Tehran University Medical Journal

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.

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.

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.

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.

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.