurred early. This study highlights the effectiveness of double-screening for identifying transient hearing losses in infants with hyperbilirubinemia, minimizing the need for diagnostic referrals. It underscores the importance of considering both bilirubin levels and onset timing to assess auditory risk fully. [ABSTRACT FROM AUTHOR]

The article describes the case study of a 6-week-old male infant with persistent respiratory distress and head bobbing. Topics include the patient's complex neonatal history; symptoms observed at home, such as tachypnea, retractions, and head bobbing that fluctuated in severity; and diagnostic assessments, including normal chest radiographs, echocardiogram showing minor heart findings, and elevated bilirubin levels without definitive respiratory or cardiac diagnoses.

Background: Acute pancreatitis following cardiac surgery is a rare complication. Early recognition of risk factors and vigilance toward initial symptoms can prevent significant morbidity and mortality. Bowel ischemia and the release of inflammatory mediators during cardiopulmonary bypass play key roles in the development of acute postoperative pancreatitis. Management is generally conservative, following the modified Atlanta 2012 criteria. This paper reviews the literature and emphasizes the importance of early investigation of abdominal pain after cardiac surgery. Case presentation: We report a case of severe acute pancreatitis that developed after double valvular replacement, performed during a 3-h cardiopulmonary bypass in a patient who initially had endocarditis and underwent dialysis 3 times. Considering the risk factors, the patient was diagnosed early and managed conservatively, leading to a positive outcome. Conclusions: Anesthesiologists must not disregard abdominal pain after cardiac surgery in the context of risk factors, as it may indicate gastrointestinal complications, including pancreatitis, which can be among the most dangerous complications if not treated promptly. [ABSTRACT FROM AUTHOR]

Background: Exchange transfusion (ET) is required in hyperbilirubinemia hospitalized neonates. Objectives: 1) Neonate's Rh factor wise grouped then the changes in hematological and biochemical parameters before and after exchange transfusion. 2) To study the effect of whole blood exchange transfusion to decrease serum bilirubin and raise hemoglobin in neonatal hyperbilirubinemia.3) To find out the underlying disease pattern of hemolytic jaundice among the study population. Methods: The study center at SMS and associated hospitals. The blood bank was licensed and fully equipped. Fall in serum bilirubin minimum 40 cases were required as the sample size of the present study. Results: Neonate's Rh factor wise grouped was Rh+ve= 37 (92.5%) and Rh-ve= 03 (7.5%). When Neonate's blood groups were Rh+ve and Rh-ve, then the Hb (g/dl) and Direct bilirubin (mg/dl) mean value before exchange transfusion was comparison revealed that the difference was non-significant. When Neonate's blood group was Rh+ve, then the Hematocrit Total bilirubin (mg/dl) Indirect bilirubin (mg/dl) means value before exchange transfusion was revealed that the difference was significant in comparison Rh-ve, was non-significant. [ABSTRACT FROM AUTHOR]

Data describing the use of extracorporeal membrane oxygenation (ECMO) in pediatric acute liver failure (PALF) are scarce. Thus, we aimed to describe the use of ECMO in patients with PALF using the data from the Extracorporeal Life Support Organization (ELSO) Registry between January 1, 2010, to December 31, 2022. We described patients' characteristics at ECMO initiation, outcome, and factors associated with mortality. A total of 335 children underwent ECMO support in the context of PALF. Veno-arterial (VA) ECMO was the most prevalent mode (66.6%), followed by veno-venous (VV) ECMO (33.4%). Extracorporeal cardiopulmonary resuscitation (ECPR) was used in 21.5% of the cardiac arrest. In-hospital mortality was 66.6%. Both higher lactate (OR 1.128, CI 1.06–1.209, p < 0.001) and PaCO2 (OR 1.022, CI 1.001–1.047, p 0.05) levels before ECMO reported greater odds of mortality. Low body weight, persistence of hyperlactatemia (OR 0.985, CI 0.973–0.997, p 0.013), and hyperbilirubinemia (OR 2.477, CI 1.042–6.100, p 0.045) after 24 h from ECMO deployment were associated to greater odds of mortality. Conclusions: Our results suggest that the use of ECMO for the management of respiratory and cardiac failure in patients with PALF should be considered with caution and that further research is needed to understand its role in this specific high-risk population. What is known: • Pediatric acute liver failure (PALF) is a clinical syndrome associated with significant morbidity and mortality. • Data on the use of extracorporeal membrane oxygenation (ECMO) in the context of PALF are scarce and controversial. What is new: • ECMO to manage acute respiratory and/or cardiac failure in the context of PALF should be considered with caution. • Bleeding and thrombotic complications in children with acute liver failure receiving ECMO are similar to the ones reported in the general pediatric population. [ABSTRACT FROM AUTHOR]

Previous investigations on the impact of oral zinc sulfate treatment on newborns' serum bilirubin levels have produced conflicting results. As a result, the goal of this clinical study was to evaluate how oral zinc sulfate affected the levels of serum bilirubin in term infants who were admitted to the neonatal intensive care unit. The study was conducted at the Neonatal Care Unit of Besat Hospital in Sanandaj, Kurdistan Province, as a double-blind randomized controlled trial. The participants included term infants (37–42 weeks of gestation) who required phototherapy and were admitted to the neonatal intensive care unit. A total of 290 infants were enrolled and randomly divided into two groups. The intervention group received oral zinc sulfate supplementation at a dosage of 1 mg/kg per day in addition to phototherapy, while the placebo group received an equivalent amount of placebo daily. Bilirubin measurements were obtained at the initiation of the intervention and subsequently every 24 h until discharge. The collected data were analyzed using STATA software version 17. After the infants were randomly allocated to the zinc-sulfate and placebo groups, the study outcomes, including the average changes in bilirubin levels after intervention, the hours of phototherapy, and the number of days of hospitalization, were analyzed and compared for a total of 160 infants in the zinc sulfate group and 130 infants in the placebo group. The reduction in bilirubin levels in infants receiving zinc sulfate was (− 3.75 ± 0.19 CI 95% − 4.12, − 3.37) and for placebo group was (− 1.81 ± 0.15 CI 95% − 2.12, − 1.50) 24 h after the intervention. Furthermore, 48 and 72 h following the intervention, bilirubin levels in the intervention group demonstrated a more substantial decline. The zinc sulfate group had a shorter hospital stay (2.13 ± 0.04 vs. 2.83 ± 1.42) and required less phototherapy hours than the placebo group (6.21 ± 2.16 vs. 8.78 ± 1.40). Conclusions: Oral zinc sulfate supplementation in term neonates with hyperbilirubinemia decreased the level of bilirubin levels, duration of phototherapy, and hospital stay. Trial registration: IRCT, IRCT20220806055625N1. Study Registered 25 December 2022, http://irct.ir/trial/66,722. What is Known? • Previous studies on oral zinc sulfate as a treatment for neonatal hyperbilirubinemia have yielded mixed results, with some suggesting benefits in reducing serum bilirubin levels, while others found minimal or no impact. • Hyperbilirubinemia is a common condition in neonates, often requiring phototherapy to prevent serious complications. What is New? • This study contributes new evidence demonstrating that oral zinc sulfate supplementation significantly reduces serum bilirubin levels in term neonates more effectively than placebo. Additionally, the study found that zinc sulfate not only accelerates the reduction of bilirubin but also decreases the duration of phototherapy and shortens the length of hospital stay, offering robust data that could influence therapeutic strategies for managing neonatal hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

The article presents a case study of two male infants diagnosed with hypertrophic pyloric stenosis, highlighting their clinical presentation and management. Topics discussed include the genetic and environmental factors contributing to pyloric stenosis, the criteria for surgical intervention, and the increased incidence of the condition among twins.

Debate exists regarding predictive value of brain MRI for long-term neurodevelopmental outcome (NDO) in infants with severe unconjugated hyperbilirubinemia (above exchange transfusion levels). To investigate whether MRI findings among (pre-)term infants with severe unconjugated hyperbilirubinemia can predict NDO at ≥ 12 months and determine optimal timing for MRI. PubMed and Embase. Last update: June 14, 2024. Studies in which (pre-)term infants with severe unconjugated hyperbilirubinemia who underwent an MRI before 24 months and had a reported NDO at ≥ 12 months were included. Patient characteristics, MRI and NDO details were extracted. The search yielded 732 studies, of which 22 were included. Individual patient information was obtained for 120 infants (MRI-timing: early (≤6 weeks) n = 75, late (>6 weeks) n = 19, unknown n = 26). Positive predictive value (PPV) of abnormal MRI in the total group for impaired NDO was high (77.5 %). The PPV of late compared to early MRI was much higher, 92.3 % versus 71.7 %. Negative predictive value of normal MRI for normal NDO in the total group was low (29.0 %) and again higher in late compared to early MRI, 50.0 % versus 27.3 %. Quantitative synthesis of results was impossible due to large heterogeneity in study designs. Furthermore, selection bias towards patients with impaired outcome might have influenced our results. Brain MRI can serve as prognostic tool for NDO in infants with severe unconjugated hyperbilirubinemia, both in early and late stages, but each timing has inherent constraints. Further prospective studies are necessary. • This systematic review uniquely evaluates the predictive value of brain MRI for neurodevelopmental outcomes in neonates with severe unconjugated hyperbilirubinemia (above exchange transfusion levels). • Late MRIs (conducted >6 weeks postnatally) demonstrate a significantly higher predictive value for impaired neurodevelopmental outcomes compared to early MRIs (conducted ≤6 weeks postnatally). • The high percentages in reported studies (75.8 %) of infants with adverse neurological outcomes after severe unconjugated hyperbilirubinemia suggest selection bias, may also be due to the wide NDO range and are not fully representative of the broader patient population. • There is a notable lack of large, prospective studies assessing the predictive value of MRI in neonatal severe unconjugated hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Neonatal jaundice is a common problem that affects newborns. We aim to investigate the effect of Kangaroo Mother Care (KMC) combined with blue-light irradiation on enhancing the therapeutic effect in the treatment of neonatal jaundice. From May 2020 to August 2022, 89 neonates with pathological jaundice and their mothers were selected as participants. All neonates received blue-light irradiation. The participants were divided into two groups: 46 neonates cared for by KMC as the research group (RG) and 43 neonates receiving routine nursing as the control group (CG). The first lactation time, first breastfeeding duration, and scores of Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) before and after nursing were recorded and compared between the groups. Pre- and post-interventional total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL) levels of both groups of newborns were measured, and the time of jaundice resolution, first defecation, and meconium yellowing were recorded. Neonatal adverse reactions (ARs) during treatment were counted, and a nursing satisfaction survey was conducted at discharge. KMC group mothers had earlier lactation and longer first breastfeeding durations (P < 0.05). Both groups' SAS and SDS scores decreased post-nursing, with greater improvement in the KMC group (P < 0.05). KMC group newborns had lower bilirubin levels and faster resolution of jaundice and meconium yellowing, with fewer adverse reactions and higher nursing satisfaction (P < 0.05). KMC can effectively improve the efficacy of blue light irradiation in the treatment of neonatal jaundice, and promote the healthy development of newborns and the efficiency of maternal breastfeeding. [ABSTRACT FROM AUTHOR]

Hyperbilirubinemia (HY) is a common condition in neonates that requires phototherapy treatment. This study aimed to evaluate the effectiveness of transcutaneous bilirubin measurements (TCB), hypersensitive C-reactive protein (hs-CRP), and unconjugated bilirubin (UCB)/albumin (ALB) as indicators of HY during neonatal phototherapy. A research group of 67 neonates with pathological HY and a control group of 55 healthy neonates were selected from a hospital between June 2020 and May 2021. TCB, hs-CRP, and UCB/ALB tests were performed before, during (at 3 days of treatment), and after (at 6 days of treatment) phototherapy in the research group and at admission in the control group. The study also included a 1-year prognostic follow-up on the research group. The study observed the difference in TCB, hs-CRP, and UCB/ALB test results between both groups and their assessment effect on adverse reactions, treatment effects, and poor prognosis in phototherapy. TCB, hs-CRP, and UCB/ALB levels were higher in the research group than in the control group and gradually decreased during phototherapy (P < 0.05). The combined TCB, hs-CRP, and UCB/ALB assay had 100.0% sensitivity and 64.58% specificity (P < 0.001) for predicting adverse reactions, 88.24% sensitivity and 80.00% specificity (P < 0.001) for predicting the effect of phototherapy, and 90.91% sensitivity and 88.89% specificity (P < 0.001) for predicting poor prognosis. The combined TCB, hs-CRP, and UCB/ALB assay showed superior assessment of adverse effects, clinical outcomes, and poor prognosis in HY neonates treated with phototherapy. TCB, hs-CRP, and UCB/ALB could be used as dynamic disease assessment indicators for HY to better prevent and treat the occurrence of HY. [ABSTRACT FROM AUTHOR]

Background: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease caused by immune hyperactivation. The overall survival (OS) of adults with secondary HLH remains suboptimal and new treatment strategies are needed. Objectives. This study aimed to compare the efficacy of different regimens in the treatment of secondary HLH in adults and analyze the prognostic factors affecting patient survival. Materials and methods: The clinical data of 245 adults with secondary HLH admitted to our hospital from January 2016 to October 2021 were analyzed retrospectively. The patients were divided into 3 groups according to different treatment regimens: corticosteroids therapy + chemotherapy + supportive treatment group (JHZ group), chemotherapy + supportive treatment group (HZ group) and corticosteroids therapy + supportive treatment group (JZ group). The clinical efficacy was compared among the 3 groups after treatment, and progression-free survival (PFS) and overall survival (OS) were calculated. Additionally, risk factors associated with prognosis were also analyzed with Cox regression analysis. Results: The objective response rate (ORR) in the JHZ group was higher than that in the HZ group and JZ group, but there was no significant difference between the 3 groups. Also, the patients in the JHZ group had the longest OS and median PFS. Further Cox regression analysis suggested that hyperbilirubinemia was an independent risk factor for OS in secondary HLH patients. Conclusions: A combination of corticosteroids therapy, chemotherapy and supportive therapy is superior to the other 2 regimens in the clinical benefit in the treatment of secondary HLH in adults, and thus may be a preferred and feasible treatment regimen. Moreover, hyperbilirubinemia was a risk factor for prognosis that has crucial guiding significance for clinical treatment of patients with secondary HLH. [ABSTRACT FROM AUTHOR]

Crigler–Najjar Syndrome (CNS) is a rare genetic disorder caused by mutations in the UGT1A1 gene, leading to impaired bilirubin conjugation and severe unconjugated hyperbilirubinemia. CNS presents in the following forms: CNS type 1 (CNS1), the more severe form with the complete absence of UGT1A1 activity, and CNS type 2 (CNS2), with partial enzyme activity. This narrative review aims to provide a detailed overview of CNS, highlighting its clinical significance and the need for new, more effective treatments. By summarizing current knowledge and discussing future treatments, this article seeks to encourage further research and advancements that can improve outcomes for CNS patients. The literature analysis showed that CNS1 requires aggressive management, including phototherapy and plasmapheresis, but liver transplantation (LT) remains the only definitive cure. The timing of LT is critical, as it must be performed before the onset of irreversible brain damage (kernicterus), making early intervention essential. However, LT poses risks such as graft rejection and lifelong immunosuppression. CNS2 is milder, with patients responding well to phenobarbital and having a lower risk of kernicterus. Recent advancements in gene therapy and autologous hepatocyte transplantation offer promising alternatives to LT. Gene therapy using adeno-associated virus (AAV) vectors has shown potential in preclinical studies, though challenges remain in pediatric applications due to liver growth and pre-existing immunity. Autologous hepatocyte transplantation avoids the risk of rejection but requires further research. These emerging therapies provide hope for more effective and less invasive treatment options, aiming to improve the quality of life for CNS patients and reduce reliance on lifelong interventions. [ABSTRACT FROM AUTHOR]

Background: Infantile jaundice affects up to 84% of term infants and is a primary cause of re-hospitalization. Phototherapy, the primary therapeutic intervention, may be associated with several complications. Therefore, employing additional compensatory therapies could reduce the duration of phototherapy and its adverse effects. Methods: A single-blind randomized clinical trial was conducted on newborns with indirect hyperbilirubinemia (IHB) undergoing phototherapy. Patients were randomly assigned to two groups: the intervention group received phototherapy and 10mg/kg of Ursodeoxycholic acid, taken twice a day with water as the solvent, while the control group received phototherapy and a placebo (water). Total bilirubin levels were measured every 12 hours, and the groups were compared regarding the reduction duration of bilirubin <10 mg/dl and the duration of phototherapy. Data analysis used SPSS-V22 software, with statistical tests done at a significance level of <0.05. Results: In total, 128 neonates, comprising 56 (43.8%) males and 72 (56.2%) females, with a mean gestational age of 39.02±0.86 weeks and a mean age of 2.77±1.45 days, were subjected to analysis. After 96 hours, the mean bilirubin level was 9.23±2.81 mg/dl overall, 7.27±2.12 mg/dl in the case group, and 10.91±2.17 mg/dl in the control group (p<0.001). The mean time to reach a bilirubin level below 10 mg/dl was 51.66±17.27 hours overall, 58.38±10.05 hours for the case group, and 62.61±14.39 hours for the control group (p<0.001). Conclusion: Ursodeoxycholic acid (UDCA) effectively reduces elevated bilirubin levels and the duration of phototherapy when employed as an adjunct treatment to phototherapy in cases of infantile indirect hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Background: Neonatal jaundice is a commonly seen clinical condition globally, including in India seen in nearly 60% of subjects born at term and 80% of neonates born pre-term in their first week of life and is the most common cause of readmission in neonates. Aim: The present study aimed to assess the predictive value of umbilical cord blood albumin level for developing neonatal jaundice in healthy neonates born at term and the usefulness of cord blood albumin for predicting subsequent significant neonatal jaundice development. Materials and Methods: The present study assessed 200 healthy term neonates where cord blood albumin level was estimated at birth. Estimation of total serum bilirubin was done for all the neonates at birth. Estimation of total serum bilirubin was done in all the neonates with clinically suspected jaundice at the age of 72-96 hours. The neonates were divided into three groups I, II, and III depending on cord albumin levels of <2.8g/dL, 2.8-3.3 g/dL, and >3.3 g/dL respectively. The main outcome assessed was concerning serum bilirubin =17 mg/dL, exchange transfusion, and the need for phototherapy. Results: Groups I, II, and III had 42, 70, and 88 newborns respectively. In Group I, 85.7% (n=36) neonates had total bilirubin of >17 mg/dL, among which 76.19% (n=32) needed phototherapy, and 9.52% (n=4) subjects required exchange transfusion. In Group II. 65.7% (n=46) neonates developed jaundice whereas phototherapy was needed in 34.2% (n=24) neonates and no subjects needed exchange transfusion. In Group III, 34.09% (n=30) neonates developed jaundice here 2.2% (n=2) subjects needed phototherapy, and no subjects needed exchange transfusion which depicted a statistically significant difference with p<0.001. Conclusion: The present study concludes that cord blood albumin level of =2.8g/dL is a significant risk factor for the development of neonatal hyperbilirubinemia that needs early intervention, whereas, cord blood albumin >3.3 g/dL is usually the safe criteria for early discharge. [ABSTRACT FROM AUTHOR]

Hemolytic disease of the fetus and newborn (HDFN) results from the destruction of the newborn's red blood cells or the fetus by the mother's immune globulin G antibodies. Although HDFN is often caused by RhD and ABO incompatibility, it can also be seen due to minor blood groups such as Kell, Kidd, Duffy, P, MNS, or Rh subgroup (C, c, E, e) alloantibodies. Our study aims to share our experiences regarding a rare cause of HDFN. The files of patients who were followed up with the diagnosis of jaundice in a third-level Neonatology Unit of a university hospital between January 2014 and September 2023 were retrospectively examined. Eleven patients with Kell incompatibility were included in the study. There was no ABO/RhD incompatibility in any case. RhD subgroup incompatibility and Kell incompatibility were present in four cases. Phototherapy was applied to all patients. The patient, whose total bilirubin level was high despite phototherapy, was treated with an exchange transfusion. No complications were observed due to treatment or high total bilirubin. No significant difference was observed between the parameters evaluated according to the gender variable. It should be kept in mind that severe hemolysis and related deaths may occur due to Kell incompatibility. In order to reduce and prevent severe hemolysis due to Kell and other minor blood groups in newborns, transfusing blood products suitable for minor blood groups to women of childbearing age (especially pregnant women) may be a correct approach as a country policy. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is a common cause of acute abdomen requiring surgical intervention. Delayed diagnosis can lead to serious complications such as appendiceal perforation. Recent studies suggest that hyperbilirubinemia could be a useful predictor for appendiceal perforation [6-8]. Aim: To investigate the relationship between elevated serum bilirubin levels and the likelihood of appendiceal perforation in patients diagnosed with acute appendicitis. Methods: This prospective observational study was conducted at the Department of General Surgery, SS Institute of Medical Sciences and Research Centre, Davangere, from March 2022 to March 2024. Patients diagnosed with acute appendicitis or appendiceal perforation were included. Demographic data, clinical signs, and laboratory results, including serum bilirubin levels, were collected. Statistical analyses, including independent samples ttests and chi-square tests, were performed to compare bilirubin levels between groups and to assess the association between bilirubin levels and appendicitis. Results: The study included 100 patients with a mean age of 45.7 years, 41% of whom were female. Elevated serum bilirubin levels were significantly associated with the presence of appendicitis (p < 0.001). Patients with appendicitis had higher mean total bilirubin (1.193 mg/dL vs. 0.704 mg/dL), indirect bilirubin (0.811 mg/dL vs. 0.479 mg/dL), and direct bilirubin levels (0.530 mg/dL vs. 0.218 mg/dL) compared to those without appendicitis. Among patients with elevated bilirubin levels, 63.6% had appendicitis compared to 3.6% without appendicitis, indicating a significant association (χ² = 42.3, df = 1, p < 0.001). Conclusion: Elevated serum bilirubin levels are significantly associated with acute appendicitis and can serve as a reliable marker for predicting appendiceal perforation. Incorporating bilirubin measurements into the diagnostic protocol for appendicitis can enhance early detection and improve patient outcomes. Further multicentric studies with larger sample sizes are needed to validate these findings. [ABSTRACT FROM AUTHOR]

The most efficient emission spectrum of light for phototherapy is blue‐green light emission diode light with peak emission at 478 nm. In the irradiance interval of phototherapy, the relationship between efficacy and irradiance is almost linear, and it is negatively related to the haemoglobin. The action sites of phototherapy are the extravascular compartment and cutaneous blood. The most immature neonates treated aggressively had not only a lower frequency of neurodevelopmental impairment than conservatively treated, but also greater mortality. Intermittent and continuous phototherapy are assumed to be equally efficient. Home‐based fibreoptic phototherapy is effective and safe. Important progress is still occurring in phototherapy. [ABSTRACT FROM AUTHOR]

Extreme levels of bilirubin in newborn is a major cause of lifelong neurodevelopmental impairment, which places a financial burden on healthcare resources and caregivers. To determine the incidence, aetiology and short-term outcomes of extreme hyperbilirubinaemia in term infants born in a resource-limited setting. This is a retrospective observational study looking at term neonates with a birth weight ≥2500 g, born in the Western health subdistrict of Cape Town, South Africa, between 1 January 2019 and 31 December 2020, who were exposed to a serum bilirubin level of ≥430 μmol/L in the first week of life and received care in the public health system. Extreme hyperbilirubinaemia occurred in 59 term infants. The incidence was 74 cases per 100 000 (<0.01%) live births equating to 1 case in every 1345 live births. The cause of hyperbilirubinaemia was identified in 51 of the cases (86%), the most common being ABO incompatibility (31/51, 61%), followed by glucose-6-phosphate dehydrogenase deficiency (11/51, 22%). Twelve infants (20 %) underwent an exchange transfusion. Six infants were encephalopathic. Forty-seven infants (80%) were readmitted after initial post-natal discharge, with a mean age of readmission of 113 h old (SD 31 h). The incidence of extreme hyperbilirubinaemia in the Western health subdistrict of Cape Town is higher than in high-income settings. Further work should focus on training of healthcare workers and education of caregivers, for the early detection of significant hyperbilirubinaemia to prevent neurological complications caused by bilirubin toxicity. [ABSTRACT FROM AUTHOR]

Objective This study aimed to compare rehospitalization rates, diagnoses, and well-baby nursery (WBN) length of stay (LOS) among rehospitalized infants born during the COVID-19 pandemic to those born prior. Study Design A retrospective comparison of 215 infants rehospitalized from March 1, 2019, to March 1, 2021, was performed in an urban academic center. Rates of readmission were determined for all infants using an unadjusted odds ratio. Among infants rehospitalized at ≤30 and ≤7 days, key cohort characteristics were analyzed using chi-square analysis, Fisher's exact test, independent t -test, and nonparametric testing as applicable. Differences in readmission diagnoses determined by International Classification of Diseases (ICD) code and chart review were evaluated with multivariable logistic regression comparing infants born during the pandemic to the year prior. Results Pandemic infants had a 51% increased odds of rehospitalization ≤7 days of discharge from WBN compared with prepandemic infants (95% confidence interval [CI]: 1.09–2.09). Rehospitalized infants born during the pandemic had shorter WBN LOS; infants rehospitalized ≤30 days had LOS of 54.3 ± 18.6 versus 59.6 ± 16.2 hours (p = 0.02) and infants rehospitalized ≤7 days had LOS of 53.8 ± 17.8 versus 60.8 ±17.0 hours (p = 0.02). The pandemic group of infants had a 3.5 increased odds of being readmitted for hyperbilirubinemia compared with other diagnoses after adjusting for biological sex, ethnicity, percent weight lost at time of discharge, gestational age, and mode of delivery (CI 1.9, 6.4). Conclusion Rehospitalization ≤7 days post-WBN discharge was more common in infants born during the pandemic. Infants rehospitalized during the pandemic were more likely to have shorter WBN LOS and to be rehospitalized for hyperbilirubinemia. Retrospective analyses limit conclusions about causation but suggest that being born during the pandemic increased risk of rehospitalization for hyperbilirubinemia among infants in urban, under resourced setting warranting further investigation. Key Points Newborns rehospitalized during the pandemic had a shorter newborn nursery stay. Newborns in the pandemic had a higher rate of rehospitalization within 7 days of birth compared to year prior. More infants who required readmission during the pandemic were hospitalized for hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

More than 80% of newborn infants experience jaundice as a result of elevated bilirubin during the first few weeks after birth. In most cases, hyperbilirubinemia is physiologic, but persistent and extreme elevations can lead to serious long-term complications, such as kernicterus. To avoid these complications and help clinicians in the successful assessment, evaluation, and treatment of hyperbilirubinemia, the American Academy of Pediatrics updated its clinical practice guideline for neonatal hyperbilirubinemia. This article reviews the guideline and highlights significant updates, such as an elevation in the threshold for phototherapy and exchange transfusion, inclusion of gestational age, and removal of racially based norms. [ABSTRACT FROM AUTHOR]

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Introduction: Gestational Diabetes Mellitus (GDM), a common medical complication of pregnancy, is an independent risk factor for obstetric complications and adverse perinatal outcomes. Insulin has been the treatment modality for many years. Recent studies indicate that metformin, an oral hypoglycaemic agent, may be a safe and effective alternative. Aim: To evaluate and compare the effectiveness of metformin and insulin in managing glycaemic control, and assessing maternal and newborn outcomes among women diagnosed with GDM. Materials and Methods: The present prospective cohort study was conducted in the Department of Obstetrics, Fernandez Hospital, Hyderabad, Telangana, India, from December 2020 to November 2021. The study population included women attending antenatal check-ups after meeting the inclusion and exclusion criteria. Those who failed to respond to lifestyle modifications were started on either metformin or insulin as per the attending physician’s advice. A total of 369 pregnant women were included in the study. Parameters such as weight gain during pregnancy, need for additional pharmacologic treatment, maternal hypoglycaemia, onset of Hypertensive Disorders of Pregnancy (HDP), gestational age at delivery, mode of delivery and neonatal details such as birth weight, occurrence of Large for Gestational Age (LGA), Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, birth injuries, neonatal hypoglycaemia, hyperbilirubinemia, respiratory distress, and neonates requiring Neonatal Intensive Care Unit (NICU) admissions were recorded. Data were subjected to statistical analysis. Analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 22.0. A p-value of

Background and Objectives: Double-volume exchange transfusion (DVET) is a life-saving procedure that replaces a neonate’s blood volume twice over with adult donor blood to treat neonatal hyperbilirubinemia and prevent kernicterus. This study assessed DVET’s effectiveness in reducing total serum bilirubin (TSB) concentration in neonates at risk of kernicterus and examined the disease conditions that necessitate DVET. Methods: This observational study assessed the effectiveness of DVET in 104 neonates at risk of kernicterus. Neonates meeting the American Academy of Pediatrics guidelines were selected. Blood samples were collected before and 24 h after DVET for TSB estimation and complete blood count analysis. Blood components were selected based on ABO, Rh, and other minor blood group incompatibility. DVET was performed using the push–pull method. Results: This study of DVET in 104 neonates with hyperbilirubinemia found that DVET is an effective treatment, reducing TSB levels by 61.72% on average. The most common cause of hyperbilirubinemia was idiopathic (25.6%), followed by ABO incompatibility (22.12%) and anti-D alloimmunization (17.31%). In hypothyroid, preterm, and sepsis cases, hemoglobin levels decreased by an average of 17.7%, 12.9%, and 13.9%, respectively, after DVET. However, in cases of minor alloimmunization and anti-D alloimmunization, hemoglobin levels increased by an average of 29% and 40.5%, respectively, after DVET. The maximum decrease in TSB level was observed in cases of ABO incompatibility with sepsis (82%), while the minimum decrease was seen in neonates undergoing DVET due to sepsis (50%). The percentage reduction of TSB level after DVET was similar for different etiologies, ranging from 50.2% to 65.4%. Conclusion: DVET is a rarely used procedure in the age of phototherapy and intravenous immunoglobulin for neonatal hyperbilirubinemia. However, it is the only effective treatment for very high bilirubin levels to prevent kernicterus or bilirubin encephalopathy.

Abstract Background Acute pancreatitis following cardiac surgery is a rare complication. Early recognition of risk factors and vigilance toward initial symptoms can prevent significant morbidity and mortality. Bowel ischemia and the release of inflammatory mediators during cardiopulmonary bypass play key roles in the development of acute postoperative pancreatitis. Management is generally conservative, following the modified Atlanta 2012 criteria. This paper reviews the literature and emphasizes the importance of early investigation of abdominal pain after cardiac surgery. Case presentation We report a case of severe acute pancreatitis that developed after double valvular replacement, performed during a 3-h cardiopulmonary bypass in a patient who initially had endocarditis and underwent dialysis 3 times. Considering the risk factors, the patient was diagnosed early and managed conservatively, leading to a positive outcome. Conclusions Anesthesiologists must not disregard abdominal pain after cardiac surgery in the context of risk factors, as it may indicate gastrointestinal complications, including pancreatitis, which can be among the most dangerous complications if not treated promptly.