Efficacy of prophylactic phototherapy for prevention of hyperbilirubinemia in very low birth weight newborns

Background: Jaundice is a common clinical condition in newborn occurring in approximately 60% of term and 80% of preterm infants. Unconjugated hyperbilirubinemia is universally common in all preterm infants especially in newborns with very low biLth weight. Low birth weight and premature infants are at major risk for exaggerated hyperbilirubinemia that can lead to bilirubin encephalopathy. Significant heterogeneity in the approach to the treatment of jaundiced neonates exists throughout the world. Phototherapy is the most common treatment for neonatal hyperbilirubinemia and could be most effective in preventing the sequelae of hyperbilirubinemia if initiated prophylactically. This randomized clinical trial has been proposed with the objective of assessing the efficacy of prophylactic photo therapy in preventing significant rise of unconjugated hyperbilirubinemia in premature neonates weighing less than 1500 gram and therefore to decrease the need for exchange transfusion and finally to reduce hospital stay due to hyperbilirubinemia. Methods: This randomized controlled clinical trial enrolled sixty newborns with birth weight less than 1500 gram. They were divided into two groups: 1) Prophylactic group, in whom phototherapy was started within 24 hours of birth and continued for 7 days and 2) Control group in whom therapeutic phototherapy was started considering serum bilirubin level and other clinical condi­tions as per institutional guidelines. Mean value of total serum bilirubin (TSB), duration of phototherapy, the need for exchange transfusion and duration of hospital stay in both groups were analyzed.Results: The maximum mean TSB level in prophylactic group was observed on 7th day and in control group it was observed on 3rd day of life. The total serum bilirubin levels were significantly lower in the 3rd and 5th days of life in the prophylactic group in comparison to control group (P value 0.001). Total serum bilirubin level exceeded therapeutic range in 6 (21 %) and 14 (50 %) newborns of the prophylactic group and control groups respectively (P value 0.026). No documented side effects of prophylactic photo­therapy was observed. Conclusion: The use of prophylactic photo therapy for infants weighing less than 1500 grn is effec­tive and sate when compared to the control group, considering satisfactory maintenance of low total serum bilimbin levels during first 7 days of life

An icteric newborn with bad obstetric history

This article has no abstract. The first 100 words appear below: A 34 week preterm baby was admitted with the complaints of respiratory distress soon after birth. The mother had bad obstetric history. She is having the fifth gravida with the first two alive and healthy who were born by the normal vaginal delivery at home. The third child was born with severe jaundice and was treated by exchange transfusion. Subsequently the baby developed bilirubin encephalopathy. Then the baby developed cerebral palsy and ultimately died due to aspiration pneumonia at the age of 2.5 years. Her first three pregnancies were not on any antenatal check-up by the health care provider due to poor socio-economic background and illiteracy

An icteric newborn with bad obstetric history

This article has no abstract. The first 100 words appear below: A 34 week preterm baby was admitted with the complaints of respiratory distress soon after birth. The mother had bad obstetric history. She is having the fifth gravida with the first two alive and healthy who were born by the normal vaginal delivery at home. The third child was born with severe jaundice and was treated by exchange transfusion. Subsequently the baby developed bilirubin encephalopathy. Then the baby developed cerebral palsy and ultimately died due to aspiration pneumonia at the age of 2.5 years. Her first three pregnancies were not on any antenatal check-up by the health care provider due to poor socio-economic background and illiteracy

Transcriptomic profile of adverse neurodevelopmental outcomes after neonatal encephalopathy

A rapid and early diagnostic test to identify the encephalopathic babies at risk of adverse outcome may accelerate the development of neuroprotectants. We examined if a whole blood transcriptomic signature measured soon after birth, predicts adverse neurodevelopmental outcome eighteen months after neonatal encephalopathy. We performed next generation sequencing on whole blood ribonucleic acid obtained within six hours of birth from the first 47 encephalopathic babies recruited to the Hypothermia for Encephalopathy in Low and middle-income countries (HELIX) trial. Two infants with blood culture positive sepsis were excluded, and the data from remaining 45 were analysed. A total of 855 genes were significantly differentially expressed between the good and adverse outcome groups, of which RGS1 and SMC4 were the most significant. Biological pathway analysis adjusted for gender, trial randomisation allocation (cooling therapy versus usual care) and estimated blood leukocyte proportions revealed over-representation of genes from pathways related to melatonin and polo-like kinase in babies with adverse outcome. These preliminary data suggest that transcriptomic profiling may be a promising tool for rapid risk stratification in neonatal encephalopathy. It may provide insights into biological mechanisms and identify novel therapeutic targets for neuroprotection