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Introduction: Prolonged jaundice is very common and can affect about 2-40% of all neonates. The condition warrants close monitoring to avoid missing serious pathology but not to over investigate a normal neonate. Transcutaneous bilirubin (TcB) measurement has been recommended by the AAP. However, there is no published data on the usage of Drager Jaundice Meter JM-105 as a screening modality for prolonged jaundice in term and late preterm neonates in Malaysia. We aimed to evaluate the accuracy of transcutaneous bilirubinometer in monitoring neonates with prolonged jaundice. Materials and methods: A prospective cross-sectional study was conducted in a university hospital in east coast Malaysia, involving 50 neonates with prolonged jaundice. Drager JM-105 device was used to measure TcB while the TSB sample was obtained simultaneously. Fifty pair measurements of TcB and TSB were compared. Results: The mean TSB was 201.96µmol/L (SD 80.98) where the mean TcB was 184.28 µmol/L (SD 73.37). This study demonstrated the mean difference of 17.68 µmol/L in total bilirubin measured by total serum bilirubin (TSB) and transcutaneous bilirubin (TcB) measured by Drager JM-105. This study also showed excellent correlation between TSB values and TcB with correlation coefficient r = 0.963 and r2 = 0.927 (p<0.05). Conclusion: This study showed excellent correlation between TSB values and TcB values. [ABSTRACT FROM AUTHOR]

Background: The cost of transcutaneous bilirubin (TcB) assessments in neonates restricts its availability outside of high-resource environments. There are typically only a few instruments, even in hospitals. Accurate bilirubinometers are becoming increasingly important for outpatient care and home monitoring, since many families these days are sent home before the period that neonatal hyperbilirubinemia peaks. We designed a novel, straightforward Tc bilirubinometer specifically for this purpose, and in this work, we assess the degree of agreement between TcB and TsB before, during, and after phototherapy treatment. Methods: In the newborn unit of the paediatric department at MGMGH and KAPV GMC in Trichy, a prospective cohort research was conducted. Included were newborns with ABO and Rh incompatibility who needed phototherapy after developing clinical jaundice within 10 days of birth. However, those who required an exchange transfusion or post-exchange, had bruises, birth marks, subcutaneous hematomas, or were suffering from conjugated hyperbilirubinemia were prohibited from taking part in the trial. This study involved 400 newborns in all. Results: The majority of newborns had gestational ages more than 35 weeks. For all gestational ages of newborns, there is a strong correlation between baseline transcutaneous bilirubinometer values and total serum bilirubin. Good agreement was found in the agreement study between TcB and TSB, with limits of agreement ranging from 0.6 to 4.1. Compared to the unpatched area, there was good agreement between the patched area TcB and TSB during the whole-time interval following the start of phototherapy. The results of the analysis of Rebound TcB and TSB were also same. Conclusion: A secure instrument for determining bilirubin levels in neonates--term and preterm--is the MBJ-20 Tc bilirubinometer. Since there is minimal possibility of overestimation when utilising TcB from a covered forehead before to, during, and following phototherapy, TcB can be used to monitor neonatal jaundice. Validating TcB's high value or bilirubin in exchange level with serum bilirubin is essential. [ABSTRACT FROM AUTHOR]

Acute appendicitis is one of the commonest causes for acute abdomen that requires surgical treatment. It may cause dire complications like ruptured or gangrenous appendicitis [RGA]. This study was aimed to find whether serum total bilirubin [STB] can be used as a new pre-operative laboratory marker to aid in the diagnosis of RGA in acute appendicitis and also to find the significance if any for RIPASA and modified Alvarado scoring system [MASS] in the same. This was a case series analysis in 150 patients admitted with right iliac fossa [RIF] pain. MASS and RIPASA scores were given and STB investigated for all patients. Further treatment was planned according to the surgeon's discretion taking into consideration the RIPASA scoring category of each patient. Post-operatively all appendix specimen were send for histopathological examination (HPE). Intra-operative diagnosis and post-operative HPE reports were taken to diagnose RGA. Further the STB values were correlated with occurrence of RGA to find any statistically significant relation between hyperbilirubinemia and RGA. A total of 150 patients were analyzed on accrual and mean STB value 1.20 mg/dl SD1.50. The mean STB values of 121 patients who were diagnosed to have appendicitis were 1.36 mg/dl SD1.62. Of these, 33 had RGA, while 88 did not. The STB values of the patients with acute appendicitis and not RGA had a mean value of 0.61 mg/dl SD0.34, while patients with RGA had a mean value of 3.37 mg/dl SD1.95. According to the present study, a STB value above 1.75 mg/dl in a patient with RIF pain has high probability to have RGA. RIPASA and MASS values could not be significantly correlated with RGA, thereby increasing the importance of serum total bilirubin as a new pre-operative laboratory marker to aid in the early diagnosis of ruptured or gangrenous appendicitis in acute appendicitis. [ABSTRACT FROM AUTHOR]

Background. Neonatal jaundice is a commonly occurring problem in both full term and preterm neonates. It is one of the major causes for neonatal mortality and morbidity. Objective. To assess the correlation among transcutaneous bilirubinometer readings and Total serum bilirubin levels at different sites in early and late preterm neonates before and at the end of phototherapy. Method. An observational study was conducted in preterm neonates diagnosed with jaundice. The Transcutaneous Bilirubin (TCB) instrument, Drager JM105 is used to assess TCB and it was recorded on three sites and average of the three readings was noted. Prior to phototherapy, TCB was noted 30 min before TSB was sent. A photo-opaque patch was placed on the sternum and phototherapy was given. At the end of the phototherapy, TCB on the sternum was noted and then TSB was sent with a time gap of not more than 30 min. Results. In this study, out of 50 neonates 14 were early preterm and 36 were late preterm babies. It was found that there was a positive correlation between TCB and TSB in early preterm babies before phototherapy (p value=0.0019), but there was no correlation between TCB and TSB at the end of phototherapy. In late preterm babies there was no correlation between TCB and TSB both before phototherapy and at the end of phototherapy. Conclusion. In this study it was found that TCB has positive correlation with TSB and can be implemented for the screening of hyperbilirubinemia even in preterm neonates.

Abstract Background The hemolytic nature of hemolytic disease of the newborn (HDN) is described as the abnormal destruction and decomposition of red blood cells, causing heterogeneous manifestations such as abnormal red blood cell volume and morphology. Mean corpuscular volume (MCV) and red blood cell volume distribution width (RDW) are commonly used parameters related to red blood cell volume. Total serum bilirubin (TSB) is routinely monitored among newborns. This study aims to explore the value of MCV and RDW, combined with TSB, to improve the efficiency of HDN diagnosis. Methods Three hundred eighty-eight children with HDN and 371 children with non-HDN pathological jaundice who were diagnosed and treated in the neonatal department of our hospital from January 2019 to December 2020 were included in the study. Clinical data collected include examination results of laboratory indicators, such as MCV, coefficient of variation of red blood cell volume distribution width (RDW-CV), standard deviation of red blood cell volume distribution width (RDW-SD), and TSB. The differences in the indicators between the two groups of children were retrospectively analyzed. Results 1) The detection rate of HDN in children in the early group was higher than that in the late group (P 163.3 μmol/L, MCV > 96.35fL, and RDW-CV > 16.05%, the diagnosis rate of HDN increased (P 96.35fL or RDW-CV > 16.05%, children with jaundice in three days of birth (especially children with TSB > 163.3 μmol/L) should be screened for HDN. A combination of TSB, MCV, and RDW-CV can improve the early detection rate of HDN, contribute to reduce the readmission rate and risk of hyperbilirubinemia.

All parts of Phyllanthus emblica L. are traditionally used for the treatment of jaundice, inflammation, and diarrhea. The present study was planned to evaluate the P. emblica leaf extract (PELE) assisted clearance of bilirubin in artificially-induced hyperbilirubinemic rabbits. Hyperbilirubinemia was induced in White New Zealand albino rabbits by oral administration of phenyl hydrazine solution (10 mg kg−1 body weight) and an intraperitoneal injection of ursodeoxycholic acid solution (10 mg kg−1 bw). PELE-assisted bilirubin clearance from animals was optimized by a bi-factorial response-surface central composite design with five levels of each of the extract dose (0, 25, 50, 75, and 100 mg kg−1 bw) and sampling period (24, 48, 72, 96, and 120 h). The oral administration of PELE showed a significant (p

Objective: To evaluate the effect of intravenous (IV) ceftriaxone on free bilirubin concentrations in term infants with unconjugated hyperbilirubinemia.Study Design: A prospective study was performed with subjects serving as their own controls. Our inclusion criteria were term infants < 7 days old with sepsis and receiving IV antibiotics for > 3days and resolving hyperbilirubinemia with total serum bilirubin levels between 6 -12 mg/dL by day 4 of life. Bf concentrations were measured by the peroxidase method using a UB analyzer and a Zone Fluidics) device prior to (baseline) and 15 minutes after (follow-up) IV ceftriaxone administration on postnatal days 4 to 6. Paired measurements of Bf were analyzed using a Student's paired t-test or Wilcoxon signed-rank test.Results: 27 infants were studied. The mean Bf (μg/dL) at follow-up was not different from that at baseline when measured by the UB analyzer (p=0.78). The mean Bf was significantly lower at follow-up compared with baseline when measured by the ZF device (p=0.02). The ratio of a Bf with and without ceftriaxone, an index of displacing effect, was 1.02 (95% confidence interval [CI]: 0.89-1.14) using the UB analyzer and 0.58 (95% CI: 0.30-0.86) using the ZF device.Conclusions: Ceftriaxone is not associated with bilirubin displacing effect in term infants with a mild unconjugated hyperbilirubinemia. Home therapy with once daily intramuscular ceftriaxone may be an alternative option for management of sepsis in asymptomatic infants with a mild unconjugated hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Background: The hemolytic nature of hemolytic disease of the newborn (HDN) is described as the abnormal destruction and decomposition of red blood cells, causing heterogeneous manifestations such as abnormal red blood cell volume and morphology. Mean corpuscular volume (MCV) and red blood cell volume distribution width (RDW) are commonly used parameters related to red blood cell volume. Total serum bilirubin (TSB) is routinely monitored among newborns. This study aims to explore the value of MCV and RDW, combined with TSB, to improve the efficiency of HDN diagnosis. Methods: Three hundred eighty-eight children with HDN and 371 children with non-HDN pathological jaundice who were diagnosed and treated in the neonatal department of our hospital from January 2019 to December 2020 were included in the study. Clinical data collected include examination results of laboratory indicators, such as MCV, coefficient of variation of red blood cell volume distribution width (RDW-CV), standard deviation of red blood cell volume distribution width (RDW-SD), and TSB. The differences in the indicators between the two groups of children were retrospectively analyzed. Results: 1) The detection rate of HDN in children in the early group was higher than that in the late group (P < 0.001). 2) The early-stage group had lower TSB levels and higher values of MCV, RDW-CV and RDW-SD (P < 0.001). Compared with the children in the non-HDN group, the indices in the HDN group were higher in the early stage (P < 0.001). 3) In the early stage, the TSB, MCV, RDW-CV, and RDW-SD were positively correlated with the diagnosis of HDN (P < 0.001). Early monitoring of TSB, MCV, RDW-CV and RDW-SD was valuable for HDN detection, the area under the curve (AUC) was 0.729, 0.637, 0.715, and 0.685, respectively (P < 0.001). 4) After a binary logistic analysis at TSB > 163.3 μmol/L, MCV > 96.35fL, and RDW-CV > 16.05%, the diagnosis rate of HDN increased (P < 0.001). The AUC of the HDN detected using the combined indicators was 0.841. Conclusion: At MCV > 96.35fL or RDW-CV > 16.05%, children with jaundice in three days of birth (especially children with TSB > 163.3 μmol/L) should be screened for HDN. A combination of TSB, MCV, and RDW-CV can improve the early detection rate of HDN, contribute to reduce the readmission rate and risk of hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Total serum bilirubin (TBIL) levels are a risk factor in critically ill patients. However, the relationship between the dynamics of TBIL and the prognosis of acute respiratory failure (ARF) patients is unclear. This study aimed to investigate the impact of different levels of TBIL during hospitalization on mortality in ARF patients. This study used a retrospective cohort study. We extracted information on ARF patients from the Medical Information Bank for Intensive Care (MIMIC)-III (version 1.4). We used propensity score matching (PSM) to adjust for the level of potential baseline-level differences between groups. Cox regression was used to analyze mortality risk factors in patients with ARF. Subgroup analysis was used to explore special populations. 2673 patients were included in the study, and 19.7% developed hyperbilirubinemia (TBIL ≥ 2 mg/dL) during their hospitalization. After PSM, multivariate Cox regression showed a 50% and 135% increased risk of death for a maximum value of TBIL ≥ 5 mg/dL and minimum value of TBIL ≥ 2 mg/dL during hospitalization, respectively, compared to the control population. In addition, age ≥ 65 years, previous comorbid malignancies, respiratory rate ≥ 22 beats/min, SpO2 ≥ 95, BUN ≥ 20 mg/dL, lactate ≥ 5 mmol/L, platelet < 100 * 10 ^ 9/L were independent risk factors for 1-year mortality in ARF patients. Subgroup analysis showed that high bilirubin had a greater effect on patients aged less than 65 years (P for interaction < 0.05). Hyper TBIL (TBIL max ≥ 5 mg/dL or TBIL min ≥ 2 mg/dL) was an independent risk factor for 1-year mortality in patients with ARF. This study suggests that clinicians should be aware of TBIL levels and intervene early in these patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the Diagnostic accuracy of Kramer's visual assessment of jaundice in term neonates by taking total serum bilirubin levels as a gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Neonatology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, Mar to Sep 2019. Methodology: The study was based on examining and investigating 300 neonates. Kramer scale was used to examine jaundice in all neonates, and results were compared to total serum bilirubin levels. Results: A total of 300 patients were included in this study. The mean bilirubin level was 229.1±74.5mol/L. The sensitivity and specificity of visual assessment of jaundice using the Kramer visual scale were 83.84% and 73.53%, respectively, for neonates who were not jaundiced below the abdomen and thighs included in Kramer zones 1 to 3. Conclusion: Kramer visual assessment can be used as a noninvasive screening method in neonates jaundiced up to the abdomen and thighs, which is included in Kramer zones 1 to 3 but for markedly jaundiced neonates Kramer scale is not a reliable noninvasive method of bilirubin estimation. [ABSTRACT FROM AUTHOR]

Aim:Transcutaneous bilirubin (TCB) measurement methods cause false results during and after phototherapy (PT), so bilirubin levels are followed by total serum bilirubin (TSB) measurement, which causes taking blood samples and increases the risk of infection. We compared the TCB measurements made with Bilicare™ and TSB measurements by preventing PT exposure of a part of the skin in newborns receiving PT and evaluating the reliability of the measurements made with Bilicare™ after PT.Methods:This study was conducted between 01 February-30 June 2020 as a single-center cross-sectional study. The study included newborns aged 35 weeks and up who were admitted to a neonatal intensive care unit for PT. TSB measurements were reviewed by the hospital automation system. Bilicare™ bilirubin meter was used for TCB measurements. Simultaneous TSB and TCB measurements were made before PT. The skin area to be measured was covered with a radio-opaque patch. After PT, simultaneous TSB, exposed skin area TCB, and patched skin area TCB were measured. Simultaneous TSB and TCB measurements were repeated 24 h after the end of PT. The relationship between these data was evaluated statistically.Results:This study was conducted with 171 late preterm and term newborns with a gestational age of ≥35 weeks. 79 (46.1%) were female and 92 (53.9%) were male newborns. The mean gestational age was 38.3±1.15 weeks. When maternal and newborn blood groups were evaluated, 107 (62.5%) had no blood incompatibility, 53 (30.9%) had ABO incompatibility incompatibility, 9 (5.2%) had Rh incompatibility, 1 (0.6%) had subgroup incompatibility, and 1 (0.6%) had ABO incompatibility and Rh incompatibility. The correlation coefficient (r) of TSB and TCB measurements made before PT was 0.97 and a strong correlation was found. A correlation coefficient (r) of 0.98 and a strong correlation between closed skin area TCB measurement and TSB measurement immediately after PT were detected. The correlation coefficient (r) was 0.96 and a strong correlation was found between the TCB and TSB measurements performed 24 h after the PT was terminated.Conclusion:This study shows that TCB measurements made from unexposed areas can be safely measured in patients with PT.

Objective: To determine the Diagnostic accuracy of Kramer's visual assessment of jaundice in term neonates by taking total serum bilirubin levels as a gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Neonatology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, Mar to Sep 2019. Methodology: The study was based on examining and investigating 300 neonates. Kramer scale was used to examine jaundice in all neonates, and results were compared to total serum bilirubin levels. Results: A total of 300 patients were included in this study. The mean bilirubin level was 229.1±74.5mol/L. The sensitivity and specificity of visual assessment of jaundice using the Kramer visual scale were 83.84% and 73.53%, respectively, for neonates who were not jaundiced below the abdomen and thighs included in Kramer zones 1 to 3. Conclusion: Kramer visual assessment can be used as a noninvasive screening method in neonates jaundiced up to the abdomen and thighs, which is included in Kramer zones 1 to 3 but for markedly jaundiced neonates Kramer scale is not a reliable noninvasive method of bilirubin estimation.

Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Jaundice is the quite common benign condition in neonates, but due to its potential toxicity, neonates must be monitored. This study was aimed to evaluate the effect of serum albumin level on the transcutaneous bilirubin (TcB) measurements in term neonates with unconjugated hyperbilirubinemia. METHODS: Serum albumin and total serum bilirubin (TSB) of 252 jaundiced term neonates were estimated and simultaneously TcB was measured over sternum and the effect of serum albumin on TcB measurements was evaluated. RESULTS: The correlation between TSB and TcB was linear and significant for the entire cohort. When this correlation was studied separately in the groups with different albumin levels, maximum correlation (r = 0.888, R2 linear = 0.789, p < 0.001) was observed in group 1 with hypo-albuminemia followed by in group 2 with normal albumin levels (r = 0.854, R2 linear = 0.729, p < 0.001) and group 3 with higher albumin levels (r = 0.809, R2 linear = 0.689, p < 0.001). Bland-Altman plot analysis of whole study population demonstrate good agreement between TSB and TcB [95% CI = –0.038 to 0.493 mg/dL, 17/252 = 6.75% outside the limits of agreement, Mean difference = 0.227]. This analysis in different groups also show good agreement between TSB and TcB. CONCLUSIONS: The correlation between the TSB and TcB may affected by serum albumin level. Therefore, transcutaneous bilirubinometry is not able to replace invasive TSB measurement. However, in the absence of TSB it could be an alternative to measure the level of bilirubin in term neonates. [ABSTRACT FROM AUTHOR]

Background: Drawing blood to measure total serum bilirubin is painful & time consuming. Transcutaneous bilirubinometer working by multiwavelength spectral reflectance from the skin surface on forehead or upper sternum is a quick & painless technique. Objectives: to compare the effectiveness of transcutaneous (over the upper sternum and forehead) and serum bilirubin measurement of neonate with jaundice. Subjects and Methods: This is a cross sectional prospective study. It enrolled 175 jaundiced neonates & excluded those exposed to phototherapy. It was conducted at Child Central Teaching Hospital in Baghdad, Iraq from the 1st of August to the 30th of October 2018. Transcutaneous bilirubin measurement on forehead and upper sternum was done by JM 103 Minolta Air shields bilirubinometer. Total serum bilirubin was measured by APEL BR 501 BILIRUBIN METER. Data entered & analyzed using SPSS 20 computer software. Means, frequencies, cutoff values, sensitivity & specificity were calculated. Results: The mean age, gestational age & birth weight were (6.3±4.3 days), (36.9±2.1 weeks) and (2.7±0.6 Kg) respectively. Mean total serum bilirubin, transcutaneous chest & forehead bilirubin levels were 12.6±4.2 mg/dl, 11.8±3.8 mg/dl & 11.2±3.9 mg/dl respectively. Mean total serum bilirubin was significantly higher than transcutaneous chest and forehead bilirubin. Cutoff values of transcutaneous chest & forehead bilirubin levels were [(9 mg/dl) with sensitivity (95.4%) & specificity (86.4%)] and [(8.2 mg/dl) with sensitivity (94.7%) & specificity (86.4%)] respectively. Conclusions: Transcutaneous bilirubin measurements on chest and forehead have an acceptable validity in predicting hyperbilirubinemia with less accuracy on forehead.

Aim: Transcutaneous bilirubin (TCB) measurement methods cause false results during and after phototherapy (PT), so bilirubin levels are followed by total serum bilirubin (TSB) measurement, which causes taking blood samples and increases the risk of infection. We compared the TCB measurements made with Bilicare™ and TSB measurements by preventing PT exposure of a part of the skin in newborns receiving PT and evaluating the reliability of the measurements made with Bilicare™ after PT. Methods: This study was conducted between 01 February-30 June 2020 as a single-center cross-sectional study. The study included newborns aged 35 weeks and up who were admitted to a neonatal intensive care unit for PT. TSB measurements were reviewed by the hospital automation system. Bilicare™ bilirubin meter was used for TCB measurements. Simultaneous TSB and TCB measurements were made before PT. The skin area to be measured was covered with a radio-opaque patch. After PT, simultaneous TSB, exposed skin area TCB, and patched skin area TCB were measured. Simultaneous TSB and TCB measurements were repeated 24 h after the end of PT. The relationship between these data was evaluated statistically. Results: This study was conducted with 171 late preterm and term newborns with a gestational age of ≥35 weeks. 79 (46.1%) were female and 92 (53.9%) were male newborns. The mean gestational age was 38.3±1.15 weeks. When maternal and newborn blood groups were evaluated, 107 (62.5%) had no blood incompatibility, 53 (30.9%) had ABO incompatibility incompatibility, 9 (5.2%) had Rh incompatibility, 1 (0.6%) had subgroup incompatibility, and 1 (0.6%) had ABO incompatibility and Rh incompatibility. The correlation coefficient (r) of TSB and TCB measurements made before PT was 0.97 and a strong correlation was found. A correlation coefficient (r) of 0.98 and a strong correlation between closed skin area TCB measurement and TSB measurement immediately after PT were detected. The correlation coefficient (r) was 0.96 and a strong correlation was found between the TCB and TSB measurements performed 24 h after the PT was terminated. Conclusion: This study shows that TCB measurements made from unexposed areas can be safely measured in patients with PT. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the utility of a Transcutaneous Bilirubin nomogram in high risk neonates and to evaluate the validity of Transcutaneous Bilirubin and Total serum bilirubin in both low and high-risk neonates. Study Design: Cross-sectional study. Place and Duration of Study: Postnatal Ward, Aga Khan University Hospital, Karachi, from May to Oct 2019. Methodology: The participants will include all neonates born and admitted in the well baby nursery with jaundice. All neonates with gestational age of

Abstract Background In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi. In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied. Methods After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination. Results Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03 (8.58%) had normal levels. Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels. It was Mixed Type of Hyperbilirubinemia in gangrenous/perforated appendicitis. The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively. Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of complicated appendicitis be 31.80%. Receiver Operating Characteristic curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence. Conclusions This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial registration Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. This was a prospective trial. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27 .

Introduction: Neonatal hyperbilirubinemia is one of the most common problem encountered during the neonatal period. Phototherapy is a widely accepted, cheap, non-invasive relatively safe and effective method of treatment for neonatal hyperbilirubinemia. Aim: To compare the efficacy of Light Emitting Diode (LED) phototherapy vs Conventional Phototherapy for treatment of neonatal hyperbilirubinemia in healthy term neonates. Materials and Methods: A quasi experimental study was conducted in Neonatal Intensive Care Unit and Post-natal wards in a tertiary care hospital affiliated to Medical College and Hospital, Ahmedabad, Gujarat from July 2018 to April 2019 with a sample size of 135 in each group. They were assessed clinically by Kramers method just before initiation of phototherapy, then using Transcutaneous Bilirubinometer (TCB) Total Serum Bilirubin (TSB) level was measured. Bilirubin assessment by these methods were done for every neonate before initiation of phototherapy and then again repeated after 24 and 48 hours of phototherapy. Data was collected and analysed in Microsoft (MS) excel Statistical Package for the Social Sciences (SPSS) 0.26. Chi-square test was used for comparison. Results: In the present study, 158 (58.51%) babies were male and 112 (41.48%) babies were female. Initially, LED was found to be better than Compact Fluorescent (CFL) conventional phototherapy on comparing the average fall in the serum bilirubin level from baseline during the first 24 hours however no such difference in the efficacy between the two light sources was seen after a period of 48 hours. Total 9 (6.66%) patients developed rebound hyperbilirubinemia after completion of conventional phototherapy whereas 14 (10.37%) developed rebound hyperbilirubinemia after completion of 48 hours of LED phototherapy. Conclusion: LED and conventional phototherapy were equally efficacious in managing non haemolytic hyperbilirubinemia in healthy term neonates.

Background: This study aims to investigate the reliability of the Dräger Jaundice Meter JM-105 for the screening of neonatal jaundice in Malay neonates. Methods: A cross-sectional study was conducted in a university hospital involving 130 jaundiced neonates requiring serum bilirubin determination from day 2 to day 7 of life. Results: The mean total serum bilirubin (TSB) was 232 µmol/L, whereas the mean transcutaneous bilirubin (TcB) measured at the forehead and sternum were 222 µmol/L and 223 µmol/L, respectively. Further, TcB underestimates TSB with a mean difference of 10.10 µmol/L at the forehead and 9.27 µmol/L at the sternum. A positive linear relationship was observed between TSB with TcB forehead (r = 0.82) and TcB sternum (r = 0.80). A good discriminations ability was observed for both the TcB forehead (receiver operating characteristics [ROC] curve = 89.8%) and sternum (ROC curve = 89.7%) at a TSB level of 205 µmol/L. The sensitivity ranges from 84.4% to 85.3%, while the specificity ranges from 77.4% to 76.4%. Conclusion: Our study demonstrates a strong linear relationship and good diagnostic accuracy of TcB values compared to TSB values. To conclude, TcB measured at the forehead or sternum is a good alternative as a non-invasive screening tool for non-severe hyperbilirubinemia in Malay neonates. [ABSTRACT FROM AUTHOR]

All parts of Phyllanthus emblica L. are traditionally used for the treatment of jaundice, inflammation, and diarrhea. The present study was planned to evaluate the P. emblica leaf extract (PELE) assisted clearance of bilirubin in artificially-induced hyperbilirubinemic rabbits. Hyperbilirubinemia was induced in WhiteNewZealand albino rabbits by oral administration of phenyl hydrazine solution (10 mg kg-1 body weight) and an intraperitoneal injection of ursodeoxycholic acid solution (10 mg kg-1 bw). PELE-assisted bilirubin clearance from animals was optimized by a bi-factorial responsesurface central composite design with five levels of each of the extract dose (0, 25, 50, 75, and 100 mgkg-1 bw) and sampling period (24, 48, 72, 96, and 120 h). The oral administration of PELE showed a significant (p < 0.05) dose-dependent linear increase in bilirubin clearance from hyperbilirubinemic rabbits. However, the sampling period showed no significant effect on bilirubin clearance. The optimum levels of PELE dose and sampling period for maximum clearance of bilirubin (0.658 mg dL-1) were found to be 94.864 mg kg-1 body weight and 51.12 h respectively. PELE was found to be effective in bilirubin clearance at the observed optimum levels of extract dose and would be a good choice for the management of hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

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Background: Neonatal jaundice is considered a major health problem in neonates owing to bilirubin deposition. Recently, zinc demonstrated a high efficiency in reduction of low bilirubin level when administrated in association with phototherapy. Aim of the work: To assess efficiency and safety of oral zinc as a therapy in treatment of indirect hyperbilirubinemia in term neonates during phototherapy. Patients and Methods:A total of 100 term neonates with indirect hyperbilirubinemia were divided into two equal groups: Intervention Group (n=50) received oral zinc sulphate preparation, in a dose of 5 mg twice daily in combination with phototherapy. Control group (n=50) received phototherapy without oral zinc supplementation. In both groups, the total serum bilirubin levels were measured at admission, 12 hours, 24 hours and at discharge. Results: Treatment of full-term neonates with hyperbilirubinemia by oral zinc sulfate at a dose of 5 mg given twice-daily induce a significant reduction of total serum bilirubin [TSB] after 12 hours, 24 hours and at discharge when compared to the control group. The duration of phototherapy in intervention group was markedly decreased with statistically significant difference in comparison to the control group. However, there was no significant differences between groups regarding adverse effects of phototherapy and zinc therapy. Conclusion: Oral zinc could play a major role in the management of neonatal jaundice when administrated at dose of ten mg/day as it can decrease the neonatal TSB with subsequent reduction of phototherapy duration.

Abstract Background The effect and safety of preoperative biliary drainage (PBD) in patients with perihilar cholangiocarcinoma are still controversial; the aim of our study is to evaluate all aspects of PBD. Methods All included studies featured PBD versus non-PBD (NPBD) groups were from 1996 to 2019 and were extracted from Cochrane Library, Embase, PubMed, and Science Citation Index Expanded. Results Sixteen studies met the inclusion criteria and were included in this analysis. PBD may lead to a significantly higher incidence of overall morbidities (OR 0.67, 95% CI 0.53, 0.85; P = 0.0009) and intraoperative transfusions (OR 0.72, 95% CI 0.55, 0.94; P = 0.02); moreover, bile leakage (OR 0.58, 95% CI 0.24, 1.41; P = 0.04), infection (OR 0.31, 95% CI 0.20, 0.47; P < 0.00001), and cholangitis (OR 0.18, 95% CI 0.007, 0.48; P = 0.0007) are also related to PBD. However, NPBD was associated with more frequent hepatic insufficiency (OR 3.09, 95% CI 1.15, 8.31; P = 0.03). In the subgroup meta-analysis, the differences in the outcomes of bile leakage and overall morbidity lost significance between the PBD and NPBD groups when the mean total serum bilirubin (TSB) concentration was above 15 mg/dl. Conclusion Meta-analysis demonstrated that compared to NPBD, PBD is associated with a greater risk of several kinds of infection and morbidities, but its ability to reduce postoperative hepatic insufficiency cannot be ignored. In patients with a high TSB concentration, PBD tends to be a better choice. However, these results need to be confirmed in a future prospective randomized trial with large samples to clarify the effects and find a specific TSB concentration for PBD.

The aim of this study was to assess whether home phototherapy was feasible and safe in a cohort of otherwise healthy term-born neonates who fulfilled the criteria for in-hospital phototherapy. This was a randomized controlled trial in which term newborns with a total serum bilirubin of 18–24 mg/dL (300–400 μmol) were randomized to either home phototherapy or conventional in-hospital phototherapy. The primary outcome measurements were safety and efficacy, length of stay and the number of failed treatments. The secondary outcomes were the number of blood samples and weight gain during treatment. One hundred forty-seven patients were recruited, 69 patients randomized to conventional phototherapy and 78 to home phototherapy. The results showed that no patients needed blood exchange and only 4% of the patients allocated to home phototherapy were admitted to the hospital. The duration of phototherapy, length of stay, amount of blood tests and weight change showed no statically significant differences. Conclusion: Home phototherapy could be a safe alternative to inpatient phototherapy for otherwise healthy newborns with hyperbilirubinemia if daily checkups and 24/7 telephone support can be provided. The parents should be informed to contact the hospital immediately if they fail to perform the treatment at home. Trial registration: Clinicaltrials.gov NCT03536078 What is Known: • Phototherapy in the hospital is a safe and effective treatment without major side effects. • Fibre optic equipment has made the choice of home phototherapy possible. What is New: • This is the first randomized controlled trial comparing home phototherapy with hospital phototherapy. • Results indicate that home phototherapy could be considered as a safe and feasible alternative when performed according to instructions given, to hospital treatment for otherwise healthy term newborns. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the utility of a Transcutaneous Bilirubin nomogram in high risk neonates and to evaluate the validity of Transcutaneous Bilirubin and Total serum bilirubin in both low and high-risk neonates. Study Design: Cross-sectional study. Place and Duration of Study: Postnatal Ward, Aga Khan University Hospital, Karachi, from May to Oct 2019. Methodology: The participants will include all neonates born and admitted in the well baby nursery with jaundice. All neonates with gestational age of <35 weeks, requiring admission in Neonatal intensive care unit, and neonates with conjugated hyperbilirubinemia will be excluded. We will stratify our neonates into high and low risk population based on predefined criteria. Eighty five neonates in low risk group and 122 neonates in high risk group will be included. Results: We aim to assess the effectiveness of Transcutaneous Bilirubin nomogram in high risk neonates as an effective and non-invasive tool in the management of neonatal jaundice in high risk neonates. We will also assess the sensitivity and specificity of Transcutaneous Bilirubin and Total serum bilirubin measurements and the analysis would be performed separately for high risk and low risk neonates to evaluate the validity of Transcutaneous Bilirubin independently in both groups. Conclusion: We hope to establish a validated phototherapy guideline based on the Transcutaneous Bilirubin nomogram, as a cost effective and noninvasive tool in the management of neonatal jaundice in both high and low risk groups in Pakistan. [ABSTRACT FROM AUTHOR]

Background: In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi. In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied.Methods: After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination.Results: Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03 (8.58%) had normal levels. Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels. It was Mixed Type of Hyperbilirubinemia in gangrenous/perforated appendicitis. The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively. Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of complicated appendicitis be 31.80%. Receiver Operating Characteristic curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence.Conclusions: This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial registration Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. This was a prospective trial. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27 . [ABSTRACT FROM AUTHOR]

Background: Bacterial infections and some antibiotics show displacer effects on bilirubin-albumin binding and increase unbound bilirubin (UB) but not total bilirubin (TB) in serum. Methods: A case study was conducted to show a successful treatment of hyperbilirubinemia by monitoring UB. Results: In an extremely preterm infant with bloodstream bacterial infection caused by methicillin-resistant coagulase-negative staphylococci, 2 days after high-dose ampicillin and regular-dose amikacin were initiated, UB markedly increased, but TB did not. After vancomycin was substituted, UB decreased immediately with phototherapy and intravenous albumin infusion. Conclusions: When using antibiotics, the clinicians should be mindful regarding the displacer effect on bilirubinalbumin binding. [ABSTRACT FROM AUTHOR]

Background: Neonatal jaundice indicates the presence of pigment in the skin and sclera. Vitamin E is an important component of the cellular antioxidant defense system. Here in the present study, we aimed to evaluate and investigate these therapeutic effects. Materials and Methods: This is a randomized clinical trial performed on 100 premature neonates. Group 1 received 10 units of Vitamin E daily for 5 days. The other group received placebo. Amount of bilirubin was measured at the time of 0, 24, 48, 72, and 96 h after birth. Results: Mean bilirubin in Vitamin E group was increasing until the 2nd day and then got a decreasing trend. In the control group, the increasing trend of bilirubin was going on till the 3rd day. Mean bilirubin increased significantly during the follow-up in both Vitamin E and control groups (χ2 [df] = 20.23 (1), P < 0.001). Although both groups showed an increasing trend in mean bilirubin, on the last day of follow-up, the average amount of increase was lower in Vitamin E group (5.06 ± 2.25 vs. 6.23 ± 3.98). Also in the 3rd and 4th days, mean bilirubin was lower in Vitamin E group. Conclusion: This study supports the usage of oral Vitamin E therapies on reducing the bilirubin levels in neonates. We also showed that this reduced trend occurs after day 3 of life, but in the follow-ups, neonates who were treated with Vitamin E had lower bilirubin levels compared to the placebo group.

Background and Aim: Jaundice is the yellowish discoloration of the skin and mucous membranes or the visible manifestation as a result of elevated serum bilirubin. With spectroscopic tools now available, it is possible to assess the skin's condition by quantitative measures and to access information from deeper layers of skin not visible to the eye. The aim of this study was to determine the relevance of the jaundice meter in determining significant bilirubin levels in term neonates at a tertiary hospital in Lagos State using the Konica Minolta JM-103. Materials and Methods: One hundred and fifty consecutive neonates who presented at the neonatal unit of the hospital were recruited for the study after checking them with set inclusion and exclusion criteria. The transcutaneous bilirubinometry (TcB) readings of the neonates were taken on the forehead, sternum, and abdomen of the calm neonate in a supine position, and blood samples for total serum bilirubin (TSB) estimation were drawn from a peripheral vein within 10 min of TcB measurement. Pearson's correlation analysis with linear regression was done to test the relationship between TSB and TcB values as well as for TcB measurements taken at different sites. Results: The difference between the bilirubin values measured with TcB and TSB was low, with 104 neonates (69.3%) having a difference that was 12 mg/dl was 45.2% compared with 56.8% obtained by TcB. In the present study, bilirubin levels measured with the JM-103 show a good agreement with TSB levels in the study neonates. A comparison of the extent of neonatal jaundice in our study at the different body sites using the Kramer's chart showed that there were similar mean recordings for TcB and TSB, with mean values of 10.27 ± 2.90 and 10.58 ± 2.90 for involvement of the face/neck and 18.34 ± 1.61 and 18.43 ± 1.42 for hand/feet obtained by TSB and TcB, respectively. Conclusion: The excellent correlation of TcB with TSB obtained from this study even at levels of bilirubin that necessitates the initiation of phototherapy is encouraging. The JM-103 device thus appears relevant in determining significant bilirubinemia in black neonates.

Background: Varied aetiologies have been proposed for the prevalence of neonatal jaundice (NNJ) in different parts of Nigeria. The aim of this study was to determine the clinical and sociodemographic correlates of NNJ in a cohort of neonates presenting at a Tertiary health Facility in Lagos, Nigeria. Materials and Methods: One hundred and fifty consecutive neonates that presented at the neonatal unit of the hospital were enlisted for the study after checking them with set inclusion and exclusion criteria. The transcutaneous bilirubin (TcB) readings of the individuals were obtained on the forehead, sternum and abdomen of the calm neonate in a supine position and blood samples for total serum bilirubin estimation were drawn from a peripheral vein within 10 min of TcB measurement. Results: One hundred and fifty neonates were included in the study of which 89 (59.33%) were males and 61 (40.67%) were females. Mothers that had only a primary level of education had babies that presented with significantly higher bilirubin values (P = 0.000). Male neonates, those that presented after 48 h, those between 40 and 42 weeks' gestational age and those that were

AIMS: To determine the efficacy of measuring the transcutaneous bilirubin as a screening tool for clinically significant hyperbilirubinaemia in Indian infants. MATERIALS AND METHODS: A cohort of 100 neonates who have clinical jaundice, admitted in NICU of Institute of Child Health, Kolkata from March 2014 to Jan 2015, were included in the study. Both the total serum bilirubin and transcutaneous bilirubin were measured for the above group. Inclusion criteria was neonates who had clinical jaundice and required extimation of serum bilirubin. Exclusion criteria was neonates who would receive phototherapy and/or exchange transfusion. STATISTICAL ANALYSIS: Software used was SPSS. RESULTS: 59 male and 41 female neonates were enrolled. A strong agreement was found between Total serum bilirubin and Transcutaneous bilirubin values. Mean gestational age was 34.91 weeks with a mean birth weight of 2492.2 gms.Mean age at the time of measurement was 86.13 hours. CONCLUSION: The above strong agreement between TSB and TCB was same in the term population as well as the whole population. The results of this study supports Transcutaneous bilirubin as an effective screening tool for estimation of neonatal hyperbilirubinaemia in Indian infants.

Introduction: Phototherapy is used to manage neonatal hyperbilirubinemia in early life. We aimed to compare between intermittent and continuous phototherapy in reducing TSB, rate of fall of bilirubin, duration of phototherapy and duration of hospitalisation in neonates with non-haemolytic hyperbilirubinemia. Methods: Total 190 neonates who were > 34 weeks and birth weight ≥ 2000 gm were included. They were randomised into group A (continuous phototherapy) and group B (intermittent phototherapy). Group A received phototherapy for three hours and 45 minutes off and group B received phototherapy for three hours and then three hours off. TSB levels estimation were done in both groups and compared after each 12 hours, 24 hours, and 48 hours of commencing phototherapy. Results: The mean TSB at presentation was 15.64 ± 2.19 mg/dl for continuous and 15.03 ± 1.07 mg/dl for intermittent group. Mean TSB at 12, 24, 48 hours were 13.26 ± 2.4 mg/dl, 10.8 ± 1.72 mg/dl, 10.16 ± 0.95 mg/dl respectively for continuous and 12.6 ± 1.65 mg/dl, 10.04 ± 1.8 mg/dl, 9.1 ± 0.66 mg/dl respectively for intermittent group (p < 0.05). The mean rate of fall in serum bilirubin was 0.22 ± 0.12 mg/dl/hr for group A and 0.21 ± 0.08 mg/dl/hr for group B (p = 0.45). There was not much difference in mean duration of hospitalisation in both groups (p = 0.547). Conclusions: Intermittent phototherapy is a non-inferior option to continuous phototherapy, in the management of non-haemolytic hyperbilirubinemia with additional advantages of less interrupted mother infant bonding and decreased irradiance. [ABSTRACT FROM AUTHOR]

Background: The effect and safety of preoperative biliary drainage (PBD) in patients with perihilar cholangiocarcinoma are still controversial; the aim of our study is to evaluate all aspects of PBD. Methods: All included studies featured PBD versus non-PBD (NPBD) groups were from 1996 to 2019 and were extracted from Cochrane Library, Embase, PubMed, and Science Citation Index Expanded. Results: Sixteen studies met the inclusion criteria and were included in this analysis. PBD may lead to a significantly higher incidence of overall morbidities (OR 0.67, 95% CI 0.53, 0.85; P = 0.0009) and intraoperative transfusions (OR 0.72, 95% CI 0.55, 0.94; P = 0.02); moreover, bile leakage (OR 0.58, 95% CI 0.24, 1.41; P = 0.04), infection (OR 0.31, 95% CI 0.20, 0.47; P < 0.00001), and cholangitis (OR 0.18, 95% CI 0.007, 0.48; P = 0.0007) are also related to PBD. However, NPBD was associated with more frequent hepatic insufficiency (OR 3.09, 95% CI 1.15, 8.31; P = 0.03). In the subgroup meta-analysis, the differences in the outcomes of bile leakage and overall morbidity lost significance between the PBD and NPBD groups when the mean total serum bilirubin (TSB) concentration was above 15 mg/dl. Conclusion: Meta-analysis demonstrated that compared to NPBD, PBD is associated with a greater risk of several kinds of infection and morbidities, but its ability to reduce postoperative hepatic insufficiency cannot be ignored. In patients with a high TSB concentration, PBD tends to be a better choice. However, these results need to be confirmed in a future prospective randomized trial with large samples to clarify the effects and find a specific TSB concentration for PBD. [ABSTRACT FROM AUTHOR]

Transcutaneous bilirubinometer devices are widely applied to assess neonatal hyperbilirubinemia. However, the optimal skin site and timing of transcutaneous bilirubin (TCB) measurements for the strongest correlation with total serum bilirubin (TSB) levels after phototherapy are still unclear. We conducted a retrospective observational study evaluating the correlation of TCB and TSB levels in neonates postphototherapy. The TCB measurements on the forehead and mid-sternum at 0 and 30 min postphototherapy were assessed by using a JM-103 bilirubinometer. Paired TCB and TSB measurements were assessed by Pearson correlation and Bland–Altman plots. We analyzed 40 neonates with 96 TSB and 384 TCB measurements. The TSB level correlated moderately with the forehead TCB level at 30 min postphototherapy (r = 0.65) and less strongly with the midsternum TCB level at 0 min postphototherapy (r = 0.52). The forehead at 30 min after cessation of phototherapy was the best time point and location of TCB measurement for the assessment of neonatal jaundice status. The reliability of TCB measurements varied across skin sites and durations after phototherapy. The effectiveness of TCB measurement to assess neonatal hyperbilirubinemia is much better on covered skin areas (foreheads) 30 min postphototherapy. The appropriate application of transcutaneous bilirubinometers could aid in clinical practice and avoid unnecessary management.

Introduction: Hyperbilirubinemia is a common condition in neonates. In this study, we aimed to investigate the association of total serum bilirubin (TSB) with sternum transcutaneous bilirubin (TcB) level obtained by KJ-8000 Transcutaneous bilirubin meter (KEJIAN medical apparatus). Methods: Eighty newborns were enrolled in the present prospective cross-sectional study. At first, blood sampling was performed for determination of TSB, and immediately after that, TcB levels were recorded at the sternum skin by KJ-8000 device. Data was analyzed by statistical software SPSS version 21.0. Results: The mean gestational age of the infants was 38.2±1.5 weeks. The mean level of TSB was 13.52±4 mg/dL, while the mean value of TcB was 13.71±3.53 mg/dL. Pearson correlation analysis showed a correlation coefficient of r=0.770 between sternum TcB recorded by KJ-8000 device and TSB. Conclusion: Given a strong correlation between TcB and TSB levels, it is advised the transcutaneous bilirubinometery be considered as the screening method in infant jaundice.

Background The gold standard for diagnosis of neonatal jaundice is total serum bilirubin (TSB) measurement. This method, however, is invasive, painful, and costly in terms of workload, time, and money. Moreover, repeated blood sampling may lead to significant blood loss, which is of particular concern in preterm infants. To overcome these drawbacks, non-invasive methods of bilirubin measurement have been proposed. Transcutaneous bilirubinometry (TcB) determines the yellowness of the subcutaneous tissue of a newborn infant by measuring the difference between optical densities for light in the blue and green wavelength regions. Objective To evaluate the accuracy of transcutaneous bilirubinometry for estimating TSB levels in neonatal jaundice. Methods Subjects were infants aged < 28 days with jaundice who had never been treated with phototherapy or exchange transfusion. The study was done from February to July 2016 in Mohammad Hoesin Hospital. Subjects underwent transcutaneous bilirubin (TcB) and TSB assays, with a maximum interval of 15 minutes between tests. Results One hundred fifty patients were included in this study. The TcB values > 5 mg/dL were correlated to TSB > 5 mg/dL, with 100% sensitivity and 83.3% specificity. This cut-off point was obtained from a receiver-operator characteristic (ROC) curve with AUC 99.3% (95%CI 97.9 to 100%; P< 0.001).The correlation coefficients (r) for TSB and TcB measurements on the forehead were 0.897 (P

Introduction: Neonatal hyperbilirubinemia is one of the most common problem encountered during the neonatal period. Phototherapy is a widely accepted, cheap, non-invasive relatively safe and effective method of treatment for neonatal hyperbilirubinemia. Aim: To compare the efficacy of Light Emitting Diode (LED) phototherapy vs. Conventional Phototherapy for treatment of neonatal hyperbilirubinemia in healthy term neonates. Materials and Methods: A quasi experimental study was conducted in Neonatal Intensive Care Unit and Post-natal wards in a tertiary care hospital affiliated to Medical College and Hospital, Ahmedabad, Gujarat from July 2018 to April 2019 with a sample size of 135 in each group. They were assessed first clinically by Kramers method just before initiation of phototherapy, then using Transcutaneous Bilirubinometer (TCB) Total Serum Bilirubin (TSB) level was measured. Bilirubin assessment by these methods were done for every neonate before initiation of phototherapy and then again repeated after 24 and 48 hours of phototherapy. Data was collected and analysed in Microsoft (MS) excel Statistical Package for the Social Sciences (SPSS) 0.26. Chi-square test was used for comparison. Results: In the present study, 158 (58.51%) babies were male and 112 (41.49%) babies were female. Initially, LED was found to be better than Compact Fluorescent (CFL) conventional phototherapy on comparing the average fall in the serum bilirubin level from baseline during the first 24 hours however no such difference in the efficacy between the two light sources was seen after a period of 48 hours. Total nine patients (6.66%) developed rebound hyperbilirubinemia after completion of conventional phototherapy whereas 14 (10.37%) developed rebound hyperbilirubinemia after completion of 48 hours of LED phototherapy. Conclusion: LED and conventional phototherapy were equally efficacious in managing non hemolytic hyperbilirubinemia in healthy term neonates. [ABSTRACT FROM AUTHOR]

Abstract Background There is no standardized method for total serum bilirubin (TSB) monitoring during phototherapy for neonatal hyperbilirubinemia and national guidelines give heterogeneous indications. Aim To assess the hypothesis that TSB values do not exceed exsanguino-transfusion (EXT) threshold during phototherapy and that it is possible to decrease its monitoring frequency in jaundiced infants. Study design We carried out a prospective observational study in which changes in TSB during phototherapy for non-haemolytic hyperbilirubinemia were recorded in a cohort of late preterm and term infants. TSB values after 6, 12, 18, and 24 h of phototherapy were compared to the EXT threshold matched to infants' gestational and postnatal age according to the specific nomogram of the Italian Society of Neonatology guidelines. Results We studied 105 infants who started phototherapy at a mean age of 89 ± 37 h when mean TSB was 17.1 ± 2.5 mg/dL. We found that TSB decreased during phototherapy and the difference between mean TSB and EXT threshold progressively increased during phototherapy; TSB exceeded EXT threshold in none of our patients (0%). Conclusions Our study demonstrates that differences between mean TSB and EXT threshold increased during phototherapy in late preterm and term infants with non-haemolytic hyperbilirubinemia; in none of our patients TSB exceeded EXT threshold. Our findings support the possibility of safely decreasing TSB monitoring during phototherapy, thus limiting noxious painful stimuli in neonates. Highlights • Differences between mean TSB and EXT threshold increased during phototherapy in late preterm and term infants with hyperbilirubinemia. • In none of our patients TSB exceeded EXT threshold. • It is possible to decrease TSB monitoring during phototherapy, limiting noxious painful stimuli in neonates. [ABSTRACT FROM AUTHOR]

Abstract Objective Determine whether introduction of a reformulated bilirubin reagent, the Roche bilirubin Gen.3 assay, changed the relationship between BiliChek transcutaneous bilirubin (TcB) and total serum bilirubin (TSB). Design and methods TcB results from term infants in the level 1 nursery obtained within one hour of a TSB were reviewed over two periods, six months before and after the conversion from the previous generation Roche bilirubin reagent to the new Roche Gen.3 bilirubin assay. TcB measurements were performed using BiliChek transcutaneous devices (Respironics, Marietta GA). Distribution of TSB results, and TcB minus TSB bias, were compared before and after introduction of the reformulated Roche bilirubin Gen.3 assay. Median and interquartile range (IQR) TSB values and bias were calculated. A statistical difference between median TSB values and bias were assessed using Man-Whitney test. Results A total of 301 paired TcB and TSB results were obtained, 172 before and 129 after implementation of the reformulated Roche bilirubin Gen.3 reagent. Median (IQR) TSB was 7.8 (6.8–8.7)mg/dL (133.3 (116.3–148.8) μmol/L) before and 7.6 (6.7–8.4)mg/dL (130 (114.6–143.6)μmol/L) after implementation of the reformulated reagent (p =.1373). Median (IQR) bias between TcB and TSB was 2.9 (2.2–3.7) mg/dL (49.6 (37.6–63.3)μmol/L) before the reformulated reagent was implemented; and did not change at 2.9 (2.1–3.9) mg/dL (49.6 (35.9–66.7)μmol/L) after implementation (p =.8242). Conclusion Implementation of the reformulated Roche bilirubin Gen.3 reagent did not affect the relationship between BiliChek transcutaneous and total serum bilirubin; thus no changes were needed to the neonatal TcB screening protocol as a result of the new bilirubin reagent. [ABSTRACT FROM AUTHOR]

Transcutaneous bilirubin (TCB) measurement is a simple, painless, and time-saving alternative for the assessment of TSB (total serum bilirubin) levels. However, TCB measurements obtained during phototherapy can yield inaccurate results. We evaluated the effectiveness of TCB measurements obtained from protected skin areas in patients who underwent phototherapy. This prospective study included neonates delivered at a gestational age of ≥340/7 weeks. TCB measurements were performed at the forehead and the lower end of the sternum using a JM-105 device. Simultaneously, blood samples were collected to determine TSB levels. During phototherapy, the forehead was covered with a photo-opaque patch. TSB and TCB were measured before, during, at the end of, and after phototherapy. In total, 200 neonates, including 110 (55 %) term and 90 (45 %) late preterm infants, were enrolled. Of these neonates, 162 (81 %) were Turkish while 38 (19 %) were refugees from Syria and Iraq. Notably, no statistically significant differences were observed in the TSB and TCB values between the Turkish and refugee groups (p > 0.05). Bland–Altman analysis was conducted between the TCB values obtained from the covered forehead area and TSB values; the analysis revealed moderate, high, and excellent agreements for the first bilirubin measurement and at the end of phototherapy, before phototherapy, and for the second and rebound bilirubin measurements, respectively. Regarding intraclass correlation coefficients, values >0.95, 0.94–0.85, 0.84–0.70, and < 0.7 indicated perfect, high, moderate, and unacceptable compatibilities, respectively. Although a significant association was observed between pre-phototherapy TCB obtained from the sternum and TSB levels, no significant associations were observed during phototherapy. Our findings indicate that the consistency observed between TCB measurements obtained from the protected skin areas and TSB values can be used to monitor phototherapy effectiveness, particularly in late preterm/term infants and those with darker skin tones. Furthermore, this approach can aid in guiding decisions related to treatment termination, evaluating rebound bilirubin levels, minimizing costs, and providing a less invasive testing option. • Simpler phototherapy-shielded TCB measurement can be considered as alternative to TSB • TCB measurement is a less invasive test and also reduces cost [ABSTRACT FROM AUTHOR]

Background" Autism spectrum disorder (ASD) is a serious neurodevelopmental disorder that impairs a child’s ability to communicate with others. It also includes restricted repetitive behaviors, interests and activities. Symptoms manifest before the age of 3. In the previous studies, we found structural abnormalities of the temporal lobe cortex. High spine densities were most commonly found in ASD subjects with lower levels of cognitive functioning. In the present study, we retrospectively analyzed medical records in relation to the neonatal levels of total serum bilirubin (TSB), neuron-specific enolase (NSE), creatine kinase brain band isoenzyme (CK-BB), and neonatal behavior in ASD patients from Southern China. Methods: A total of 80 patients with ASD (ASD group) were screened for this retrospective study. Among them, 34 were low-functioning ASD (L-ASD group) and 46 were high-functioning ASD (H-ASD group). Identification of the ASD cases was confirmed with a Revised Autism Diagnostic Inventory. For comparison with ASD cases, 80 normal neonates (control group) were selected from the same period. Biochemical parameters, including TSB, NSE and CK-BB in the neonatal period and medical records on neonatal behavior were collected. Results: The levels of serum TSB, NSE and CK-BB in the ASD group were significantly higher when compared with those from the control group (P < 0.01, or P < 0.05). The amounts of serum TSB, NSE and CK-BB in the L-ASD group were significantly higher when compared with those in the H-ASD group (P < 0.01, or P < 0.05). The Neonatal Behavioral Assessment Scale (NBAS) scores in the ASD group were significantly lower than that in the control group (P < 0.05). Likewise, the NBAS scores in the L-ASD group were significantly lower than that in the H-ASD group (P < 0.05). There was no association between serum TSB, NSE, CK-BB and NBAS scores (P > 0.05) in the ASD group. Conclusions: The neonatal levels of TSB, NSE and CK-BB in ASD from Southern China were significantly higher than those of healthy controls. These findings need to be investigated thoroughly by future studies with large sample.

Introduction: One of the most common pathologies in neonates is hyperbilirubinemia, which is a good marker for damage to the central nervous system. The sensitivity of the auditory system to bilirubin has been previously documented, with much discrepancy in its effects on Auditory Brainstem Response results. Thus the objective of this study was to evaluate the effects of hyperbilirubinemia on Auditory Brainstem Response of neonates treated with phototherapy. Materials and Methods: Forty-two term neonates with hyperbilirubinemia, who underwent phototherapy participated in this cross sectional study. The recording of Auditory Brainstem Response was made shortly after confirming that the total serum bilirubin level was greater than 15 µg/dl. Latency of waves I, III, V and inter-peak latencies of the waves were measured. To test the hypothesis about the difference of means between the two groups, continuous variables were compared using either the t-test (normal distribution) or the Mann-Whitney test (non-normal distribution). Results: There was a significant increase in the absolute latencies of waves III and V, and I-III and I-V inter-peak latencies of the sample group compared to the control group in both ears (P0.05). Conclusion: The results of this study underline the importance of the Auditory Brainstem Response Test as an efficient tool for monitoring the auditory brainstem pathway in neonates who are at risk of neurotoxicity and for diagnosing the earliest stages of auditory damage caused by high levels of bilirubin.