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Introduction: Neonatal jaundice is a common and life-threatening health problem in neonates due to overaccumulation of circulating unconjugated bilirubin. Gut flora has a potential influence on bilirubin metabolism. The infant gut microbiome is commonly copied from the maternal gut. During pregnancy, due to changes in dietary habits, hormones and body weight, maternal gut dysbiosis is common, which can be stabilised by probiotics supplementation. However, whether probiotic supplements can reach the baby through the mother and reduce the incidence of neonatal jaundice has not been studied yet. Therefore, we aim to evaluate the effect of prenatal maternal probiotic supplementation on the incidence of neonatal jaundice., Methods and Analysis: This is a randomised double-blind placebo-controlled clinical trial among 94 pregnant women (47 in each group) in a tertiary hospital in Hong Kong. Voluntary eligible participants will be recruited between 28 and 35 weeks of gestation. Computer-generated randomisation and allocation to either the intervention or control group will be carried out. Participants will take either one sachet of Vivomixx (450 billion colony-forming units per sachet) or a placebo per day until 1 week post partum. Neither the study participants nor researchers will know the randomisation and allocation. The intervention will be initiated at 36 weeks of gestation. Neonatal bilirubin level will be measured to determine the primary outcome (hyperbilirubinaemia) while the metagenomic microbiome profile of breast milk and maternal and infant stool samples as well as pregnancy outcomes will be secondary outcomes. Binary logistic and linear regressions will be carried out to assess the association of the microbiome data with different clinical outcomes., Ethics and Dissemination: Ethics approval is obtained from the Joint CUHK-NTEC Clinical Research Ethics Committee, Hong Kong (CREC Ref: 2023.100-T). Findings will be published in peer-reviewed journals and presented at international conferences., Trial Registration Number: NCT06087874., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Yinzhihuang granule, consisting of extracts of Artemisia capillaris Thunb., Gardenia jasminoides Ellis, Lonicera japonica Thunb., and Scutellaria baicalensis Georgi is a well-known traditional Chinese patent medicine for patients with liver injury in China. However, the effects and safety of its use for pathologic jaundice in newborns require further systematic evaluation., Purpose: To systematically evaluate the efficacy and safety of Yinzhihuang granules for the treatment of neonatal pathologic jaundice and to provide clinical evidence., Methods: Chinese databases (China Network Knowledge Infrastructure, Wan Fang Database, and VIP Database) and English databases (PubMed, EmBase, and the Cochrane Library) were thoroughly investigated through screening randomized controlled trials on Yinzhihuang granules for neonatal pathologic jaundice from the establishment of all databases to November 18, 2021. A meta-analysis was performed for selected data using STATA software. TSA software was used for trial sequential analyses of the total effective rate and adverse reactions., Results: A total of 19 trials and 2,221 newborns with pathologic jaundice were included in this study. Outcome measures of clinical efficacy in the experimental group were higher than in controls, including total bilirubin (WMD = -30.34, 95% CI = -35.44 to -25.23, p < 0.001), direct bilirubin (WMD = -15.03, 95% CI = -23.54 to -6.52, p < 0.001), indirect bilirubin (WMD = -11.22, 95% CI = -17.50 to -4.95, p < 0.001), recovery time (WMD = -2.96, 95% CI = -3.92 to -2.00, p < 0.001), hospitalization time (WMD = -3.83, 95% CI = -4.89 to -2.76, p < 0.001), and liver function indices. There were statistically significant differences between the two groups. Likewise, the incidence of adverse reactions, including diarrhea, erythra, and fever decreased remarkably in the trial group (RR = 0.44, 95% CI =  0.33 to 0.59, p < 0.001). Publication bias did not exist. We verified the efficacy and safety of Yinzhihuang granules with phototherapy for pathologic jaundice in newborns according using TSA analysis., Conclusion: Yinzhihuang granules with phototherapy for neonatal pathologic jaundice are more effective than phototherapy alone. The incidence of ADRs does not increase with the application of Yinzhihuang granules. Due to the heterogeneity across the included studies, additional multicenter clinical trials with follow-ups are needed to confirm our findings., (Copyright © 2022. Published by Elsevier GmbH.)

Aim: Traditional beliefs about neonatal jaundice persist in Sub-Saharan Africa, and because those beliefs might worsen the outcomes of the disease by delaying care or by treating it at home with unproven remedies; our study sought to identify the traditional beliefs of antenatal mothers regarding the management and prevention of neonatal jaundice in rural areas of Ekiti State, Southwestern Nigeria., Methods: The study employed a descriptive cross-sectional design. A total of 190 women who attended two primary health care centers in Ekiti State were recruited for the study from April 1 to May 31, 2017, by convenience sampling through the antenatal clinic register. Data was collected by the use of an adapted self-administered, structured questionnaire., Results: Of the women selected, 56% had at least one child before.36% of all the respondents would use pawpaw extract to treat neonatal jaundice, 30% would use sunlight, 26% would use antibiotics, 16% would use over the counter drugs, and 5% would use phototherapy. With regards of preventive measures, 48% indicated that neonatal jaundice can be prevented by breast feeding, 11% by drinking herbal concoctions by both mother and baby, 26% by giving glucose water to the baby and 12% of respondents by avoidance of cold water when pregnant., Conclusion: Our study showed that traditional beliefs regarding the management and prevention of neonatal jaundice are prevalent in Ado Ekiti, Nigeria., (Copyright © 2021 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Background: Phototherapy remains an important component of the management of unconjugated neonatal jaundice, a major cause of newborn morbidity. During phototherapy the toxic unconjugated form of bilirubin is converted to nontoxic form through action of light delivered by phototherapy. An important possible complication of phototherapy is retinal damage and therefore eye protective measures are taken during therapy to prevent this from occurring. Devices currently in use for phototherapy are capable of providing intensive phototherapy with the attendant increased risk of eye injury. The materials used in providing eye protection are varied among care providers. A dearth of information exists on shielding provided by the commonly used eye protectors during phototherapy, more so during intensive phototherapy., Objective: To evaluate the shielding provided by the different eye protectors commonly used in our setting under intensive phototherapy., Materials and Method: Five materials in use for eye shielding were obtained. Using an institutional built light emitting diode phototherapy device, intensive phototherapy was provided and the irradiance at varying distances of 35 cm, 25 cm, 15 cm and 10 cm was measured using an Olympic bili meterTM Natus. At the distance of each measured irradiance the different eye protective materials were then placed one after the other over the surface of the measuring sensor of the meter and the irradiance measurement was recorded. Two measurements were taken for each material at each distance and the average irradiance measurement was then recorded for each of the materials tested at that distance., Results: Five eye shielding materials in use were identified: black cotton fabric, white cotton fabric, black cotton fabric with foam, white cotton fabric with foam and gauze. The black cotton fabric with or without foam at the phototherapy device irradiances of 30, 46.3, 58.7 and 75.4 µw/m2/nm recorded 0 irradiance., Conclusion: Black cotton fabric with or without foam pad provided the most shielding under intensive phototherapy., (© The Author(s) [2021]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Acute bilirubin encephalopathy (ABE) and the other serious complications of severe hyperbilirubinemia in the neonate occur far more frequently in low- and middle-income countries (LMIC). This is due to several factors that place babies in LMIC at greater risk for hyperbilirubinemia, including increased prevalence of hematologic disorders leading to hemolysis, increased sepsis, less prenatal or postnatal care, and a lack of resources to treat jaundiced babies. Hospitals and clinics face frequent shortages of functioning phototherapy machines and inconsistent access to electricity to run the machines. Sunlight has the potential to treat hyperbilirubinemia: it contains the wavelengths of light that are produced by phototherapy machines. However, it contains harmful ultraviolet light and infrared radiation, and prolonged exposure has the potential to lead to sunburn, skin damage, and hyperthermia or hypothermia., Objectives: To evaluate the efficacy of sunlight administered alone or with filtering or amplifying devices for the prevention and treatment of clinical jaundice or laboratory-diagnosed hyperbilirubinemia in term and late preterm neonates., Search Methods: We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 5), MEDLINE, Embase, and CINAHL on 2 May 2019. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials (RCTs), quasi-RCTs, and cluster RCTs. We updated the searches on 1 June 2020., Selection Criteria: We included RCTs, quasi-RCTs, and cluster RCTs. We excluded crossover RCTs. Included studies must have evaluated sunlight (with or without filters or amplification) for the prevention and treatment of hyperbilirubinemia or jaundice in term or late preterm neonates. Neonates must have been enrolled in the study by one-week postnatal age., Data Collection and Analysis: We used standard methodologic procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Our primary outcomes were: use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, chronic bilirubin encephalopathy, and death., Main Results: We included three RCTs (1103 infants). All three studies had small sample sizes, were unblinded, and were at high risk of bias. We planned to undertake four comparisons, but only found studies reporting on two. Sunlight with or without filters or amplification compared to no treatment for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates One study of twice-daily sunlight exposure (30 to 60 minutes) compared to no treatment reported the incidence of jaundice may be reduced (risk ratio [RR] 0.61, 95% confidence interval [CI] 0.45 to 0.82; risk difference [RD] -0.14, 95% CI -0.22 to -0.06; number needed to treat for an additional beneficial outcome [NNTB] 7, 95% CI 5 to 17; 1 study, 482 infants; very low-certainty evidence) and the number of days that an infant was jaundiced may be reduced (mean difference [MD] -2.20 days, 95% CI -2.60 to -1.80; 1 study, 482 infants; very low-certainty evidence). There were no data on safety or potential harmful effects of the intervention. The study did not assess use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, and long-term consequences of hyperbilirubinemia. The study showed that sunlight therapy may reduce rehospitalization rates within seven days of discharge for treatment for hyperbilirubinemia, but the evidence was very uncertain (RR 0.55, 95% CI 0.27 to 1.11; RD -0.04, -0.08 to 0.01; 1 study, 482 infants; very low-certainty evidence). Sunlight with or without filters or amplification compared to other sources of phototherapy for the treatment of hyperbilirubinemia in infants with confirmed hyperbilirubinemia Two studies (621 infants) compared the effect of filtered-sunlight exposure to other sources of phototherapy in infants with confirmed hyperbilirubinemia. Filtered-sunlight phototherapy (FSPT) and conventional or intensive electric phototherapy led to a similar number of days of effective treatment (broadly defined as a minimal increase of total serum bilirubin in infants less than 72 hours old and a decrease in total serum bilirubin in infants more than 72 hours old on any day that at least four to five hours of sunlight therapy was available). There may be little or no difference in treatment failure requiring exchange transfusion (typical RR 1.00, 95% CI 0.06 to 15.73; typical RD 0.00, 95% CI -0.01 to 0.01; 2 studies, 621 infants; low-certainty evidence). One study reported ABE, and no infants developed this outcome (RR not estimable; RD 0.00, 95% CI -0.02 to 0.02; 1 study, 174 infants; low-certainty evidence). One study reported death as a reason for study withdrawal; no infants were withdrawn due to death (RR not estimable; typical RD 0.00, 95% CI -0.01 to 0.01; 1 study, 447 infants; low-certainty evidence). Neither study assessed long-term outcomes. Possible harms: both studies showed a probable increased risk for hyperthermia (body temperature greater than 37.5 °C) with FSPT (typical RR 4.39, 95% CI 2.98 to 6.47; typical RD 0.30, 95% CI 0.23 to 0.36; number needed to treat for an additional harmful outcome [NNTH] 3, 95% CI 2 to 4; 2 studies, 621 infants; moderate-certainty evidence). There was probably no difference in hypothermia (body temperature less than 35.5 °C) (typical RR 1.06, 95% CI 0.55 to 2.03; typical RD 0.00, 95% CI -0.03 to 0.04; 2 studies, 621 infants; moderate-certainty evidence)., Authors' Conclusions: Sunlight may be an effective adjunct to conventional phototherapy in LMIC settings, may allow for rotational use of limited phototherapy machines, and may be preferable to families as it can allow for increased bonding. Filtration of sunlight to block harmful ultraviolet light and frequent temperature checks for babies under sunlight may be warranted for safety. Sunlight may be effective in preventing hyperbilirubinemia in some cases, but these studies have not demonstrated that sunlight alone is effective for the treatment of hyperbilirubinemia given its sporadic availability and the low or very low certainty of the evidence in these studies., (Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Objectives: Jaundice is a typical condition in the neonatal period, particularly in the Asian continent. Drowsiness and disruption of breastfeeding, behavioral and neurological disorders, hearing loss and mental retardation are the results of impairment in controlling it. The increase in oxidant substances can stimulate the heme oxygenase enzyme and increase the conversion of heme to bilirubin. In some studies, vitamin C levels in the blood of infants with hyperbilirubinemia were lower than in healthy infants., Design: In this double-blind clinical trial study, 144 healthy pregnant women aged 20-40 years who were in 34th weeks of gestation were randomly divided into intervention, and control groups and until the end of pregnancy, they took a 500 mg tablet of vitamin C or placebo (Preparation of starch) daily. Demographic information, dietary intake, and physical activity level of the participants were also evaluated. The total blood bilirubin level was measured on the fifth day after birth using a sample of the neonatal heel. Statistical analysis was performed using SPSS software version 22. In this study P-value < 0. 05 was considered significant., Results: Of the 144 participants, 128 of them completed the intervention. There was no significant difference between the two groups at the level of vitamin C intake through diet, and anthropometric indices, but the total bilirubin level in the neonates of the two groups was statistically different (P = 0.02)., Conclusion: Vitamin C supplementation in the last month of pregnancy had a significant effect on neonatal bilirubin level and decreased it significantly., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Delayed cord clamping was not adopted widely in China because of the potential effect of neonatal hyperbilirubinemia, jaundice and polycythemia, and the optimal cord clamping time remained controversial., Aim: To assess the effect of delayed cord clamping versus early cord clamping on neonatal jaundice for term infants., Study Design: This retrospective study included 1981 mother-infant pairs, who were assigned to early cord clamping groups (n = 1005) and delayed cord clamping group (n = 949). The delayed cord clamping included three subgroups (30-60 s, 61-90 s, 91-120 s). The main outcomes were transcutaneous bilirubin levels at 0 to 4 days of age, the rate of jaundice requiring phototherapy, the neonatal hematological status at 1 to 3 days after birth., Results: Compared with the early cord clamping group, the neonatal transcutaneous bilirubin level did not differ and the neonatal hematological status (hemoglobin and hematocrit levels) were improved in combined and three subgroups of delayed cord clamping group. Increasing the duration of cord clamping from 90 s to 120 s did not result in further increases in hemoglobin and hematocrit levels but led to a trend towards a higher risk of neonatal jaundice requiring phototherapy and neonatal polycythemia., Conclusions: Delayed cord clamping for <90 s in healthy term infants may not only improve the early hematological status of newborns but also avoid excessive neonatal jaundice requiring phototherapy., Competing Interests: Declaration of competing interest Neither of the authors have any conflicts of interest to declare., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Neonatal jaundice (NNJ) is a preventable cause of neonatal morbidity and mortality. Improving mothers' knowledge will help with early recognition of NNJ, prompt and appropriate intervention. This study highlights the knowledge, attitude and practice regarding neonatal jaundice among expectant mothers attending the antenatal clinics of Korle-Bu Teaching Hospital and Mamprobi Polyclinic in Accra., Methods: This was a cross-sectional study involving 175 expectant mothers. Interviewer based questionnaire was used to obtain data on knowledge, attitude and practice concerning NNJ. The study was conducted between 1 st and 17 th November 2013 at two antenatal clinics in Accra., Results: Out of the 175 respondents, 135 (77.1%) had heard about NNJ but only 37 (27.4%) of them heard it from the hospital. Among those who had heard about NNJ, 98 (72.6%) knew at least one symptom of NNJ; 125 (92.6%) did not know the causes of jaundice or had the wrong information and there was no significant association with their level of education (X 2 =6.757, p=0.15). Only 7(5.2%) knew one or more correct forms of treatment of NNJ; 67(49.6%) knew one or more danger signs and 86(63.5%) knew one or more complications., Conclusion: Majority of expectant mothers attending antenatal clinics at a Teaching Hospital and a Polyclinic in Accra, Ghana are aware of NNJ but have poor knowledge about the causes, danger signs and treatment of NNJ, irrespective of their level of education or their parity., Funding: None declared., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Ethnopharmacological Relevance: Cotoneaster nummularioides Pojark manna (Shir-e-Khesht) is popular in Persian medicine. Different effects of some Cotoneaster species manna include antibacterial, antioxidant, anticancer, and hepatoprotective effects, as well as bilirubin serum levels reduction. Cotoneaster species manna is used in many parts of Iran as a laxative and accelerates the passage of meconium. Neonatal jaundice has relatively costly and sometimes invasive therapeutic interventions, which its prevention from becoming severe cases can be a priority in neonatal medicine., Aim of the Study: The aim of this study was to evaluate the effectiveness of an herbal product (Purgative Manna, native to Iran and Asian countries) in preventing severe cases of jaundice and reducing total bilirubin levels in neonates., Materials and Methods: This randomized double-blind controlled clinical trial included full-term babies. Four hundred and forty-five (445) eligible neonates were assigned to two groups using the block balanced randomization method; 222 neonates received the Purgative Manna product as drops, and 223 neonates received placebo drops. The neonates received a dose of 5 drops per kilogram of neonatal weight (divided into three doses per day) for three days. The treatment period was three days, and a 24-h (three times) examination was performed to measure the initial outcome of the trial (i.e., the total serum bilirubin level). The secondary outcomes of this trial were the need for hospitalization due to jaundice and/or phototherapy from 4 to 14 days after birth, the frequency of defecation within 24 h, and the triple complications of diarrhoea, dehydration symptoms, and abdominal colic., Results: In this study, 220 neonates in the Purgative Manna product group and 222 neonates in the placebo group completed their interventions within the predicted period of the study. At the end of study, the total bilirubin level in the Purgative Manna treated group was significantly lower than that of the placebo group. The difference between the mean total bilirubin levels of the two groups was approximately 2.1 mg/dl on the third day after treatment, with an effect size of 0.79 (95% CI: 0.06-0.98). The relative risk for reducing the need for hospitalization or phototherapy in the group treated with Purgative Manna drops was 0.26, compared with the placebo group. The risk of occurrence of severe jaundice or phototherapy in the Purgative Manna group was 75% lower than that of the placebo group. The median frequency of defecation in the intervention group at three time intervals in the first, second and third days after treatment was 1-2 times more than that of the comparison group (p < 0.001)., Conclusions: Meanwhile, considering the fact that one in every eight neonates who used the product avoided having a severe and high-risk case of jaundice or the need for phototherapy intervention (even through an exchange transfusion), the use of Purgative Manna drops can be recommended; however, further study is necessary., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Jaundice caused by hyperbilirubinaemia is a physiological phenomenon in the neonatal period. However, severe hyperbilirubinaemia, when left untreated, may cause kernicterus, a severe condition resulting in lifelong neurological disabilities. Although commonly applied, visual inspection is ineffective in identifying severe hyperbilirubinaemia. We aim to investigate whether among babies cared for in primary care: (1) transcutaneous bilirubin (TcB) screening can help reduce severe hyperbilirubinaemia and (2) primary care-based (versus hospital-based) phototherapy can help reduce hospital admissions., Methods and Analysis: A factorial stepped-wedge cluster randomised controlled trial will be conducted in seven Dutch primary care birth centres (PCBC). Neonates born after 35 weeks of gestation and cared for at a participating PCBC for at least 2 days within the first week of life are eligible, provided they have not received phototherapy before. According to the stepped-wedge design, following a phase of 'usual care' (visual assessment and selective total serum bilirubin (TSB) quantification), either daily TcB measurement or, if indicated, phototherapy in the PCBC will be implemented (phase II). In phase III, both interventions will be evaluated in each PCBC. We aim to include 5500 neonates over 3 years.Primary outcomes are assessed at 14 days of life: (1) the proportion of neonates having experienced severe hyperbilirubinaemia (for the TcB screening intervention), defined as a TSB above the mean of the phototherapy and the exchange transfusion threshold and (2) the proportion of neonates having required hospital admission for hyperbilirubinaemia treatment (for the phototherapy intervention in primary care)., Ethics and Dissemination: This study has been approved by the Medical Research Ethics Committee of the Erasmus MC Rotterdam, the Netherlands (MEC-2017-473). Written parental informed consent will be obtained. Results from this study will be published in peer-reviewed journals and presented at (inter)national meetings., Trial Registration Number: NTR7187., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: This study was designed as a randomized controlled trial to determine the effect of abdominal massage on bilirubin levels of newborn infants., Design and Methods: The sample group consisted of 90 newborn infants (experimental group: 44; control group: 46) who were followed in a university hospital after birth between March and August 2017. The data were collected using an Information Form, Observation Form, and Transcutaneous Bilirubin Level Meter. Bilirubin levels were measured 1 hr after the first breastfeeding in both groups. The abdominal massage was performed for 5 min in each session, was continued in three sessions per day; was completed in totally six sessions for 2 days in infants in the experimental group. The second bilirubin measurements were repeated at the 48th hour after the birth and bilirubin levels were compared in two groups. The Student t test was used to evaluate the normally distributed data and the Mann-Whitney U test was used to carry out statistics in nonnormal distribution of quantitative data., Results: The bilirubin levels of the groups (experimental group: 1.06 ± 0.92; control group: 1.01 ± 0.98) were statistically similar before abdominal massage, t(88) = 0.25, p = 0.803. The difference of the bilirubin levels was compared in the groups before and after abdominal massage. The increase of bilirubin levels in the experimental group (1.96 ± 1.69 mg/dl) was statistically significantly lower compared with the control group (2.80 ± 2.30 mg/dl), t(88) = -1.974, p = 0.048., Practice Implications: Abdominal massage is effective to reduce bilirubin levels of newborn infants., (© 2019 Wiley Periodicals, Inc.)

Challenges in treating severe neonatal jaundice in low and middle-income country settings still exist at many levels. These include: a lack of awareness of causes and prevention by families, communities and even sometimes health care professionals; insufficient, ineffective, high quality affordable diagnostic and therapeutic options; limited availability of rehabilitation provision for kernicterus. Collectively these challenges lead to an unacceptably high global morbidity and mortality from severe neonatal jaundice. In the past decade, there has been an explosion of innovations addressing some of these issues and these are increasingly available for scale up. Scientists, healthcare providers, and communities are joining hands to explore educational tools, low cost screening and diagnostic options including at point-of-care and treatment modalities including filtered sunlight and solar powered phototherapy. For the first time, the possibility of eliminating the tragedy of preventable morbidity and mortality from severe NNJ is on the horizon, for all., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Neonatal jaundice is a common problem in newborns. Inadequate breastfeeding jaundice is an important consideration for the neonatal jaundice. Early breastfeeding initiation and good breastfeeding practices may help to prevent neonatal jaundice., Objective: To find the association of breastfeeding practices, the time to initiate breastfeeding, the breastfeeding frequency, breast milk volume, and appropriate latching with neonatal jaundice at the early postpartum., Material and Method: The subjects were postpartum women and newborns who had normal deliveries without complications at the HRH Princess Maha Chakri Sirindhorn Medical Center in the Nakhon Nayok province between July 2013 and June 2014. During postpartum period, the time of the first neonatal suckling, the breastfeeding frequency per day, the breastfeeding duration for each instance, the breast milk volume, and appropriate latching were assessed. The newborns had routine microbilirubin evaluation done at 48 hours postpartum. The data of newborn with neonatal jaundice was collected, analyzed, and compared with no jaundice newborn. The demographic data and breastfeeding factors were analyzed by Chi-square, t-test, and the Fisher’s exact test., Results: The data of 176 newborns (neonatal jaundice 88 cases and no jaundice newborn 88 cases) and mothers were analyzed. It had shown that the mean time for the initiation of breastfeeding was 1.57±0.6 hours in the no jaundice newborn group and 5.56±3.1 hours in the neonatal jaundice group. The percentages of ‘breastfeeding frequency less than eight times per day’ in the neonatal jaundice and no jaundice newborn groups were 92.0% and 1.1% at day 1 postpartum, and 42.0% and 0.0% at day 2 postpartum, respectively. The percentages of ‘breastfeeding duration less than 10 minutes’ per feeding in the neonatal jaundice group were 35.2% and 13.6% at day 1 and day 2 postpartum. No one in the no jaundice newborn group had breastfeeding durations of less than 10 minutes for each feeding. The percentages of mothers in the neonatal jaundice and no jaundice newborn groups having no milk were 84.1% and 1.1% at day 1, and 4.5% and 0.0% at day 2 postpartum, respectively. The percentages of ‘latch scores greater than 8’ in the neonatal jaundice and no jaundice newborn groups were at 15.9% and 50.0% at day 1, and 31.8% and 95.5% at day 2 postpartum. There were statistically significant differences in the breastfeeding parameters., Conclusion: The factors of the time of the initiation of breastfeeding, breastfeeding frequency, duration, breast milk volume, and appropriate latching are associated with neonatal jaundice at the second day postpartum.

Background: In populations with a high prevalence of glucose-6-phosphate dehydrogenase deficiency, practices that can induce haemolysis need to be identified to raise awareness of preventable risks. The aim of this survey was to determine the proportion of prospective mothers using haemolytic agents and their knowledge and practice surrounding neonatal jaundice., Methods: Pregnant mothers were invited to participate in a cross-sectional survey conducted at Shoklo Malaria Research Unit on the Thailand-Myanmar border., Results: From 12 April 2015 to 12 June 2015, 522 pregnant women completed the survey. Mothball use in the household was reported by 41.4% (216 of 522) of prospective mothers and menthol containing products on baby skin by 46.7% (244 of 522)., Conclusion: Just over 40% of the households reported use of naphthalene-containing mothballs. Future health promotion activities that focus on reducing naphthalene mothball and menthol-containing products use have the potential to reduce rates of severe neonatal jaundice in this population., (© The Author [2016]. Published by Oxford University Press.)

Optimal cord clamping is known and now widely recognised as having positive consequences for the neonate in the short- and medium-term. This review of some of the key literature published over the last five years on the effects of both ECC and OCC provides an insight into the evidence on this topic. The aim of this article is to summarise the key papers on the topic of the effect of timing of cord clamping, including some of those included in the Cochrane Review as well as the majority that have been published since, to provide an up-to-date overview.

Background: Two oral hypoglycaemic agents, metformin and glibenclamide, have been compared with insulin in separate large randomised controlled trials and have been found to be as effective as insulin in gestational diabetes. However, very few trials have compared metformin with glibenclamide., Materials and Methods: Of 159 South Indian women with fasting glucose ≥5.5 mmol/l and ≤7.2 mmol/l and/or 2-h post-prandial value ≥6.7 mmol/l and ≤13.9 mmol/l after medical nutritional therapy consented to be randomised to receive either glibenclamide or metformin. 80 women received glibenclamide and 79 received metformin. Neonatal outcomes were assessed by neonatologists who were unaware that the mother was part of a study and were recorded by assessors blinded to the medication the mother was given. The primary outcome was a composite of neonatal outcomes namely macrosomia, hypoglycaemia, need for phototherapy, respiratory distress, stillbirth or neonatal death and birth trauma. Secondary outcomes were birthweight, maternal glycaemic control, pregnancy induced hypertension, preterm birth, need for induction of labour, mode of delivery and complications of delivery., Results: Baseline characteristics were similar but for the higher fasting triglyceride levels in women on metformin. The primary outcome was seen in 35% of the glibenclamide group and 18.9% of the metformin group [95% CI 16.1 (2.5, 29.7); P = 0.02]. The difference in outcome related to a higher rate of neonatal hypoglycaemia in the glibenclamide group (12.5%) versus none in the metformin group [95% CI 12.5(5.3, 19.7); P = 0.001]. Secondary outcomes in both groups were similar., Conclusion: In a south Indian population with gestational diabetes, metformin was associated with better neonatal outcomes than glibenclamide., (© 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

"Common" neonatal jaundice can lead to dangerous levels of hyperbilirubinemia, causing neurological damage and even death. This article outlines evidence-based assessment techniques, management guidelines, and treatments for neonatal hyperbilirubinemia, addressing complexities that have arisen with new technologies and research results. We also explicate the role of the nurse in both prevention and care of patients and families who are affected by hyperbilirubinemia and jaundice.

Delayed cord clamping is a collaboration between the obstetric team and the neonatal team. Although the optimal timing for clamping the umbilical cord after birth continues to be subject to study, delaying clamping for at least 30-60 seconds, with the newborn held at or below the level of the uterus/placenta supports normal physiology and has proven benefits. Practical issues such as thermoregulation and equipment can be overcome with team collaboration and prebriefing planning. Neonatal nurses who attend deliveries are perfectly poised to influence this practice and improve short- and long-term outcomes for their patients.

Objective: Breast milk is an important source of bacteria in establishing the infantile intestinal microbiota that appear to influence the enterohepatic circulation of bilirubin. The aim of the present study was to evaluate the effect of breast milk's microbiological content on the development of breast milk jaundice (BMJ)., Methods: A total number of 60 mother-infant pairs enrolled to the study. Two groups were defined: BMJ group (n=30), full-term otherwise healthy newborns who were considered BMJ; control group (n=30), full-term healthy newborns without jaundice. All newborns in the study were exclusively breast-fed. The breast milk samples and the feces of infants were evaluated for content of selected bacterial populations (Bifidobacterium, Lactobacillus, Clostridium, Staphylococcus, and Streptococcus species) with real-time polymerase chain reaction., Results: Bifidobacterium bifidum content in the breast milk and B adolescentis, B bifidum, and B longum content in the fecal samples were higher in the control group than in the BMJ group. The milk and fecal concentrations of B bifidum were significantly correlated. The concentrations of breast milk B bifidum and fecal B bifidum, B adolescentis, and B longum were found to be negatively correlated with bilirubin levels., Conclusions: Our results suggest that Bifidobacterium species in breast milk may protect against BMJ.

Background: Low birth weight and premature infants are at major risk for exaggerated hyperbilirubinaemia and jaundice that can lead to bilirubin encephalopathy. Phototherapy is the most common treatment for neonatal hyperbilirubinaemia and could be most effective in preventing the sequelae of hyperbilirubinaemia if initiated prophylactically., Objectives: To evaluate the efficacy and safety of prophylactic phototherapy for preterm (< 37 weeks gestational age) or low birth weight infants (birth weight < 2500 g)., Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3) on 31 March 2011, MEDLINE (1950 to 31 March 2011), EMBASE (1980 to 31 March 2011) and CINAHL (1982 to 31 March 2011)., Selection Criteria: Randomised controlled trials or quasi-randomised controlled studies evaluating the effects of prophylactic phototherapy for preterm or low birth weight infants., Data Collection and Analysis: Two authors independently obtained data from published articles. We performed fixed-effect meta-analysis for the outcomes: rate of exchange transfusion, cerebral palsy or other neurodevelopmental impairment, peak serum bilirubin level and all-cause mortality., Main Results: Nine studies of 3449 participants were included. The rate of exchange transfusion was reduced in one study with liberal transfusion criteria (risk ratio (RR) 0.20; 95% confidence interval (CI) 0.13 to 0.31) but not in the other two more recent studies with stringent criteria (typical RR 0.66; 95% CI 0.19 to 2.28). There was no statistically significant difference in the rate of cerebral palsy (typical RR 0.96; 95% CI 0.50 to 1.85; two studies, 756 participants). However, one large study that reported on neurodevelopmental impairment (a composite outcome including cerebral palsy) found a slightly lower rate of neurodevelopmental impairment with prophylactic phototherapy (RR 0.85; 95% CI 0.74 to 0.99; 1804 participants). The prophylactic phototherapy group had lower peak bilirubin levels (mean difference (MD) -2.73; 95% CI -2.89 to -2.57; six studies, 2319 participants) and had fewer neonates with peak unconjugated serum bilirubin levels > 10 mg/dl (typical RR 0.27; 95% CI 0.22 to 0.33; three studies, 1090 participants) or peak unconjugated serum bilirubin levels > 15 mg/dl (typical RR 0.13; 95% CI 0.07 to 0.23; four studies, 1116 participants). There was no statistically significant difference in the rate of all-cause mortality between the two groups (typical RR 1.08; 95% CI 0.93 to 1.26; four studies, 3044 participants)., Authors' Conclusions: Prophylactic phototherapy helps to maintain a lower serum bilirubin concentration and may have an effect on the rate of exchange transfusion and the risk of neurodevelopmental impairment. However, further well-designed studies are needed to determine the efficacy and safety of prophylactic phototherapy on long-term outcomes including neurodevelopmental outcomes., (Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

This article provides a brief overview of pros and cons of clamping the cord too early (within seconds) after birth. It also highlights evolving data that suggest that delaying cord clamping for 30 to 60 seconds after birth is beneficial to the baby, with no measurable negative effects either the baby or the mother., (Published by Elsevier Inc.)

Hyperbilirubinemia and jaundice are natural, physiological phenomena which are only to be expected in the neonatal period, within certain limits. The highest percentage of jaundice in breastfed newborns should be evaluated in connection with inadequate management of breastfeeding rather than a direct effect of breast milk. Breastfeeding is also linked to visible jaundice persisting beyond the first two weeks of life (“breast milk jaundice”), but the appearance of skin jaundice is not a reason for interrupting breastfeeding which can and should continue without any interruption in most cases. There have been numerous contributions to the literature which have rescaled the direct role of breast milk both in early jaundice and in the more severe cases of late jaundice. The reviewed guidelines for detection and management of hyperbilirubinemia underline how prevention of badly managed breastfeeding and early support for the couple mother-child are effective prevention measures against severe early-onset jaundice; furthermore, the breastfeeding interruption is no longer recommended as a diagnostic procedure to identify breast milk jaundice because of its low specificity and the risk to disregarding the detection of a potentially dangerous disease.

Background: Low birth weight and premature infants are at major risk for exaggerated hyperbilirubinaemia and jaundice that can lead to bilirubin encephalopathy. Phototherapy is the most common treatment for neonatal hyperbilirubinaemia and could be most effective in preventing the sequelae of hyperbilirubinaemia if initiated prophylactically., Objectives: To evaluate the efficacy and safety of prophylactic phototherapy for preterm (< 37 weeks gestational age) or low birth weight infants (birth weight < 2500 g)., Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3) on 31 March 2011, MEDLINE (1950 to 31 March 2011), EMBASE (1980 to 31 March 2011) and CINAHL (1982 to 31 March 2011)., Selection Criteria: Randomised controlled trials or quasi-randomised controlled studies evaluating the effects of prophylactic phototherapy for preterm or low birth weight infants., Data Collection and Analysis: Two authors independently obtained data from published articles. We performed fixed-effect meta-analysis for the outcomes: rate of exchange transfusion, cerebral palsy or other neurodevelopmental impairment, peak serum bilirubin level and all-cause mortality., Main Results: Nine studies of 3449 participants were included. The rate of exchange transfusion was reduced in one study with liberal transfusion criteria (risk ratio (RR) 0.20; 95% confidence interval (CI) 0.13 to 0.31) but not in the other two more recent studies with stringent criteria (typical RR 0.66; 95% CI 0.19 to 2.28). There was no statistically significant difference in the rate of cerebral palsy (typical RR 0.96; 95% CI 0.50 to 1.85; two studies, 756 participants). However, one large study that reported on neurodevelopmental impairment (a composite outcome including cerebral palsy) found a slightly lower rate of neurodevelopmental impairment with prophylactic phototherapy (RR 0.85; 95% CI 0.74 to 0.99; 1804 participants). The prophylactic phototherapy group had lower peak bilirubin levels (mean difference (MD) -2.73; 95% CI -2.89 to -2.57; six studies, 2319 participants) and had fewer neonates with peak unconjugated serum bilirubin levels > 10 mg/dl (typical RR 0.27; 95% CI 0.22 to 0.33; three studies, 1090 participants) or peak unconjugated serum bilirubin levels > 15 mg/dl (typical RR 0.13; 95% CI 0.07 to 0.23; four studies, 1116 participants). There was no statistically significant difference in the rate of all-cause mortality between the two groups (typical RR 1.08; 95% CI 0.93 to 1.26; four studies, 3044 participants)., Authors' Conclusions: Prophylactic phototherapy helps to maintain a lower serum bilirubin concentration and may have an effect on the rate of exchange transfusion and the risk of neurodevelopmental impairment. However, further well-designed studies are needed to determine the efficacy and safety of prophylactic phototherapy on long-term outcomes including neurodevelopmental outcomes.

Background: In 2003, Mali introduced intermittent preventive therapy in pregnancy (ITPp) with sulfadoxine-pyrimethamine (SP) for the control of malaria in pregnancy, consisting of 2 doses of SP given in the 2nd and 3rd trimester. This widely used regimen, although very effective, leaves many women unprotected from malaria during the last 4-to-8 weeks of gestation, which is a pivotal period for fetal weight gain. The aim of the study was to compare the efficacy and safety of 3-dose versus 2-dose IPTp-SP for the prevention of placental malaria and associated low birth weight (LBW)., Methods: We conducted a parallel-group, open-label, individually randomized controlled superiority trial involving 814 women of all gravidity, enrolled from April 2006 through March 2008. All women were seen at least 3 times and received either 2 (n = 401) or 3 (n = 413) doses of IPTp-SP. The primary endpoint measured was placental malaria, LBW, preterm births, and maternal anemia were secondary endpoints, and severe maternal skin reactions and neonatal jaundice were safety endpoints., Results: Among the 96% of study subjects who were followed up until delivery, the prevalence of placental malaria was 2-fold lower in the 3-dose group (8.0%) than in the 2-dose group (16.7%); the adjusted prevalence ratio (APR) was 0.48 (95% confidence interval [CI], 0.32-0.71). LBW and preterm births were also reduced; the prevalence of LBW was 6.6% in the 3-dose group versus 13.3% in the 2-dose group (APR, 0.50; 95% CI, 0.32-0.79), and the prevalence of preterm births was 3.2% versus 8.9% (APR, 0.37; 95% CI, 0.19-0.71). No significant reductions in maternal anemia or differences in safety endpoints were observed., Conclusions: Adding a third dose of ITPp-SP halved the risk of placental malaria, LBW, and preterm births in all gravidae, compared with the standard 2-dose regimen, in this area of highly seasonal transmission with low levels of SP resistance., Clinical Trials Registration: ISRCTN 74189211.

Readmission rate for neonatal jaundice approximate 10 per 1000 live births. After applying hyperbilirubinemia guidelines and universal screening for bilirubin in term and near-term newborns, the readmission rate declined significantly from 24 to 3.7 per 1000 live births. Decreased readmission rate for neonatal jaundice may reduce kernicterus rate and health care costs. Further studies are necessary to explore these potential benefits.

Objective: The objective of this study was to demonstrate efficacy of universal predischarge neonatal bilirubin screening in reducing potentially dangerous hyperbilirubinemia in a large, diverse national population., Methods: This was a 5-year prospective study directed at neonates who were aged < or =28 days and evaluated at facilities of the Hospital Corporation of America with a serum bilirubin level of > or =20.0 mg/dL. This time frame includes periods before, during, and after the initiation of systemwide institution of a program of universal predischarge neonatal bilirubin screening. The primary outcome measures were serum bilirubin 25.0 to 29.9 and > or =30.0 mg/dL. Neonatal phototherapy use during these years was also analyzed., Results: Of the 1,028,817 infants who were born in 116 hospitals between May 1, 2004, and December 31, 2008, 129,345 were delivered before implementation and 899,472 infants were delivered after implementation of this screening program in their individual hospitals. With a program of universal screening, the incidence of infants with total bilirubin 25.0 to 29.9 mg/dL declined from 43 per 100,000 to 27 per 100,000, and the incidence of infants with total bilirubin of > or =30.0 mg/dL dropped from 9 per 100,000 to 3 per 100,000 (P = .0019 and P = .0051, respectively). This change was associated with a small but statistically significant increase in phototherapy use., Conclusions: A comprehensive program of prevention, including universal predischarge neonatal bilirubin screening, significantly reduces the subsequent development of bilirubin levels that are known to place newborns at risk for bilirubin encephalopathy.

Objective: To observe the clinical efficacy of Yinzhihuang Oral Liquid (YOL) to prevent the premature infantile jaundice., Methods: After excluded hemolytic, suffocation, infection, and the very low birth weight, 242 cases of premature infants were randomly assigned to two groups, the treatment group and the control group. Both groups were taken conventional procedures, such as warmth, feeding, and blood glucose monitoring, and the treated group was administered YOL 5 mL each time, twice daily additionally, and the control group without any treatment. The percutaneous bilirubin and blood cells were observed every day., Results: Compared the two groups, the jaundice indices were more significantly different at 24-48 h, 48-72 h, and more than 72 h (P<0.05), but not statistically different at 0-24 h (P>0.05). Hemoglobin, reticulocyte, platelets, and leucocyte were not significantly different between the two groups (P>0.05)., Conclusion: YOL as an early intervention has positive significance to decrease the incidence of pathological jaundice in the premature infants, and no significant impact on the blood cells.

Acute kernicterus remains a clinical emergency and its delayed management represents an easily preventable neonatal brain injury. Yet, practitioners encounter recurrent questions regarding the risk and timing of bilirubin-related neurotoxicity. These include the following: does bilirubin damage the brain of healthy infants? Is there a re-emergence of kernicterus in the United States? Was kernicterus previously prevented in the United States? What was the public health impact of 1994 American Academy of Pediatrics Guidelines? What is the current incidence of kernicterus and severe neonatal hyperbilirubinemia? What is the estimated risk of kernicterus in infants with excessive hyperbilirubinemia? Is there a specific bilirubin threshold total serum bilirubin (TSB) value for neurotoxicity? Are there sequelae of severe or prolonged moderate hyperbilirubinemia in the absence of recognized acute bilirubin encephalopathy? Can we define a bilirubin level that is safe in newborns? We address these questions in the context of available data and evidence, and estimate the current risk of chronic kernicterus is about one in seven in infants with TSB >30 mg per 100 ml (513 micromol l(-1)).

Providing safe and effective care requires coordination among the multiple levels of the health care system. These levels comprise the newborn (patient, family and community), nursery or primary care practice (microsystem), hospital or managed care organization (macro-organization) and policy, payment or regulatory issues (environmental context). Contemporary care practices associated with childbirth and early newborn care often reflect disruptions in coordination of these processes and place newborns at risk for poor outcomes. For example, with routine early postpartum discharge, often at less than 48 h after vaginal birth, the peak of serum bilirubin at 3 to 5 days of age typically occurs at home, rather than observed by clinicians in a newborn nursery. In addition, lactation is rarely well established by early discharge and support is often inadequate, increasing the risk of hyperbilirubinemia and discontinuation of breastfeeding. Also, late preterm infants are frequently cared for in the newborn nursery, although they often have difficulty establishing oral feeding and are at substantially higher risk for severe hyperbilirubinemia than infants born at term. Finally, pediatric follow-up is often delayed beyond the first week, after the optimal time for continued assessment of jaundice and lactation. The American Academy of Pediatrics Safe and Healthy Beginnings Initiative, a pilot quality improvement project, will target newborn nurseries, primary care practices and coordination between these sites using a systems-based approach to facilitate implementation of the 2004 guideline for management of hyperbilirubinemia.

To address systems failures and promote a safer management of newborn jaundice, we propose an 'aviation safety standard' for newborn health-care services during the first week after birth. Systems failure in newborn jaundice management has been characterized by lapses in concern, loss of continuity, and delays in care by multiple providers at multiple sites. Components for a six-step national strategy to prevent severe neonatal hyperbilirubinemia and possibly kernicterus are being implemented as delineated in the 2004 AAP guidelines. The clinical guidelines for safer and evidence-based practice have been characterized by both healthcare and societal communities. Professional and community organizations are optimizing outreach resources and facilitating institutionalization of these practices. Nationwide implementation at individual birthing hospitals concurrent with surveillance feedback needs to be initiated. Implementation of a 'six-sigma' approach, as proposed to the current Center for Disease Control and Prevention-initiated partnership (health-care providers, public health and community advocates) may be achieved through collaboration with state and national agencies.

Objective: To investigate the clinical curative effect of Lianhuang Decoction (LHD) in treating fetomaternal ABO blood group incompatibility (FM-ABOI)., Methods: Sixty pregnancy women diagnosed as FM-ABOI were randomly assigned to two groups, Group A treated with LHD and Group B treated with Western medicine. The therapeutic efficacy in the two groups was observed., Results: The antibody titer decreased after treatment in both groups to different extent; the effective rate was 90.0% in Group A and 56.7% in Group B. The bilirubin level in cord blood of Group A was lower than that in Group B significantly (P<0.01). No statistically significant difference was found between the two groups new-bom in terms of 5-minute Apgar score, body weight and hemoglobin content in cord blood (P>0.05)., Conclusion: LHD has good clinical curative effect in treating FM-ABOI, could decrease the serum antibody titer, and prevent the occurrence of postpartum hemolytic disease in newborns.

One of the goals of Healthy People 2010 (set in 1998) was to reduce preterm birthrates from 11.6% to 7.6%. However, in 2004, the preterm birthrate of 12.5% was actually higher than the rate in 1998. Approximately 65% of this increase in prematurity rate is attributed to the increasing birthrate of the late preterm infant. Care of the late preterm infant is far more complicated than many hospital policies and clinical guidelines imply. It cannot be stressed enough to frontline clinicians that late preterm infants are not full-term infants. Their care should not be defined by the same policies and practices that govern term infants. The purpose of this article is to explore the complications that accompany late preterm birth. The following complications will be discussed: thermoregulation challenges, feeding difficulty, late neonatal sepsis, prolonged physiologic jaundice, hypoglycemia, possible neurodevelopmental differences, and respiratory problems.

Parents face a paradox when they are told: Breast is best; bottle-feeding is hazardous to health. But breast-fed babies are more likely to become severely jaundiced than bottle-fed babies, and severe jaundice can lead to brain damage. This article will explore the natural physiology of jaundice with a focus on breast-feeding-associated jaundice, primary prevention of hyperbilirubinemia, and current evidence-based recommendations about feeding jaundice breast-fed infants.

Kernicterus and neurologic sequelae caused by severe neonatal hyperbilirubinemia are preventable conditions. A structured and practical approach to the identification and care of infants with jaundice can facilitate prevention, thus decreasing rates of morbidity and mortality. Primary prevention includes ensuring adequate feeding, with breastfed infants having eight to 12 feedings per 24 hours. Secondary prevention is achieved by vigilant monitoring of neonatal jaundice, identifying infants at risk of severe hyperbilirubinemia, and ensuring timely outpatient follow-up within 24 to 72 hours of discharge. Total serum bilirubin or transcutaneous bilirubin levels should be routinely monitored in all newborns, and these measurements must be plotted on a nomogram according to the infant's age in hours. The resultant low-, intermediate-, or high-risk zones, in addition to the infant's risk factors, can guide timing of postdischarge follow-up. Another nomogram that consists of age in hours, risk factors, and total bilirubin levels can provide guidance on when to initiate phototherapy. If the infant requires phototherapy or if the bilirubin level is increasing rapidly, further work-up is indicated.

Plasma bilirubin testing is crucial to prevent the occurrence of neonatal kernicterus. Haemolysis may occur during sampling and interfere with bilirubin determination. Moreover, lipidic infusions may induce plasma lipemia and also interfere with bilirubin measurement. We evaluated the interference of haemolysis and lipemia with three methods of total and direct bilirubin measurement adaptated on an Advia 1650 analyser (Siemens Medical Solutions Diagnostics) : Synermed (Sofibel), Bilirubin 2 (Siemens) and Bilirubin Auto FS (Diasys). The measurement of total bilirubin was little affected by haemolysis with all three methods. The Bilirubin 2 (Siemens) method was the less sensitive to haemolysis even at low bilirubin levels. The measurement of conjugated bilirubin was significantly altered by low heamoglobin concentrations for Bilirubin Auto FS(R) (30 microM or 0,192 g/100 mL haemoglobin) and for Synermed (60 microM or 0,484 g/100 mL haemoglobin). In marked contrast, we found no haemoglobin interference with the Direct Bilirubin 2 reagent which complied with the method validation criteria from the French Society for Biological Chemistry. The lipemia up to 2 g/L of Ivelip did not affect neither the measurement of total bilirubin for all three methods nor the measurement of conjugated bilirubin with the Diasys and Siemens reagents. However, we observed a strong interference starting at 0,5 g/L of Ivelip with the Synermed reagent. Our data suggest that both Siemens and Diasys methods allow to measure accurately total and conjugated bilirubin in hemolytic and lipemic samples, nevertheless, the Siemens methodology is less affected by these interferences.

Introduction: Cultural, religious and personal factors impact greatly on parenting. This survey aims to identify gaps in knowledge and perception about common parenting issues, with respect to mandarin-speaking Chinese in Singapore. There is an emphasis on first-time parents, who the authors feel may be the group which will require additional education and support on these issues., Methods: A 37-item written survey was conducted before a public mandarin-language forum. Our response rate was 67 percent., Results: Only 44 percent felt that paediatricians allocated sufficient time to discuss parenting issues. 99 percent of parents believed that breast milk was better than formula milk and that 93 percent intended to breastfeed. However, the vast majority of respondents thought that breastfeeding should be stopped if jaundice developed, and that sunning was effective in preventing jaundice. Moreover, the majority did not recognise the seriousness of jaundice, prolonged or otherwise. Widespread misconceptions existed about milk formulas, with half of the respondents thinking that it was necessary to change to lactose-free formula once a child developed diarrhoea. The majority also thought that certain milk formulas could help improve IQ., Conclusion: We hope that more comprehensive and accessible parental education will be available to aid in raising awareness of parental practices, and to dispel misconceptions regarding neonatal care.

Objective: To investigate the predictive value of umbilical cord serum (UCS) bilirubin for subsequent jaundice in healthy term newborns., Methods: Five hundred and twenty-three healthy term newborns (275 boys, 248 girls) were selected. The cord blood total serum bilirubin concentration and the serum albumin concentration were determined. All the infants were assessed for jaundice daily by measurement of transcutaneous bilirubin (TCB). When the infant's TCB was >or= 18 within the first 24 h after birth, >or= 21 at 48 h, >or= 25 at or after 72 h, the venous total serum bilirubin (TSB) was determined and treatment against jaundice was applied as needed. The infants were aligned into four groups according to their UCS bilirubin levels, starting from < 30 micromol/L(group 1); >or= 30 micromol/L(group 2); >or= 36 micromol/L(group 3); >or= 42 micromol/L(group 4). The frequency of hyperbilirubinemia and phototherapy (PT) were compared among the four groups. An analysis of UCS bilirubin as a predictor of later development of jaundice was performed. The characteristics of the infants who became jaundiced (jaundiced group) were compared with the normal infants (non-jaundiced group)., Results: A clear correlation between UCS bilirubin level and the development of hyperbilirubinemia was found in all populations of the four groups. Only eight of the 194 infants in group 1 showed a TCB index >or= 25. TSB values > 205 micromol/L but < 257 micromol/L were observed in 2 newborns. None of the infants in this group showed TSB > 257 micromol/L or needed PT. Thirty-two infants in group 2 showed TCB >or= 25, 12 infants had TSB > 205 micromol/L but < 257 micromol/L, 2 infants had TSB > 205 micromol/L and received PT. In group 3, one infant developed hyperbilirubinemia at 48 h after birth and received PT. Thirty-nine infants showed TCB >or= 25, 16 infants TSB > 205 micromol/L but < 257 micromol/L, 2 infants had TSB > 205 micromol/L and also received PT. In group 4, 4 infants showed a range of TSB from 200 to 215 micromol/L at 48 h and received PT. Twenty-two infants showed TCB >or= 25, 17 of them showed TSB > 205 micromol/L but < 257 micromol/L, and 5 of them had TSB > 205 micromol/L and received PT. The frequency of TSB > 205 micromol/L increased from 1.03% in group 1, 5.77% in group 2, 19.75% in group 3 and to 42.5% in group 4. None of the 194 newborns in group 1 needed phototherapy, whereas 0.96%, 3.70% and 22.5% of the newborns in groups 2 - 4, needed PT. The frequency of patients with hyperbilirubinemia or phototherapy increased with increasing UCS bilirubin levels. For the prediction of TCB >or= 25 using a UCS bilirubin cut-off level, such as >or= 35 micromol/L, we found a positive predictive value of 45.68% and sensitivity of 68.27%. It is significant to predict neonatal jaundice by UCS bilirubin levels (P < 0.001). In the jaundiced group (TCB >or= 25) UCS bilirubin levels were significantly higher than those in the non-jaundiced group (t = 10.96, P < 0.001). No significant differences were found in the cord blood serum albumin concentration (t = 2.38, P > 0.05), the gestational age (t = -0.90, P > 0.05), and birthweight (t = 0.10, P > 0.05) between the jaundiced and non-jaundiced groups., Conclusions: UCS bilirubin level is useful in predicting the subsequent jaundice in healthy term infants. The use of UCS bilirubin values may help detect infants at low or high risk for hyperbilirubinemia and minimize an unnecessary prolongation of hospitalization.

Objective: To assess the prevalence of Rh-negative pregnant women who attended the antenatal clinic and delivered in Rajavithi Hospital., Material and Method: A descriptive retrospective study in Rh-negative pregnant women was done. The present study included the general characteristic of cases, anti-D immunoglobulin prophylaxis administration, fetal anemia and neonatal jaundice., Results: During the study period, 147 Rh-negative pregnant women delivered at Rajavithi Hospital. The prevalence of Rh-negative pregnant women in Rajavithi hospital was 0.31%. Fetal anemia and neonatal jaundice were detected in 21.9% and 37.2%, respectively, and 68.14% of cases received antenatal anti-D immunoglobulin. Anti-D immunoglobulin prophylaxis significantly reduced the incidence of neonatal jaundice (p < 0.05)., Conclusion: The prevalence of Rh-negative pregnant women was 0.31%.

Objective: To compare the effectiveness of glyburide and insulin for the treatment of Gestational diabetes mellitus (GDM) in women who had OGCT >or=200 mg/dl and fasting hyperglycemia., Study Design: A retrospective study was performed among a subset of women treated with glyburide or insulin for GDM from 1999 to 2002 with an OGCT >or=200 mg/dl and pretreatment fasting plasma glucose >or=105 mg/dl. Exclusion criteria included pretreatment fasting >or=140 mg/dl, gestational age >or=34 weeks and multiple gestation. Maternal and neonatal outcomes were assessed. Statistical methods included bivariate and multivariable logistic regression analyses., Results: In 1999 to 2000, 78 women were treated with insulin; in 2001 to 2002, 44 of 69 (64%) received glyburide. There were no statistically significant differences between the two groups with regards to mean OGCT (230+/-25 vs 223+/-23 mg/dl, P=0.07) and mean pretreatment fasting (120+/-10 vs 119+/-11 mg/dl, P=0.45). Seven women (16%) failed glyburide. Women in the insulin group were younger (31.5+/-5.8 vs 35.2+/-4.7 years, P<0.001) and had a higher mean BMI (32.4+/-6.4 vs 29.1+/-5.8 kg/m(2), P=0.003) compared to glyburide group. There were no significant differences in birth weight (3524+/-548 vs 3420+/-786 g, P=0.65), macrosomia (19 vs 23%, P=0.65), pre-eclampsia (12 vs 11%, P=0.98) or cesarean delivery (39 vs 46%, P=0.45). Neonates in the glyburide group were diagnosed more frequently with hypoglycemia (34 vs 14%, P=0.01). When controlled for confounders, macrosomia was found to be associated with glyburide treatment (OR 3.5, 95% CI 1.1 to 11.4)., Conclusion: In women with GDM who had a markedly elevated OGCT and fasting hyperglycemia, glyburide achieved similar birth weights and delivery outcomes but was associated with an increased risk of macrosomia. The possible increased risk of neonatal hypoglycemia in the glyburide group warrants further investigation.

Background: Neonates from isoimmunized pregnancies have increased morbidity from neonatal jaundice. The increased bilirubin from haemolysis often needs phototherapy, exchange transfusion or both after birth. Various trials in pregnant women who were not isoimmunized but had other risk factors for neonatal jaundice have shown a reduction in need for phototherapy and exchange transfusion by the use of antenatal phenobarbital. A recent retrospective case-controlled study showed reduction in the need for exchange transfusion for the neonates from isoimmunized pregnancies., Objectives: To assess the effects of antenatal phenobarbital in red cell isoimmunized pregnancies in reducing the incidence of phototherapy and exchange transfusion for the neonate., Search Strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2006)., Selection Criteria: Randomised and quasi-randomised controlled trials of pregnant women established to have red cell isoimmunization in the current pregnancy during their antenatal testing and given phenobarbital alone or in combination with other drugs before birth., Data Collection and Analysis: All three review authors independently assessed study eligibility and quality., Main Results: No trials met the inclusion criteria for this review., Authors' Conclusions: The use of antenatal phenobarbital to reduce neonatal jaundice in red cell isoimmunized pregnant women has not been evaluated in randomised controlled trials.

In July 2004, The American Academy of Pediatrics (AAP) summarized the latest medical research regarding newborn jaundice and updated the current clinical guidelines. The AAP recommends that clinicians 1) promote breastfeeding and not routinely supplement newborns with water; 2) assess the risk of severe hyperbilirubinemia before discharge; 3) provide follow-up visits after discharge to assess jaundice; and 4) when indicated, treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia and kernicterus. This article summarizes the new guidelines.

Breastmilk is a species-specific food, that is, milk made by human mothers for human infants, and thus is the only natural fluid appropriate for the newborn human. There is a plethora of information available discussing the dangers of water supplementation to babies. This article aims to collate the more recent research papers. Fully breastfed babies do not require water, even in the hottest weather. The dangers of newborn water intoxication, risk of reduction in breastmilk supply and early weaning as well as not following the Ten Steps to Successful Breastfeeding's step six, are discussed. The impact of the attitude of and information from influential persons in the mother's life is also noted.

Objective: To verify the usefulness of the BiliCheck transcutaneous bilirubin meter as a screening device for neonatal jaundice in a Chinese population compared with the Minolta bilirubin meter., Design: A prospective correlation study that compared transcutaneous bilirubin measurements with serum bilirubin levels., Setting: Obstetric ward and a neonatal unit of a regional hospital in Hong Kong., Patients: Neonates with gestation above 32 weeks with neonatal jaundice who were admitted between April 2001 and February 2002., Main Outcome Measures: Transcutaneous measurements of serum bilirubin obtained from the forehead and the sternum with two instruments: BiliCheck and Minolta Airshields JM 102., Results: A total of 77 term and six near-term babies (gestation, 32-37 weeks) were recruited. The mean age at the time of data collection was 3.96 days (range, 2-9 days). The correlations between serum bilirubin and transcutaneous bilirubin measurements of the two devices at the two sites were high, with a coefficient of 0.718 (95% confidence interval, 0.610-0.800; n=100) for forehead measurements, and 0.814 (95% confidence interval, 0.740-0.870; n=99) for sternum using the Minolta Airshields JM 102; and a coefficient of 0.757 (95% confidence interval, 0.657-0.827; n=98) for forehead measurements, and 0.794 (95% confidence interval, 0.700-0.862; n=92) for sternum using the BiliCheck. For BiliCheck, a cut-off point of 250 micromol/L at the forehead and 260 micromol/L at the sternum had a specificity of 61.9% and 70.0%, respectively with a sensitivity of 100% for the detection of serum bilirubin concentrations of 250 micromol/L or higher. This level is commonly used as the level for initiation of treatment such as phototherapy., Conclusion: BiliCheck is a useful screening tool for neonatal jaundice in the Chinese population and is comparable with the Minolta Airshields JM 102.