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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]

Introduction: Neonatal jaundice and prematurity pose significant barriers to breastfeeding in the first days of life. There is limited literature exploring the relationship between prolonged jaundice in breastfed infants and Gilbert's (Meulengraght) syndrome. This case study describes the diagnostic and therapeutic challenges associated with Gilbert's syndrome in a late preterm breastfed infant born in Germany. Main Issue: In this case report, an infant born to a primipara woman presented at 3 weeks postpartum to an International Board Certified Lactation Consultant. The initial assessment revealed a late preterm infant with inadequate weight gain and jaundice. The dyad received breastfeeding support and eventually achieved adequate weight gain; however, the infant's jaundice persisted. Management: The consulting midwife suggested that the persistent jaundice was "breastmilk jaundice" and recommended temporarily interrupting breastfeeding. Due to a suspected family history of Gilbert's Syndrome, the dyad was referred, instead, to a pediatric gastroenterologist. Pathologic liver disease was excluded, and genetic testing confirmed Gilbert's Syndrome. At 6 months of age, the dyad was successfully breastfeeding and beginning complementary feeding. Conclusion: Genetic testing for Gilbert's Syndrome should be considered for infants with prolonged jaundice and positive family history. Interruption or cessation of breastfeeding are not evidence-based recommendations, and current guidelines do not support these practices. Lactation professionals play a critical role in the management of breastfeeding for preterm infants with prolonged jaundice and should refer to specialists to rule out pathologic etiologies. [ABSTRACT FROM AUTHOR]

Introduction: Jaundice is one of the most common problems at neonatal period and seen in 60-70% of all newborns at first days of life. Prolonged jaundice is defined as hyperbilirubinemia persisting at the end of week 2 in term newborns. In this study, we reviewed term newborns diagnosed with prolonged jaundice. It was aimed to demonstrate delaying laboratory evaluations for a week in infants with favorable clinical presentation can prevent unnecessary tests in majority of newborns. Materials and Methods: The study included full-term newborns who presented after day 14 of life and diagnosed with prolonged jaundice at neonatology outpatient clinic of Health Sciences University, Keçiören Teaching and Research Hospital in 2016. Overall, 336 infants with prolonged jaundice were screened. The infants with congenital anomaly, those with findings of sepsis or severe infection, those with history of intrauterine infection, those with history of acholic stool and those with no available data were excluded. In 180 patients included, clinical evaluations, bilirubin levels and advanced test results were assessed at baseline and weekly follow-up. Findings: Of the infants included, 51.7% were boys while 48.3% were girls. The most common blood type was A Rh (+). There was ABO incompatibility alone in 24 infants ('4.2%), Rh incompatibility alone in 6 infants (3.5%) and ABO plus Rh incompatibility in 3 infants ('.2%). In '30 infants, total bilirubin was studied on both week 2 and 3. At week 3, total bilirubin value was >10 mg/dl in only 36 infants (27.7%) while it was decreased below '0 mg/dL in 94 infants (72.3%). Urinary tract infection (UTI) was detected in 7 of 38 infants with available tests at week 2. Two of 6 infants with UTI had other clinical signs of UTI. Mean total bilirubin value was '7.9 mg/dL in 5 infants. A significant correlation was found between UTI and vomiting, breastfeeding and feeding pattern (p<0.05). Congenital hypothyroidism was detected in 6 of 38 infants with available tests at week 2. It was seen that 2 infants had suspected congenital hypothyroidism in neonatal heel prick test and underwent further evaluations while mean total bilirubin value was '7.5 mg/dL at week 2 in remaining 4 infants. Given the vast majority of cases are breast milk jaundice, a novel cut-off value was defined for total bilirubin measurement at week 2 to distinguish the cases in which total bilirubin decreases below '0 mg/dL at week 3. Conclusion: Although several disorders that may lead prolonged jaundice at neonatal period have been identified, it is well-known that prolonged jaundice can be seen without any pathological condition in majority of infants fed by breast milk. Delaying laboratory evaluations recommended at week for prolonged jaundice is an approach that may prevent unnecessary testing in most infants. [ABSTRACT FROM AUTHOR]

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Hepatitis E virus (HEV) genotypes 3 and 4 are zoonotic strains that are primarily transmitted through the consumption of undercooked pork or game meat. They also cause asymptomatic infections, acute hepatitis, acute-on-chronic liver failure, chronic hepatitis, and extrahepatic manifestations. Here, we report a man in his 80s who had chronic hepatitis B, took entecavir for it, and presented with higher levels of alanine aminotransferase (ALT) and jaundice. An abdominal computed tomography scan revealed choledocholithiasis with cholecystolithiasis. Although endoscopic papillary balloon dilatation was performed for the removal of a common bile duct stone, the abnormal liver function tests, including jaundice, were prolonged. After other viral hepatitis and other causes of the liver injury were ruled out, as his serum was positive for immunoglobulin A anti-HEV and HEV genotype 3b RNA, we diagnosed him as having acute hepatitis E. In this case, with chronic hepatitis B and a common bile duct stone, the prolonged abnormal results for the liver function tests seemed to be caused by HEV infection. In conclusion, in cases with high ALT levels after removing choledocholithiasis, other factors, including HEV infection, should be considered to determine the cause of abnormal liver function test results. The further examination of hepatitis D virus infection and high ALT levels may be needed in HBV-infected individuals. [ABSTRACT FROM AUTHOR]

Hepatitis E virus (HEV) genotypes 3 and 4 are zoonotic strains that are primarily transmitted through the consumption of undercooked pork or game meat. They also cause asymptomatic infections, acute hepatitis, acute-on-chronic liver failure, chronic hepatitis, and extrahepatic manifestations. Here, we report a man in his 80s who had chronic hepatitis B, took entecavir for it, and presented with higher levels of alanine aminotransferase (ALT) and jaundice. An abdominal computed tomography scan revealed choledocholithiasis with cholecystolithiasis. Although endoscopic papillary balloon dilatation was performed for the removal of a common bile duct stone, the abnormal liver function tests, including jaundice, were prolonged. After other viral hepatitis and other causes of the liver injury were ruled out, as his serum was positive for immunoglobulin A anti-HEV and HEV genotype 3b RNA, we diagnosed him as having acute hepatitis E. In this case, with chronic hepatitis B and a common bile duct stone, the prolonged abnormal results for the liver function tests seemed to be caused by HEV infection. In conclusion, in cases with high ALT levels after removing choledocholithiasis, other factors, including HEV infection, should be considered to determine the cause of abnormal liver function test results. The further examination of hepatitis D virus infection and high ALT levels may be needed in HBV-infected individuals.

Congenital Adrenal Hyperplasia (CAH) is a genetic disorder that leads to cortisol deficiency. However, prolonged neonatal jaundice is a rare presentation of CAH. The pathophysiology of hyperbilirubinemia in CAH is still ill-defined. Plausible causes are related to the synthesis of bile, maturity of the liver and adrenal function. This case reported a neonate who presented with severe prolonged jaundice that lasted for more than a month. A short Synacthen test confirmed diagnosis of CAH. He was started on steroid replacement. He had regular follow-up under paediatric endocrinologist and primary care physician for long-term monitoring and overall health care. This case demonstrates the importance of recognizing the clinical and biochemical features of CAH for early detection and referral. Long-term follow-up and monitoring is necessary due to the risk of complications and side effects of medications. This is the first case of CAH presented with persistent hyperbilirubinemia to be reported from Malaysia. The case describes the difficult workup that has been encountered in the patient’s care and management.

BackgroundThis study aimed to investigate the influence of a variant of the UGT1A1 gene on the occurrence and severity of prolonged jaundice in Chinese infants at term.Methods175 infants with prolonged jaundice and 149 controls were used in this retrospective case-control study. The infants with prolonged jaundice were subdivided into the mild-medium and severe jaundice groups (TSB ≥ 342 µmol/L). The frequency and genotype distribution of the UGT1A1 and G6PD genes, and clinical parameters including sex, birth weight, delivery mode, gestational age, and feeding mode, were analyzed, and the differences in the parameters between the two groups were compared.ResultsThe allele frequency of UGT1A1*6 in the prolonged jaundice group was higher than that in the control group. Similarly, it was also higher in the severe jaundice group than in the mild-medium jaundice group. Homozygous and heterozygous UGT1A1*6 were also found more frequently in the prolonged jaundice group than in the control group. Exclusive breastfeeding, homozygous and heterozygous forms of UGT1A1*6 were significant risk indicators for prolonged jaundice. Moreover, UGT1A1*6 was the best predictor of prolonged severe jaundice.ConclusionUGT1A1*6 appears to be a risk factor for prolonged jaundice with hyperbilirubinemia in term infants of Chinese ancestry who are exclusively breastfed.

Biliary atresia is one of the commonest causes of prolonged jaundice in neonate, whereas cystic biliary atresia is a rare form of biliary atresia with similar presentation, but a slightly different sonographic finding. Being able to differentiate them radiologically is important as the surgical management is different for these two diagnoses. An ultrasound examination was done for a 2-month-old baby girl with prolonged jaundice with the finding of a cyst along the portal triad, which raised the suspicion for cystic biliary atresia. The diagnosis was confirmed with intraoperative cholangiography (IOC) and Kasai procedure was done. The patient was well after the surgery with resolution of jaundice. [ABSTRACT FROM AUTHOR]

Background: Early detection of neonatal cholestasis (NC) is important for better clinical outcomes but can be challenging. Objective: The objective of this study was to evaluate the knowledge and practice styles of pediatric providers (PPs) regarding NC in the western region of Saudi Arabia. Methods: This cross-sectional, questionnaire study was conducted between November 2019 and February 2020 in three major cities of the western region of Saudi Arabia (namely, Taif, Makkah and Jeddah). PPs included pediatric residents, pediatric specialists, pediatric consultants and family physicians. The questionnaire included 15 items in five subscales (definition, causes, diagnosis and management of NC and knowledge of guidelines). Results: A total of 488 participants completed the questionnaire. Only 30.2% were aware of the correct definition of NC (P < 0.001). Two-thirds of the respondents did not consider a history of pale stool being important for evaluating NC. The importance of biliary atresia as a serious cause of NC was found to be significantly different between pediatric consultants and other pediatricians (P < 0.001). In cases of prolonged NC, 32.4% of the PPs refer to pediatric gastroenterologist. Only 18.9% of the respondents were aware of liver biopsy being the gold standard investigation of NC. The majority of the respondents (41.8%) used ursodeoxycholic acid as a supportive therapy of NC. Conclusions: This study found a significant deficit in the knowledge and practice styles of PPs in the western region of Saudi Arabia. These findings highlight the need for policymakers to develop educational materials for PPs to increase their knowledge of NC.

Introduction: Prolonged neonatal jaundice is affecting 15-40% of breastfed new-borns. Although breastmilk jaundice is the common aetiology, undetected pathological causes could lead to unfavourable sequelae. This study described the characteristics, aetiology and burden of prolonged neonatal jaundice investigated at the primary care level in Kota Bharu district. Methods: This crosssectional study was done from July till December 2019, involving 14 health clinics in Kota Bharu. Selection criteria involved term new-borns at day 14 of life or preterm at day 21 of life that had visible jaundice or serum bilirubin >85?mol/l. Clinical details, investigations, and management were carried out based on normal practice at the clinics. A registry was established to capture the burden. Results: Prolonged jaundice were detected among 22.5% [95% CI 21.5, 23.6] of new-borns attending primary health clinics in Kota Bharu. A total of 291 cases were further analysed; 275 (94.5%) were term newborns and 243 (83.5%) were breastfed. Affected new-borns underwent blood and urine sampling with multiple follow-ups. On average, jaundice subsided within 12 days [SD=5.5, 95% CI:11.7, 13.1] after detection of this condition. Majority had prolonged unconjugated hyperbilirubinemia (98.6%) and main aetiology was breastmilk jaundice (84.5%). Minority had hypothyroidism (3.4%) and conjugated hyperbilirubinemia (1.7%). Out of 129 cases sent for urine culture, 12 (9.3%) had significant growth, mostly E.coli. Conclusion: The majority of neonates with prolonged jaundice were term and breastfed. While the main aetiology was breastmilk jaundice, other underlying pathologies were also identified. As the burden of this condition is high, multistage investigation is strongly recommended. Urinary tract infections screening should be routinely considered.

Congenital Adrenal Hyperplasia (CAH) is a genetic disorder that leads to cortisol deficiency. However, prolonged neonatal jaundice is a rare presentation of CAH. The pathophysiology of hyperbilirubinemia in CAH is still ill-defined. Plausible causes are related to the synthesis of bile, maturity of the liver and adrenal function. This case reported a neonate who presented with severe prolonged jaundice that lasted for more than a month. A short Synacthen test confirmed diagnosis of CAH. He was started on steroid replacement. He had regular follow-up under paediatric endocrinologist and primary care physician for long-term monitoring and overall health care. This case demonstrates the importance of recognizing the clinical and biochemical features of CAH for early detection and referral. Long-term follow-up and monitoring is necessary due to the risk of complications and side effects of medications. This is the first case of CAH presented with persistent hyperbilirubinemia to be reported from Malaysia. The case describes the difficult workup that has been encountered in the patient's care and management. [ABSTRACT FROM AUTHOR]

Background: There were only few publications related to pancreaticoduodenal resection (PDR) /Whipple procedure in Indonesia in the past decade. Method: Retrospectively report of the characteristics and outcomes of PDR performed by Cipto Mangunkusumo Hospital surgical team from 1993 to 2017 were collected. Results: PDR were performed in 213 patients, with a mean age of 50.6 years and 54.4% patients were females. Predominant preoperative clinical findings were jaundice (68.9%) and mild hypoalbuminemia (69.9%). Biliary decompression was performed in 112 (52.6%) subjects. Average surgical waiting time was 3.5 months. While PDR were performed in 84 (39.5%) subjects, pyloric preserving pancreaticoduodenal technique was predominated in 128 (59.8) and predominated, especially during the latter years. Fifteen (9.0%) cases were benign. Thirty-one (14.6%) subjects underwent relaparotomy, 16 (51.6%) of whom died post-operatively. Overall operative mortality decreased from 16.9% to 5.5% in 2016, while resection rate generally increased over time, ranging from 2 - 21/year. Less than 10% of subjects survived for 5 years, while 20% survived for 24 months. Overall morbidity was 65.1% in 177 survivors, with surgical site infection in 52.5%, pancreatic fistula in 24.2%, and post-pancreatectomy haemorrhage (PPH) as a fatal postoperative complication in 19 (8.9%) cases. Patients who died within 30 days postoperatively had significantly more relaparotomies and PPH (p 0.001). Conclusion: Prolonged jaundice and mild hypoalbuminemia are dominant characteristics in our Indonesian PDR subjects. Cipto Mangunkusumo Hospital is a high-volume PDR centre and world class hospital. Mortality rates decreased with the increasing resection rates. Relaparotomy and PPH are predictors of poor outcome.

Prolonged jaundice of newborns is a common pathology during the neonatal period. Recently, there has been a tendency toward an increased number of newborns with prolonged jaundice with duration longer than 14 days of life. According to the polyetiologic nature of neonatal jaundice, it is necessary to investigate new diagnostic signs that can predict the development of prolonged jaundice in newborns and, allow identification of new methods of differential diagnosis of neonatal jaundice, as well as decrease the frequency of this pathology. The parameters of serum alpha-fetoprotein (AFP) content in newborns with prolonged jaundice were studied. The content of AFP in blood serum was 1.7 times higher in newborns with prolonged jaundice than in newborns with jaundice for up to 14 days of life: Me = 671.1 [Q1 = 479.9; Q3 = 815.03] ng/ml and Me = 401.0 [Q1 = 284.9; Q3 = 684.0] ng/ml, respectively (P < 0.05). The content of blood serum AFP in newborns with prolonged jaundice was higher for total serum bilirubin greater than 250 μmole/l: Me = 626.2 [Q1 = 454.7; Q3 = 793.2] ng/ml which was confirmed by a strong direct correlation relationship (rxy = 0.64, P < 0.05). The results of the ROC analysis confirmed that AFP ≥ 571.7 ng/ml can identify newborns with prolonged jaundice with a sensitivity of 74.2% and a specificity of 74.5%. The area under the curve (AUC) was 0.870 (95% CI 0.804, 0.937), which confirms the good quality of the AFP model ≥ 571.7 ng/ml.

Objective: This study aims to evaluate the demographic information, clinical and laboratory findings of patients with glucose 6 phosphate dehydrogenase deficiency. Material and Methods: We collected data by reviewing files and electronic records of 65 patients with glucose 6 phosphate dehydrogenase deficiency under the age of 18 years who were followed up in our clinic between 2007 and 2019. Demographic, clinical, and laboratory features, family history, complications of the disease, and history of splenectomy and cholecystectomy were evaluated. Mean, standard deviation, and median values were used when descriptive analyses were presented. Results: The age of diagnosis ranged between 1-192 months and the median age of diagnosis was two months. Fifty-nine patients (90.7%) were boys and six (9.2%) were girls. The mean value of glucose 6 phosphate dehydrogenase enzyme on admission was 1,9±1,4 U/g of hemoglobin (Hb). Family history was present in 40% of patients in whom information was available. The most common presentation was prolonged jaundice and the most common physical finding was jaundice. Splenomegaly was detected in none of the patients. Cholelithiasis was present in one of 21 patients who were evaluated with ultrasonography. None of the patients required splenectomy, cholecystectomy, and regular erythrocyte transfusion during follow-up. Conclusion: As G6PD variants with chronic hemolysis are not usually seen in Turkey, patients who required splenectomy, cholecystectomy, and regular erythrocyte transfusion were not detected. Although glucose 6 phosphate dehydrogenase deficiency is more common in males, it can also be seen in girls. In Turkey, glucose 6 phosphate dehydrogenase deficiency should be considered in patients presenting with prolonged jaundice. [ABSTRACT FROM AUTHOR]

Background and purpose: Hyperbilirubinemia is the most common cause of neonatal hospitalization and can be a sign of urinary tract infection during infancy. Urinary tract infection (UTI) is one of the reasons for prolonged jaundice. This research aimed at studying the prevalence of urinary tract infection in neonates with hyperbilirubinemia admitted to Tonekabon Shahid Rajaei Hospital, 2015. Materials and methods: This cross-sectional study was conducted in 259 infants. The samples were selected by census method. To diagnose the urinary tract infection, urine with a 2-cc syringe was taken by pediatrician through suprapubic method. Data were analyzed by Chi-square test. Results: UTI was identified in 18 (6.9%) neonates, including 10 (55.5%) boys and 8 (44.4%) girls. Urine culture revealed 12 E. coli spp. and 6 Proteus spp. Also, in 49 (91.18%) were found to have prolonged jaundice. Conclusion: Due to the prevalence of UTI in neonates, urine culture is suggested in all infants hospitalized for jaundice even in those without prolonged jaundice.

Uzamış sarılık varlığında altta yatan ciddi bir patoloji olabileceği düşünülmelidir ve ayırıcı tanı yapılmalıdır. İnfantil hipertrofik pilor stenozu (İHPS) pilor kanalının daralması sonucunda oluşan mide çıkışı tıkanıklığıdır. Bu olgu sunumunda uzamış sarılık ve kusma şikayetiyle tarafımıza başvuran yapılan fizik muayene, ultrasonografi ve direkt grafi ile İHPS tanısı alıp opere edilen 33 günlük erkek bir bebek tartışılmıştır. Yenidoğan döneminde etyolojisi saptanamayan uzamış sarılık varlığında, kusma ve beslenme bozukluğu eşlik ediyorsa çok nadir gözükse de İHPS mutlaka akılda tutulmalıdır.

Urinary tract infection (UTI) is a common disease in childhood. The incidence of bacterial infections in the neonatal period is 5-6%.Prolonged jaundice is one of the common problems of the neonatal period, and urinary tract infection is also included in the etiology. The aim of this study is to determine the incidence of urinary tract infection, which is one of the important causes in newborns with prolonged jaundice, and to determine accompanying etiological factors. In addition, to review clinical, laboratory and radiological findings and to compare cases with positive radiological findings, to prevent complications secondary to urinary tract infection with early diagnosis. [ABSTRACT FROM AUTHOR]

Neonatal liver disease encompasses many diagnoses, including structural and genetic aetiologies. Many have significant health implications requiring long-term specialist treatment including liver transplantation. Jaundice is a common presenting feature. The ability of health-care professionals to differentiate neonatal liver disease from benign diagnoses such as physiological jaundice is very important. Persistent (more than 2 weeks) of conjugated jaundice always warrants investigation. Severe unconjugated jaundice (requiring prolonged phototherapy) should also be promptly investigated. Recent advances in genomics have enabled previously elusive, precise diagnoses in some patients with neonatal liver disease. This review paper discusses the commoner causes, with a focus on early detection and need for referral to paediatric liver services. [ABSTRACT FROM AUTHOR]

Background: Prolonged jaundice is a type of neonatal jaundice, which occurs in infants with high bilirubin levels (>10 mg/dl) persisting beyond day 14 of life in term neonates, and beyond day 21 in preterm neonates. Prolonged jaundice may be caused by predominantly conjugated or unconjugated hyperbilirubinemia. Distinguishing between these types of jaundice helps to determine the risk for pathological causes of prolonged jaundice. Phenobarbital has been used to treat neonatal jaundice since the 1960s. Numerous clinical trials have shown that both administration of phenobarbital to pregnant mothers before delivery and phenobarbital administration to neonates after delivery limit the severity of unconjugated hyperbilirubinemia, reduce the peak serum total bilirubin concentrations caused by physiologic jaundice by 50%, and the need for exchange transfusion. Objective: The aim of this study was to evaluate the role of phenobarbital in reducing the total serum bilirubin(TSB) in neonates with prolonged unconjugated hyperbilirubinemia. Methods: This is a prospective clinical trial study that was performed in Karbala teaching hospital for children from 18th of December 2017 to the end of December 2018. A total of 101 neonate with prolonged unconjugated hyperbilirubinemia were included in this study. All neonates who included in this study received phenobarbital tablet (5 mg /kg/day) twice a day for 10 days and some of them need phototherapy according to American Academy Of Pediatrics Guidelines for phototherapy, Results: There was a highly statistically significant decrease in TSB for the patients who were treated with phenobarbital compared to the baseline level, mean baseline TSB 14.57± 2.31 mg/dl versus TSB after phenobarbital 6.79±1.62 mg/dl (P value <0.001). There was a highly statistically significant decrease in TSB for the patients who were treated with phototherapy in addition to phenobarbital compared to the baseline level, mean baseline TSB 19.94±1.36 mg/dl versus TSB after phototherapy and phenobarbital 6.33±1.37 mg/dl (P value <0.001). Conclusions: 1. Oral phenobarbital supplementation in the neonates with prolonged unconjugated hyperbilirubinemia can significantly accelerate reduction in serum bilirubin levels. 2. Phenobarbital was safe, tolerable and no obvious adverse effects had been reported. 3. No need for cessation of breast feeding in cases of presumed breast milk jaundice. [ABSTRACT FROM AUTHOR]

Background. Neonatal jaundice is one of the urgent problems in neonatology. There is a tendency to increase the incidence of prolonged jaundice. The aim of our study was to explore the features of history, anthropometric data and some liver functions in children with prolonged jaundice. Materials and methods. The study involved 111 children with prolonged jaundice aged from 3 weeks to 3 months. In all children with prolonged jaundice, we have examined complete blood count, urinalysis, blood chemistry (determination of total bilirubin and fractions, total protein, albumin, glucose) and used instrumental methods of examination — ultrasound of the abdominal cavity and cranial ultrasonography, electrocardiography. Most children with prolonged jaundice were breastfed and were term infants. Results. Indicators of physical development at birth (body weight, body length, head circumference, chest circumference) in children with prolonged jaundice and in healthy children had not statistically significant differences. Neonatal jaundice was prolonged in children, who were born from the first pregnancy, — 60 children (54.1 %). A high level of total and indirect bilirubin was accompanied by a low level of albumin in the blood serum of children with prolonged jaundice. Protein-synthesis function of the liver was reduced in children with prolonged jaundice.

In children, acute viral hepatitis-A infection is usually a self-limiting illness. In most children, it resolves uneventfully within weeks from the onset of disease. However, rare presentations like acute acalculous cholecystitis and persistent cholestatic jaundice have been reported. We report on a 7-year-old boy with prolonged cholestatic jaundice, which resolved without steroid treatment. [ABSTRACT FROM AUTHOR]

Background: There were only few publications related to pancreaticoduodenal resection (PDR)/Whipple procedure in Indonesia in the past decade. Method: Retrospectively report of the characteristics and outcomes of PDR performed by Cipto Mangunkusumo Hospital surgical team from 1993 to 2017 were collected. Results: PDR were performed in 213 patients, with a mean age of 50.6 years and 54.4% patients were females. Predominant preoperative clinical findings were jaundice (68.9%) and mild hypoalbuminemia (69.9%). Biliary decompression was performed in 112 (52.6%) subjects. Average surgical waiting time was 3.5 months. While PDR were performed in 84 (39.5%) subjects, pyloric preserving pancreaticoduodenal technique was predominated in 128 (59.8) and predominated, especially during the latter years. Fifteen (9.0%) cases were benign. Thirtyone (14.6%) subjects underwent relaparotomy, 16 (51.6%) of whom died post-operatively. Overall operative mortality decreased from 16.9% to 5.5% in 2016, while resection rate generally increased over time, ranging from 2 - 21/year. Less than 10% of subjects survived for > 5 years, while < 20% survived for < 24 months. Overall morbidity was 65.1% in 177 survivors, with surgical site infection in 52.5%, pancreatic fistula in 24.2%, and post-pancreatectomy haemorrhage (PPH) as a fatal postoperative complication in 19 (8.9%) cases. Patients who died within 30 days postoperatively had significantly more relaparotomies and PPH (p < 0.001). Conclusion: Prolonged jaundice and mild hypoalbuminemia are dominant characteristics in our Indonesian PDR subjects. Cipto Mangunkusumo Hospital is a high-volume PDR centre and world class hospital. Mortality rates decreased with the increasing resection rates. Relaparotomy and PPH are predictors of poor outcome. [ABSTRACT FROM AUTHOR]

Background/aim: Prolonged jaundice is one of the most common problems during neonatal period. The aim of this study was to evaluate the efficiency of ursodeoxycholic acid (UDCA) treatment in newborn infants with prolonged unconjugated hyperbilirubinemia., Materials and Methods: The present study included 27 patients who were fed by breast milk and followed up in the outpatient clinic due to prolonged jaundice without any underlying etiological factor; 10 mg/kg/day UDCA was administrated in two doses for 7 days. Furthermore, 20 newborns diagnosed with prolonged jaundice with same characteristics were enrolled as the control group. The control group was also given a placebo; demographic characteristics, liver functions tests before and after the treatment, bilirubin decrease rates, and hemogram parameters of groups were compared., Results: Total bilirubin levels in the study and control groups before the treatment were 16.02 ± 1.41 mg/dL and 15.93 ± 1.66 mg/dL, respectively (P = 0.84). Total bilirubin levels in the study and control groups at day 7 after UDCA treatment were detected 8.18 ± 2.31 mg/dL and 13.92 ± 2.66 mg/dL, respectively (P < 0.001), and at day 14 after the treatment were 5.45 ± 2.59 mg/dL and 11.91 ± 2.83 mg/dL, respectively (P < 0.001). Furthermore, serum aspartate aminotransferase (AST) was detected <21 U/L in the ROC analysis after UDCA treatment (P = 0.04)., Conclusion: The study outcomes indicated that an efficient reduction in total bilirubin levels may be achieved, and outpatient clinic follow-up period may be reduced in patients whom UDCA was administrated. Moreover, it may be speculated that AST can be used to evaluate the efficacy after treatment. However, studies with larger sample sizes are needed for the routine use of UDCA in the treatment of prolonged jaundice., Competing Interests: None

Objective: Prolonged jaundice is defined as persisting hyperbilirubinemia after the 14th day following birth for term and after the 21st day for preterm babies. This study was carried out to evaluate the clinical and laboratory findings of infants with prolonged jaundice followed-up at our neonatal outpatient clinic and to determine its etiology. Material and Methods: A total of 100 infants with prolonged jaundice were included in this retrospective study. Prenatal, natal and postnatal characteristics of the babies were investigated. Results of laboratory tests were recorded after a detailed history and physical examination. Infants were followed-up until the total bilirubin level decreased to below 10 mg/dL. Results: The mean birth weight of the infants was 3150±415 g (2200-4100 g), mean gestational age was 38±1.4 weeks (35-41 weeks), mean total bilirubin level at the time of diagnosis was 15±2 mg/dL and mean duration of follow-up was 41±12 days (20-70 days). Term, early term, and late preterm infants made up 39%, 49%, and 12% of the infants respectively. There was no difference between these infants except their birth weights and gestational ages. All the infants were appropriate for gestational age. The male ratio was 62%, the cesarean delivery was rate 47%, and 51% of babies had been treated with phototherapy. The underlying causes of prolonged jaundice were as follows: unknown (78%), urinary tract infection (14%), deficiency of glucose-6-phosphate dehydrogenase (3%), congenital hypothyroidism (3%), and blood group incompatibility (2%). Babies previously treated with phototherapy had a higher mean total bilirubin level at the time of diagnosis than those not treated (p=0.02). Conclusion: The etiology of prolonged jaundice is still unknown in the majority of infants. The initial laboratory tests include direct-indirect bilirubin, the mother and infant's blood group, complete blood count, thyroid functions, glucose-6-phosphate dehydrogenase, urine analysisculture, and reducing substance in the urine. Advanced investigations such as liver function tests, metabolic evaluation, TORCH and abdominal ultrasonography must be performed in the presence of direct hyperbilirubinemia and kept for later otherwise. [ABSTRACT FROM AUTHOR]

Summary Introduction An extremely variable and high prevalence of urinary tract infection (UTI) in infants with prolonged jaundice has been reported in Iran. However, there is no research from the area that has attempted to estimate pooled prevalence of UTI from considerably diverse evidence. Therefore, this systematic review and meta-analysis study aimed to estimate the prevalence of UTI in infants with prolonged jaundice who were admitted into clinics or hospitals in Iran. Methods A systematic review and meta-analysis was conducted of published articles on UTI prevalence in infants with prolonged jaundice in Iran. Electronic databases were searched, including Web of Sciences, PubMed/Medline, Scopus, Iranian Scientific Information Database (SID) and Iranmedex, for both English and Persian language articles published between January, 2000 and March, 2017. All possible combinations of the following keywords were used: jaundice, icterus, hyperbilirubinemia during infancy, infection and neonatal. Nine studies that reported prevalence of UTI in infants with prolonged jaundice were included. The overall prevalence of UTI was estimated using random-effects meta-analysis models. Results A total of 1750 infants were pooled to estimate the overall prevalence of UTI in infants with prolonged jaundice. The prevalence reported by the studies included in this literature review was extremely variable and ranged 0.6–53.9%. The overall prevalence was 11% (95% Confidence Interval (CI): 5.0–18.0), and Escherichia coli was found to be the main cause of UTI. Conclusion The overall prevalence of UTI was 11%, and E. coli was the main cause of UTI in infants with prolonged jaundice. Screening of UTI should be considered for infants with prolonged jaundice. [ABSTRACT FROM AUTHOR]

Background: Hemizygous mutations in the immunoglobulin superfamily member 1 ( IGSF1) gene have been demonstrated to cause congenital central hypothyroidism in males. This study reports a family with a novel mutation in the IGSF1 gene located on the long arm of the X chromosome. Patient findings: A two-month-old boy was diagnosed with central hypothyroidism because of prolonged jaundice. A thyrotropin-releasing hormone (TRH) stimulation test indicated dysfunction in both the hypothalamus and the pituitary gland, and prompted the IGSF1 gene to be analyzed. The patient had a novel nonsense variant, c.2713C>T (p.Q905X), in exon 14 of the IGSF1 gene. Studies of the family revealed that the patient's sister and mother were heterozygous carriers of the IGSF1 mutation. The patient's maternal uncle carried the same mutation as the proband but had no overt symptoms. The mother and uncle started levothyroxine supplementation because of subclinical hypothyroidism. Summary: A novel mutation (c.2713C>T, p.Q905X) of the IGSF1 gene was identified that causes congenital central hypothyroidism in a Japanese family. The findings further expand the clinical heterogeneity of this entity. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Fifteen to forty percent of neonates developed to prolonged jaundice. Several therapeutic modalities have been used for the treatment of prolonged jaundice. This study was carried out to evaluate the effect of clofibrate on prolong jaundice in full term neonates. METHODS: This double blind clinical trial study was done on 56 neonates that divided randomly in two groups. Treatment group received clofibrate 100mg/kg by oral and control group received sterile water. Inclusion criteria were term neonates with prolonged jaundice (bilirubin concentration higher than 10 mg/dl) in neonates older than 14 days old). All babies were fed exclusively by their own mothers milk. Exclusion criteria were using of phenobarbital or traditional medicine and neonates with clinical and paraclinical sign of liver disease or direct hyperbilirobinemia above 1.5 mg. Bilirubin concentrations were measured before and 72 hours after treatment and compared in both groups. FINDINGS: Distribution of sex, blood group and Rh in mother and neonate and mean of age, birth weight, hematocrit and hemoglobin showed no significant difference before intervention between two groups. The mean level (mg/dl) of indirect bilirubin (11.7±1.4 in control and 12.4±1.6 in case) and direct bilirubin (0.4±0.1 in control and 0.5±0.1 in case) wasn significant difference between two groups before treatment, but the mean level of indirect bilirubin after treatment in case (8.4±1.8) was significantly lower than control (10.4±2) (p=0.000). The mean level of direct bilirubin after treatment showed no significant difference between case (0.4±0.1) and control (0.5±0.1). CONCLUSION: Clofibrate is an effective agent in reduction of serum bilirubin level in term healthy neonates with prolonged jaundice.

Jaundice is the most common clinical sign in neonatal medicine, but only rarely is it associated with bilirubin neurotoxicity or the harbinger of significant underlying disease. Cases of kernicterus, which should be a never event, are still occurring. Delays in the diagnosis of pathological causes of prolonged jaundice, such as biliary atresia are still resulting in life long morbidity. These are salutary reminders that healthcare professionals should never take neonatal jaundice for granted. Phototherapy remains the mainstay of treatment of significant unconjugated hyperbilirubinaemia, and its optimal use will usually prevent the need for exchange blood transfusion. In cases of antibody-mediated haemolysis high-dose immunoglobulin is indicated if the serum bilirubin is continuing to rise despite multiple phototherapy. For babies with prolonged jaundice investigation should be directed towards making a timely diagnosis and avoiding secondary complications. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the influence of a variant of the UGT1A1 gene on the occurrence and severity of prolonged jaundice in Chinese infants at term., Methods: 175 infants with prolonged jaundice and 149 controls were used in this retrospective case-control study. The infants with prolonged jaundice were subdivided into the mild-medium and severe jaundice groups (TSB ≥ 342 µmol/L). The frequency and genotype distribution of the UGT1A1 and G6PD genes, and clinical parameters including sex, birth weight, delivery mode, gestational age, and feeding mode, were analyzed, and the differences in the parameters between the two groups were compared., Results: The allele frequency of UGT1A1*6 in the prolonged jaundice group was higher than that in the control group. Similarly, it was also higher in the severe jaundice group than in the mild-medium jaundice group. Homozygous and heterozygous UGT1A1*6 were also found more frequently in the prolonged jaundice group than in the control group. Exclusive breastfeeding, homozygous and heterozygous forms of UGT1A1*6 were significant risk indicators for prolonged jaundice. Moreover, UGT1A1*6 was the best predictor of prolonged severe jaundice., Conclusion: UGT1A1*6 appears to be a risk factor for prolonged jaundice with hyperbilirubinemia in term infants of Chinese ancestry who are exclusively breastfed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Yang, Lin, Xu, Yang, Wu, Chen, Xie, Huang, Lin, Wu, Ma, Li and Yang.)

Background: Jaundice is the most common clinical problem among the newborns. Prolonged jaundice in the neonate is defined as a jaundice that lasts longer than 14 days and has multiple possible causes. This study aimed to evaluate the causes of prolonged jaundice in newborns referred to Shahid-Beheshti hospital, Kashan, Iran. Materials and Methods: This cross-sectional study was conducted on 237 neonates with prolonged jaundice referred to Shahid-Beheshti hospital in Kashan. Clinical prolonged jaundice was defined as the yellow discoloration of the skin and mucous membranes, and persisting beyond 14 days of age. Blood tests were performed to determine the causes of jaundice. Results: None of the infants had a direct hyperbilirubinemia. Breast milk jaundice (59.1%) was the most common cause of newborn jaundice and other possible causes were urinary tract infection (12.2%), Glucose-6-phosphate dehydrogenase deficiency (9.7%) and hypothyroidism (6.3%). The exact etiology was unknown in 12.7% of the cases. Moreover, while there was a relation between the incidence of neonatal jaundice and sex, no relation was seen between the incidence and age, weight and the initial bilirubin level. Conclusion: Although the most common cause of prolonged jaundice is breast milk jaundice with no serious complication, a detailed investigation is recommended to determine the other important causes of the disease. [ABSTRACT FROM AUTHOR]

Abstract: Jaundice is the most common clinical sign in neonatal medicine, but only rarely is it associated with bilirubin neurotoxicity or the harbinger of significant underlying disease. A resurgence of kernicterus and not infrequent delays in the diagnosis of hepatic, metabolic, endocrine, and genetic causes serve as reminders that current management of neonatal jaundice needs refinement. Phototherapy remains the mainstay of treatment of significant unconjugated hyperbilirubinaemia, and its optimal use should keep the level of jaundice below the threshold for exchange blood transfusion. In cases of isoimmune haemolysis high-dose immunoglobulin is indicated if the serum bilirubin is continuing to rise despite multiple phototherapy. For babies with prolonged jaundice investigation should be directed towards making a timely diagnosis and avoiding secondary complications. The importance of identifying conjugated hyperbilirubinaemia at an early stage cannot be overstated. [Copyright &y& Elsevier]

Aim: The aim of this study is to determine the etiology in neonates admitted with prolonged jaundice. Materials and Method: Neonates with prolonged jaundice were included to this prospective study designed between January 2007 and December 2007. Prolonged jaundice was defined as total bilirubin level >5 mg/dL in newborns older than 14 days of age. After detailed history and physical examination, blood tests including blood groups of baby and mother, total, direct and indirect bilirubin, complete blood count (CBC), blood smear, reticulocyte count, Coombs test, serum aspartat transaminase (AST) level, serum alanin transaminase (ALT) level, viral markers, thyroid function tests, and glucose-6 phosphate dehydrogenase (G-6 PD) level and routine urine analysis with urine culture were performed in all newborns. Results: A total of 154 neonates were enrolled to the study. The most frequent cause of prolonged jaundice was breast milk jaundice (53%). It was followed by urinary tract infections and clinical sepsis (29%), hemolytic causes due to blood group incompetency (10%) and congenital hypothyroidism (8%). However, there were no significant differences between etiology and mean bilirubin levels. Conclusion: It is important to determine the etiology and to plan therapy according to etiology is important in newborns with prolonged jaundice. Breast milk jaundice, urinary tract infection and sepsis, hypothyroidism and hemolytic causes must be considered as the main etiology in newborns with prolonged jaundice. [ABSTRACT FROM AUTHOR]

Summary: How to assess the infant with prolonged jaundice is a common clinical concern for health visitors, general practitioners and paediatricians. Over the past decade in the UK there have been attempts to co-ordinate a national screening programme for extra-hepatic biliary atresia. A reliable methodology would appear to be elusive. Currently, a variety of approaches to screening the baby with prolonged jaundice are being adopted. Most jaundice beyond 2 weeks of age in the term infant is associated with breastfeeding and, as such, is benign. Rarely, however, prolonged jaundice is the marker for a range of haematological, hepatobiliary, metabolic, endocrine, infectious and genetic disorders that are associated with significant morbidity. Thorough clinical assessment is warranted in all cases of prolonged jaundice, but the threshold and range of investigation remain debatable. A reliable diagnosis of breast-milk jaundice can only be made on exclusion of pathological causes. A diagnosis of conjugated hyperbilirubinaemia prompts urgent further investigation. In all cases of ‘neonatal hepatitis syndrome’ blood coagulation must be assessed if presentation with catastrophic haemorrhage is to be avoided. This article describes ‘breast-milk jaundice’ and covers several of the more common pathologies that may present with prolonged jaundice. A clinical approach to investigation is provided based on current evidence. [Copyright &y& Elsevier]

The symptoms of urinary tract infections in infants are very non-specific and have historically included prolonged hyperbilirubinaemia. We studied the results of routine urine samples in 319 infants with prolonged jaundice. Convincing findings of UTI was not found in any of these children even if one of them was treated with antibiotics after four consecutive urine cultures with different bacteria. Conclusion: A urine culture might thus not be an appropriate investigation in a child with prolonged jaundice without any other symptoms of UTI. [ABSTRACT FROM AUTHOR]

Background: Early detection of neonatal cholestasis (NC) is important for better clinical outcomes but can be challenging., Objective: The objective of this study was to evaluate the knowledge and practice styles of pediatric providers (PPs) regarding NC in the western region of Saudi Arabia., Methods: This cross-sectional, questionnaire study was conducted between November 2019 and February 2020 in three major cities of the western region of Saudi Arabia (namely, Taif, Makkah and Jeddah). PPs included pediatric residents, pediatric specialists, pediatric consultants and family physicians. The questionnaire included 15 items in five subscales (definition, causes, diagnosis and management of NC and knowledge of guidelines)., Results: A total of 488 participants completed the questionnaire. Only 30.2% were aware of the correct definition of NC ( P < 0.001). Two-thirds of the respondents did not consider a history of pale stool being important for evaluating NC. The importance of biliary atresia as a serious cause of NC was found to be significantly different between pediatric consultants and other pediatricians ( P < 0.001). In cases of prolonged NC, 32.4% of the PPs refer to pediatric gastroenterologist. Only 18.9% of the respondents were aware of liver biopsy being the gold standard investigation of NC. The majority of the respondents (41.8%) used ursodeoxycholic acid as a supportive therapy of NC., Conclusions: This study found a significant deficit in the knowledge and practice styles of PPs in the western region of Saudi Arabia. These findings highlight the need for policymakers to develop educational materials for PPs to increase their knowledge of NC., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Saudi Journal of Medicine & Medical Sciences.)

Neonatal hepatitis represents an often met pediatric pathology. In order to determine a diagnosis multiple investigations are required, to rule out other pathologies associated with cholestasis or even associated to neonatal hepatitis. , which might alter the therapeutic formula and the prognosis of the disease. 293 children were screened, admitted for various conditions that could generate intra- or extrahepatic cholestasis. Neonatal hepatitis is one of the main pathologies involved in the occurrence of cholestasis in young age. The most frequent etiology is the infectious one, most cases being engendered by the cytomegalic virus. Using a previously designed algorithm we could determine a diagnosis earlier, and we could also evaluate the systemic echo of the cholestasis. For an early, clearcut diagnosis, a previously designed diagnosis protocol must be acquired in the case of a child with cholestasis, as neonatal hepatitis represents a significant proportion of the children with cholestasis [ABSTRACT FROM AUTHOR]

Neonatal hepatitis represents an often met pediatric pathology. In order to determine a diagnosis multiple investigations are required, to rule out other pathologies associated with cholestasis or even associated to neonatal hepatitis, which might alter the therapeutic formula and the prognosis of the disease. The study aim to underline the importance of early identification of the cholestasis and it's objective manifestations through a detailed protocole. Material and method: 293 children were screened, admitted for various conditions that could generate intra- or extrahepatic cholestasis. Results: Neonatal hepatitis is one of the main pathologies involved in the occurrence of cholestasis in young age. The most frequent etiology is the infectious one, most cases being engendered by the cytomegalic virus. Using a previously designed algorithm we could determine a diagnosis earlier, and we could also evaluate the systemic echo of the cholestasis. Conclusions: For an early, clearcut diagnosis, a previously designed diagnosis protocol must be acquired in the case of a child with cholestasis, as neonatal hepatitis represents a significant proportion of the children with cholestasis. [ABSTRACT FROM AUTHOR]

Thirteen breast-fed one-month-old infants with prolonged jaundice not due to known causes were included in this study. All infants were investigated at one and twelve months of age. Serum concentrations of total (TB) and conjugated bilirubin (CB), aspartate (ASAT) and alanine aminotransferase (ALAT), alkaline phosphatase (AP), alpha-1-antitrypsin (alpha-1-AT), alpha-1-fetoprotein (AFP) and the two primary bile acids; cholic (CA) and chenodeoxycholic acid (CDCA) were determined at both ages. The Pi-phenotype of alpha-1-AT was determined at the age of twelve months. The serum concentrations of TB, CB, AP and AFP were elevated at the age of one month but were normal at the age of twelve months. No changes in the serum concentrations of ASAT or ALAT were observed between one and twelve months of age, and the values were within the reference ranges. The serum concentrations of alpha-1-AT were within the reference range at both ages. Two infants were heterozygous for MZ, and they had normal serum alpha-1-AT concentrations. The serum concentrations of CA and CDCA were elevated at the age of one month and were still significantly elevated at the age of twelve months indicating that the infants had slight cholestasis at the age of one month, and that the cholestasis had largely subsided by the end of the first year of life. [ABSTRACT FROM AUTHOR]