Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings.

Hyperbilirubinaemia is a ubiquitous transitional morbidity in the vast majority of newborns and a leading cause of hospitalisation in the first week of life worldwide. While timely and effective phototherapy and exchange transfusion are well proven treatments for severe neonatal hyperbilirubinaemia, inappropriate or ineffective treatment of hyperbilirubinaemia, at secondary and tertiary hospitals, still prevails in many poorly-resourced countries accounting for a disproportionately high burden of bilirubin-induced mortality and long-term morbidity. As part of the efforts to curtail the widely reported risks of frequent but avoidable bilirubin-induced neurologic dysfunction (acute bilirubin encephalopathy (ABE) and kernicterus) in low and middle-income countries (LMICs) with significant resource constraints, this article presents a practical framework for the management of late-preterm and term infants (≥ 35 weeks of gestation) with clinically significant hyperbilirubinaemia in these countries particularly where local practice guidelines are lacking. Standard and validated protocols were followed in adapting available evidence-based national guidelines on the management of hyperbilirubinaemia through a collaboration among clinicians and experts on newborn jaundice from different world regions. Tasks and resources required for the comprehensive management of infants with or at risk of severe hyperbilirubinaemia at all levels of healthcare delivery are proposed, covering primary prevention, early detection, diagnosis, monitoring, treatment, and follow-up. Additionally, actionable treatment or referral levels for phototherapy and exchange transfusion are proposed within the context of several confounding factors such as widespread exclusive breastfeeding, infections, blood group incompatibilities and G6PD deficiency, which place infants at high risk of severe hyperbilirubinaemia and bilirubin-induced neurologic dysfunction in LMICs, as well as the limited facilities for clinical investigations and inconsistent functionality of available phototherapy devices. The need to adjust these levels as appropriate depending on the available facilities in each clinical setting and the risk profile of the infant is emphasised with a view to avoiding over-treatment or under-treatment. These recommendations should serve as a valuable reference material for health workers, guide the development of contextually-relevant national guidelines in each LMIC, as well as facilitate effective advocacy and mobilisation of requisite resources for the optimal care of infants with hyperbilirubinaemia at all levels

Flexural strength of concrete prism strengthened using CFRP with modified mortar

Reinforced concrete (RC) is a good durable material that commonly used in construction compared to others. However, reinforced concrete structures may be damaged and are suffering from various deteriorations because of overloading and an inadequacy of design which may be attributed to cracks, spalling, large deflection, and more. Hence, it is essential to find repair and strengthening techniques of deteriorated concrete structures not only suitable in terms of the economy, but also to use them for their intended service life

Risk factors for sensorineural hearing loss among high-risk infants in Golestan province, Iran in 2010 - 2011

Background: Hearing impairment, as one of the most common birth defects, is a hidden disability with negative impacts on speech and cognitive development. Objectives: The aim of this study was to assess the prevalence of sensorineural hearing loss (SNHL) and determine the associated risk factors among infants admitted to neonatal intensive care units (NICUs) and neonatal wards of teaching hospitals, affiliated to Golestan University of Medical Sciences, Gorgan, Iran. Patients and Methods: In this cross-sectional study, 791 infants were recruited via non-random sampling. Demographic and clinical characteristics of the subjects were gathered, and the Automated Auditory Brainstem Response (AABR) test was performed upon admission. Afterwards, the subjects were followed-up and re-assessed, using the AABR test. For infants with abnormal AABR results, the Auditory Brainstem Response (ABR) test was performed on the day of discharge. Results: The mean age of the infants was 3.75 ± 4.86 days upon admission, and 56.4% of the subjects were female. The mean length of hospital stay was 9.63 ± 1.1 days; the subjects were hospitalized for 3.50 ± 10.21 days in the NICUs and 6.1 ± 5.27 days in the neonatal wards. In total, 3.4% of the infants presented with SNHL. No significant difference was found between SNHL and neonates’ age (P = 0.52), sex (P = 0.5), or sepsis (P = 0.94). However, SNHL was significantly associated with gestational age (P = 0.045), birth weight (P < 0.001), length of hospital stay (P < 0.001), pathological jaundice (P=0.033), antibiotic treatments (P = 0.007), and total serum bilirubin level (P = 0.01). Additionally, binary logistic regression analysis demonstrated the association between SNHL and these factors. Conclusions: In this study, the prevalence of SNHL among hospitalized neonates was similar to previous reports in Iran and other countries. Based on the findings, administration of ototoxic drugs during the neonatal period can lead to SNHL. Therefore, it seems essential to regularly screen newborns under treatment and limit the indiscriminate use of ototoxic drugs. © 2015, Iranian Red Crescent Medical Journal

RISIKO GANGGUAN PENDENGARAN PADA NEONATUS HIPERBILIRUBINEMIA

ABSTRACT Background. The prevalence of hearing impairment on the Indonesian population according to 2007 WHO data is estimated at 4.2 %, and one of the cause is neonatal hyperbilirubinemia. Early detection of hearing impairment and optimal intervention on the first 6 months can prevent speech and language impairment, lack of academic achievement, disturbance of personal social relationship and emotional in the children. Method. A Cohort research was conducted in 36 neonates in Dr Kariadi Hospital in March 2009-March 2010, 18 in the case group with indirect bilirubin > 12 mg/dl and 18 neonates as control group with indirect bilirubin < 12 mg/dl, both taken with consecutive sampling method. We recorded clinical, laboratory, and tymphanometry data, OAE and BERA results at first and after three months. Statistical analysis were done using Chi-square analysis, Mc Nemar analysis, and T-test. Results. Hearing impairment on the first BERA examination was 9 cases (25%) and 3 cases (8.3%) on the second BERA examination, however it did not differed significantly (p>0,05). On the first BERA examination, the mean indirect bilirubin concentration with hearing impairment of 14,18+6,289 mg/dl was not significantly different (p>0,05) from neonate without hearing impairment of 11,29+2,995 mg/dl. The Relative Risk (RR) was 2 (p>0,05; 95% CI 0,6-6,8), but statistically it was not significant. Conclusion. The incidence of hearing impairment on neonatal with hyperbilirubinemia is 25%. Indirect bilirubin of > 12 mg/dL is not proved to be the risk factor of hearing impairment in neonatal with hyperbilirubinemia. Keywords:BERA, hearing impairment, neonatal hyperbilirubinemia, OAE

Live transplantation in children with biliary atresia and vascular anomalies

Eight of 29 infants and children undergoing orthotopic liver transplantation for extrahepatic biliary atresia had associated major vascular anomalies. A distinctive and highly unusual vascular malformation consisting of absent inferior vena cava, anomalous origin of the hepatic artery, and preduodenal portal vein was encountered in three of these children. Although at times technically difficult, single anomalies of hepatic vasculature were satisfactorily handled. In contrast, transplantation attempts were lethal in all three infants having the complex vascular malformation. The suggestion is made that this specific subgroup of patients with biliary atresia be identified in advance and that, at the moment, children with this composite anomaly are highly questionable candidates for liver transplantation. © 1974

Screening methods for neonatal hyperbilirubinemia:benefits, limitations, requirements, and novel developments

Severe neonatal hyperbilirubinemia (SNH) is a serious condition that occurs worldwide. Timely recognition with bilirubin determination is key in the management of SNH. Visual assessment of jaundice is unreliable. Fortunately, transcutaneous bilirubin measurement for screening newborn infants is routinely available in many hospitals and outpatient settings. Despite a few limitations, the use of transcutaneous devices facilitates early recognition and appropriate management of neonatal jaundice. Unfortunately, however, advanced and often costly screening modalities are not accessible to everyone, while there is an urgent need for inexpensive yet accurate instruments to assess total serum bilirubin (TSB). In the near future, novel icterometers, and in particular optical bilirubin estimates obtained with a smartphone camera and processed with a smartphone application (app), seem promising methods for screening for SNH. If proven reliable, these methods may empower outpatient health workers as well as parents at home to detect jaundice using a simple portable device. Successful implementation of ubiquitous bilirubin screening may contribute substantially to the reduction of the worldwide burden of SNH. The benefits of non-invasive bilirubin screening notwithstanding, any bilirubin determination obtained through non-invasive screening must be confirmed by a diagnostic method before treatment. ImpactKey message: Screening methods for neonatal hyperbilirubinemia facilitate early recognition and timely treatment of severe neonatal hyperbilirubinemia (SNH). Any bilirubin screening result obtained must be confirmed by a diagnostic method. What does this article add to the existing literature? Data on optical bilirubin estimation are summarized. Niche research strategies for prevention of SNH are presented. Impact: Transcutaneous screening for neonatal hyperbilirubinemia contributes to the prevention of SNH. A smartphone application with optical bilirubin estimation seems a promising low-cost screening method, especially in low-resource settings or at home.Afdeling Klinische Chemie en Laboratoriumgeneeskunde (AKCL

Design and Development of Electronic Sensor and Monitoring System of Smart Low-cost Phototherapy Light System for Non-Invasive Monitoring and Treatment of Neonatal Jaundice

This paper showcases our previous and continuously improving development at Ateneo Innovation Center (AIC) and partners in designing and further enhancing the existing Low-cost Phototherapy Light System (LPLS) and Improved Low-cost Phototherapy Light System (ILPLS) to the new Smart Low-cost Phototherapy Light System (Smart LPLS) with non-invasive jaundice monitoring for newborns with Neonatal Jaundice (NNJ). Developing this tool will help determine the intensity of yellowish color in infants and can monitor NNJ in a non-invasive way. The system is envisioned to be integrated with Mobile or Near Cloud as part of Smart Nursing Station together with other hospital equipment for monitoring, collection, and management of medical records and services. Its solar-power features for off-grid and remote deployments were also explored. This contribution is an extension of the Intelligent Sensors and Monitoring System for Low-cost Phototherapy Light for Jaundice Treatment that was presented in the International Symposium on Multimedia and Communication Technology (ISMAC) in 2019

Diagnostic Value Parameters Of Acute Phase Reactances Of Infectious-inflammatory Process In Diagnostics Of Early Neonatal Sepsis

An advanced progress of clinical neonatology in recent years has enabled to achieve considerable success in newborn management with due respect to both medical treatment and general care, especially in the group of neonates with low body weight at birth. At the same time, neonatal sepsis in the early period still predetermine sickness and mortality of newborns.Material and methods. Clinical-paraclinical indices with detection of diagnostic value of C-reactive protein and interleukins-6 and 8 were evaluated in 100 neonates with available susceptibility factors to early neonatal infection from mother\u27s side and clinical signs of organ dysfunction in neonates with precautions of generalized infectious-inflammatory process at the end of their first day of life.Results. The data obtained substantiate that low concentrations of IL-6 and IL-8 prevail, and therefore the mentioned mediators hardly can be used to verify early neonatal infection. In the majority of children C-reactive protein elevated the concentration of 10.0 mg/L which is traditionally considered to be a discriminant as to the verification of an infectious process in newborns.Conclusions. None of the clinical signs associated with infectious-inflammatory process in newborns in the first two days of their life enabled to verify reliably availability of systemic bacterial infection

Haematalogical investigations in children

The haematology laboratory is able to perform a number of tests to help establish the cause of illness in children. The full blood count (FBC, also known as a complete blood count, CBC) is one of the most basic blood tests performed on children attending hospital or a primary care clinic. All doctors should therefore have an understanding of how the test is performed, possible pitfalls, be able to interpret results and know when more specialised testing or advice is required. Other haematological investigations in routine use include coagulation screens, blood film examination, reticulocyte counts and methods for estimation of iron stores and detection of abnormal haemoglobins. This section will focus on these basic tests and simple algorithms for the subsequent investigation and differential diagnosis of the commonest haemato-logical abnormalities encountered in general paediatric practice. The reader is referred to Chapter 15 for an account of the clinical presentation and management of primary haematological disorders in children