脐血胆红素预测新生儿黄疸的意义

目的研究脐带血胆红素水平预测足月健康新生儿后续黄疸程度的价值。方法523例足月健康新生儿,测定脐血胆红素、白蛋白水平,监测每日经皮胆红素值（TCB）。对时龄0—24hTCB≥18;-48hTCB≥21;-72hTCB≥25;〉72h≥25者,送检静脉血血清胆红素值（TSB）,考虑是否需要光疗。将新生儿按脐血胆红素水平分为〈30μmol／L;≥30μmoL／L;≥36μmol／L;≥42μmoL／L,共4组。比较4组新生儿TCB≥25、TSB〉205μmol／L、TSB〉257μmoL／L及需要光疗的发生率。对脐血胆红素水平预告新生儿黄疸进行分析。比较黄疸组新生儿和非黄疸组新生儿临床特征。结果脐血胆红素水平升高,各组新生儿TCB≥25、TSB〉205μmol／L、TSB〉257μmoL／L和需要光疗的发生率增加。脐血胆红素水平用于预测新生儿黄疸发生有统计学意义（P〈0．001）。黄疸组新生儿脐血胆红素值显著高于非黄疸组（t=10．96,P〈0．001）。而脐血清白蛋白值（t=2．38,P〉0．05）、妊娠周数（t=-0．90,P〉0．05）、出生体重（t=0．10,P〉0．05）比较,两组均无统计学差异。结论脐血胆红素水平用于预测足月健康新生儿后续黄疸的程度是一种有效的方法。     

Normal serum bilirubin levels in the newborn and the effect of breast-feeding

We measured the serum bilirubin concentrations in 2,416 consecutive infants admitted to our well-baby nursery. The maximum serum bilirubin concentration exceeded 12.9 mg/dL (221 mumol/L) in 147 infants (6.1%), and these infants were compared with 147 randomly selected control infants with maximum serum bilirubin levels less than or equal to 12.9 mg/dL. In 66 infants (44.9%), we identified an apparent cause for the jaundice, but in 81 (55%), no cause was found. Of infants for whom no cause for hyperbilirubinemia was found, 82.7% were breast-fed v 46.9% in the control group (P less than .0001). Breast-feeding was significantly associated with hyperbilirubinemia, even in the first three days of life. The 95th percentile for bottle-fed infants is a serum bilirubin level of 11.4 mg/dL v 14.5 mg/dL for the breast-fed population, and the 97th percentiles are 12.4 and 14.8 mg/dL, respectively. Of the formula-fed infants, 2.24% had serum bilirubin levels greater than 12.9 mg/dL v 8.97% of breast-fed infants (P less than .000001). When compared with previous large studies, the incidence of "readily visible" jaundice (serum bilirubin level greater than 8 mg/dL) appears to be increasing. The dramatic increase in breast-feeding in the United States in the last 25 years may explain this observation. There is a strong association between breast-feeding and jaundice in the healthy newborn infant. Investigations for the cause of hyperbilirubinemia in healthy breast-fed infants may not be indicated unless the serum bilirubin level exceeds approximately 15 mg/dL, whereas in the bottle-fed infant, such investigations may be indicated if the serum bilirubin exceeds approximately 12 mg/dL.(ABSTRACT TRUNCATED AT 250 WORDS)     

Weight loss and hypernatremia in breast-fed babies: frequency in neonates with non-hemolytic jaundice

OBJECTIVE: The aim of this study was to determine what proportion of newborns admitted with idiopathic non-hemolytic hyperbilirubinemia exhibit severe weight loss and hypernatremia. METHODS: The prospective study involved 115 infants >48 h old who were admitted with jaundice between July 2002 and July 2003, and had unconjugated bilirubin levels >12 mg/dL. Premature babies (gestational age <37 weeks) and those with hemolytic jaundice and other pathologic causes of non-hemolytic jaundice were excluded. Postnatal age (days) at admission, bodyweight at admission, weight change since birth (percentage weight loss calculated at admission) and mode of feeding (breast-feeding, formula feeding, mixed feeding) were recorded. Severe weight loss was defined in babies who showed >10% weight loss or had not regained enough to reach birthweight by postnatal day 10. Serum Na levels and breast-milk Na levels were also measured. RESULTS: Twenty-eight (33%) of the 86 newborns with idiopathic hyperbilirubinemia in the study exhibited severe weight loss. Almost all the 86 babies were exclusively breast-fed, and 10 babies (12%) had severe weight loss combined with hypernatremia. The group with severe weight loss and hypernatremia had higher breast-milk Na levels than the other infants. CONCLUSION: The results indicate that a large proportion of babies with non-hemolytic jaundice have severe weight loss, and that breast-fed newborns with the combination of weight loss and hypernatremia may present with non-hemolytic jaundice.     

Cord blood bilirubin and prediction of neonatal hyperbilirubinemia and perinatal infection in newborns at risk of hemolysis

ObjectiveTo assess the accuracy of umbilical cord bilirubin values to predict jaundice in the first 48 h of life and neonatal infection.MethodNewborn infants treated at a regional well-baby nursery born at ≥36 weeks of gestation were included in this retrospective cohort study. All infants born in a 3-year period from mothers with O blood type and/or Rh-negative were included and had the umbilical cord bilirubin levels measured. Hyperbilirubinemia in the first 48 h was defined as bilirubin levels above the phototherapy threshold. Neonatal infection was defined as any antibiotic treatment before discharge.ResultsA total of 1360 newborn infants were included. Two hundred and three (14.9%) newborn infants developed hyperbilirubinemia in the first 48 h of life. Hyperbilirubinemic infants had smaller birth weight, higher levels of umbilical cord bilirubin, a higher rate of infection and were more often direct antiglobulin test positive. Umbilical cord bilirubin had a sensitivity of 76.85% and a specificity of 69.58% in detecting hyperbilirubinemia in the first 48 h, with the cut-off value at 34 μmol/L. The area under the receiver operating characteristic curve was 0.80 (95% CI: 0.78–0.82). Umbilical cord bilirubin had a sensitivity of 27.03% and specificity of 91.31% in detecting perinatal infection. The area under the receiver operating characteristic (ROC) curve was 0.59 (95% CI: 0.57–0.63).ConclusionsA positive correlation was found between umbilical cord bilirubin and hyperbilirubinemia in the first 48 h of life. Umbilical cord bilirubin is a poor marker for predicting neonatal infection.     

Neonatal hyperbilirubinemia and its association with thyroid hormone levels and urinary iodine excretion

Objective : To investigate, if, urinary iodine contents as a marker of iodine deficiency and hypothyroidism are associated with the incidence of neonatal hyperbilirubinemia.Methods : One hundred neonates with total serum bilirubin ≥15 mg/dl and with no known cause of jaundice were included in the study as a jaundice group. An equal number (n=100) of non-jaundiced neonates (bilirubin ≤14.9 mg/dl) with matching for age, gestation period and weight were enrolled in the study as a control group.Results : Thirteen neonates (13%) in the study group had urinary iodine levels < 100 mg/dl as against only 2 (2%) in the control group (p<0.05). Thirty-four (34/200-17%) neonates i.e. 17 each in the study and control groups had serum TSH> 5 mU/ml and hence an indirect indicator of iodine deficiency in the study population. The mean serum levels of total T3, T4 and TSH in the study neonates were 1.52 ±1.23 ng/ml, 15.8±12.0 μg/dl & 3.13 ±3.0 mU/ml respectively and did not differ significantly from the mean levels in the control group. Only one neonate in the study group had serum TSH > 20 mU/ml which was suggestive of hypothyroidism, but had normal T3 & T4. Seven neonates in the study group and 8 in the control group had low T4. There was no significant correlation between the maternal and neonatal urine iodine levels, thyroid functions and the bilirubin levels (p>0.01).Conclusion : The jaundiced babies had lower urine oidine levels than the control population. Since, there was no significant difference in the levels of the thyroid hormones, no cause and effect relationship could be inferred between iodine deficiency and jaundice.     

Extreme hyperbilirubinaemia in Zimbabwean neonates: neurodevelopmental outcome at 4 months

As part of a prospective study of severely jaundiced Zimbabwean infants, the relationship between maximum total serum bilirubin (TSB) concentration in the neonatal period and neurodevelopmental outcome at the corrected age of 4 months was studied. Fifty infants with a TSB of >400 μmol/l (23.4 mg/dl) were enrolled and screened with a neonatal neurological examination (NNE). The cause of jaundice was low birth weight in 22 (44%), ABO incomptability in 8 (16%), sepsis in 8 (16%) and congenital syphilis (6%) in 3 infants. In 9 infants a cause could not be determined. At 4 months, 2 infants had died and 3 were lost to follow up, leaving 45 infants for the infant motor screen (IMS) at 4 months of age. Mean TSB in the neonatal period was 485 μmol/l (28.2 mg/dl), and 7 infants received an exchange transfusion. Mean TSB of the infants with an exchange transfusion was 637 μmol/l (37.2 mg/dl) (range 429–865 μmol/l (25–50.3 mg/dl)) and of the infants without transfusion 459 μmol/l (26.8 mg/dl) (range 400–740 μmol/l (23.4–43 mg/dl)) (P < 0.0001). The TSB was not associated with birth weight, gestational age, gender or head circumference of the baby. On the IMS, 6 of 45 (13.3%) infants scored abnormal, 6 (13.3%) suspect and 33 (73%) scored normal. Three of the six (50%) remaining infants who received an exchange transfusion scored abnormal on the IMS while only 3 of the 39 (8%) infants without exchange transfusion were abnormal. Conclusion More than 25% of infants with a TSB of >400 μmol/l (23.4 mg/dl) scored abnormal or suspect at 4 months of age and half of these infants already showed irreversible neurological symptoms. All infants who scored abnormal or suspect on the IMS with bilirubin levels between 400 and 500 μmol/l (23.4 and 29.2 mg/dl) had haemolytic disease or were premature. Received: 4 October 1996 / Accepted: 5 February 1997     

Effect of milk feeding on intestinal bilirubin absorption in the rat

The hypothesis that the etiologic mechanism of the late-onset, prolonged, unconjugated hyperbilirubinemia of the breast-fed infant, known as the breast milk jaundice syndrome, results from exaggeration of intestinal bilirubin absorption has been investigated in an adult rat model, which permits quantitative measurement of the enterohepatic circulation of bilirubin. After instillation of unconjugated bilirubin in buffer into the duodenum, 25% of the dose was absorbed and appeared in bile. Administration of bilirubin in human milk or cow milk formula resulted in a marked reduction in absorption to 2%. Administration of bilirubin in milk from mothers of infants with breast milk jaundice syndrome not only failed entirely to prevent the absorption of bilirubin, but enhanced late absorption, to produce a total absorption of 60% of the bilirubin dose. Thus, although normal milk significantly retarded intestinal bilirubin absorption and diminished the bilirubin load to the liver, milk from mothers of infants with breast milk jaundice syndrome appeared to enhance the enterohepatic circulation of bilirubin and to increase the total hepatic bilirubin load. This exaggeration of the enterohepatic circulation of bilirubin may be related to the increased concentrations in these milks of long-chain nonesterified fatty acids.     

False-negative results of pre-discharge neonatal bilirubin screening to predict severe hyperbilirubinemia: a need for caution

Routine bilirubin screening prior to newborn hospital discharge, using an hour-specific bilirubin nomogram, has been advocated to assess risk for subsequent severe hyperbilirubinemia. However, the false-negative rate has never been adequately studied. Our objective was to determine false-negative results of pre-discharge bilirubin screening. After routine pre-discharge, bilirubin screening was in place for over 4 years, we performed a retrospective chart review to identify infants readmitted for total bilirubin levels > 17 mg/dl (>290.7 μmol/l). We documented each infant's pre-discharge bilirubin level, risk-zone assignment by nomogram, the presence or absence of risk factors for severe hyperbilirubinemia, co-morbidities upon readmission, treatment received, and ultimate disposition. Readmitted infants whose pre-discharge bilirubin was in the low-risk (<40th percentile) and low-intermediate (40–75th percentile) risk zones of the nomogram, were considered false-negatives. Of the 6,220 infants discharged from the newborn nursery during the 51-month study period, 28 (0.45%) were readmitted for treatment of serum bilirubin levels > 17 mg/dl (>290.7 μmol/l). All received phototherapy and none required exchange transfusion. Pre-discharge bilirubin values were <40th percentile (low-risk zone) in one infant (3.6%), and between 40–75th percentiles (low-intermediate risk zone) in twelve infants (43%). Risk factors for the development of severe hyperbilirubinemia were present in 27 (96%) readmitted infants. In conclusion, nearly half of readmitted infants had pre-discharge bilirubin values in zones considered at lower risk. The use of pre-discharge bilirubin screening alone to assign future risk for severe hyperbilirubinemia may provide false reassurance. Rigorous research is required to determine the test characteristics of pre-discharge bilirubin screening before widespread acceptance and implementation. Universal early post-discharge follow-up should remain the cornerstone of preventing severe hyperbilirubinemia.     

Early corticosteroid treatment does not affect severity of unconjugated hyperbilirubinemia in extreme low birth weight preterm infants

Aim: To determine the relationship between early postnatal dexamethasone (DXM) treatment and the severity of hyperbilirubinemia in extreme low birth weight (ELBW) preterm infants. Methods: In 54 ELBW preterm infants, total serum bilirubin concentrations (TSB) and phototherapy (PT) data during the first 10 days were evaluated retrospectively. ELBW infants had participated in a randomized controlled trial of early DXM treatment which aimed to assess effects on chronic lung disease. Infants had been treated with DXM (0.25 mg/kg twice daily at postnatal day 1 and 2) or with placebo (normal saline). Analysis was performed on an intention to treat basis. Results: Twenty‐five Infants had been randomized into the DXM group; 29 into the placebo group. Mean (±SD) TSB [120 (±19) μmol/L vs. 123 (±28) μmol/L, DXM versus placebo, respectively] and maximum TSB [178 (±23) μmol/L vs. 176 (±48), DXM versus placebo, respectively] concentrations were similar. TSB concentrations peaked 30 h earlier in the DXM group (p ≤ 0.05). The need for PT as well as the duration of PT was similar in both groups. Conclusions: Early DXM treatment does not affect the severity of neonatal hyperbilirubinemia in ELBW preterm infants. Our results seem compatible with the concept that factors other than bilirubin conjugation capacity are important for the pathophysiology of neonatal jaundice in ELBW preterm infants.     

Assessment of hyperbilirubinemia in full-term infants: Part II

The nurse practitioner plays an important role in assessing infants for factors that may contribute to unconjugated bilirubinemia. Healthy, full-term infants with unconjugated hyperbilirubinemia and no evidence of hemolysis require monitoring of their total serum bilirubin levels and stooling patterns, and they need encouragement to feed more frequently to resolve the hyperbilirubinemia. Promoting frequent breast-feeding is essential, especially for infants with unconjugated hyperbilirubinemia. For those infants with evidence of hemolysis or exaggerated physiologic jaundice, more advanced medical intervention such as phototherapy and exchange transfusion are available when indicated.     

Predictive value of umbilical cord blood bilirubin in neonatal hyperbilirubinemia

IntroductionJaundice is a clinical condition that is often present in pediatric practice and constitutes one of the major issues within the neonatal period. It occurs in both the physiological and pathological processes in newborns.¹ Although most newborns with jaundice are otherwise healthy, they need to be monitored because bilirubin is potentially toxic to the central nervous system.² The American Academy of Pediatrics (AAP) in 2004 recommended that newborns discharged within 48 h should have follow up visits after 2–3 days to detect significant jaundice.³Aim of the workThis study was done to evaluate the predictive value of umbilical cord bilirubin in identifying infants for subsequent hyperbilirubinemia, in full-term (FT) and late pre-term (PT) newborns.Subjects and methodsThis study is a prospective clinical study which was carried out on 94 newborns taken from the delivery room (DR) and neonatal intensive care unit (NICU) of Ismailia General Hospital at Ismailia Governorate. The study population was followed up clinically and by laboratory investigations from birth and daily during the first week of life.ResultsThe study population consisted of 50 males and 44 females with the mean gestational age of 38.70 ± 1.38 weeks in FT compared to 35.62 ± 0.64 in late PT. It was shown that 40.4% of PT needed treatment in the form of phototherapy compared to 29.8% of FT, and no one of both groups needed exchange transfusion. The mean total cord bilirubin was higher among males, preterm, cesarean deliveries, and ABO and RH incompatibility positive newborns. It was found that when cord blood in late PT newborns was ⩾1.75 mg/dl and ⩾1.85 mg/dl in FT newborns, there was a probability that those newborns may need phototherapy and when the levels of total cord bilirubin were ⩾2.05 mg/dl in PT newborns and ⩾2.15 mg/dl in FT it means that those babies are in actual need of phototherapy. Thus the cut-off points for total cord bilirubin level in PT and FT groups were 2.05 and 2.15 mg/dl respectively.ConclusionIt was concluded that total serum bilirubin in cord blood was indicative of the jaundice severity developed by healthy FT and late PT newborns without complications, during the first week of life.RecommendationsCord blood bilirubin could be a useful indicator of developing jaundice in newborns and the use of cut off cord bilirubin levels could be a useful predictor of significant hyperbilirubinemia.     

Vitamin K deficiency in newborns: a case report in alpha-1-antitrypsin deficiency and a review of factors predisposing to hemorrhage

A 4-week-old, breast-fed female infant appeared healthy until signs and symptoms of CNS deterioration suddenly occurred. At presentation the infant was found to have a left-sided parietal intracerebral hematoma, markedly prolonged prothrombin time, and partial thromboplastin time, normal platelet count, and jaundice with a total and direct serum bilirubin level of 5.4 mg/dL and 2.6 mg/dL, respectively. Vitamin K1 and fresh frozen plasma returned the prothrombin time and partial thromboplastin time to normal values within 18 hours, suggesting that the infant had severe vitamin K deficiency complicated by intracerebral hemorrhage. Evaluation of the infant's direct hyperbilirubinemia led to the diagnosis of homozygous (pi-type ZZ [PiZZ] ) alpha-1-antitrypsin deficiency. The clinical circumstances predisposing to vitamin K deficiency in newborns and infants are discussed. Based on our observations in this case, we suggest that cholestatic liver disease should be suspected when unexplained vitamin K deficiency occurs in early infancy. The role of vitamin K in hemostasis and the laboratory diagnosis of vitamin K deficiency are discussed as they apply to the evaluation of hemorrhage in newborns and infants.     

Neurodevelopmental outcome at 1 year in Zimbabwean neonates with extreme hyperbilirubinaemia

The study concentrates on estimating the magnitude of the effect of a single risk factor, maximum total serum bilirubin (TSB) in excess of 400 μmol/l (23.4 mg/dl), on the neurodevelopmental outcome of 50, singleton, Zimbabwean neonates at 1 year of age. At 1 year corrected age the Bayley Scales of Infant Development (BSID) was administered. Two infants died and five were lost to follow up. TSB was neither associated with birth weight nor with gestational age. Of 43 infants with a TSB >400 μmol/l (23.4 mg/dl),11(26%) scored abnormal on the BSID at 1 year of age and 5 (12%) infants developed the choreo-athetoid type of cerebral palsy. Conclusion Infants with bilirubin levels between 400 and 500 μmol/l (23.4 and 29.2 mg/dl) who scored abnormal or suspect on the Bayley Scales of Infant Development were preterm or had haemolytic disease. All term infants without haemolysis and with bilirubin levels between 400 and 500 μmol/l (23.4 mg/dl–29.2 mg/dl) were normal at 1 year of age. Received: 19 February 1998 / Accepted: 22 June 1998     

Cord Blood Alkaline Phosphatase as an Indicator of Neonatal Jaundice

Background:

Management of hyperbilirubinemia remains a challenge for neonatal medicine because of the risk of neurological complications related to the toxicity of severe hyperbilirubinemia.

Objectives:

The purpose of this study was to examine the validity of cord blood alkaline phosphatase level for predicting neonatal hyperbilirubinemia.

Patients and Methods:

Between October and December 2013 a total of 102 healthy term infants born to healthy mothers were studied. Cord blood samples were collected for measurement of alkaline Phosphatase levels immediately after birth. Neonates were followed-up for the emergence of jaundice. Newborns with clinical jaundice were recalled and serum bilirubin levels measured. Appropriate treatment based on serum bilirubin level was performed. Alkaline phosphatase levels between the non-jaundiced and jaundiced treated neonates were compared.

Results:

The incidence of severe jaundice that required treatment among followed-up neonates was 9.8%. The mean alkaline phosphatase level was 309.09 ± 82.51 IU/L in the non-jaundiced group and 367.80 ± 73.82 IU/L in the severely jaundiced group (P = 0.040). The cutoff value of 314 IU/L was associated with sensitivity 80% and specificity 63% for predicting neonatal hyperbilirubinemia requiring treatment.

Conclusions:

The cord blood alkaline phosphatase level can be used as a predictor of severe neonatal jaundice.     

The natural history of neonatal jaundice

The relationship between infant feeding type and the occurrence and natural history of neonatal jaundice in term newborn infants has been studied. A retrospective chart review of 124 records confirmed earlier reports indicating that jaundice is recognized more often in breast-fed than in formula-fed infants. A prospective cohort study of 140 term newborn infants was conducted using the Minolta Air-Shields transcutaneous jaundice meter. For 3 weeks, 115 white infants and 25 black infants were followed at predetermined intervals. The peak jaundice meter readings were higher and the elevated levels lasted longer in breast-fed than in formula-fed infants. Formula-fed infants' readings returned to base-line levels in eight days whereas the readings were still elevated in breast-fed infants when the study ended on the 21st day. Black infants had higher transcutaneous readings than white infants due to their deeper skin pigmentation, but otherwise they followed a course identical with that of the white babies. The distribution of jaundice in the white infants was bimodal; in approximately one fourth of the breast-fed infants, the jaundice meter readings reached levels corresponding to bilirubin values greater than 13 mg/dL whereas the remaining three fourths followed a pattern similar to that of the formula-fed infants. It can be concluded that human milk feeding is associated with more prolonged hyperbilirubinemia than formula-feeding in normal term infants.     

Correlation between unconjugated bilirubin and total cholesterol in the sera of 1‐month‐old infants

Aim: To investigate why breastfed infants are more likely to have prolonged jaundice than formula‐fed infants. Methods: Serum unconjugated bilirubin (UCB), total cholesterol (TC) and triglyceride (TG) were measured for 102 infants of 1 month. Enrolled infants were 42 breastfed, 40 mixed‐fed and 20 bottle‐fed infants. Statistic analyses for relationship among UCB, TC, TG, perinatal factors and post‐natal factors were performed for these infants. Results: In correlation analyses UCB was correlated with peak transcutaneous bilirubin value in neonatal period (TcBn) (r = 0.612, P < 0.0001) and with TC (r = 0.383, P < 0.0001). When analyses of covariance (ANCOVA) for UCB were performed using TcBn as the covariate, the results indicated that there was neither significant main nor interaction effect of feeding method on UCB, and that main and interaction effects of TC on UCB were significant when TC was categorised into two groups (≤150 mg/dL and >150 mg/dL). Conclusions: It is suggested that both neonatal hyperbilirubinemia and subsequent higher plasma TC are associated factors for prolonged jaundice.     

高胆红素血症新生儿血清S-100蛋白及总胆红素与白蛋白比值的变化及意义

目的 研究高胆红素血症(高胆)新生儿血清S-100蛋白水平和总胆红素(TBC)与白蛋白(B/A)比值的变化,为早期预测胆红素脑损伤提供新的方法.方法 根据胎龄、体质量和是否符合黄疸干预标准将出生7 d内的84例新生儿分为足月高胆组、足月对照组、早产高胆组、早产对照组.检测4组血清S-100蛋白、TBC、白蛋白水平,计算B/A比值.结果 足月高胆组S-100蛋白含量[(0.36±0.14)μg/L]高于足月对照组[(0.25±0.07)μg/L],差异有显著性(P＜0.05),足月高胆组S-100蛋白含量与B/A比值呈正相关性(r=0.509,P＜0.05).早产高胆组S-100蛋白含量[(0.40±0.09)μg/L)高于早产对照组[(0.28±40.05)μg/L],差异有显著性(P＜0.05),S-100蛋白含量与B/A比值无相关性(r=0.356,P＞0.05).结论 血清S-100蛋白和B/A比值可作为早期预测胆红素神经毒性的敏感指标.     

Plasma concentrations of vitamin K1 and PIVKA-II in bottle-fed and breast-fed infants with and without vitamin K prophylaxis at birth

Plasma vitamin K₁ and proteins induced by vitamin K absence (PIVKA) were assayed simultaneously 1–4 days and 29–35 days after delivery in three groups of infants: breast-fed not receiving vitamin K at birth (n=12), bottle-fed without vitamin K administration at birth (n=7) and breast-fed receiving 1 mg vitamin K₁ administered by intramuscular injection at birth (n=13). The bottle-fed infants had a significantly higher vitamin K₁ plasma level than breast-fed infants who did not receive vitamin K₁ at birth. Extremely high levels of vitamin K were obtained 1–4 days after intramuscular administration. At the age of 1 month, breast-fed infants had the same plasma vitamin K₁ concentration whether or not they had received vitamin K₁ supplements. Decarboxy prothrombin (PIVKA-II) a reliable indicator of biochemical vitamin K deficiency, was found in 5 out of 12 breast-fed and in 2 out of 6 bottle-fed infants who had not received supplemental vitamin K₁ after birth. In a separate study, we followed up to 90 days after birth a larger group if infants. PIVKA-II was found with significantly greater frequency in breast-fed infants receiving no vitamin K than in breast-fed infants receiving 1 mg vitamin K intramuscularly at birth, or in bottle-fed infants without extra vitamin K₁. These data form a strong argument for routine vitamin K prophylaxis after birth for all breast-fed infants. The optimum dose and manner of administration require further study.Abbreviations PIVKA proteins induced by vitamin K absence - PIVKA-II decarboxy prothrombin - AU arbitrary units     

Red cell pyruvate kinase deficiency in neonatal jaundice cases in India

Objective Pyruvate Kinase (PK) deficiency is the most common enzymopathy of the glycolytic pathway in erythrocytes. It constitutes one of the common causes of hereditary non-spherocytic hemolytic anemia. The aim of this study was to screen newborns in India for pyruvate kinase (PK) deficiency in relation to unconjugated hyperbilirubinemia. Methods Laboratory investigations done included complete blood counts, reticulocyte counts, direct and indirect bilirubin, assay of G6PD and PK activity, ATP and 2,3 DPG levels. All variables were studied in 50-cord blood samples from normal deliveries and 218 neonates with hyperbilirubinemia. Results 7 of the 218 cases of neonatal jaundice were PK deficient with 30–40% reduction in PK activity. These cases also had a 3–4-fold increase in 2,3 DPG:ATP ratios, which is one of the additional indicators for PK deficiency. Six of the 7 infants had a severe clinical course. Conclusion This study shows that the prevalence of PK deficiency in Indian neonatal jaundice cases is 3.21%, which is relatively high. This emphasizes the need for screening neonatal hyperbilirubinemia cases in India for PK deficiency.     

Serum bile acids and their conjugates in breast-fed infants with prolonged jaundice

Serum bile acids and their conjugates were analysed in 20 breast-fed infants with prolonged jaundice. The mean total bile acid levels in serum were increased in the breast-fed infants with jaundice, as compared with those in either breastor bottle-fed infants without jaundice. However, there were no significant differences between the groups. All the breast-fed infants examined, regardless of association with jaundice, had a bile acid pattern dominated by taurine conjugates (the ratio of glycine- to taurine-conjugated bile acid, G/T ratio, less than 1.00). In contrast, the bottle-fed infants without jaundice had a pattern dominated by glycine conjugates (G/T ratio, more than 1.00). Among the breast-fed infants with jaundice, the mean G/T ratio in those who had serum bilirubin levels over 10 mg/100 ml was significantly lower than that in those who had serum bilirubin levels of less than 10 mg/100 ml. The altered bile acid metabolism might be associated with the pathology of breast milk jaundice.Abbreviation LP-X lipoprotein-X