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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 purpose of the study was to investigate correlation and concordance between total serum bilirubin (TSB) and transcutaneous bilirubin measured at covered (TcBC) and uncovered (TcBU) skin during and after discontinuation of phototherapy. A cross-sectional study included ≥ 34 weeks gestation infants requiring phototherapy for neonatal hyperbilirubinemia. In-house, photo-opaque patches were placed on infants' sternums before phototherapy initiation. Simultaneous blood sampling for TSB, TcBC, and TcBU measurements were performed. Among 103 infants included in the final analysis, 70% were full-term. Covering skin during phototherapy resulted in strong TcBC-TSB correlation (r = 0.91, 95% CI 0.87–0.94, P < 0.001) compared to TcBU (r = 0.53, 95% CI 0.37–0.65, P < 0.001), persisting post-phototherapy (r = 0.88, 95% CI 0.82–0.91, P < 0.001). Bland–Altman analysis showed a higher mean difference and wider 95% limits of agreement for TcBU-TSB during phototherapy (-6.3 mg/dL and -11.1 to -1.6) vs TcBC-TSB (0.9 mg/dL and -1.2 to 2.9). Passing-Bablok regression analysis confirmed good agreement between TcBC and TSB. Conclusions: The application of in-house, photo-opaque patches enhanced the correlation and agreement between TcBC and TSB during and after discontinuation of phototherapy. This may prove particularly useful in resource-limited settings where commercial devices are unavailable. What is Known: • Transcutaneous bilirubin measurement has been widely used as a screening method for neonatal hyperbilirubinemia. • The accuracy of transcutaneous bilirubin measurements during and after phototherapy in infants with hyperbilirubinemia has been debated. What is New: • Our study demonstrated that utilizing carefully designed photo-opaque patches enhanced the accuracy of transcutaneous bilirubin measurement during and after phototherapy. • Effective in-house alternatives are crucial in resource-limited settings where commercial opaque patches are not always accessible or affordable. [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]

Background & Objective: The father contributes in the chromosomal make-up of the child, in addition he is contributing in the environment for the fetal development as example; smoking. The aim of this study was to determine the effect of paternal general health and age as a risk on pregnancy outcome in name of preterm or post term, low birth weight, admission to neonatal care unit, neonatal jaundice and congenital anomaly. Materials & Methods: This was population based cross-sectional descriptive study conducted in Iraq/Babil in time period of 3rd of March 2022 to 3rd of March 2023, online questionnaire was published as a Google form, and Iraqi couple filled it voluntary, the data then was analyzed using SPSS version 22. Results: In the research of 333 parents, 3% had parents aged ≥40, 65.8% had parents aged <30, 31.2% had parents aged 30-39, 82.3 % (274) were government employees, 35.7% were smokers, and 58.6% did not smoke. A study found a significant correlation between paternal occupation and poor pregnancy outcomes, including preterm or post term birth, low birth weight, admission to NICU, neonatal jaundice, and congenital anomalies (p value 0.046). However, age did not significantly affect outcomes after controlling for maternal demographics, medical history, and lifestyle factors (P < 0.05). Conclusion: Paternal factors do not appear to be an independent risk of adverse pregnancy outcomes apart from occupation. [ABSTRACT FROM AUTHOR]

Filtered-sunlight phototherapy (FSPT) that blocks ultraviolet light and reduces infrared radiation is safe and non-inferior to intensive electric phototherapy (IEPT) for treating mild-to-severe neonatal hyperbilirubinemia. In this randomized non-inferiority trial, the safety, efficacy, exchange transfusion (ET), and mortality rates of FSPT versus IEPT among Nigerian neonates with severe-to-hazardous hyperbilirubinemia were investigated. Safety was defined as the absence of hyperthermia, hypothermia, dehydration, or sunburn; efficacy by the proportion of assessable treatment days during which total serum or plasma bilirubin (TSB) increased by < 0.2 mg/dL/hr for newborns aged ≤ 72 h-old or decreased for newborns > 72 h-old. A treatment day was deemed assessable if a neonate received phototherapy for ≥ 4 h, and non-inferiority was inferred for differences within a 10% margin. We enrolled 192 newborns (admission TSB ≤ 62 mg/dL), assigned to FSPT (n = 98) or IEPT (n = 94). FSPT was effective on 94.2% of the assessable treatment days compared with 97.1% for IEPT. The mean difference in efficacy between FSPT and IEPT was -2.9%, 95% CI: -7.6, 1.9). 2.6% of newborns who received FSPT developed controlled hyperthermia, and no baby met the criteria for withdrawal for safety reasons. Overall, 50.6% (39/77) of newborns who received FSPT and 53.7% (51/95) of newborns who received IEPT had ET (p = 0.89) and 7 in each group (9.1% vs 7.4%; p = 0.86) died. In conclusion, FSPT is safe and non-inferior to IEPT for treating neonates with severe-to-hazardous hyperbilirubinemia, it is not associated with significantly higher rates of ET and mortality and should be considered where practicable when IEPT cannot be assured. Clinical Trials.gov Number: NCT02612727 (24/11/2015). [ABSTRACT FROM AUTHOR]

Neonatal hyperbilirubinemia (NH) is a common condition in newborns, with elevated bilirubin levels potentially causing neurological damage or death. Accurate and timely measurements of total serum bilirubin are essential to prevent these outcomes. Direct spectrophotometry, a reliable method for measuring bilirubin, is particularly useful in constrained settings due to its potential for portable low-cost instrumentation. However, this method is susceptible to interference from hemoglobin, often present due to hemolysis. Typically, this interference is reduced using complex optical filters, reagents, multiple wavelengths, or combinations thereof, which increase costs and complexity while reducing usability. This study presents a hemoglobin compensation algorithm applied to a simple, portable, two-wavelength (465 and 590 nm) reflectance photometer designed to receive 30 µL of plasma or whole blood samples and perform the measurement without any reagents. Testing across five bilirubin and hemoglobin levels (4.96 to 28 mg/dL and 0.06 to 0.99 g/dL, respectively) demonstrated that the algorithm effectively reduces hemoglobin interference and overestimation errors. The overall root mean square error was reduced from 4.86 to 1.45 mg/dL, while the measurement bias decreased from −4.46 to −0.10 mg/dL. This substantial reduction in overestimation errors supports future clinical trials with neonatal blood samples. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal mortality is a major contributor to under-five deaths yet the main causes of these deaths are preventable. Postnatal health education programs can improve timely detection and care seeking for newborn morbidities such as neonatal jaundice (NNJ). Being a common occurrence in low-income countries, it is surprising that women do not have sufficient knowledge about NNJ. Although the knowledge can be improved through routine education programs, healthcare providers rarely engage women in evaluating such programs, which limits their uptake and sustainability. Methods: This was a qualitative study evaluating a postnatal neonatal jaundice health education program conducted at Jinja Regional Referral Hospital (JRRH). Narrative data on the structure, design, and delivery of the program was recorded from 12 postnatal women through unstructured interviews. The participants were those who had taken part in an enhanced NNJ education program. Qualitative content analysis, guided by the Consolidated Framework for Implementation Research (CFIR) was performed. Results: Using the CFIR, two themes were identified; the intervention characteristics domain and the individual domains. The constructs under these domains were intervention design quality and packaging, relative advantage, and maternal knowledge needs. The augmented nature of the intervention, sorting individual needs, ability to promote continuity of care, and care-seeking were identified as key facilitators. Lack of group interaction was identified by some women as a possible barrier. Conclusion: Overall, the education program was positively perceived by women and preferred compared to the conventional method of health education. In low-resource settings where maternal health education can contribute to a reduction in newborn mortality, the design, implementation, and evaluation of maternal education programs should be informed by women's preferences. Healthcare providers should utilize multiple sources of information and routinely practice patient-centered evaluation to meet the changing knowledge demands of postnatal women. [ABSTRACT FROM AUTHOR]

Background: Traditional fixed thresholds for oral glucose tolerance test (OGTT) results may inadequately prevent adverse pregnancy outcomes in twin pregnancies. This study explores latent OGTT patterns and their association with adverse outcomes. Methods: This study retrospectively analyzed 2644 twin pregnancies using latent mixture models to identify glucose level patterns (high, HG; medium, MG; and low, LG) and their relationship with maternal/neonatal characteristics, gestational age at delivery, and adverse outcomes. Results: Three distinct glucose patterns, HG, MG, and LG patterns were identified. Among the participants, 16.3% were categorized in the HG pattern. After adjustment, compared with the LG pattern, the HG pattern was associated with a 1.79‐fold, 1.66‐fold, and 1.32‐fold increased risk of stillbirth, neonatal respiratory distress, and neonatal hyperbilirubinemia, respectively. The risk of neonatal ICU admission for MG and HG patterns increased by 1.22 times and 1.32 times, respectively, compared with the LG pattern. As gestational weeks increase, although there is an overlap in the confidence intervals between the HG pattern and other patterns in the restricted cubic splines analysis, the trend suggests that pregnant women with the HG pattern are more likely to face risks of their newborns requiring neonatal intensive care unit admission, and adverse comprehensive outcomes, compared with other patterns. In addition, with age and body mass index increasing in HG mode, gestation weeks at delivery tend to be later than in other modes. Conclusion: Distinct OGTT glucose patterns in twin pregnancies correlate with different risks of adverse perinatal outcomes. The HG pattern warrants closer glucose monitoring and targeted intervention. [ABSTRACT FROM AUTHOR]

Background: Neonatal jaundice is a common condition affecting newborns worldwide, with potential longterm health implications. Previous studies have suggested a correlation between low birth weight (LBW) and increased risk of neonatal jaundice, yet comprehensive analyses incorporating gestational age, maternal health, and prenatal care remain limited. Methods: This observational study analyzed data from 100 newborns, categorized by birth weight into LBW (<2500 grams) and normal birth weight (NBW, ≥2500 grams) groups. We assessed the incidence of neonatal jaundice, conducted a chi-square test to explore the association between birth weight and jaundice, and utilized a T-test to examine differences in gestational age. Additional analyses included the impact of gender distribution, maternal hypertension, and prenatal care on the incidence of jaundice. Results: Our findings indicate that 80% of LBW newborns developed neonatal jaundice, compared to 30% of NBW newborns. Statistical analysis revealed a significant association between LBW and increased incidence of jaundice (χ²=22.36, p<0.001). LBW newborns were also significantly more likely to be born preterm compared to their NBW counterparts (t=7.88, p<0.001). Maternal hypertension and lower rates of prenatal care utilization were significantly associated with LBW. Conclusion: The study confirms a significant correlation between LBW and the increased incidence of neonatal jaundice. It highlights the importance of addressing factors such as maternal health and prenatal care to mitigate the risks associated with LBW and neonatal jaundice. Further research is recommended to explore targeted interventions for pregnant women and LBW newborns. [ABSTRACT FROM AUTHOR]

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Background: Neonatal jaundice is a leading cause of death and disability among newborns in sub-Saharan Africa, due in large part to late identification of an otherwise treatable illness. The burden of NNJ recognition and care-seeking falls on infant caretakers and community health workers (CHWs), who are in charge of both maternal education and neonatal home visits. Objective: This study sought to understand community health workers' (CHW) knowledge and perceptions of community beliefs surrounding neonatal jaundice (NNJ), a treatable but potentially fatal condition prevalent in sub-Saharan Africa. Methods: In this cross-sectional qualitative study, CHWs in Kumasi, Ghana, completed in-depth interviews with trained research assistants using a semi-structured interview guide. Interviews were audiotaped, transcribed verbatim, and analyzed using grounded theory methodology. Results: Knowledge of NNJ varied widely among the 23 respondents: 74% knew NNJ could cause death, 57% knew how to screen for NNJ. 35% of CHWs favored home treatment (sunlight therapy or watchful waiting). Three main themes emerged: CHWs perceived that caregivers prefer home treatment, equating hospital care with death; sunlight and herbs are the most common home treatments; and caregivers attribute NNJ to supernatural causes, delaying jaundice diagnosis. Conclusion: Incomplete understanding of NNJ among trained CHWs and local communities will require improved education among both groups to improve outcomes. [ABSTRACT FROM AUTHOR]

Bilirubin is a product of the metabolism of hemoglobin from red blood cells. Higher levels of bilirubin are a sign that either there is an unusual breaking down rate of red blood cells or the liver is not able to eliminate bilirubin, through bile, into the gastrointestinal tract. For adults, bilirubin is occasionally monitored through urine or invasive blood sampling, whilst all newborns are routinely monitored visually, or non-invasively with transcutaneous measurements (TcBs), due to their biological immaturity to conjugate bilirubin. Neonatal jaundice is a common condition, with higher levels of unconjugated bilirubin concentration having neurotoxic effects. Actual devices used in TcBs are focused on newborn populations, are hand-held, and, in some cases, operate in only two wavelengths, which does not necessarily guarantee reliable results over all skin tones. The same occurs with visual inspections. Based on that, a continuous bilirubin monitoring device for newborns is being developed to overcome visual inspection errors and to reduce invasive procedures. This device, operating optically with a mini-spectrometer in the visible range, is susceptible to patient movements and, consequently, to situations with a lower signal quality for reliable bilirubin concentration estimates on different types of skin. Therefore, as an intermediate development step and, based on skin spectra measurements from adults, this work addresses the device's placement status prediction as a signal quality indication index. This was implemented by using machine learning (ML), with the best performances being achieved by support vector machine (SVM) models, based on the spectra acquired on the arm and forehead areas. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding provides vital nutrients and fosters maternal–infant bonding, benefiting both mother and child. However, breastfeeding duration is influenced by various factors, especially in women of high-risk pregnancy. This study aims to identify predictors of breastfeeding duration among women of high-risk and low-risk pregnancy, focusing on exclusive and mixed feeding practices. Methods: Conducted at a public hospital in Attica, Greece, this 20-month prospective cohort study (May 2020–January 2022) included 380 pregnant women, divided into high-risk and low-risk groups. The final sample of 157 women, after excluding non-breastfeeding participants, was assessed across five phases from prenatal to six months postpartum using interviews, calls, and surveys. Multiple linear regression identified key predictors, with statistical methods applied. Results: Results revealed birth weight as a consistent significant predictor of breastfeeding duration. For women with high-risk pregnancy, additional factors like infant gender, jaundice, and early introduction of solid foods influenced breastfeeding duration. The mixed breastfeeding model for women with high-risk pregnancy explained 72.9% of the variance. Exclusive and mixed breastfeeding models for women with low-risk pregnancy also highlighted birth weight's influence. Conclusion: The findings highlight the important role of birth weight and other specific factors in determining breastfeeding duration among women of high-risk and low-risk pregnancy. Further research is needed to validate these findings across diverse populations. [ABSTRACT FROM AUTHOR]

Objective: Neonatal jaundice is a common problem and is the most common cause of hospitalization. We aimed to determine the characteristics and etiological factors of late preterm and term newborns hospitalized due to indirect hyperbilirubinemia. Methods: Late preterm and term newborns hospitalized between January 1,2009 and December 31,2014 with a diagnosis of indirect hyperbilirubinemia were included. Demographic and clinical characteristics, duration, and patterns of treatment were obtained retrospectively. Etiological factors were determined. Result: Late preterm and term infants with indirect hyperbilirubinemia were included (n=412). 54.6% of the patients were male, 40.8 % were first babies, the mean gestational age was 38.3±1.1 weeks, and the mean birth weight was 3031±520 grams. 84.5 % were exclusively breastfed. The time of presentation was 4.6 ±2.6 days, and the serum total bilirubin level was 18.6 ±4.7 mg/dl. ABO incompatibility was found in 29 %, dehydration in 10.7 %, and Rh incompatibility in 7.1% of the patients. The mean duration of hospitalization was 3.1 ±2.2 days, and the mean duration of phototherapy was 44.8±22.8 hours. 16 patients received intravenous immunoglobulin. An exchange transfusion was performed in 14 patients. In the group with a serum total bilirubin level of ≥ 20 mg/dl, male gender and normal spontaneous vaginal delivery were statistically significantly higher than the group with a serum total bilirubin level below 20 mg/dl (p = 0.02 for both). Conclusion: Indirect hyperbilirubinaemia, which is common in the neonatal period, should be recognized early and is a treatable condition. We should promptly identify and treat the cause before complications arise. [ABSTRACT FROM AUTHOR]

Measurement of total bilirubin (TBil) concentration in serum is the gold standard approach for diagnosing neonatal unconjugated hyperbilirubinemia. It is of utmost importance that the measured TBil concentration is sufficiently accurate to prevent under treatment, unnecessary escalation of care, or overtreatment. However, it is widely recognized that TBil measurements urgently require improvement in neonatal clinical chemistry. External quality assessment (EQA) programs for TBil assess for differences between laboratories and provide supporting evidence of significant differences between various methods, manufacturers and measurement platforms. At the same time, many countries have adopted or only slightly adapted the neonatal hyperbilirubinemia management guidelines from the USA or UK, often without addressing differences in the methodology of TBil measurements. In this report, we provide an overview of the components of bilirubin that are measured by laboratory platforms, the availability of current reference measurement procedures and reference materials, and the role of EQA surveys in this context. Furthermore, the current status of agreement in neonatal bilirubin against clinical decision thresholds is reviewed. We advocate for enhancements in accuracy and comparability of neonatal TBil measurements, propose a path forward to accomplish this, and reflect on the position of the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Working Group Neonatal Bilirubin (WG-NB) in this matter. [ABSTRACT FROM AUTHOR]

This letter discusses the issue of standardizing the measurement of neonatal bilirubin levels, which is important for the management of jaundice in newborns. The authors highlight the potential errors and delays in decision-making that can occur due to inter-technical differences in bilirubin measurement methods. They present a case study to illustrate the impact of these differences on pediatric care. The authors suggest actions that clinical laboratories and healthcare providers can take to improve the accuracy and efficiency of bilirubin measurement and management. They emphasize the need for international harmonization and collaboration in this area. [Extracted from the article]

OBJECTIVE: To summarize the principles and application of phototherapy consistent with the current 2022 American Academy of Pediatrics "Clinical Practice Guideline Revision for the Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation." METHODS: Relevant literature was reviewed regarding phototherapy devices in the United States, specifically those that incorporate blue to blue-green light-emitting diode, fluorescent, halogen, or fiberoptic light sources, and their currently marketed indications. RESULTS: The efficacy of phototherapy devices varies widely because of nonstandardized use of light sources and configurations and irradiance meters. In summary, the most effective and safest devices have the following characteristics: (1) incorporation of narrow band blue-to-green light-emitting diode lamps (~460-490 nm wavelength range; 478 nm optimal) that would best overlap the bilirubin absorption spectrum; (2) emission of irradiance of at least 30 µW/cm²/nm (in term infants); and (3) illumination of the exposed maximal body surface area of an infant (35% to 80%). Furthermore, accurate irradiance measurements should be performed using the appropriate irradiance meter calibrated for the wavelength range delivered by the phototherapy device. CONCLUSIONS: With proper administration of effective phototherapy to an infant without concurrent hemolysis, total serum or plasma bilirubin concentrations will decrease within the first 4 to 6 hours of initiation safely and effectively. [ABSTRACT FROM AUTHOR]

To evaluate the risk of epilepsy in children who received neonatal phototherapy. A cohort of live singletons born at a Danish hospital (2002–2016) with a gestational age ≥ 35 weeks. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of epilepsy in children treated with neonatal phototherapy compared to children not treated with neonatal phototherapy in the general population, and in a subpopulation of children who had serum bilirubin measurement. Adjusted HRs (aHR) were computed using multivariable and propensity score matching models to take maternal and neonatal factors into consideration. Children were followed from day 29 after birth to diagnosis of epilepsy, death, emigration, or December 31, 2016. Among 65,365 children, 958 (1.5%) received neonatal phototherapy. Seven children (incidence rates (IRs): 10.8 /10,000 person-years) who received neonatal phototherapy and 354 children (IR: 7.7) who did not receive neonatal phototherapy were diagnosed with epilepsy. Neonatal phototherapy was not associated with an increased risk of epilepsy using the multivariable (aHR 0.95, 95% CI: 0.43–2.09) and propensity score matched (aHR 0.94, 95% CI: 0.39–2.28) models. In the subpopulation of 9,378 children with bilirubin measurement, 928 (9.9%) received neonatal phototherapy. In the analysis of the subpopulation in which bilirubin level and age at the time of bilirubin measurement were further taking into consideration, neonatal phototherapy was not associated with an increased risk of epilepsy using the multivariable (aHR 1.26, 95% CI: 0.54–2.97) and propensity score matched (aHR 1.24, 95% CI: 0.47–3.25) models, Conclusions: Neonatal phototherapy was not associated with an increased risk of epilepsy after taking maternal and neonatal factors into consideration. What is known: • A few studies have suggested that neonatal phototherapy for hyperbilirubinemia may increase the risk of childhood epilepsy. • Whether the observed associations contribute to hyperbilirubinemia, phototherapy, or underlying factors requires further investigation. What is new: • This study revealed no increased risk of epilepsy in children treated with neonatal phototherapy compared to children not treated with phototherapy after taking maternal and neonatal factors into consideration. • After further taking bilirubin level and age at the time of bilirubin measurement into consideration, neonatal phototherapy was not associated with an increased risk of epilepsy. [ABSTRACT FROM AUTHOR]

Glucose-6-phosphate dehydrogenase (G6PD) deficiency and variants of the UDP-glucuronosyltransferase 1A1 (UGT1A1) gene are the most common genetic causes of neonatal unconjugated hyperbilirubinemia (NUH). In this review, we searched PubMed for articles on the genetic causes of NUH published before December 31, 2022, and analyzed the data. On the basis of the results, we reached eight conclusions: (1) 37 mutations of the G6PD gene are associated with NUH; (2) the clinical manifestation of G6PD deficiency depends not only on ethnicity but also on the molecular mechanisms underlying the deficiency (and thus its severity); (3) of mutations in the UGT1A1 gene, homozygous c.−53A(TA) 6 TAA > A(TA) 7 TAA is the main cause of NUH in Caucasians and Africans, whereas homozygous c.211G > A is the main genetic cause of NUH in East Asians; (4) in Indonesian neonates, homozygous c.−3279T > G is the most common cause of NUH development, and neither c.−53 A(TA) 6 TAA > A(TA) 7 TAA nor c.211G > A causes it; (5) in breast-fed East Asian neonates, the TA7 repeat variant of the UGT1A1 gene protects against the development of NUH; (6) G6PD deficiency combined with homozygous c.211G > A variation of the UGT1A1 gene increases the risk of severe NUH; (7) in Pakistani and Caucasian patients with Crigler–Najjar syndrome type 2 (CN-2), point mutations of the UGT1A1 gene are widely distributed and frequently occur with variation at nucleotide −53, whereas in Asian patients with CN-2, compound homozygous variations in the coding region are frequently observed; and (8) records of G6PD deficiency and UGT1A1 variation status for a neonate offer useful pharmacogenomic information that can aid long-term care. These results indicate that timely diagnosis of NUH through molecular tests is crucial and that early initiation of treatment for the neonates and educational programs for their parents improves outcomes. [ABSTRACT FROM AUTHOR]

Using mobile phones for medical applications are proliferating due to highquality embedded sensors. Jaundice, a yellow discoloration of the skin caused by excess bilirubin, is a prevalent physiological problem in newborns. While moderate amounts of bilirubin are safe in healthy newborns, extreme levels are fatal and cause devastating and irreversible brain damage. Accurate tests to measure jaundice require a blood draw or dedicated clinical devices facing difficulty where clinical technology is unavailable. This paper presents a smartphone-based screening tool to detect neonatal hyperbilirubinemia caused by the high bilirubin production rate. A machine learning regression model is trained on a pretty large dataset of images, including 446 samples, taken from newborns' sternum skin in four medical centers in Iran. The learned model is then used to estimate the level of bilirubin. Experimental results show a mean absolute error of 1.807 mg/dl and a correlation of 0.701 between predicted bilirubin by the proposed method and the TSB values as ground truth. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is a common endocrine disease that can occur during pregnancy, increasing the risk of fetal morbidity and mortality. Metformin is a commonly used therapeutic approach for managing GDM. However, there is controversy regarding the effects of metformin on fetal outcomes during pregnancy. This study aimed to evaluate the safety of metformin in relation to neonatal complications, compared to treatment with insulin and/or specialized diets. Method: This was a retrospective study that included pregnant women who were diagnosed with GDM and treated with specialized diets, metformin, or insulin. Data were collected from patients' electronic medical records and analyzed to evaluate the risk of neonatal outcomes in the metformin group compared to the others. Results: The study included 234 women with GDM. There was no difference between the metformin and insulin groups in terms of the rates of neonatal outcomes, while neonatal hypoglycemia, neonatal hyperbilirubinemia, large for gestational age, and respiratory distress were higher in the metformin group when compared to the diet group. Metformin slightly increased the risk of a lower APGAR score compared to diet alone. Conclusions: Metformin was found to be a safe therapy for the fetus when used to manage GDM, compared to insulin therapy. More randomized studies are needed to confirm these findings in the Saudi population. [ABSTRACT FROM AUTHOR]

Background and Objectives: To evaluate the clinical findings of glucose 6-phosphate dehydrogenase (G6PD) and pyruvate kinase (PK) deficiency in prolonged jaundice and to determine whether the systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) can be used in the diagnosis of neonatal prolonged jaundice. Materials and Methods: Among full-term neonates with hyperbilirubinemia who were admitted to Medicine Hospital between January 2019 and January 2024 with the complaint of jaundice, 167 infants with a serum bilirubin level above 10 mg/dL, whose jaundice persisted after the 10th day, were included in this study. Results: G6PD activity was negatively correlated with NLR, SII, age, and hematocrit (Hct). There was a weak negative correlation between G6PD and NLR and a moderate negative correlation between G6PD activity and SII when adjusted for age and Hct. PK activity showed no significant correlation with G6PD, NLR, PLR, SII, age, and Hct. A linear relationship was observed between G6PD activity and SII and NLR. Conclusions: NLR and SII can be easily calculated in the evaluation of prolonged jaundice in G6PD deficiency has a considerable advantage. NLR and SII levels may contribute by preventing further tests for prolonged jaundice and regulating its treatment. It may be useful to form an opinion in emergencies and in early diagnostic period. [ABSTRACT FROM AUTHOR]

BACKGROUND: Most neonates have neonatal jaundice, with 5–15% requiring phototherapy. Although phototherapy is beneficial, it can potentially extend hospital stays and cause harm. This study's purpose was to analyze the effects of fenofibrate and phototherapy on total serum bilirubin (TSB) levels at 24 and 48 hours (primary outcome) after intervention. Furthermore, the phototherapy duration and adverse events were also of interest (secondary outcome). METHODS: The study protocol was registered in the PROSPERO database. Articles were searched on EMBASE, PubMed, Cochrane Library, and Google Scholar. Study selection was done following PRISMA and risk of bias studies were conducted. The Review Manager 5.4 was used for the meta-analysis. RESULTS: Nine studies, including 610 newborns, were identified and included in the meta-analysis. This meta-analysis discovered a significant change in TSB levels at 24 hours after intervention (mean difference (MD) –0.96 (95% CI –1.09, –0.83), p < 0.00001) with low heterogeneity and at 48 hours after intervention (MD –1.75 (95% CI –2.26, –1.24), p < 0.00001) with high heterogeneity. Significant shortening of phototherapy duration was observed in the interventional group (MD –15.28 (95% CI –20.65, –9.90), p < 0.00001) with high heterogeneities. One of the nine studies reported a non-significant occurrence of abdominal distension and diarrhea in the fenofibrate group. CONCLUSION: Fenofibrate might be applied as an adjuvant in unconjugated neonatal hyperbilirubinemia to reduce the average total serum bilirubin and shorten the length of phototherapy. [ABSTRACT FROM AUTHOR]

Objective: Neonates with hyperbilirubinemia are at risk of brain damage, and at least two-thirds of neonates show clinical signs of jaundice in the first week of life. To predict the correlation between cord carboxyhemoglobin (COHb) with postnatal 24th-hour total serum bilirubin (TSB) level in newborns with ABO incompatibility. Methods: This retrospective cohort study included newborns older than 35 weeks of gestation who were followed up in the Neonatal Intensive Care Unit of Tokat Gaziosmanpaşa University Hospital between January 2019 and December 2023. Patients were divided into three groups; Group 1: ABO incompatibility with direct Coombs (DC) positive newborns, Group 2: ABO incompatibility and DC negative newborns, and Group 3: ABO incompatibility with no known hemolysis risk factors. Results: A total of 292 patients in 3 groups were included in the study. Group 1 consisted of 93 patients, Group 2 consisted of 99, and Group 3 consisted of 100. The mean newborn cord COHb was 1.59±0.56%, the mean cord bilirubin was 3.12±2.05 mg/dL, the mean 24-h TSB was 6.40±1.99 mg/dL, and the mean cord blood gas hemoglobin was 18.06±2.57 g/dL. In the first group, the correlation between cord COHb and 24-h TSB was high and statistically significant. In the second group, the correlation between cord COHb and 24-h PTH was low and statistically significant. Conclusion: The use of COHb as a predictor of 24-h postnatal TSB levels in ABO-incompatible neonates is plausible.

Introduction: Glucose- 6-phosphate dehydrogenase deficiency is the most common enzymatic disorder of the red cell and an important risk factor for neonatal jaundice. Methodology: The aim of the study was to determine the incidence of G-6-PD deficiency among jaundiced neonates, and describe the associated morbidity and mortality pattern in them. A prospective cross sectional study was conducted and we studied one hundred consecutive jaundiced neonates (55 males, 45 females) presenting at Aminu Kano Teaching Hospital from between 2004 and August 2005. G-6-PD activity was assayed by Quantitative spectrophotometric method of Kornberg; serum bilirubin and haemoglobin levels were estimated by standard techniques. Exposure to possible Icterogenic agents, clinical features of kernicterus and the outcome were noted. Results: The incidence of G-6-PD deficiency was found to be 46% with male to female ratio of 3:1 (Χ 2 = 15, p = 0.001). A higher proportion (60.6%) of the inborn neonates had G-6-PD deficiency (x2 = 5.5, p = 0.06). Jaundice was noticed significantly earlier in the G-6-PD deficient neonates (mean = 2.0, SD = 1 days) compared to (mean = 2.7, SD = 1.6 days) in the sufficient neonates (t = 2.3, p = 0.02). Sixteen (16%) neonates developed kernicterus, of these 10 (63%) were G-6-PD deficient. The mortality rate among G-6-PD deficient neonates was 15% (7 of 46) twice as much as in the sufficient neonates 7% (4 of 54). Only six neonates 0.6% ware exposed to naphthalene of whom three were G -6PD deficient. Five babies were given traditional medicine two of which were G6-PD deficient. Conclusion: G-6-PD deficiency is an important risk factor for neonatal jaundice. Jaundice appeared early in the deficient neonates. There is high incidence of kernicterus and mortality among them. Low admission weight significantly contributed to the mortality.

Background Phototherapy (PT) for unconjugated hyperbilirubinaemia remains an important and invaluable intervention in the management of neonatal jaundice when appropriately and optimally employed. The efficiency of PT greatly depends on the irradiance of the device, which is measured using an irradiance meter. Available optimal phototherapy is a key desirable newborn service that should be offered and accessible in secondary and tertiary health care facilities. Objective: The study aimed at determining the availability and irradiance measure of phototherapy devices in neonatal units in Kaduna state, Northwestern Nigeria. Materials and Methods: The study was an action research survey of all hospitals providing newborn care in Kaduna state including public and private profit and nonprofit faith based facilities. Phototherapy devices in use in the facilities were documented (types, brand and bulbs). The average irradiance of PT device was measured using model 22 Olympic Bili – MeterTM at facility traditional PT distance and distance of optimal irradiance was also determined and documented. Facilities were introduced to and educated on protocols on neonatal jaundice and how to ensure optimization of irradiance and management of neonatal jaundice. Results: None of the 31 public secondary health care facilities operated a newborn unit nor provided management for neonatal jaundice. Overall 15 facilities provided PT services of which 87%were non-government facilities made up of 15% faith based and 85% private for profit facilities. Only 13.3% facilities had PT devices which offered irradiance (> 10 µW/cm2 / nm) suitable for conventional PT at the facilities’ traditional PT distance this however, increased to 7 (46.7%) facilities with adjusted distances. Only 3 (20%) facilities had devices that could offer intensive PT (irradiance > 30 µW/cm2 / nm) at varying distances. None of the surveyed facilities had a radiometer nor knew irradiance of their PT devices and neither did any have a written protocol for the management of neonatal jaundice. Expertise for and availability of exchange blood transfusion (EBT) services was available only in 26.7% of the facilities. Conclusions: Private health care facilities constitute a major provider of neonatal jaundice healthcare services however the services were grossly suboptimal and inadequate and will need significant and urgent improvement to enhance newborn health and indices.

Background: Severe neonatal jaundice remains common in Nigeria. Phototherapy is the most commonly used inhospital treatment for neonatal hyperbilirubinaemia. Objectives: To describe the availability and distribution of phototherapy services as an essential neonatal service in hospitals in Jos, North-Central Nigeria. Methods: This was a crosssectional study of all secondary and tertiary level health facilities in Jos-North, Jos-South and Jos- East Local government Areas (LGAs) between January and March 2015. Results: There were 30 (90.9%) secondary and three (9.1%) tertiary health facilities. Twenty – eight (84.8%) were privately owned. Fourteen (42.4%) of the 33 hospitals provided phototherapy services, of which 11 (78.6%) were private. Phototherapy services were available in all the tertiary facilities and in only 11 (36.7%) of the secondary level health facilities. Most (10; 71.4%) of the hospitals with phototherapy were located in Jos-North LGA. There were 38 phototherapy units in all the 14 hospitals that offered phototherapy, consisting of 8 (21.1%) light emitting diodes (LED) and 30(78.9%) conventional units of which 25(83.3%) were locally fabricated. In all the hospitals that provided phototherapy, jaundiced neonates were managed by physicians of whom only 12% were fulltime paediatricians. All hospitals that offered phototherapy had laboratory facilities to assay bilirubin. Conclusions: Phototherapy services in Jos, Nigeria are inadequate and are concentrated in the urban private sector. An increase in phototherapy services especially in secondary public facilities is needed.

Background: Phototherapy (PT) remains difficult to deliver in many resource- constrained countries, including Nigeria due to the unavailability of devices that can deliver intensive PT (irradiance ≥30 µW/cm2 / nm) needed to treat the more severe cases of hyperbilirubinaemia. The basic equipment is expensive and replacement parts are often not available. Objective: To compare the blue light irradiance of four locally designed and fabricated PT devices with a proprietary device. Materials and Methods: Four types of intensive PT devices were locally fabricated. Irradiance was measured using an Olympic Medical Bili-Meter. The mean irradiance of triplicate measurements at three positions in the light footprint of each device was determine that distances of 10, 20, 30, 40, 50, 60cm from light source to meter sensor. Results: The irradiance of the fabricated devices (F1-4) and commercial device (C) measured at the most common clinically-used distance of 30 cm for intensive PT were 29.5 ±6.3, 30.3 ±5.3, 25.8 ±5.0,49.0 ±10.5 and 39.2 ± 13.6µW/cm2 /nm respectively with corresponding maximum central irradiance of 36.4, 32.1, 31.2,59.5 and 54.5 µW/cm2 /nm. At a distance of 25cm, all devices delivered irradiance ≥ 30µW/cm2 /nm. The cost of each local device was less than 12% of the commercial one. Conclusions: Locally fabricated devices cost much less and were suitable for delivery of intensive phototherapy (≥30 µW/cm2 /nm) at a distance of 25cm.

Introduction: Neonatal jaundice is a very important problem that occurs in 80% of premature infants. Treatments for jaundice include phototherapy and blood transfusions. But phototherapy is expensive and covering the eyes disrupts the relationship between mother and child. Also, in bilirubin above 20, the power of reducing bilirubin due to phototherapy is not so highMethods: Samples will be selected by the probabilistic method. The infants were admitted to the study at the NICU of Imam Reza and Samen Al-A'meh Hospitals in Mashhad. Random allocation is given in one of the two phenobarbital or case and the placebo groups. Routine laboratory tests for jaundice are performed for all infants. Then phototherapy and medicine are prescribed. Bilirubin levels are checked every 6, 12, 24, and 48 hours after medication and until discharge. After collecting information, the data is analyzed with SPSS software version 16.Results: According to these results, there were no significant differences between sex, gestational age, infant weight and age in two groups. The mean and standard deviation of bilirubin levels before the intervention and after intervention were not significantly different between the two groups after 6 , 12, 24,48 hours, and discharge time. Conclusion: Phototherapy with 20 mg/kg phenobarbital was prescribed for the study group and only phototherapy was performed for the control group. In neonates with jaundice, phototherapy with phenobarbital 20 mg single dose did not reduce bilirubin levels and length of hospital stay.

This study aimed to select Lactobacillus with high bile salt hydrolase (BSH) and to explore its protective role against neonatal jaundice. The LBS selective medium supplemented with 25 U/mL nystatin was used to screen and identify Lactobacillus strains isolated from the feces of healthy newborns and breast milk. L. rhamnosus (LGG) was used as a positive control to evaluate the in vitro probiotic properties and bile salt hydrolase activity of the Lactobacillus strains. Thereafter, the protective effect and mechanism of the selected isolates with high bile salt hydrolase activity against phenylhydrazine hydrochloride (PHZ)-induced neonatal jaundice in rats were investigated by analyzing serum bilirubin levels, hepatotoxicity, and the expression of inflammatory cytokines and nuclear transcription factors in the liver. The results showed that compared with the LGG, L. gasseri FWJL-5, which was isolated from infant feces, exhibited outstanding in vitro probiotic properties and higher bile salt hydrolase activity than LGG. L. gasseri FWJL-5 significantly alleviated the increase in serum bilirubin levels, liver tissue swelling and hemolysis in PHZ-treated neonatal rats, reduced the release of hepatic enzymes, inhibited the secretion of proinflammatory cytokines, and promoted the expression of UGT1A1, pregnane X receptor (PXR), and farnesol X receptor (FXR). Taken together, L. gasseri FWJL-5 could regulate bilirubin metabolism in the liver by up-regulating the expression of FXR/PXR and UGT1A1, thereby alleviating neonatal jaundice in rats. Our findings may provide new ideas for the prevention and treatment of neonatal jaundice by L. gasseri.

Aim Methods Results Conclusion This study estimated the healthcare cost savings for the government due to the prevention of gastroenteritis (GE) infections and lower respiratory tract infections (LRTI) in the first year of life, attributed to an increase in the exclusive breastfeeding rate at 4 months in Hong Kong.The model used the best available data inputs, with uncertainty considered using probabilistic sensitivity analysis. We additionally assessed the impact of neonatal jaundice (NNJ) on the economic benefits of increasing exclusive breastfeeding rates.During 2010–2019, five admissions for GE and three admissions for LRTI per 1000 births would have been prevented in the first year of life if the exclusive breastfeeding rate at 4 months increased from the actual levels (~15–30%) to 50%, resulting in annual healthcare cost savings of USD1.05 (95% CI 1.03–1.07) million/year. The cost saving would reach USD1.89 (95% CI 1.86–1.92) million/year if the exclusive breastfeeding rate at 4 months increase to 70%. However, if higher NNJ admissions during 7–90 days related to more exclusive breastfeeding are considered, the cost saving would reduce by 60%.Our findings can guide policymakers in allocating budget and resources for breastfeeding promotion in Hong Kong. The prevention of unnecessary NNJ admissions would maximise the economic benefits of exclusive breastfeeding at 4 months. [ABSTRACT FROM AUTHOR]

Jaundice affects almost all neonates in their first days of life and is caused by the accumulation of bilirubin. Although the core biochemistry of bilirubin metabolism is well understood, it is not clear why some neonates experience more severe jaundice and require treatment with phototherapy. Here, we present the first genome-wide association study of neonatal jaundice to date in nearly 30,000 parent-offspring trios from Norway (cases ≈ 2000). The alternate allele of a common missense variant affecting the sequence of UGT1A4 reduces the susceptibility to jaundice five-fold, which replicated in separate cohorts of neonates of African American and European ancestries. eQTL colocalization analyses indicate that the association may be driven by regulation of UGT1A1 in the intestines, but not in the liver. Our results reveal marked differences in the genetic variants involved in neonatal jaundice compared to those regulating bilirubin levels in adults, suggesting distinct genetic mechanisms for the same biological pathways. The underlying causes of neonatal jaundice are not well understood. Here, the authors identify genetic variants associated with neonatal jaundice, including a variant in the gene UGT1A, finding a distinct genetic basis from adult bilirubin levels. [ABSTRACT FROM AUTHOR]

Jaundice is a symptom of high blood bilirubin levels affecting about 80% of neonates. In neonates fed with breast milk, jaundice is particularly prevalent and severe, which is likely multifactorial. With the development of genomics and metagenomics, a deeper understanding of the neonatal gut microbiota has been achieved. We find there are accumulating evidence to indicate the importance of the gut microbiota in the mechanism of jaundice. In this paper, we present new comprehensive insight into the relationship between the microbiota and jaundice. In the new perspective, the gut is a crucial crossroad of bilirubin excretion, and bacteria colonizing the gut could play different roles in the excretion of bilirubin, including Escherichia coli as the main traffic jam causers, some Clostridium and Bacteroides strains as the traffic police, and most probiotic Bifidobacterium and Lactobacillus strains as bystanders with no effect or only a secondary indirect effect on the metabolism of bilirubin. This insight could explain why breast milk jaundice causes a longer duration of blood bilirubin and why most probiotics have limited effects on neonatal jaundice. With the encouragement of breastmilk feeding, our perspective could guide the development of new therapy methods to prevent this side effect of breastfeeding. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence, risk factors and outcomes of babies with neonatal jaundice in a network of referral‐level hospitals in Nigeria. Design: A cross‐sectional analysis of perinatal data collected over a 1‐year period. Setting: Fifty‐four referral‐level hospitals (48 public and 6 private) across the six geopolitical zones of Nigeria. Population: A total of 77 026 babies born at or admitted to the participating facilities (67 697 hospital live births; plus 9329 out‐born babies), with information on jaundice between 1 September 2019 and 31 August 2020. Methods: Data were extracted and analysed to calculate incidence and sociodemographic and clinical risk factors for neonatal jaundice. Main outcome measures: Incidence and risk factors of neonatal jaundice in the 54‐referral hospitals in Nigeria. Results: Of 77 026 babies born in or admitted to the participating facilities, 3228 had jaundice (41.92 per 1000 live births). Of the 67 697 hospital live births, 845 babies had jaundice (12.48 per 1000 live births). The risk factors associated with neonatal jaundice were no formal education (adjusted odds ratio [aOR] 1.68, 95% CI 1.11–2.52) or post‐secondary education (aOR 1.17, 95% CI 0.99–1.38), previous caesarean section (aOR 1.68, 95% CI 1.40–2.03), booked antenatal care at <13 weeks or 13–26 weeks of gestation (aOR 1.58, 95% CI 1.20–2.08; aOR 1.15, 95% CI 0.93–1.42, respectively), preterm birth (aOR 1.43, 95% CI 1.14–1.78) and labour more than 18 hours (aOR 2.14, 95% CI 1.74–2.63). Conclusions: Hospital‐level and regional‐level strategies are needed to address newborn jaundice, which include a focus on management and discharge counselling on signs of jaundice. [ABSTRACT FROM AUTHOR]

Phototherapy (PT) is a widely used treatment for neonatal jaundice, yet the ideal model of application remains controversial. In this study, the effects of continuous phototherapy (CPT) and intermittent phototherapy (IPT) models were compared in the treatment of neonatal indirect hyperbilirubinemia (IHB) and whether IPT is a superior modality is investigated. Single-centre parallel randomized controlled open label trial. A computer-based table of random numbers was used to allocate treatments. Newborns ≥ 34 weeks' gestation who received phototherapy in our neonatal intensive care unit (NICU) between July 2022 and April 2023 were included. CPT was applied continuously for 6 h, and IPT was applied as 2 cycles of 1 h on and 2 h off in a 6-h session. Rebound TSB was measured 8 h after phototherapy was stopped in both groups. Phototherapy duration, TSB reduction rate and rebound bilirubin rate were compared between intervention groups. One hundered and four neonates met the inclusion criteria during the study period. CPT and IPT were each used in 52 newborns. Demographic characteristics of the study groups, including sex, mode of delivery, birth weight, admission weight, age at postnatal presentation, diet, discharge weight, and history of PT in siblings, were similar (p > 0.05). The most common cause of IHB in both groups was ABO incompatibility. The median phototherapy time was 12 h (6–15) in the CPT group and 4 h (2–4) in the IPT group (p < 0.001). The mean rate of bilirubin decrease was 1.12 ± 0.73 mg/dl/h in those who underwent IPT and 0.51 ± 0.33 mg/dl/h in those who underwent CPT (p < 0.001). The mean rebound bilirubin rate 8 h after phototherapy was 0.08 ± 0.28 mg/dl/h in the CPT group, and −0.01 ± 0.17 mg/dl/h in the IPT group (p = 0.039). The length of hospital stay was longer in the CPT group (p = 0.032). Skin rash, diarrhoea and increased body temperature were less frequent in the IPT group (p < 0.001). Conclusions: In this study, IPT was found to be at least as effective as CPT in reducing total serum bilirubin. Even though the duration of PT is shorter in IPT, the slower rate of rebound bilirubin, shorter hospital stays and lower incidence of side effects indicated that intermittent phototherapy is superior to continuous phototherapy. Choosing IPT over CPT is a more rational approach in neonatal jaundice. ClinicalTrials.gov Identifier: NCT 06386731 (registered retrospectively on 23/04/2024) What is Known: • PT is common used in the treatment of neonatal jaundice. • There is no standard model of application for PT. What is New: • The IPT model is as effective as CPT. • Newborns are discharged faster with IPT. [ABSTRACT FROM AUTHOR]

Background: Neonatal hyperbilirubinemia is a common neonatal condition requiring immediate diagnosis and treatment to prevent severe hyperbilirubinemia that can cause brain damage known as kernicterus. Identifying risk factors and monitoring at-risk infants can help reduce the incidence of severe hyperbilirubinemia. Materials and Methods: The present study was a retrospective cohort study analyzed medical records of infants with gestational age (GA) of more than 35 weeks born at Naresuan University Hospital between January 2019 and December 2020. One thousand fifteen infants were enrolled and divided into two groups: the hyperbilirubinemia group comprising 287 infants (28.3%), and the non-hyperbilirubinemia group consisting of 728 infants (71.7%). Results: The incidence of neonatal hyperbilirubinemia in infants with GA of more than 35 weeks was 30.7% (345 out of 1,122). Compared to vaginal delivery, cesarean section reduced the risk of neonatal hyperbilirubinemia by 32% (adjusted odds ratio 0.68). Sepsis increased the risk of neonatal hyperbilirubinemia by 73% (adjusted odds ratio 1.73). Infants in the hyperbilirubinemia group had a longer hospital stay, averaging approximately 28 hours. Conclusion: Vaginal delivery and neonatal sepsis were identified as significant risk factors for neonatal hyperbilirubinemia. Close monitoring of infants identified as at-risk may aid in the prevention of severe hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Copyright of Balikesir Health Sciences Journal / Balıkesir Sağlık Bilimleri Dergisi is the property of Balikesir Health Sciences Journal (BAUN Health Sci J) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To determine the effect of visible blue wavelengths of argon laser beams in reducing bilirubin levels in newborns with jaundice. Background: Newborn jaundice ("hyperbilirubinemia") results from increased bilirubin concentrations in the skin and blood. Sunlight, comprising various light rays, is commonly used to treat this condition by breaking down bilirubin molecules. Other phototherapy techniques, including lamp phototherapy, are also employed. Methods: An experimental study was conducted on six male infants (5 to 15 days old) with jaundice at a hospital. These infants were exposed to blue-violet scattered light from an argon laser with a wavelength of 450 nm. Results: The concentration of bilirubin in these infants decreased following exposure to the argon laser light. The 450 nm wavelength effectively absorbs bilirubin, facilitating its breakdown. Conclusion: The study demonstrates the effectiveness of using argon laser with visible blue light in reducing bilirubin levels in infants with jaundice. This finding encourages health professionals to consider argon laser therapy as a treatment option for neonatal jaundice. [ABSTRACT FROM AUTHOR]

This article discusses two siblings who experienced hyperbilirubinemia, a condition characterized by high levels of bilirubin in the blood, during the neonatal period. The siblings had double missense variants in the UGT1A1 gene, including a previously uncharacterized variant. The authors suggest that the variant p. Arg403His may be associated with neonatal hyperbilirubinemia at levels similar to those seen in Crigler-Najjar syndrome type II. The study highlights the importance of genetic testing in understanding the underlying causes of hyperbilirubinemia. [Extracted from the article]

Background: Hospitalization, follow-up, and total serum bilirubin (TsB) testing are required in instances with a high risk of kernicterus, including day-one icter, hepatosplenomegaly, and other similar conditions. For non-invasive testing, transcutaneous bilirubinometry (TcB) is one option. Objective: Assessment of the accuracy of transcutaneous bilirubinometry in comparison to serum total bilirubin level. Subjects and methods: This hospital-based study was carried out at the Neonatal Care Unit of Zagazig University Teaching Hospital on 108 healthy neonates suspected on clinical grounds of having neonatal jaundice, of whatever etiology, admitted to the unit for hyperbilirubinemia. Gestational age was estimated from obstetric history and new Ballard Score method. Result: TsB mean ± SD and TcB differed significantly from each other. At the 2-day, 3-day, 4-day, and 5-day points after the initial measurement, there was a statistically significant difference between the total serum bilirubin and transcutaneous bilirubin levels, when categorized by age. There were extremely significant differences between preterm and full-term newborns in terms of platelet count, C-reactive protein, total serum bilirubin, and transcutaneous bilirubin level. Levels of total serum bilirubin and transcutaneous bilirubin were stratified from 2nd to 5th day of measurement according to age as follows: TcB average, TcB over sternum, and TcB over forehead, and were significantly different. Conclusion: The great sensitivity of TcB makes it a potential tool for the prediction of neonatal icter. Nevertheless, in newborns who are at high risk of jaundice, it should not be used as a replacement for TsB measurement. [ABSTRACT FROM AUTHOR]

Background Presently, transcutaneous determination of bilirubin has become a valuable method for the early detection of neonatal hyperbilirubinemia. This study aims to determine the correlation of transcutaneous bilirubin with serum bilirubin levels and assess the factors affecting transcutaneous bilirubin measurement in term and late preterm neonates. Materials and Methods The study included 100 newborns born at a gestational age of 35 to 41 weeks, with a birth weight of 2100 to 3500 g. Simultaneous measurement of bilirubin by traditional (invasive) and transcutaneous (non-invasive) methods was carried out within 15 minutes of admission in the neonatal intensive care unit. Parallel transcutaneous measurements were taken in the forehead and sternum. Statistical analysis was done to determine the correlation of transcutaneous (forehead and sternal) bilirubin with serum bilirubin levels and assess the factors affecting transcutaneous bilirubin measurement. Results In the range of serum bilirubin concentrations till 15 mg/ dl, a close correlation was observed between serum bilirubin (TSB) estimated by direct spectrophotometric method and transcutaneous bilirubin (TcB) estimated by “Bilitest 2000”. TcB estimation on the sternum was better correlated than that on the forehead (r-value: 0.962 vs. 0.935). TcB had a good correlation with TSB across the range of 12.5 - 20.5 mg/dl. Neonatal hypothermia significantly decreased TcB estimation (p =0.021, F=4.227). Respiratory distress, convulsion, sclerema and shock in neonates did not affect TcB estimation. Conclusion TcB has a good correlation with TSB in term and late preterm neonates. Thus TcB readings can be u [ABSTRACT FROM AUTHOR]

This study reports the spectrum of discharge diagnoses in a national cohort of newborns admitted during a 3-month period to hospitals across Jamaica. The data were analyzed using measures of central tendency and risk assessed using odds ratio. Data on 1607 admissions were used to describe the spectrum of morbidity in hospitalized infants. Eight hundred and seven (50%) male and 754 (48%) female neonates were admitted. There was a 15% (240) readmission rate during the neonatal period. Infants of diabetic mothers were almost three times as likely to be admitted as infants whose mothers were not diabetic OR 2.89 (CI 1.96 − 4.13). Infants of women who were hypertensive were 1.5 times more likely to be admitted than infants of non-hypertensive women OR 1.56 (CI 1.56–1.9). The odds ratio for admission of an infant born to a woman delivere d by caesarean section was 2.1 (CI: 1.67–2.38). Premature infants constituted 50% of admissions. The most prevalent discharge diagnosis included presumed sepsis, respiratory distress and neonatal jaundice in both preterm and term neonates. In the extreme preterm infant respiratory distress syndrome was the most predominant discharge diagnosis. Multiple gestation was a significant risk for admission OR 2.7 (CI 1.8 to 3.9). Prematurity, multiple gestation, macrosomia, maternal diabetes, maternal hypertension and low 5 minute Apgar score < 7 were all found to be independent predictors of neonatal admission in a logistic regression model (p < 0.001). The recognition of the discharge morbidity is useful for future health planning for the most vulnerable in our population. [ABSTRACT FROM AUTHOR]

Measurement of transcutaneous bilirubin (TcB) is a non-invasive, widely used technique to estimate serum bilirubin (SB). However, its reliability in multiethnic populations during and after phototherapy is still controversial even in covered skin. The aim of this study was to determine the reliability of TcB in covered (cTcB) and exposed (eTcB) skin during and after phototherapy in a multiethnic population of term and preterm neonates according to Neomar's neonatal skin color scale. Prospective, observational study comparing SB and TcB. We determined SB when clinically indicated and, at the same time, measured cTcB under a photo-opaque patch and eTcB next to it with a jaundice meter (Dräger JM-105TM). All dyads TcB-SB were compared, both globally and according to skin color. We obtained data from 200 newborns (color1: 44, color2: 111, color3: 41, color4: 4) and compared 296 dyads TcB/SB. Correlation between cTcB and SB is strong during (0.74–0.83) and after (0.79–0.88) phototherapy, both globally and by color group. The SB-cTcB bias depends on gestational age during phototherapy and on skin color following phototherapy. The correlation between eTcB and SB during phototherapy is not strong (0.54), but becomes so 12 h after discontinuing phototherapy (0.78). Conclusions: Our study supports the reliability of cTcB to assess SB during and after phototherapy, with differences among skin tones after the treatment. The use of cTcB and Neomar's scale during and mainly after phototherapy may help reduce the number of blood samples required. What is Known: • Controversies exist on the reliability of jaundice meters during and after phototherapy in covered skin. Only a few studies have analyzed their accuracy in multiethnic populations, but none has used a validated neonatal skin color scale. What is New: • We verified correlation between serum and transcutaneous bilirubin in covered skin in a multiethnic population depending on skin color based on our own validated neonatal skin color scale during and after phototherapy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to inform the revision of a targeted surveillance risk registry by identifying which risk factors predict postnatally identified hearing loss (PNIHL) in children who pass newborn hearing screening and to determine whether hearing surveillance beyond the age of 1 year is warranted. Method: We used retrospective analysis of the audiological outcomes of children born in the state of Queensland, Australia, between January 1, 2010, and December 31, 2019, who passed the newborn hearing screen with risk factors. Results: Approximately one third of children were lost to follow-up and could not be included in the analysis. Risk factors that predicted PNIHL in the analyzed cohort were as follows: syndromes associated with hearing loss, craniofacial anomalies, perinatal infections, and family history of permanent childhood hearing loss. Severe asphyxia did not predict PNIHL but yielded some cases of significant bilateral hearing loss. Hearing loss in children with a history of prolonged ventilation was mild and/or unilateral in nature (except in cases where the hearing loss was due to an unrelated etiology). There were no cases of PNIHL in children with hyperbilirubinemia or neonatal bacterial meningitis. For the risk factors that predicted PNIHL, nearly all hearing losses were detected by 1 year of age, except for children with family history where one quarter of hearing losses had a later onset. Conclusions: The four risk factors recommended for efficient postnatal identification of hearing loss are as follows: syndromes associated with hearing loss, craniofacial anomalies, perinatal infection, and family history of permanent childhood hearing loss. Hearing surveillance through to 1 year old is sufficient except for children with a family history, where a second phase assessment is indicated. Alternative targeted surveillance protocols and models of care are required to minimize loss to follow-up. [ABSTRACT FROM AUTHOR]

Background: Hyperbilirubinemia is a common condition in newborns. While mild cases of jaundice are common and typically resolve spontaneously, severe hyperbilirubinemia can lead to serious neurologic complications if left untreated. With the constant adaptation of guidelines, clinical management has significantly improved, and treatment has become routine for pediatricians. However, for parents of affected children, managing the condition is not routine. In today's digital age, parents often seek additional information by accessing a wide range of medical resources on the internet. While this can be empowering, it also presents challenges, as the quality and accuracy of online medical information can vary widely. Therefore, we analyzed the current quality of information on jaundice found on the internet by parents. Methods: A simulated internet search (using the Google search engine) was conducted from a layperson's perspective using German ("Neugeborenes Gelbsucht", "Baby Gelbsucht") and English ("jaundice newborn", "jaundice baby") search terms. Subsequently, the quality of the search results was assessed by two independent neonatologists based on the DISCERN Plus Score, HONcode certification, and the JAMA criteria. Results: Websites targeting non-medical laypersons exhibited significant variability in quality. Notably, the content of English websites was superior to that of websites in the German language. The majority of English sites were predominantly institutional, whereas most German sites were commercially oriented. Conclusions: Although information on jaundice is readily accessible online for non-medical individuals, there were notable differences in quality based on language and significant variability in the quality of information warranting attention from healthcare professionals. Furthermore, German websites providing information on jaundice were often hosted by commercial organizations. We propose that pediatric societies engage in developing and maintaining organization-based medical information to improve online resources for parents. [ABSTRACT FROM AUTHOR]

Hyperbilirubinemia is a physiological health problem of newborn infants, mostly occurring in the first week of life, which can delay development or cause disabilities or death. Massaging newborn infants early after delivery can promote bilirubin excretion and reduce hyperbilirubinemia. This quasi-experimental study aimed to determine the effect of infant massage performed by mothers on bilirubin levels and re-hospitalization for hyperbil- irubinemia. The study was conducted at an obstetrics and gynecology ward of a secondary hospital in Bangkok, Thailand. The participants were 30 paired full-term infants and mothers who met the inclusion criteria. The experimental group (n = 15) received body massage performed by their mother for 15 minutes twice a day for four consecutive days, while the control group (n = 15) received only usual care. The transcutaneous bilirubin levels were recorded at 6, 48, and 96 hours after birth. Data on re-hospitalization with hyperbilirubinemia were recorded on Day 7 after birth and analyzed using Fisher's exact test, independent t-test, and repeated measures ANOVA. The results revealed that the infants who received the massage had significantly lower mean bilirubin levels than those in the control group. However, there was no difference in the re-hospitalization with hyperbilirubinemia between the groups. In addition, the frequency of defecation on the first and fourth days in the experimental group was significantly greater than in the control group. The present study's result indicated that mothers' infant massage can help reduce bilirubin levels in full-term infants. The findings hold promise for nurses to integrate infant massage in training mothers at an early stage after birth for the prevention of hyperbilirubinemia in newborn infants. However, further testing with a larger sample size and randomized controlled trials are needed. [ABSTRACT FROM AUTHOR]

Purpose: To analyze leptin levels in placental tissue and premature infants undergoing phototherapy and to evaluate the potential for prescribing passive exercise after phototherapy in this population. Patients and Methods: This analytical, longitudinal, prospective cohort study included 108 parturients and their respective premature infants. Variables examined included weight, gestational age, body mass index, sex, serum leptin levels in placental tissue, serum bilirubin levels, and reticulocyte count. Results: When comparing each group to a leptin threshold, statistically significant differences were observed at all evaluated time points for placental leptin levels (p < 0.001). Additionally, reticulocyte count decreased in relation to rebound time (p < 0.004). No correlations were found between leptin/bilirubin levels, leptin/reticulocytes, onset of nutrition, and BMI/leptin levels. Conclusion: The findings regarding leptin levels suggest that prescribing passive exercises to premature infants undergoing phototherapy may be feasible because this intervention did not increase leptin levels. [ABSTRACT FROM AUTHOR]