Relationship of serum bilirubin levels and hearing impairment in newborn infants

A comparison has been made between 39 infants with a birthweight of 1500 g or less and a bilirubinlevel of 240 mumol/l or above, born between January 1980 and December 1983 and 19 infants with the same criteria, born between January 1984 and December 1985. Eight of the 22 high risk and two of the 17 low risk infants were diagnosed to have sensorineural deafness (SND) during the first period and this was strongly associated with the duration of the hyperbilirubinaemia. During the second period, more active intervention for hyperbilirubinaemia led to an increased number of exchange transfusions and a marked drop in the mean duration of hyperbilirubinaemia (less than 240 mumol/l). None of the very low birth weight (VLBW) infants born in the second period have developed SND. To investigate the independent effect of hyperbilirubinaemia on hearing, six low risk infants with bilirubin levels less than 320 mumol/l were studied by serial auditory brainstem responses (ABR). Impairment of the ABRs was found in four infants, with further deterioration with the persistence of high bilirubin levels in two. Although recovery of hearing thresholds was noted in all infants with impaired ABRs, an absence of wave I was noted in three infants at 6 months of age, which could indicate damage to the auditory nerve-cochlear complex. These findings suggest that hyperbilirubinaemia in itself can have an adverse effect on hearing and that careful management of hyperbilirubinaemia may reduce the incidence of sensorineural deafness.     

Relationship between serum bilirubin and coagulation test results in 1-month-old infants

Objective: Although the connection between cholestasis and conjugated hyperbilirubinemia is well known, mild hepatic dysfunction or cholestasis may also be associated with unconjugated hyperbilirubinemia in some infants with prolonged jaundice. The aim of this study was to investigate the relationship between serum bilirubin levels and alanine aminotransferase levels, asparte aminotransferase levels, prothrombin time, activated partial thromboplastin time and international normalization ratio findings in a group of infants.Methods: The study included 77 healthy, term, breast-fed infants with jaundice and 56 age-matched, healthy, term, non-jaundiced controls. The 133 babies were divided into three subgroups according to their total bilirubin levels [group I (controls) <50 μmol/L, group II=50–100 μmol/L, and group III >100 μmol/L, and the findings for the noted parameters were compared].Results: The mean conjugated bilirubin level was significantly higher, and the mean activated partial thromboplastin time significantly longer in group III than in group I. A significant positive correlation was found between bilrubin levels and PT and APTT results.Conclusion: Clinical vitamin K deficiency appeared unlikely to develop in this group of infants with prolonged unconjugated hyperbilirubinemia. However, a significant positive correlation between bilirubin levels and PT and APTT suggest that a higher bilirubin load to the liver may cause some degree of vitamin K deficiency due to mild cholestasis. The importance of this finding, and the possible benefits of vitamin K supplementation in 1-month-old breast-fed infants with bilirubin levels higher than 100 μmol/L require further investigation.     

Fecal bilirubin excretion and serum bilirubin concentrations in breast-fed and bottle-fed infants

To assess the rate of excretion of bilirubin in the stools and its effects on serum bilirubin concentrations, we studied 24 breast-fed and 13 bottle-fed infants during the first 3 days after birth. Bottle-fed infants passed significantly more stool (3-day totals, 82 vs 58 gm, P less than 0.001), excreted more bilirubin (3-day totals, 23.8 vs 15.7 mg, P less than 0.05), and had lower serum bilirubin values (day 3, 6.8 vs 9.5 mg/dl, P less than 0.02). Among the breast-fed infants, greater stool output was associated with greater fecal bilirubin excretion (r = 0.56, P less than 0.05) and lower serum bilirubin concentrations (r = 0.66, P less than 0.001). Our data suggest that hyperbilirubinemia in breast-fed infants may be related to a delay in bilirubin clearance resulting from low stool output.     

早产儿血清促红细胞生成素水平与脑损伤的关系

目的 探讨早产儿血清促红细胞生成素（EPO）水平与脑损伤的关系。方法 选取2014 年10月至2015 年9 月出生胎龄在28~34 周的早产儿304 例作为研究对象。采用颅脑B 超和MRI 检查诊断脑损伤,ELISA 检测血清EPO、S100 蛋白、神经元特异性烯醇化酶（NSE）和髓鞘碱性蛋白（MBP）水平,比较不同血清EPO 水平早产儿脑损伤的发生率,分析血清EPO 水平与各指标的相关性;采用多因素Logistic 回归分析研究血清EPO 水平与脑损伤的关系。结果 304 例早产儿中发生脑损伤125 例（41.1%）;低水平EPO 组缺血性脑损伤发生率明显高于中高水平EPO 组（P P P P 结论 血清EPO 低水平的早产儿脑损伤发生率高,血清EPO 水平与早产儿脑损伤密切相关。     

Initial response of serum bilirubin levels to phototherapy.

We demonstrated the phenomenon of transiently increasing total serum bilirubin within 4 h of phototherapy. We attempted to resolve the mechanism of this phenomenon in 29 hyperbilirubinemic full-term newborn infants who received continuous phototherapy for 24 h. Our present study suggests that this phenomenon may in part be bilirubin load (photobilirubin, photoisomers) from skin and subcutaneous bilirubin and/or peripheral capillary wall bilirubin into the blood stream pool, rather than delayed clearance of bilirubin and photoisomers from the blood stream to bile or urine. Further study is needed to determine these bilirubin compounds for safe and more effective phototherapy.     

Lipid and apolipoprotein levels and enteral nutrition in very low-birth-weight preterm infants

Lipid, lipoprotein cholesterol and apolipoprotein A-I, A-II and B levels were determined in 10 very low-birth-weight (birth weight 1279 ±144 g; gestational age 29.2±1.2 weeks, mean ± SD) preterm infants on postnatal days 3, 10 and 21. Feeding with pooled human milk began on day 3 ± 1 and by day 10 all infants were exclusively enterally fed. Both triglyceride and total cholesterol levels increased significantly from day 3 to day 10 (0.84 ± 0.28 versus 1.53 ± 0.72 and 2.42 ± 0.47 versus 3.24 ± 0.80, mmol/l, respectively) ( p <0.01); thereafter no further increase was observed. The increase in total cholesterol level was primarily due to a significant enhancement of very low-density lipoprotein and low-density lipoprotein cholesterol (1.52±.34 versus 2.29 ± 0.73 mmol/l, p <0.01). Apo A-I, A-II and B levels did not change between day 3 and day 10. From day 10 to day 21, however, a significant increase in apo A-I concentration was noted (0.57±.20 versus 0.87 ± 0.17 g/l, p <0.01), whereas apo A-II levels increased significantly from day 3 to 21 (0.15 ± 0.03 versus 0.27 ± 0.08 g/l, p<0.01). No change in apo B level was seen.     

Lipid and apolipoprotein levels and enteral nutrition in very low-birth-weight preterm infants

Lipid, lipoprotein cholesterol and apolipoprotein A-I, A-II and B levels were determined in 10 very low-birth-weight (birth weight 1279 ± 144 g; gestational age 29.2 ± 1.2 weeks, mean ± SD) preterm infants on postnatal days 3, 10 and 21. Feeding with pooled human milk began on day 3 ± 1 and by day 10 all infants were exclusively enterally fed. Both triglyceride and total cholesterol levels increased significantly from day 3 to day 10 (0.84 ± 0.28 versus 1.53 ± 0.72 and 2.42 ± 0.47 versus 3.24 ± 0.80, mmol/l, respectively) ( p <0.01); thereafter no further increase was observed. The increase in total cholesterol level was primarily due to a significant enhancement of very low-density lipoprotein and low-density lipoprotein cholesterol (1.52 ± 0.34 versus 2.29 ± 0.73 mmol/l, p< 0.01). Apo A-I, A-II and B levels did not change between day 3 and day 10. From day 10 to day 21, however, a significant increase in apo A-I concentration was noted (0.57 ± 0.20 versus 0.87 ± 0.17 g/l, p< 0.01), whereas apo A-II levels increased significantly from day 3 to 21 (0.15 ± 0.03 versus 0.27 ± 0.08 g/l, p<0.01). No change in apo B level was seen.     

Total serum bilirubin levels during cyclooxygenase inhibitor treatment for patent ductus arteriosus in preterm infants

Aim: To determine whether ibuprofen use in VLBW infants is associated with increased serum bilirubin levels and impaired neurodevelopmental outcome at 2 years of age compared to indomethacin.
Methods: We retrospectively evaluated bilirubin data and outcome parameters of 178 VLBW infants treated with COX inhibitors for a haemodynamically relevant patent ductus arteriosus (PDA) between 1998 and 2003 in a single institution. In our department ibuprofen replaced indomethacin for PDA treatment in 2001, while clinical and echocardiagraphic criteria for the indication of PDA invention have remained unchanged.
Results: Ibuprofen and indomethacin therapy groups did not differ in their baseline clinical profile. Peak serum bilirubin concentration was 10.2 mg/dL in the ibuprofen group and 8.6 mg/dL in the indomethacin group (p < 0.01), while phototherapy duration did not differ. At 2 years of age neurodevelopmental outcome was similar in both groups. In a single case analysis, four cases of adverse neurodevelopmental outcome despite inconspicuous clinical course were identified in the ibuprofen group.
Conclusion: In VLBW infants with PDA, ibuprofen treatment was associated with higher bilirubin levels than indomethacin.     

Hepatic enzymes,their induction and usefulness in predicting maximal serum bilirubin levels in premature newborn infants

Sixty-seven babies were utilized to (a) document the serum bilirubin lowering effect and safety of a phenobarbitone and nikethamide combination in neonatal hyperbilirubinaemia of non-hemolytic origin; (b) determine whether birthweight and/or SGOT, SGPT or SGGT activity on day one of life correlated with the maximum serum bilirubin level achieved; and (c) investigate the pattern of hepatic enzyme levels in serum under normal conditions and following drug induction. Results indicate a significantly lower serum bilirubin level in the treated group of babies. Birthweight and day one SGGT levels, and SGGT/birthweight ratio correlated well with the maximum serum bilirubin reached, the latter ratio being particularly useful in predicting the degree of hyperbilirubinaemia.