Jon F Watchko

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (151)578.12 Total impact

  • Jon F. Watchko

    No preview · Article · Oct 2015 · The Journal of pediatrics
  • Abeer Azzuqa · Jon F Watchko
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    ABSTRACT: To assess the total serum bilirubin (TSB) levels at which conjunctival icterus is observed in neonates of ≥34 weeks gestation during the first week of life. Two convenience samples of neonates were examined for conjunctival icterus within 4 hours of TSB measurements. A concurrent assessment of cephalopedal cutaneous icterus was performed and the TSB characterized using the Bhutani hour-specific risk zone nomogram. Two hundred forty neonates were studied of which 76 had conjunctival icterus. Conjunctival icterus was always accompanied by cutaneous jaundice to at least the chest and more often than not a TSB >14.9 mg/dL (255 umol/L) consistently in the 76th%-95th% to >95th% range on the Bhutani nomogram. Only a few infants with TSB in the range of 10-14.9 mg/dL (171-255 umol/L) had conjunctival icterus. Conjunctival icterus was observed in a subset of jaundiced neonates and associated with elevated hour-specific TSB levels frequently >95th% on the Bhutani nomogram. Conjunctival icterus is a sign of clinically relevant hyperbilirubinemia that merits a TSB measurement and evaluation of the infant. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Aug 2015 · The Journal of pediatrics
  • Jon F. Watchko
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    ABSTRACT: "Common red blood cell disorders encountered in the normal newborn nursery include hemolytic disease of the newborn and resultant hyperbilirubinemia, anemia, and polycythemia. A less frequent clinically relevant hematologic issue in newborns to be covered herein is thrombocytopenia." Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jan 2015 · Pediatric Clinics of North America
  • Jon F Watchko · Michael J Painter · Ashok Panigrahy
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    ABSTRACT: Investigators have hypothesized a range of subcortical neuropathology in the genesis of bilirubin-induced neurologic dysfunction (BIND). The current review builds on this speculation with a specific focus on the cerebellum and its connections in the development of the subtle neuromotor disabilities of BIND. The focus on the cerebellum derives from the following observations: (i) the cerebellum is vulnerable to bilirubin-induced injury; perhaps the most vulnerable region within the central nervous system; (ii) infants with cerebellar injury exhibit a neuromotor phenotype similar to BIND; and (iii) the cerebellum has extensive bidirectional circuitry projections to motor and non-motor regions of the brainstem and cerebral cortex that impact a variety of neurobehaviors. Future study using advanced magnetic resonance neuroimaging techniques have the potential to shed new insights into bilirubin's effect on neural network topology via both structural and functional brain connectivity measurements. Copyright © 2014 Elsevier Ltd. All rights reserved.
    No preview · Article · Dec 2014 · Seminars in Fetal and Neonatal Medicine
  • Jon F. Watchko · Darrell Triulzi

    No preview · Article · Nov 2014 · Transfusion
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    Jon Watchko
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    ABSTRACT: Advances in the clinical assessment strategies used to identify neonates at risk for the development of severe hyperbilirubinemia and bilirubin neurotoxicity, as well as the treatment measures to control hyperbilirubinemia in newborns, continue to be made. They include, among others, universal predischarge birth hospitalization bilirubin screening, the confirmation that hemolysis is an important risk factor for bilirubin neurotoxicity, the use of a numeric scoring system to help stage the severity of acute bilirubin encephalopathy, the potential advantages of turquoise-light phototherapy, and the potential role of heme-oxygenase inhibitors in preventing the need for exchange transfusions, all of which are reviewed here.
    Preview · Article · Nov 2014
  • Jon F. Watchko · M. Jeffrey Maisels
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    ABSTRACT: Low bilirubin kernicterus in preterm neonates, though rare, remains an unpredictable and refractory form of brain injury. Hypoalbuminemia, co-morbid CNS insult(s), infection, and inflammation are contributing causes that, in many cases, appear to interact in potentiating bilirubin neurotoxicity. Despite compulsive attention to serum bilirubin levels, and clinical and laboratory indices of neurotoxicity risk, low bilirubin kernicterus continues to be seen in contemporary NICUs. While efforts to refine and improve current treatment guidelines are certainly needed, such revision(s) will also have to take into account the risks and benefits of any intervention, including phototherapy.
    No preview · Article · Sep 2014 · Seminars in Perinatology
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    ABSTRACT: Infants with chronic bilirubin encephalopathy often demonstrate abnormal bilateral, symmetric, high-signal intensity on T2-weighted magnetic resonance imaging of the globus pallidus and subthalamic nucleus, consistent with the neuropathology of kernicterus. Early magnetic resonance imaging of at-risk infants, while frequently showing increased T1-signal in these regions, may give false-positive findings due to the presence of myelin in these structures. Advanced magnetic resonance imaging including diffusion-weighted imaging, magnetic resonance spectroscopy, and diffusion tensor imaging with tractography may shed new insights into the pathogenesis of bilirubin-induced brain injury and the neural basis of long-term disability in infants and children with chronic bilirubin encephalopathy.
    No preview · Article · Sep 2014 · Seminars in Perinatology
  • M Jeffrey Maisels · Jon F Watchko

    No preview · Article · Sep 2014 · Healthcare
  • Sanjiv B Amin · Vinod K Bhutani · Jon F Watchko
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    ABSTRACT: Central apnea, defined as cessation of breathing for ≥20s, is frequent in premature infants born at <34 weeks׳ gestation but uncommon among healthy late preterm (34(0/7)-36(6/7) weeks׳ gestation) and term (≥37 weeks׳ gestation) infants, where it is usually a clinical manifestation of a neurological or metabolic problem. There is growing evidence that marked unconjugated hyperbilirubinemia is associated with central apnea in neonates. This article explores the reported association between acute bilirubin encephalopathy and symptomatic apneic events in newborns and the possible mechanisms involved in the pathogenesis of this phenomenon. The prevalence of symptomatic apneic events in reports of acute bilirubin encephalopathy suggests this clinical finding should be considered a sign of bilirubin neurotoxicity.
    No preview · Article · Sep 2014 · Seminars in Perinatology
  • Jon F Watchko

    No preview · Article · Jul 2014 · Journal of Pediatrics
  • Mamdouha Ahdab-Barmada · Jon F Watchko

    No preview · Article · Dec 2013 · Pediatric Neurology
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    Jon F Watchko · Claudio Tiribelli
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    ABSTRACT: The complex cascade of molecular and cellular events leading to bilirubin-induced neurotoxicity remains incompletely delineated. This review discusses bilirubin-induced brain damage and recent insights into its pathogenesis and prevention. Neonatal unconjugated hyperbilirubinemia and resultant clinical jaundice affect up to approximately 85% of newborns. Although this condition is generally a benign, transitional phenomenon, unconjugated bilirubin levels that can pose a direct threat of serious brain injury develop in a small proportion of neonates. Acute bilirubin encephalopathy may ensue and progress to kernicterus (chronic bilirubin encephalopathy), a permanent disabling neurologic condition that is classically characterized by the extrapyramidal movement disorders of dystonia, choreoathetosis, or both; hearing loss due to auditory neuropathy spectrum disorders; and oculomotor pareses.(1) These central nervous system (CNS) sequelae reflect the regional CNS topography of bilirubin-induced neuropathology, which ...
    Full-text · Article · Nov 2013 · New England Journal of Medicine
  • M J Maisels · J F Watchko
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    ABSTRACT: JPER is a multi-disciplinary journal that promotes the health of the preterm infant.
    No preview · Article · Jul 2013 · Journal of perinatology: official journal of the California Perinatal Association
  • Jon F Watchko

    No preview · Article · Feb 2013 · The Journal of pediatrics
  • J F Watchko · M Kaplan · A R Stark · D K Stevenson · V K Bhutani
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    ABSTRACT: Glucose-6-phosphate dehydrogenase (G6PD) deficiency, a common X-linked enzymopathy can lead to severe hyperbilirubinemia, acute bilirubin encephalopathy and kernicterus in the United States. Neonatal testing for G6PD deficiency is not yet routine and the American Academy of Pediatrics recommends testing only in jaundiced newborns who are receiving phototherapy whose family history, ethnicity, or geographic origin suggest risk for the condition, or for infants whose response to phototherapy is poor. Screening tests for G6PD deficiency are available, are suitable for use in newborns and have been used in birth hospitals. However, US birth hospitals experience is limited and no national consensus has emerged regarding the need for newborn G6PD testing, its effectiveness or the best approach. Our review of current state of G6PD deficiency screening highlights research gaps and informs specific operational challenges to implement universal newborn G6PD testing concurrent to bilirubin screening in the United States.Journal of Perinatology advance online publication, 21 February 2013; doi:10.1038/jp.2013.14.
    No preview · Article · Feb 2013 · Journal of perinatology: official journal of the California Perinatal Association
  • Jon F Watchko · Michael J Painter · Ashok Panigrahy

    No preview · Article · Feb 2013 · Japanese journal of radiology
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    Monica J Daood · Mitchell Hoyson · Jon F Watchko
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    ABSTRACT: Background: Hazardous levels of bilirubin produce oxidative stress in vitro and may play a role in the genesis of bilirubin-induced neurologic dysfunction (BIND). We hypothesized that the antioxidants taurourosdeoxycholic acid (TUDCA), 12S-hydroxy-1,12-pyrazolinominocycline (PMIN), and minocycline (MNC) inhibit oxidative stress and block BIND in hyperbilirubinemic j/j Gunn rat pups that were given sulfadimethoxine to induce bilirubin encephalopathy. Methods: At peak postnatal hyperbilirubinemia, j/j Gunn rat pups were dosed with sulfadimethoxine to induce bilirubin encephalopathy. Pups were given TUDCA, PMIN, MNC, or vehicle pretreatment (15 min before sulfadimethoxine). After 24 h, BIND was scored by using a rating scale of neurobehavior and cerebellar tissue 4-hydroxynonenal and protein carbonyl dinitrophenyl content were determined. Nonjaundiced heterozygous N/j pups served as controls. Results: Administration of sulfadimethoxine induced BIND and lipid peroxidation but not protein oxidation in hyperbilirubinemic j/j pups. TUDCA, PMIN, and MNC each reduced lipid peroxidation to basal levels observed in nonjaundiced N/j controls, but only MNC prevented BIND. Conclusion: These findings show that lipid peroxidation inhibition alone is not sufficient to prevent BIND. We speculate that the neuroprotective efficacy of MNC against BIND involves action(s) independent of, or in addition to, its antioxidant effects.
    Preview · Article · Aug 2012 · Pediatric Research
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    M J Maisels · J F Watchko · V K Bhutani · D K Stevenson
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    ABSTRACT: We provide an approach to the use of phototherapy and exchange transfusion in the management of hyperbilirubinemia in preterm infants of <35 weeks of gestation. Because there are limited data for evidence-based recommendations, these recommendations are, of necessity, consensus-based. The recommended treatment levels are based on operational thresholds for bilirubin levels and represent those levels beyond which it is assumed that treatment will likely do more good than harm. Long-term follow-up of a large population will be needed to evaluate whether or not these recommendations should be modified.
    Preview · Article · Jun 2012 · Journal of perinatology: official journal of the California Perinatal Association
  • Jon F Watchko

    No preview · Article · May 2012 · The Journal of pediatrics

Publication Stats

3k Citations
578.12 Total Impact Points


  • 1993-2015
    • University of Pittsburgh
      • • Department of Pediatrics
      • • Department of Medicine
      • • Department of Orthopaedic Surgery
      • • Magee Womens Research Institute
      Pittsburgh, Pennsylvania, United States
  • 1988-2015
    • Magee-Womens Hospital
      • Department of Pediatrics
      Pittsburgh, Pennsylvania, United States
  • 2013
    • Università degli Studi di Trieste
      Trst, Friuli Venezia Giulia, Italy
  • 1999-2003
    • University of Oslo
      • Department of Paediatrics
      Kristiania (historical), Oslo County, Norway
  • 1995-1998
    • Mayo Clinic - Rochester
      • Department of Anesthesiology
      Рочестер, Minnesota, United States
  • 1985-1991
    • University of Washington Seattle
      • Department of Pediatrics
      Seattle, Washington, United States