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Showing 10 results for Bilirubin
Study of newborn with pathologic hyperbilirubinemia after 5 days of birth in Children Medical Center Hospital
Sm Milani,
Volume 59, Issue 6 (11-2001)
Abstract
Hyperbilirubinemia is one of the common and major problems during neonatal period. Our propose was to determine the etiologic and predisposing factor in neonatal hyperbilirubinemia. We analyzed the patients record of 312 neonate including 184 male and 128 female with median age of 16.5 days (range 6-28 days) in children medical center hospital at 1998. The main cause of hyperbilirubinemia in our study was breast feeding (76.6 percent), followed by sepsis (11.5 percent) and hypothyroidism (10.6 percent). Also other uncommon etiology of hyperbilirubinemia that were seen in our patients were TORCH, G6PD deficiency and cephalhematoma. The age of 60 out of our patients (19.2 percent) was 6 days and others were 7 days (15.7 percent), 8 days (14.4 percent) and only 2 out of 312 patients were at age of 28 days. According to our study we suggest that role of breast-feeding should be considered in any neonate with hyperbilirubinemia.
The effect of fluid supplementation on serum bilirubin level during phototerapy in term infants
Torkaman M, Afsharpeyman Sh, Khalili Matinzadeh Z, Amirsalary S, Kavehmanesh Z, Hashemi S.a,
Volume 64, Issue 10 (10-2006)
Abstract
Background: Jaundice is a common and benign problem in neonatal period. Several therapeutic procedures for decreasing of serum bilirubin level has been recommended. phototherapy is most common them. Our goal Form this study is the evaluation of serum therapy effects in decreasing of serum bilirubin concentration in icteric infants that are treated with phototherapy.
Methods: This is a prospective clinical trial in Najmeih Hospital in 2002. In this study 80 term icteric infants with bilirubin level greater than 17 mg/dl were randomized in two groups, both groups underwent phototherapy and in the case group intravenous fluid supplementation was added. There were no significant differences in the mean gestational age, birth weight, hemoglobin, and also in total serum bilirubin level at admission in the two groups.
Results: There were no significant differences in the mean rate of of serum bilirubin level decline during first 24 and 48 hours of hospitalization and also the time of bilirubin decreasing to less than 15 mg/dl and the length of hospitalization in two groups.
Conclution: Our study showed intravenous fluid supplementation could be limited to special cases of neonatal icter such as moderate to severe dehydration.
Risk factors of kernicterus a study in 312 icteric neonates
Behjati Ardakani S, Nikkhah A, Sedaghat M,
Volume 65, Issue 3 (6-2007)
Abstract
Background: Kernicterus, also known as bilirubin encephalopathy, is a neurologic syndrome resulting from the deposition of unconjugated bilirubin in the basal ganglia and brainstem nuclei. Indirect bilirubin is toxic for brain. Neurologic dysfunction (BIND) that include acute phase (hyperbilirubin encephalopathy) and chronic phase (Kernicterus) resulting from hyperbilirubinemia and disruption of blood brain barrier. In this study, the association between bilirubin encephalopathy and risk factors was evaluated.
Methods: In this retrospective study, 312 icteric neonates were admitted in the neonatal ward of Children's Hospital, Medical Center, Tehran, and 305 of these cases were evaluated. Patient histories were taken and physical examinations were performed. For each patient, the age, sex, birth weight, time of discharge from the hospital and risk factors were recorded, and a questionnaire was completed.
Results: In this study, of the 305 icteric neonates evaluated, 25 cases had kernicterus. Risk factors included acidosis, prematurity, hemolysis, hypoglycemia, sepsis, respiratory distress, low birth weight, ABO incompatibility and G6PD deficiency. The mean level of bilirubin in cases of kernicterus was 32 mg/dl and in the others was 20 mg/dl (p=0.001). Kernicterus was most common among high risk neonates (p<0.001). Birth weight less than 2,500 gm was also an important factor (p=0.04).
Conclusion: High-risk neonates need prompt treatment for hyperbilirubinemia compared to low risk neonates.
The relation of increasing serum bilirubin during 24-48 hours of birth and birth season
Sajjadian N, Shajari H, Mofid R, Jahadi R, Alizadeh Taheri P,
Volume 70, Issue 12 (3-2013)
Abstract

Background: The relationship between season of birth and human diseases is well known and such a relationship could be mediated by seasonal and environmental effects on early events of extrauterine life Empirical neonatological experience suggests that prevalence and degree of neonatal jaundice might be dependent on seasonal variation, mainly due to the sunshine duration. However, evidence based data on this issue are scarce. Thus, we have analyzed the seasonal effect on the rise of serum bilirubin level during the neonatal period.
Methods: A prospective cohort study was done on a sample of 629 term and healthy  infants born consecutively in Shariati Hospital, Tehran, Iran, during the years 2008-2009. The cord bilirubin level and then the serum bilirubin level near to 48 hour of age were measured. Seasonal differences in rise of serum bilirubin were studied.
Results: Rise of serum bilirubin in spring was 3.951.4 mg/dl, in summer 3.761.69 mg/dl, in fall 3.511.60 mg/dl and in winter 4.791.99 mg/dl. Serum bilirubin level in cord blood did not appear to be correlated with season of birth. After correction for the possible effect of these variables the relation between season of birth and rise of serum bilirubin remained significant. The rise of serum bilirubin in winter was significantly higher than other season (P<0.0001).
Conclusion: Season acts as an independent etiological factor of neonatal hyperbilirubinemia. Mean rise of serum bilirubin in winter is higher than other season. This provided information to improve education for nurses in identifying risk factors and the prevention of hyperbilirubinemia readmissions.


Frequency of major and minor risk factors associated with jaundice in hospitalized newborns
Hassan Boskabadi, Maryam Zakerihamidi, Fatemeh Bagheri,
Volume 75, Issue 2 (5-2017)
Abstract

Background: Hyperbilirubinemia is the most common cause for readmission in the early neonatal period 5 to 36 percent of healthy term infants who are discharged from hospital are again hospitalized due to severe to moderate hyperbilirubinemia. Detection of major and minor risk factors associated with neonatal jaundice helps to identify high-risk infants and prevent neonatal jaundice. This study was performed aiming to evaluate the major and minor risk factors associated with jaundice in infants hospitalized.

Methods: This cross-sectional study was performed on 2207 term infants (<15 days) with hyperbilirubinemia (>15 mg/dl) in neonatal clinic or emergency unit or neonatal intensive unit, of Mashhad Ghaem Hospital, Iran, from April 2010 to May 2016. The jaundice of infants was confirmed by the pediatrician and laboratory tests. Then the researcher-made questionnaire containing maternal information and neonatal characteristics was completed. Values were expressed as mean±SD. Student t-test and Mann-Whitney test were used as appropriate. P-value less than 0.05 was considered significant.

Results: Sixty one percent of neonates had major risk factors and 80% of neonates had minor risk factor for jaundice. For neonatal jaundice, the most common major risk factors were significant weight loss (27.5%), jaundice visible in the first 24 hours (16.3%), history of treatment with phototherapy and exchange transfusion in sibling (14.8%), Gestational age of 35 to 36 week (9.9%), ABO incompatibility (9.2%), RH incompatibility (3.3%) and G6PD deficiency (3.33%), and the most common minor risk factors were age over 25 years (51.4%), male (49.7%), history of hyperbilirubinemia in sibling (22.3%), diabetic mother's infants (1.5%).

Conclusion: The major risk factors for neonatal hyperbilirubinemia were significant weight loss, jaundice visible in the first 24 hours, history of treatment with phototherapy and exchange transfusion in sibling, gestational age of 35 to 36 week, ABO incompatibility, RH incompatibility and G6PD deficiency.

Intermittent versus continuous phototherapy for the treatment of non-hemolytic moderate hyperbilirubinemia in term infants: a randomized controlled trial
Roya Taheritafti, Moj Taheritafti ,
Volume 76, Issue 10 (1-2019)
Abstract
Background: Phototherapy is the most effective treatment for neonatal jaundice and intermittent phototherapy is as effective as continuous phototherapy but with fewer complications and more benefits. This study compared the hospital length of stay, duration of phototherapy and the reducing rate of total serum bilirubin after 24 and 36 hours of phototherapy in two groups.
Methods: The current double-blinded randomized controlled trial was conducted on 60 icteric term neonates from November 2016 to June 2017. A total of 60 icteric term neonates were randomly divided into two groups. In the continuous group, the phototherapy device was turned on for 24 hours and in the intermittent phototherapy group, the phototherapy device was turned on for 18 hours and off for eight hours. Inclusion criteria were term neonates with non-hemolytic hyperbilirubinemia admitted to the neonatal ward of Loghman Hospital, Tehran, Iran. Infants were excluded for any of the following reasons: Hemolytic anemia, prematurity, sepsis, sever hyperbilirubinemia (total bilirubin>18 mg/dl), direct hyperbilirubinemia and onset of jaundice within the first 24 hours of life. In both arms, phototherapy continued until total serum bilirubin reached<11 mg/dL.
Both early and late complications were compared including the length of hospital stay, duration of phototherapy, the rate of kernicterus, decreasing rate of serum bilirubin after 24 and 36 hours.
Results: The demographic parameters did not differ significantly between the intermittent and continuous phototherapy groups. The length of hospital stay was 2.3±0.60 and 2.46±0.93 days in the continuous and intermittent groups, respectively (P=0.516) and there was not significant differences between them. The duration of phototherapy was 45.26±16.39 and 46±11.82 hours in the continuous and intermittent groups, respectively, and they had no significant differences (P=0.843). The rate of serum bilirubin cessation in the two groups was similar after 36 hours.
Conclusion: According to the current study results, intermittent phototherapy was as effective as continuous phototherapy to treat icteric full-term neonates. The intermittent phototherapy also helps to maintain mother-infant bonding and it is useful to maintain breastfeeding.

The relationship between magnesium levels and complications of jaundice in infants
Razieh Sangsari, Maryam Saeedi, Malihe Kadivar, Mahsa Niknam,
Volume 78, Issue 5 (8-2020)
Abstract
Background: The effects of magnesium physiology are contradictory to the neurotoxic effect of bilirubin, but the relationship between magnesium level and hyperbilirubinemia in neonates has not been well studied. In this study, we investigated the relationship between serum magnesium level and hyperbilirubinemia and hyperbilirubinemia complications at the Children’s Medical Center.
Methods: In this cross-sectional and prospective study, 100 neonates who were admitted to the Children's Medical Center from October 2018 to 2019 due to neonatal jaundice were enrolled. Neonates were divided into two groups: serum bilirubin levels 16-20 mg/dl were included in the moderate hyperbilirubinemia group and bilirubin >20 mg/dl into severe hyperbilirubinemia group. Serum magnesium levels and clinical complications of hyperbilirubinemia including fever, seizure, apnea, bradycardia, and abnormal neurological examinations were recorded in these infants.
Results: In this study, 100 neonates were evaluated. The mean serum magnesium level in these patients was 2.32 mg/dl. This rate was significantly higher in neonates with seizure (P=0.038), hyperbilirubinemia fever (P=0.048), and neonates with chronic encephalopathy (P=0.003). The mean serum magnesium level was significantly higher in severe hyperbilirubinemia (P<0.001). Serum Magnesium in complications of chronic encephalopathy (P=0.007), Fisting (P=0.001), retrocoli (P=0.001), hypertonia (P=0.004), hypotonia (P=0.001) and seizures (P=0.030) were significantly different. The serum magnesium levels were positively correlated with total bilirubin (r=0.443, P<0.001). The magnesium levels correlated with the chronic encephalopathy (OR: 4.15, P=0.040) and it was observed that magnesium levels above 2.15 could predict chronic encephalopathy with a sensitivity of 100%, the specificity of 47.82%, a negative predictive value of 100% and a positive predictive value of 14.28%.
Conclusion: The results of this study showed that serum magnesium levels significantly correlated with serum total bilirubin and magnesium cutting points above 2.15 mg/dl in patients with jaundice could predict chronic encephalopathy.

Drug-induced cholestasis: case report
Vahid Eslami, Azin Gheymati,
Volume 78, Issue 8 (11-2020)
Abstract
Background: Clopidogrel is an effective anti-platelet drug that is commonly prescribed for patients with atherosclerotic coronary and peripheral vascular diseases, especially after angioplasty and coronary artery bypass graft surgery. Even though this drug seems safe, there are case reports of important side effects with its use.
Case Presentation: The patient was 67 years old male admitted with a diagnosis of inferior myocardial infarction who underwent angioplasty on RCA with a drug-eluting stent and was discharged with an uneventful course from hospital with medical treatment, including Clopidogrel. The patient came back to the clinic 30 days later with icter, nausea and loss of appetite. The lab data showed: Bilirubin (total= 5, direct=4), ALT=220, AST=100, Gama GT=830, Alk.phop=445. Virologic and imaging studies were normal. With a possible diagnosis of drug-induced hepatic injury all possible Prescribed drugs were held stepwise but bilirubin and the patient’s symptoms did not relieve until Clopidogrel has been changed. After 10 days bilirubin and his symptom relieved.
Conclusion: Clopidogrel is a common and partially safe drug, but it may cause hepatic injury. Considering Clopidogrel side effects and its interactions seem necessary for patient management.
 

Comparing transcutaneous bilirubin versus serum bilirubin measurement using spectrophotometry for jaundice screening of full-term neonates
Fariba Hemmati, Zahra Hashemi, Negar Yazdani,
Volume 78, Issue 12 (3-2021)
Abstract
Background: Neonatal jaundice is an almost common problem among neonates that may cause complications such as kernicterus in severe cases. Since early diagnosis and proper treatment of neonatal jaundice is vital to prevent the related complications, it is necessary to check bilirubin before discharging the neonates. There are several evaluating and diagnostic methods to measure the level of bilirubin. Thus, this study aimed to compare the transcutaneous method versus measurement of serum bilirubin, using spectrophotometry for jaundice screening of full-term neonates before discharge from hospital.
Methods: This observational analytic study was conducted on six hundred neonates with birth weight more than 2000 grams and gestational age more than 35 weeks from September 2012 to March 2013 in Hafez hospital, Shiraz University of Medical Sciences. Parameters such as bilirubin level of neonates were measured and compared, using spectrophotometry and transcutaneous by Bili check with multi waves.
Results: Six hundred neonates were enrolled in this study. The Pearson correlation test showed that there was a significant correlation between the two methods of the transcutaneous versus measurement of serum bilirubin, using spectrophotometry (r=0.63), (P>0.05). There was no significant difference between the mean of measured bilirubin, using each method in some demographic variables such as the different groups of gender (P=0.896), birth weight (P=0.419), and type of feeding in neonates (P=0.323), but it was significant in other demographic variables such as the different groups of gestational age and post-neonatal age (P<0.0001). Also, the results revealed that there was a significant correlation between two methods of the trans cutaneous versus measurement of serum bilirubin, using spectrophotometry based on demographic variables (P<0.0001).
Conclusion: In general, the bilirubin measurement using trans-cutaneous method may estimate bilirubin significantly less than the serum bilirubin measurement method, and this difference can be more obviously noticeable in infants with less gestational age and also less post-natal age.
 

Evaluation of severity, duration and complications of jaundice in infants of both sexes at Ghaem Hospital in Mashhad from 2014 to 2021
Hassan Boskabadi , Mahdie Mir, Maryam Zakerihamidi,
Volume 80, Issue 6 (9-2022)
Abstract
Background: The gender of the baby is one of the risk factors for neonatal jaundice, but the difference in the severity of jaundice and its prognosis between the two sexes is not clear. Therefore, in this study, we investigated the severity, duration and prognosis of jaundice in both sexes.
Methods: The present study is a cross-sectional study that was performed on 2847 icteric neonates over 35 weeks admitted to Ghaem Hospital in Mashhad from May 2014 to May 2021. This study is done by available sampling. After confirmation of jaundice in infants, data were recorded using a researcher-made checklist including maternal demographic information (maternal age, mode of delivery), complete infant characteristics (age, birth weight, age at onset of jaundice, jaundice recovery age) and laboratory findings (Bilirubin, Indirect Coombs, direct Coombs, G6PD), and neonatal development up to two years of age was performed based on the Denver 2 test. Then data analysis was performed by SPSS software using Chi-square test and Student’s t-test.
Results: 1642 infants (57.7%) were boys and 1205 infants (42.3%) were girls. Mean and standard deviation of bilirubin in values less than 20 mg/dl in boys was 17.20±2.48 mg/dl and in girls was 16.54±2.80 mg/dl (P=0.000), birth weight was 3.16±0.49 (kg) for boys and 3.07±0.45 for girls (P=0.000). In two groups of male and female infants, age (P=0.004), direct bilirubin (P=0.001), direct and indirect Coombs (P=0.000), and G6PD enzyme deficiency (P=0.000) had a significant difference. Acute kernicterus was reported in 25 (2.03%) boys and 4 (0.46%) girls (P<0.001). In the two-year follow-up, 23 boys (1.9%) and 11 girls (1.28%) had developmental delay (P<0.05).
Conclusion: The incidence of jaundice in male infants was higher than female infants, which is probably due to a higher prevalence of G6PD deficiency in boys. The severity of jaundice was higher in boys less than 20 mg/dl. Jaundice has a worse prognosis in male infants.

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