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Difference between individual phototherapy treatment threshold and total serum bilirubin level according to degree of jaundice as visually assessed. The area above the red bar indicates a total serum bilirubin level above phototherapy treatment threshold.
Source publication
Jaundice caused by hyperbilirubinaemia is a common phenomenon during the neonatal period. Population-based studies evaluating assessment, management, and incidence of jaundice and need for phototherapy among otherwise healthy neonates are scarce. We prospectively explored these aspects in a primary care setting via assessing care as usual during th...
Similar publications
Background: Neonatal jaundice is a very common condition worldwide, occurring in up to 60% of term and 80% of pre-term newborns in the 1st week of life and the most common cause for readmission. The present study was conducted to evaluate the predictive value of umbilical cord blood albumin level for subsequent development of neonatal jaundice in h...
Citations
... Instead, the evaluation of newborns heavily relies on HCWs' subjective assessments of the extent of 'yellowness' in the baby's skin. Similar findings have been reported in a prospective cohort study of 860 Dutch newborns assessed in primary care birth centres [37]. The research revealed that TcB or TSB measurements were not quantified in 44% of newborns considered 'quite yellow' and in 20% considered 'very yellow' . ...
Background
Neonatal jaundice is a common condition that can lead to brain damage and disabilities when severe cases go undetected. Low- and middle-income countries often lack accurate methods for detecting neonatal jaundice and rely on visual assessment, resulting in a higher incidence of adverse consequences. Picterus Jaundice Pro (Picterus JP), an easy-to-use and affordable smartphone-based screening device for the condition, has demonstrated higher accuracy than visual assessment in Norwegian, Philippine and Mexican newborns. This study aimed to identify the barriers and facilitators to implementing Picterus JP in public health services in low-income settings in Mexico by exploring the current process of neonatal jaundice detection and stakeholders’ perspectives in that context.
Methods
Qualitative data collection techniques, including one focus group, 15 semi-structured interviews and four observations, were employed in urban and rural health facilities in Oaxaca, Mexico. The participants included medical doctors, nurses and health administrators. The data were analysed by thematic analysis guided by the Consolidated Framework for Implementation Research.
Results
The analysis yielded four main themes: (I) the current state of neonatal care and NNJ detection, (II) the needs and desires for enhancing NNJ detection, (III) the barriers and facilitators to implementing Picterus JP in the health system and (IV) HCWs’ expectations of Picterus JP. The findings identify deficiencies in the current neonatal jaundice detection process and the participants’ desire for a more accurate method. Picterus JP was perceived as easy to use, useful and compatible with the work routine, but barriers to adoption were identified, including internet deficiencies and costs.
Conclusions
The introduction of Picterus JP as a supporting tool to screen for neonatal jaundice is promising but contextual barriers in the setting must be addressed for successful implementation. There is also an opportunity to optimise visual assessment to improve detection of neonatal jaundice.
... Neonatal jaundice is a common condition during the first month of life, as approximately 70% of neonates have some level of jaundice, and 5% to 10% require phototherapy for treatment of unconjugated hyperbilirubinemia. [1][2][3] Phototherapy is commonly used to decrease bilirubin levels in order to avoid the neurotoxic effects of high bilirubin levels. Some of the known risk factors for unconjugated hyperbilirubinemia requiring phototherapy are maternal red blood cell antibodies, prematurity, birth injuries, hereditary factors (ethnicity and a history of phototherapy in older siblings), and maternal obesity. ...
Context
Observational studies have shown conflicting results as to whether exposure to neonatal phototherapy is associated with increased rates of childhood cancer.
Objective
To describe the rates of childhood neoplasms and cancer after neonatal phototherapy.
Data sources
The CENTRAL, PubMed, Scopus, and Web of Science databases.
Study selection
Observational studies regardless of design were included.
Data extraction
The data were extracted by one author and validated by another. The risk-of-bias assessment was performed using the ROBINS-E and Joanna Briggs Institute critical appraisal tools.
Results
Six cohort and 10 case-control studies were included. The overall risk of bias was high in seven and low in nine studies. In cohort studies, the odds ratio (OR) was increased for hematopoietic cancer (1.44; confidence interval [CI]: 1.16–1.80) and solid tumors (OR: 1.18; CI: 1.00–1.40). In case-control studies, the OR was 1.63 (CI: 0.99–2.67) for hematopoietic cancers and 1.18 (CI: 1.04–1.34) for solid tumors.
Conclusions
Children with a history of neonatal phototherapy had increased risk of hematopoietic cancer and solid tumors. The evidence quality was limited due to the high risk of bias and potential residual confounding.
... Participants were recruited while in the postpartum recovery ward to ensure that they received information on neonatal jaundice before they were discharged home as all of the women in the immediate postpartum are discharged through this ward. As neonatal jaundice commonly occurs in the first week of life [22], we delivered our intervention with in the first week post-delivery with three in four of all the mothers (73.4%) receiving the enhanced neonatal jaundice education intervention within 24 hours of giving birth. All women with live born infants including preterm and low birth weight babies were eligible for inclusion. ...
Background
Neonatal jaundice (NNJ) is a major contributor to childhood morbidity and mortality. As many infants are discharged by 24 hours of age, mothers are key in detecting severe forms of jaundice. Mothers with limited knowledge of NNJ have a hard time identifying these infants who could go on to have the worst outcomes. This study aimed to determine the effect of a jaundice education package delivered to mothers prior to hospital discharge on maternal knowledge after discharge.
Methods
This was a before and after interventional study involving an education package delivered through a video message and informational voucher. At 10–14 days after discharge, participants were followed up via telephone to assess their post-intervention knowledge. A paired t-test was used to determine the effectiveness of the intervention on knowledge improvement. Linear regression was used to determine predictors of baseline knowledge and of change in knowledge score.
Results
Of the 250 mothers recruited, 188 were fit for analysis. The mean knowledge score was 10.02 before and 14.61 after the intervention, a significant difference (p<0.001). Factors determining higher baseline knowledge included attendance of 4 or more antenatal visits (p < 0.001), having heard about NNJ previously (p < 0.001), having experienced an antepartum illness (p = 0.019) and higher maternal age (p = 0.015). Participants with poor baseline knowledge (β = 7.523) and moderate baseline knowledge (β = 3.114) had much more to gain from the intervention relative to those with high baseline knowledge (p < 0.001).
Conclusion
Maternal knowledge of jaundice can be increased using a simple educational intervention, especially in settings where the burden of detection often falls on the mother. Further study is needed to determine the impact of this intervention on care seeking and infant outcomes.
... Neonatal hyperbilirubinemia (NHB) is the most common neonatal disease, with a prevalence rate of 20-40%, which is increasing year by year [1]. NHB threatens fetal health and increases the risk of long-term disease. ...
... The authors declare no competing interests. 1 Research center for clinical medical sciences, Hebei key laboratory of maternal and fetal medicine, The Fourth Hospital of Shijiazhuang, Shijiazhuang 050000, China ...
Background
To explore the association between liver metabolism-related indicators in maternal serum and neonatal hyperbilirubinemia (NHB), and further investigate the predictive value of these indicators in NHB-related amino acid metabolism disorders.
Methods
51 NHB and 182 No-NHB newborns and their mothers who treated in the Fourth Hospital of Shijiazhuang from 2018 to 2022 were participated in the study. The differences in clinical data were compared by the Mann-Whitney U test and Chi-square test. Multivariate logistic regression was used to analyze the relationship between maternal serum indicators and the occurrence of NHB. The correlation analysis and risk factor assessment of maternal serum indicators with NHB-related amino acid metabolic disorders were performed using Spearman correlation analysis and multivariate logistic regression.
Results
Compared to the non NHB group, the NHB group had higher maternal serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), ALT/AST, and total bile acid (TBA), while lower levels of serum albumin (ALB), total cholesterol (TC) and high-density lipoprotein (HDL). The levels of alanine (ALA), valine (VAL), ornithine (ORN), and proline (PRO) in the newborns were reduced in NHB group, while arginine (ARG) showed a tendency to be elevated. Multiple logistic regression analysis showed that maternal ALT, AST, ALT/AST, and TBA levels were all at higher risk with the development of NHB, whereas ALB, TC, and HDL levels were negatively associated with NHB development. Increasing maternal TBA level was associated with lower ALA (r=-0.167, p = 0.011), VAL (r=-0.214, p = 0.001), ORN (r=-0.196, p = 0.003), and PRO in the newborns (r=-0.131, p = 0.045). Maternal ALT level was negatively associated with ALA (r=-0.135, p = 0.039), VAL (r=-0.177, p = 0.007), ORN (r=-0.257, p < 0.001), while ALT/AST was positively correlated with ARG (r = 0.133, p = 0.013). After adjustment for confounding factors, maternal serum TBA and ALT were the independent risk factor for neonatal ORN metabolic disorders [(adjusted odds ratio (AOR) = 0.379, 95%CI = 0.188–0.762, p = 0.006), (AOR = 0.441, 95%CI = 0.211–0.922, p = 0.030)]. Maternal ALT level was an independent risk factor for neonatal VAL metabolic disorders (AOR = 0.454, 95%CI = 0.218–0.949, p = 0.036).
Conclusions
The levels of high TBA, ALT, AST, and low HDL, TC of maternal were associated with the risk of NHB. Maternal TBA and ALT levels were independent risk factors for NHB-related amino acid disturbances which have value as predictive makers.
... Untimely diagnosis and delayed treatment may result in various symptoms, including jaundice, anemia, and bilirubin encephalopathy. In severe cases, it may lead to hepatosplenomegaly and even more severe heart failure, posing a severe threat to the newborn's life (5). Furthermore, reports have indicated that this ailment may harm the newborn's central system, which can significantly impact their intellectual development (6). ...
Objective
The purpose of this study is to examine the prognostic significance of the amalgamated indicators, reticulocyte percentage (RET%), lactate dehydrogenase (LDH), and γ-Glutamyltransferase (γ-GT), in neonatal ABO hemolytic disease.
Methods
A total of 137 hospitalized children with pathological jaundice were included. Based on their medical conditions, they were categorized into two groups, hemolytic (67 cases) and non-hemolytic (70 cases). Pearson linear correlation and binary logistic multivariate analysis were used to analyze LDH, γ-GT, RET% and hemolysis. Furthermore, the predictive value of the combined predictors of RET%, LDH, and γ-GT on ABO neonatal hemolytic disease was evaluated using the ROC curve analysis.
Results
The laboratory indexes of the two groups were subject to analysis using binary logistic regression to identify suspicious influencing factors. The study revealed that RET%, LDH, and γ-GT were independent risk factors for hemolysis. Pearson linear correlation analysis indicated a positive correlation between LDH and γ-GT with RET% ( r = 0.529, P < 0.01; r = 0.526, P = <0.01, respectively). Furthermore, the predictive value of each combined predictor was obtained using the ROC curve, and it was observed that combined predictor L (RET% + LDH + γ-GT)>L1 (RET% + LDH)>L2 (RET% + γ-GT).
Conclusion
Combined predictor L (RET% + LDH + γ-GT)demonstrate its optimal diagnostic efficacy, offering a novel approach towards diagnosing early-onset ABO hemolytic disease of the newborn.
... Neonatal hyperbilirubinaemia is a common phenomenon during the neonatal period. 1 Hyperbilirubinaema is a major risk factor for brain damage caused by bilirubininduced neurological dysfunction. 2 Hyperbilirubinaema manifests as a yellowish colour of the skin and mucous membranes. ...
Objective: To determine the relationship between coagulation system markers and hyperbilirubinaemia in full-term neonates.
Methods: This retrospective case–control study enrolled full-term neonates with hyperbilirubinaemia and healthy control full-term neonates. Prothrombin time (PT), thrombin time (TT), fibrinogen (Fbg), activated partial thromboplastin time (APTT) and international normalized ratio (INR) were recorded. The correlation between INR and total bilirubin and between INR and indirect bilirubin was analysed by linear regression analysis. Receiver operating characteristic curve analysis was used to assess the efficacy of INR to identify neonates with hyperbilirubinaemia.
Results: This study enrolled 40 full-term neonates with hyperbilirubinaemia and 30 healthy controls. PT, INR and APTT were significantly higher in the neonates with hyperbilirubinaemia compared with the healthy controls. There was a significant positive correlation between INR and the level of total bilirubin in neonates with hyperbilirubinaemia ( R = 0.3327). There was also a significant positive correlation between INR and the level of indirect bilirubin in neonates with hyperbilirubinaemia ( R = 0.3406). INR in neonates with hyperbilirubinaemia significantly achieved an area under the curve of 0.800 (95% confidence interval, 0.6288, 0.9712; cut-off value, 1.060; specificity, 71.43%; sensitivity, 80.00%).
Conclusion: These findings suggest that INR is a novel biomarker for the diagnosis of neonatal hyperbilirubinaemia in full-term neonates.
... Hyperbilirubinemia is a common neonatal condition which is a result of imbalance between rate of formation and rate of elimination of bilirubin. It is usually observed in the first week of life in 60% term and 85% preterm neonates [8,9].The incidence is more in preterm neonates owing to the developmentally immature liver and gastrointestinal tract that is unable to excrete bilirubin as fast as it is formed. This leads to accumulation of bilirubin in the body [10]. ...
Background. Neonatal jaundice is a commonly occurring problem in both full term and preterm neonates. It is one of the major causes for neonatal mortality and morbidity. Objective. To assess the correlation among transcutaneous bilirubinometer readings and Total serum bilirubin levels at different sites in early and late preterm neonates before and at the end of phototherapy. Method. An observational study was conducted in preterm neonates diagnosed with jaundice. The Transcutaneous Bilirubin (TCB) instrument, Drager JM105 is used to assess TCB and it was recorded on three sites and average of the three readings was noted. Prior to phototherapy, TCB was noted 30 min before TSB was sent. A photo-opaque patch was placed on the sternum and phototherapy was given. At the end of the phototherapy, TCB on the sternum was noted and then TSB was sent with a time gap of not more than 30 min. Results. In this study, out of 50 neonates 14 were early preterm and 36 were late preterm babies. It was found that there was a positive correlation between TCB and TSB in early preterm babies before phototherapy (p value=0.0019), but there was no correlation between TCB and TSB at the end of phototherapy. In late preterm babies there was no correlation between TCB and TSB both before phototherapy and at the end of phototherapy. Conclusion. In this study it was found that TCB has positive correlation with TSB and can be implemented for the screening of hyperbilirubinemia even in preterm neonates.
... El 85,71 % (n=12) respaldaron la cuantificación de la TSB como estándar de oro para la detección de hiperbilirrubinemia neonatal. Además, el 64,28 % (n=9) aceptó la medición de bilirrubina Khurshid et al. [12] van der Geest et al. [3] Okwundu et al. [13] Chatur et al. [14] van der Geest et al. [15] Thomas et al. [4] Hulzebos et al. [5] Orhon et al. [10] Springer et al. [16] Anderson et al. [1] Zhang [17] Alkén et al. [18] Evaluación transcutánea (TcB) como alternativa válida para la detección de la hiperbilirrubinemia neonatal. ...
... En los recién nacidos existen enfermedades de origen genético que afectan la producción, metabolismo o excreción de la bilirrubina, como el síndrome de Dubin-Johnson (SDJ) y el de Crigler-Najjar, así como trastornos sanguíneos como la enfermedad hemolíti-ca, talasemias y anomalías congénitas de las membranas de los eritrocitos [15,16,20]. Las anomalías congénitas de las membranas de los eritrocitos aumentan el riesgo de hiperbilirrubinemia neonatal. ...
... Sin embargo, Okwundu et al. [25] reconocen la evaluación visual como poco confiable, porque suele ser afectada por la iluminación y color de piel del neonato. No se recomienda su uso exclusivo e incluso suele reemplazarse por pruebas confiables como la determinación de TSB y TcB [5,12,15]. ...
Introducción. La hiperbilirrubinemia es la séptima causa de muerte neonatal, afecta alrededor del 60 % de recién nacidos a término y al 80 % de prematuros. El objetivo de este artículo fue evaluar la utilidad de las pruebas de laboratorio clínico disponibles en la actualidad para el diagnóstico de la hiperbilirrubinemia neonatal y resumir los factores de riesgo más frecuentes en neonatos para desarrollar hiperbilirrubinemia. Metodología. Revisión sistemática donde se realizaron búsquedas en bases de datos como Elsevier, PubMed, Scopus y The Cochrane Library, y en las guías de artículos relevantes publicados entre 2018 y 2023 en el idioma inglés. Los documentos se examinaron con la metodología PRISMA. Resultados. Se evaluaron 17 documentos sobre el diagnóstico y factores de riesgo de la hiperbilirrubinemia neonatal. El 64,28 % de los documentos estableció la edad gestacional <37 semanas como factor de riesgo, seguido por los antecedentes familiares en un 57,14 %, alimentación subóptima (malnutrición neonatal) en un 50 % y anomalías congénitas en un 42,85 %. El 50 % de los documentos estableció la evaluación visual como método útil para determinar la presencia de hiperbilirrubinemia neonatal, el 85,71 % recomendaron la medición de la bilirrubina sérica total como prueba diagnóstica, mientras que la bilirrubina transcutánea se recomendó en el 64,28 %. Conclusión. La cuantificación exacta de la bilirrubina sérica total por parte del laboratorio clínico es considerada como el estándar de oro para el diagnóstico, seguimiento y control de la hiperbilirrubinemia neonatal. Aunque la medición de bilirrubina transcutánea y la evaluación visual también se pueden utilizar para evaluar la hiperbilirrubinemia, se ha observado que el resultado de estas pruebas suele ser impreciso.
... Instead, the evaluation of newborns heavily relies on HCWs' subjective assessments of the extent of 'yellowness' in the baby's skin. Similar ndings have been reported in a prospective cohort study of 860 Dutch newborns assessed in primary care birth centres (37). The research revealed that TcB or TSB measurements were not quanti ed in 44% of newborns considered 'quite yellow' and in 20% considered 'very yellow'. ...
Background: Neonatal jaundice is a common condition that can lead to brain damage and disabilities when severe cases go undetected. Low- and middle-income countries often lack accurate methods for detecting neonatal jaundice and rely on visual assessment, resulting in a higher incidence of adverse consequences. Picterus Jaundice Pro (Picterus JP), an easy-to-use and affordable smartphone-based screening device for the condition, has demonstrated higher accuracy than visual assessment in Norwegian, Philippine and Mexican newborns. This study aimed to identify the barriers and facilitators to implementing Picterus JP in public health services in low-income settings in Mexico by exploring the current process of neonatal jaundice detection and stakeholders’ perspectives in that context. Methods: Qualitative data collection techniques, including one focus group, 15 semi-structured interviews and four observations, were employed in urban and rural health facilities in Oaxaca, Mexico. The participants included medical doctors, nurses and health administrators. The data were analysed by thematic analysis guided by the Consolidated Framework for Implementation Research. Results: The analysis yielded four main themes: (I) the current state of neonatal care and NNJ detection, (II) the needs and desires for enhancing NNJ detection, (III) the barriers and facilitators to implementing Picterus JP in the health system and (IV) HCWs’ expectations of Picterus JP. The findings identify deficiencies in the current neonatal jaundice detection process and the participants’ desire for a more accurate method. Picterus JP was perceived as easy to use, useful and compatible with the work routine, but barriers to adoption were identified, including internet deficiencies and costs. Conclusions: The introduction of Picterus JP as a supporting tool to screen for neonatal jaundice is promising but contextual barriers in the setting must be addressed for successful implementation. There is also an opportunity to optimise visual assessment to improve detection of neonatal jaundice.
During clinical posting all five new born were assessed for hyperbilirubinemia in detail. All were babies were having yellowish discolouration on skin, eyes and baby was very weak. Majority were term babies, having normal birth weight and anthropometric measurements were normal. The total bilirubin count is very high in all the babies. All the babies were receiving phototherapy. After couple of days of phototherapy the bilirubin level is dropped.
