Hyperbilirubinemia Research Papers - Academia.edu (original) (raw)

Systemic disorders in pediatric patients, such as congenital biliary atresia, acute liver failure, and biliary hypoplasia, may be the indications for a need of liver transplantation. One of the manifestations of these disorders is the... more

Systemic disorders in pediatric patients, such as congenital biliary atresia, acute liver failure, and biliary hypoplasia, may be the indications for a need of liver transplantation. One of the manifestations of these disorders is the elevated serum levels of bilirubin (hyperbiliru-binemia), a product of hemoglobin degradation, which is deposited in different tissues, including mineralized and soft tissues. When hyperbilirubinemia occurs during the period of dental development, these teeth can develop a green coloration, which remains permanently, because, after maturation, these tissues loose their metabolic activity. This case report describes a 9-year-old girl who required a liver transplant due to biliary atresia when she was three years old. Some of her pigmented teeth needed extraction and afterwards were submitted for histological analysis and compared with sound teeth.

Objective. To investigate the relationship of delivery type, maternal anesthesia, feeding modalities, and first feeding and meconium passage times with early bilirubin levels of healthy infants. Methods. Cord, 24 hours' and 48... more

Objective. To investigate the relationship of delivery type, maternal anesthesia, feeding modalities, and first feeding and meconium passage times with early bilirubin levels of healthy infants. Methods. Cord, 24 hours' and 48 hours' total bilirubin levels were measured in 388 study infants. Results. Infants born with cesarean section were fed later and more often had mixed feeding. First meconium passage was delayed with general anesthesia. Cord, 24 and 48 hours' bilirubin levels were not correlated with first feeding time, meconium passage time, mode of delivery, existence and type of anesthesia, and feeding modalities. Being in high intermediate risk zone at 72 hours of Bhutani's nomogram was only related to first feeding time and high cord bilirubin level. Late preterm infants were more frequently born with cesarean section and offered supplementary formula. Therefore, first meconium passage times and bilirubin levels were similar in the late preterm and term inf...

There are variety serious diseases of the children liver. Biliary atresia is the most frequent surgical cause of cholestatic jaundice in neonates and should be evoked whenever this clinical sign is associated with pale stools and... more

There are variety serious diseases of the children liver. Biliary atresia is the most frequent surgical cause of cholestatic jaundice in neonates and should be evoked whenever this clinical sign is associated with pale stools and hepatomegaly. Early diagnosis is the greatest help for these children. Without surgical treatment these patients die during the first two years of life from the progression of the liver disease, oesophageal bleeding or infection. In this article we would like to provide a brief overview of these diseases, describe the main diagnostic criteria, and we also want to turn the attention of pediatricians and neonatologists on diagnostic difficulties during the diagnostic period. Despite of the rarity of these diseases, biliary atresia should be on the list of differential diagnoses. Thanks to early diagnosis, performance of Kasai portoenterostomy and the possibility of liver transplantation was made significant progress in the treatment of children with those diseases in the last decade.

Aim: Our objective was to compare the predictive ability of predischarge serum total bilirubin (STB) and clinical factors for significant hyperbilirubinemia (SHB) in newborn to see if we can improve the prediction of the... more

Aim: Our objective was to compare the predictive ability of predischarge serum total bilirubin (STB) and clinical factors for significant hyperbilirubinemia (SHB) in newborn to see if we can improve the prediction of the hyperbilirubinemia. Methods: We conducted a prospective cohort study, recruiting healthy newborn infants of > 35 weeks gestation, in a tertiary hospital in south India. The risk factors for SHB were identified and serum bilirubin was performed between 36-48 hours of age before discharge. SHB was defined as a bilirubin level that exceeded or was within 1 mg/ dL (17µmol/L) of the hour-specific phototherapy treatment threshold recommended in the American Academy of Pediatrics (AAP) clinical practice guideline on the management of neonatal hyperbilirubinemia. SPSS 21 was used for statistical analysis. Results: Of 605 infants, 486 infants were included in final analysis, among which 72 babies (14%) developed SHB. On univariate analysis, STB, gestational age (GA) and percentage of weight loss were found to be predictive of SHB. On multiple logistic regressions, the predictive ability of predischarge STB is higher than that of percentage of weight loss and GA. The predictive accuracy of predischarge (< 48 hours) STB level was similar to that of percentage of weight loss (AUC = 0.83, 95 % CI 0.78– 0.88). However, the prediction model that combined multiple clinical risk factors (predischarge STB, GA and percentage of weight loss) had the best accuracy for predicting SHB. Conclusions: Predischarge serum total bilirubin, when combined with specific clinical factors (gestational age and percentage of weight loss), best predicts development of significant hyperbilirubinemia.

To confirm that the naproxen metabolite O-desmethylnaproxen interferes with the Jendrassik and Grof method for total bilirubin and was a possible cause of spurious hyperbilirubinemia in a case of naproxen overdose.Plasma was spiked with... more

To confirm that the naproxen metabolite O-desmethylnaproxen interferes with the Jendrassik and Grof method for total bilirubin and was a possible cause of spurious hyperbilirubinemia in a case of naproxen overdose.Plasma was spiked with naproxen or O-desmethylnaproxen before total and direct bilirubin analysis.O-desmethylnaproxen concentration showed a linear relationship with measured total bilirubin.O-demethylnaproxen interferes with the total bilirubin method. Interference of glucuronide metabolites of naproxen and O-demethylnaproxen is not excluded.

The goal of this study was to evaluate risk factors for readmission among late-preterm (34-36 weeks' gestation) infants in clinical practice. This was a retrospective, matched case-control study of late-preterm infants receiving care... more

The goal of this study was to evaluate risk factors for readmission among late-preterm (34-36 weeks' gestation) infants in clinical practice. This was a retrospective, matched case-control study of late-preterm infants receiving care across 8 regional hospitals in 2009 in the United States. Those readmitted within 28 days of birth were matched to non-readmitted infants at a ratio of 1:3 according to birth hospital, birth month, and gestational age. Step-wise modeling with likelihood ratio tests were used to develop a multivariable logistic regression model. A subgroup analysis of hyperbilirubinemia readmissions was also performed. Of 1861 late-preterm infants delivered during the study period, 67 (3.6%) were readmitted within 28 days of birth. These were matched to 201 control infants, for a final sample of 268 infants. In multivariable regression, each additional day in length of stay was associated with a significantly reduced odds ratio (OR) for readmission (0.57, P = .004); ...

Hyperbilirubinaemia with or without jaundice is one of the side effects of atazanavir boosted with low-dose ritonavir (ATV/rit) related to the drug plasma levels, as a result of its metabolism by UGT1A1 – uridine diphosphate-glucuronosyl... more

Hyperbilirubinaemia with or without jaundice is one of the side effects of atazanavir boosted with low-dose ritonavir (ATV/rit) related to the drug plasma levels, as a result of its metabolism by UGT1A1 – uridine diphosphate-glucuronosyl transferase. Genotyping for UGT1A1*28 before initiation of antiretroviral therapy containing atazanavir may aid in identifying individuals at risk of hyperbilirubinaemia. Our objective was to estimate the prevalence of the UGTA1A1*28 polymorphism in HIV-infected individuals in Greece and to determine its potential association with hyperbilirubinaemia in patients receiving ATV/rit. The prevalence of the UGTA1A1*28 variant was estimated in 79 HIV-infected patients prior to the administration of the first-line treatment. The UGTA1A1*28 variant was detected in 46 out of 79 individuals (58.2%). Antiretroviral therapy was administered to 64/79 patients (81%). Among them, 26/64 (40.6%) received ATV/rit. Of the ATV/rit-treated patients, 14 were found to be ...

Background. Hyperbilirubinemia in new-borns with glucose-6-phosphate dehydrogenase (G6PD) deficiency is a serious clinical problem because of the severity and unpredictability of its course. An innovative approach to this problem is... more

Background. Hyperbilirubinemia in new-borns with glucose-6-phosphate dehydrogenase (G6PD) deficiency is a serious clinical problem because of the severity and unpredictability of its course. An innovative approach to this problem is suggested by previous experience with Sn-mesoporphyrin (SnMP), a potent inhibitor of bilirubin production, in moderating neonatal hyperbilirubinemia caused by ABO incompatibility, immaturity, and unspecified mechanisms. Objective. To compare the effectiveness of the preventive and therapeutic uses of SnMP in ameliorating the course of bilirubinemia of G6PD-deficient neonates. Methods. Neonates born at the Metera Maternity Hospital, Athens, Greece, and found to be G6PD-deficient by cord blood testing were stratified by sex and gestational age (210–265 days and >265 days) and randomized in pairs to receive SnMP (6 μmol/kg birth weight, intramuscularly) either on the first day of life (preventive use) or if and when the plasma bilirubin concentration (P...

Crigler-Najjar syndrome type I is a rare inborn error of bilirubin metabolism due to a deficiency of the hepatic microsomal bilirubin uridine diphosphate-glucuronosyltransferase (B-UDPGT) enzyme. To reduce the risk of life threatening... more

Crigler-Najjar syndrome type I is a rare inborn error of bilirubin metabolism due to a deficiency of the hepatic microsomal bilirubin uridine diphosphate-glucuronosyltransferase (B-UDPGT) enzyme. To reduce the risk of life threatening kernicterus, patients undergo daily session of phototherapy. The only therapeutic alternatives are liver or hepatocyte transplantation but significant risks and costs are associated with these procedures. Since all other pathways for bilirubin metabolism are functional in the patients, gene therapy may represent an alternative treatment. An excellent model of this disease exists in the Gunn rat. Previously, partial correction of hyperbilirubinemia in Gunn rats for up to 4 weeks was reported using E1-deleted adenoviral (Ad) vectors; however, the therapeutic index of E1-deleted Ad is limited due to strong host immune response to the viral proteins, acute toxicity and short duration of expression. Helper-dependent adenoviral (HD-Ad) vectors, devoid of all viral coding sequences, have a safer chronic toxicity profile compared with early generation Ad vectors and allow for long-term transgene expression. We used HD-Ad vectors and tissue-restricted expression of human B-UDPGT in Gunn rats. Complete correction of hyperbilirubinemia was achieved after a single systemic administration of 3 x 1012 viral particles/kg of HD-Ad vectors expressing human B-UDPGT under the control of the rat phosphoenolpyruvate carboxylase (PEPCK) promoter into Gunn rats. Total bilirubin levels in the plasma were stably reduced from above 7.0 mg/dL to less than 1.0 mg/dL for at least 7 months. Specific hepatic expression of human B-UDPGT was confirmed by RNA and protein analysis in liver biopsy from animals sacrificed 20 weeks post-injection. A clinically significant reduction in total bilirubin levels was observed with a dose as low as 6 x 1011 viral particles/kg. No significant increase in liver enzymes was detected at a dose as high as 1 x 1013 viral particles/kg. Transient, dose-related thrombocytopenia developed after systemic injection of the vector at higher doses and resolved in 3 weeks. We conclude that complete, long-term correction of hyperbilirubinemia may be achieved by a single HD-Ad adenoviral administration in the animal model of Crigler-Najjar syndrome type I with negligible chronic toxicity.

Bilirubin is a potent antioxidant in vitro. To determine whether bilirubin also is an antioxidant in vivo, we studied markers of oxidative injury in the Gunn rat model exposed to hyperoxia. Homozygous jaundiced males were mated with... more

Bilirubin is a potent antioxidant in vitro. To determine whether bilirubin also is an antioxidant in vivo, we studied markers of oxidative injury in the Gunn rat model exposed to hyperoxia. Homozygous jaundiced males were mated with heterozygous nonjaundiced females to obtain both jaundiced and nonjaundiced pups within a litter. Once delivered, the pups and their mother were placed in

BACKGROUND: Activated partial thromboplastin time (aPTT) and antifactor Xa (anti-Xa) monitoring methods for unfractionated heparin (UFH) often disagree. The extent of discordance for those with elevated bilirubin remains unclear. Our... more

BACKGROUND: Activated partial thromboplastin time (aPTT) and antifactor Xa (anti-Xa) monitoring methods for unfractionated heparin (UFH) often disagree. The extent of discordance for those with elevated bilirubin remains unclear. Our objective was to evaluate concordance between activated aPTT and anti-Xa methods for hyperbilirubinemic patients on UFH.