Hyperbilirubinemia Current Guidelines and Emerging Therapies

Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Pediatric emergency care (Impact Factor: 0.92). 09/2011; 27(9):884-9. DOI: 10.1097/PEC.0b013e31822c9b4c
Source: PubMed

ABSTRACT It is estimated that about two thirds of newborns will appear clinically jaundiced during their first weeks of life. As newborns and their mothers spend fewer days in the hospital after birth, the number of infants readmitted yearly in the United States for neonatal jaundice over the last 10 years has increased by 160%. A portion of these infants present to the emergency department, requiring a careful history and physical examination assessing them for the risk factors associated with pathologic bilirubin levels. Although the spectrum of illness may be great, the overwhelming etiology of neonatal jaundice presenting to an emergency department is physiologic and not due to infection or isoimmunization. Therefore, a little more than a good history, physical examination, and indirect/direct bilirubin levels are needed to evaluate an otherwise well-appearing jaundiced newborn. The American Academy of Pediatrics' 2004 clinical practice guidelines for "Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation" are a helpful and easily accessible resource when evaluating jaundiced newborns (available at;114/1/297). There are several exciting developments on the horizon for the diagnosis and management of hyperbilirubinemia including increasing use of transcutaneous bilirubin measuring devices and medications such as tin mesoporphyrin and intravenous immunoglobulin that may decrease the need for exchange transfusions.

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    ABSTRACT: Background Neonatal jaundice resulting from elevated unconjugated bilirubin (UCB) occurs in 60-80% of newborn infants. Although mild jaundice is generally considered harmless, little is known about its long-term consequences. Recent studies have linked mild bilirubin-induced neurological dysfunction (BIND) with a range of neurological syndromes, including attention deficit-hyperactivity disorder. The goal of this study was to measure BIND across the lifespan in the Gunn rat model of BIND.Methods Using a sensitive force plate actometer, we measured locomotor activity and gait in jaundiced (jj) Gunn rats versus their non-jaundiced (Nj) littermates. Data were analyzed for young adult (3-4 months), early middle-aged (9-10 months), and late middle-aged (17-20 months) male rats.Resultsjj rats exhibited lower body weights at all ages and a hyperactivity that resolved at 17-20 months of age. Increased propulsive force and gait velocity accompanied hyperactivity during locomotor bouts at 9-10 months in jj rats. Stride length did not differ between the two groups at this age. Hyperactivity normalized and gait deficits, including decreased stride length, propulsive force, and gait velocity, emerged in the 17-20-month-old jj rats.Conclusions These results demonstrate that, in aging, hyperactivity decreases with the onset of gait deficits in the Gunn rat model of BIND.Pediatric Research (2014); doi:10.1038/pr.2014.199.
    Pediatric Research 12/2014; 77(3). DOI:10.1038/pr.2014.199 · 2.84 Impact Factor
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    ABSTRACT: Purpose: Determination of bilirubin levels is performed for many newborns in the first days of life, and several different transcutaneous bilirubinometers are available. We aimed to determine whether transcutaneous bilirubin measurement, as performed using Jaundice Detector JH20-1C, a new device, correlates with Minolta/Hill-Rom Air-Shields Transcutaneous Jaundice Meter model JM-103.Design and Sample: The study was performed on term or near-term newborn infants who underwent transcutaneous bilirubin measurements as part of their normal care. The study group consisted of 585 newborn infants with gestational ages ranging from 35 to 42 weeks, coming from an uneventful pregnancy. In this prospective study, bilirubin concentrations were determined with two different transcutaneous bilirubinometers.Main Outcome Variable: In 585 infants, the correlation coefficient for Jaundice Detector JH20-1C versus Minolta Air-Shields Jaundice Meter model JM-103 was .965 (p < .0001). The mean (± standard deviation) difference between the Jaundice Detector JH20-1C versus Minolta Air-Shields Jaundice Meter model JM-103 was 0.26 ± 0.95 mg/dL. Results showed the Jaundice Detector JH20-1C to have an acceptable level of intradevice imprecision (r = .978, p < .0001, mean differences .0158 ± .871 mg/dL).Results: Jaundice Detector JH20-1C showed the good performances of intradevice and interdevice imprecision in comparison with Minolta/Hill-Rom Air-Shields Transcutaneous Jaundice Meter model JM-103. Jaundice Detector JH20-1C may be suitable for screening term or near-term newborn infants for jaundice in the well-baby nursery or maternity ward.
    Neonatal network: NN 05/2014; 33(3):138-42. DOI:10.1891/0730-0832.33.3.138
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