DOCSLIB.ORG

Exchange Transfusion Safety and Outcomes in Neonatal Hyperbilirubinemia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Exchange Transfusion Safety and Outcomes in Neonatal Hyperbilirubinemia Journal of Perinatology (2020) 40:1506–1512 https://doi.org/10.1038/s41372-020-0642-0 ARTICLE Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia 1 1 1 2 2 2 2 Mattie F. Wolf ● Julie Childers ● Keyaria D. Gray ● Caroline Chivily ● Mike Glenn ● Laila Jones ● Mini Kpa ● 2 2 1,2 3 1,2 Taylor McMannen ● Isaias Reyes ● Kanecia O. Zimmerman ● Reese H. Clark ● Rachel G. Greenberg Received: 10 October 2019 / Revised: 11 February 2020 / Accepted: 25 February 2020 / Published online: 9 March 2020 © The Author(s), under exclusive licence to Springer Nature America, Inc. 2020 Abstract Objective To characterize the prevalence of exchange transfusion (ET), clinical characteristics of infants receiving ET, and ET-associated morbidity and mortality. Study design We conducted a multicenter cohort study of infants ≥23 weeks of gestational age (GA) with hyperbilir- ubinemia who underwent ET within 30 days of birth from 1997 to 2016. We examined clinical characteristics and adverse events after ET. We used multivariable logistic regression to examine the association between clinical risk factors and death. Result A total of 1252 infants were included; 4% died within 7 days of ET and 6% died before discharge. Compared ≥ ≤ fi 1234567890();,: 1234567890();,: with infants 37 weeks of GA, infants 29 weeks of GA had greater odds of death (adjusted odds ratio [95% con dence interval] = 20.08 [7.32, 55.07]). Conclusions Infants ≤ 29 weeks of GA had greater odds of death following ET compared with term infants. These data will support clinicians in evaluating risks and prognosis for infants who require ET. Introduction hyperbilirubinemia in term infants [7, 8], there are no data on the prevalence of kernicterus in preterm survivors. Hyperbilirubinemia affects upto 85% of neonates born at Kernicterus is preventable through the use of photo- term gestation (≥37 weeks gestational age [GA]) and 80% therapy, treatment with intravenous immunoglobulins of premature newborns [1–3]. While severe hyperbilir- (IVIg), or the use of exchange transfusion (ET) to lower ubinemia (total serum bilirubin [TSB] level of >20 mg/dL serum bilirubin levels [9]. Phototherapy is an effective, [342.1 μmol/L]) occurs in <2% of term infants, it can lead to noninvasive, first-line treatment to lower the levels of permanent neurodevelopmental delay and kernicterus (i.e., unconjugated bilirubin. IVIg has some support as an adju- chronic bilirubin encephalopathy) [2]. Furthermore, though vant therapy for hyperbilirubinemia in cases of Rh hemo- preventable, kernicterus occurs in 20% of infants with TSB lytic disease, although the efficacy is controversial [10]. ET >30 mg/dL [4, 5]. The prevalence of kernicterus on autopsy is more efficient at reducing bilirubin levels and is often in preterm infants who die is thought to be around 4% [6]. used when maximal phototherapy and/or IVIg are unsuc- In addition, although small case series have described sur- cessful or when hemolysis is excessive [11, 12]; however, vivors with neurologic sequelae associated with ET has known complications including vascular accidents, cardiovascular compromise, and electrolyte and hematolo- gic derangement [13]. Furthermore, infants undergoing ET are at higher risk of requiring intubation and mechanical ventilation, both of which are associated with additional * Rachel G. Greenberg complications [14]. [email protected] The incidence of meeting or exceeding American 1 Department of Pediatrics, Duke University School of Medicine, Academy of Pediatrics thresholds for ET is low, involving Durham, NC, USA ~1.2 per 1000 live births. Nevertheless, premature infants 2 Duke Clinical Research Institute, Duke University School of have a tenfold increased risk of eventual bilirubin level Medicine, Durham, NC, USA meeting or exceeding thresholds for ET compared with term 3 Pediatrix Medical Group, Sunrise, FL, USA neonates [15]. Furthermore, the frequency of ET has Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia 1507 steadily declined over time due to increased hyperbilir- ensure we did not miss important abnormalities, we eval- ubinemia screening, treating pregnant women who are uated the proportion of abnormal laboratory values on the Rh-negative with Rh-factor therapy, the increased use of day of ET in infants who were missing values within 7 days phototherapy, development of IVIg, and ET safety concerns after ET. Severe intraventricular hemorrhage (IVH) inclu- [4, 16]. Previous studies evaluating safety do not have the ded grades III and IV [28]. We defined neonatal sepsis as most current data and have been single-center evaluations or any positive blood or cerebrospinal fluid culture, including included only relatively small neonatal populations definite and probable coagulase-negative staphylococcal at [13, 14, 16–19]. In this cohort study, we sought to further any point prior to, on 1 day after, and within 7 days after ET assess and characterize the prevalence of ET use in our [29]. Necrotizing enterocolitis (NEC) included diagnosis of neonatal intensive care unit (NICU) population, as well as stage 2 or 3 by the Bell criteria [30]. Seizures were defined the safety of ET for treating hyperbilirubinemia. as documented by the provider. IVH, sepsis, NEC, and seizures were evaluated at any point prior to, on 1 day after, and within 7 days after ET. Respiratory support was col- Methods lected on the day of, 1 day after, and within 7 days after ET and included nasal cannula, continuous positive airway Study design pressure, and mechanical ventilation as documented by the provider. With the exception of laboratory abnormalities We conducted a retrospective cohort study of infants ≥ and sepsis, events were only reported after ET if they were 23 weeks of GA discharged from 1997 to 2016 from not present prior to ET. Laboratory abnormalities and Pediatrix Medical Group NICUs. For the ET population, we respiratory support were reported among infants who had included infants with hyperbilirubinemia who underwent evaluations (nonmissing data) within the time period of ET within 30 days of birth. Demographic, clinical, and interest. maternal data were extracted from a clinical data warehouse that prospectively captures data from electronic health Statistical analysis records, including daily progress notes and other doc- umentation generated by clinicians using a computer- We used descriptive statistics, including counts, percen- assisted tool [20]. The study was approved by the Duke tages, medians, and percentiles, to summarize demographic University Institutional Review Board as exempt research. characteristics and clinical data. Among the entire popula- tion of infants ≥ 23 weeks of GA, we determined the overall Variables of interest prevalence of ET in the setting of hyperbilirubinemia in the first 30 postnatal days by discharge year. Among the ET We defined ET as any infant who received ET. Known analysis population, clinical characteristics of interest partial volume ETs were excluded. Hyperbilirubinemia was included postnatal age at the time of ET and at discharge, defined as either (1) a documented diagnosis of hyperbi- the number of ETs, and receipt of IVIg prior to ET. We lirubinemia or (2) a serum bilirubin level >15 mg/dL for reported the presence of the above clinical and laboratory infants 38 weeks gestation and older, or >10 mg/dL in events of interest prior to and after ET. We reported the infants aged ≤37 weeks prior to or on the day of ET, without percentage of infants who died of any cause within 7 days evidence of an alternate diagnosis that may have justified a following ET and during hospitalization overall and by GA. requirement for ET [21, 22]. We also evaluated maximum We also reported the percentage of infants who experienced bilirubin levels for infants 1 day following ET and 7 days grade 3 or 4 IVH, sepsis, NEC, thrombocytopenia, hypo- after ET, and we noted the use of IVIg prior to ET. Small calcemia, hyperkalemia, and seizures within 7 days fol- for gestational age (SGA) status was defined based on the lowing ET by GA. We used multivariable logistic Olsen definition [23]. The number of ETs was evaluated as regression to examine the association between death before a percentage of total infants over time during the study discharge and GA, SGA status, and maximum total serum period. bilirubin. STATA 15.1 (College Station, TX) was used to Laboratory abnormalities evaluated 1 day prior to, 1 day perform statistical analyses. A p value of < 0.05 was con- after, and within 7 days after ET included: thrombocyto- sidered statistically significant. penia (platelets <100,000/µL [24, 25]), hypocalcemia (total serum calcium level < 7 mg/dL [26]), and hyperkalemia (potassium >7 mEq/L [27]). Our database did not allow us Results to distinguish timing of laboratory values, so we could not determine whether laboratory values on the day of ET Of a total 1,247,425 infants ≥ 23 weeks of GA from occurred before or after the ET. As a sensitivity analysis to 392 sites, 1252 (0.1%) underwent ET. Overall, the number 1508 M. F. Wolf et al. Table 1 Demographic characteristics of infants undergoing exchange transfusion. Characteristic N = 1252 (%) Gestational age (weeks) ≤29 159 (13) 30–34 272 (22) 35–37 338 (27) >37 483 (39) Birthweight (g) <1000 101 (8) 1000–1499 109 (9) Fig. 1 Percentage of infants undergoing ET over time. This figure 1500–2499 284 (23) displays the percentage of infants who have undergone ET from 1997 >2499 758 (61) to 2015. ET exchange transfusion. Male 687 (55) SGA 134 (11) of infants receiving ET decreased from a maximum of 0.3% Race/ethnicity to a minimum of 0.05% of all infants ≥ 23 weeks in our White 540 (45) study population over the course of the study period Black 263 (22) (Fig. 1). Among the infants who underwent ET, the median Hispanic 295 (25) (25th–75th percentile) GA and birthweight of infants Other 93 (8) receiving ET were 37 weeks (33–38 weeks) and 2789 g Inborn 856 (69) (1928–3275 g), respectively.
Load more

Recommended publications
  • Neonatal Orthopaedics
    NEONATAL ORTHOPAEDICS NEONATAL ORTHOPAEDICS Second Edition N De Mazumder MBBS MS Ex-Professor and Head Department of Orthopaedics Ramakrishna Mission Seva Pratishthan Vivekananda Institute of Medical Sciences Kolkata, West Bengal, India Visiting Surgeon Department of Orthopaedics Chittaranjan Sishu Sadan Kolkata, West Bengal, India Ex-President West Bengal Orthopaedic Association (A Chapter of Indian Orthopaedic Association) Kolkata, West Bengal, India Consultant Orthopaedic Surgeon Park Children’s Centre Kolkata, West Bengal, India Foreword AK Das ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD. New Delhi • London • Philadelphia • Panama (021)66485438 66485457 www.ketabpezeshki.com ® Jaypee Brothers Medical Publishers (P) Ltd. Headquarters Jaypee Brothers Medical Publishers (P) Ltd. 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd. Jaypee-Highlights Medical Publishers Inc. Jaypee Brothers Medical Publishers Ltd. 83, Victoria Street, London City of Knowledge, Bld. 237, Clayton The Bourse SW1H 0HW (UK) Panama City, Panama 111, South Independence Mall East Phone: +44-2031708910 Phone: +507-301-0496 Suite 835, Philadelphia, PA 19106, USA Fax: +02-03-0086180 Fax: +507-301-0499 Phone: +267-519-9789 Email: [email protected] Email: [email protected] Email: [email protected] Jaypee Brothers Medical Publishers (P) Ltd. Jaypee Brothers Medical Publishers (P) Ltd. 17/1-B, Babar Road, Block-B, Shaymali Shorakhute, Kathmandu Mohammadpur, Dhaka-1207 Nepal Bangladesh Phone: +00977-9841528578 Mobile: +08801912003485 Email: [email protected] Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2013, Jaypee Brothers Medical Publishers All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.
    [Show full text]
  • Necrotizing Enterocolitis in a Newborn Following Intravenous Immunoglobulin Treatment for Haemolytic Disease
    CASE REPORT Necrotizing Enterocolitis in a Newborn Following Intravenous Immunoglobulin Treatment for Haemolytic Disease Semra Kara1, Hulya Ulu-ozkan2, Yavuz Yilmaz2, Fatma Inci Arikan3, Ugur Dilmen4 and Yildiz Dallar Bilge3 ABSTRACT ABO iso-immunization is the most frequent haemolytic disease of the newborn. Treatment depends on the total serum bilirubin level, which may increase very rapidly in the first 48 hours of life in cases of haemolytic disease of the newborn. Phototherapy and, in severe cases, exchange transfusion are used to prevent hyperbilirubinaemic encephalopathy. Intravenous immunoglobulins (IVIG) are used to reduce exchange transfusion. Herein, we present a female newborn who was admitted to the NICU because of ABO immune haemolytic disease. After two courses of 1 g/kg of IVIG infusion, she developed necrotizing enterocolitis (NEC). Administration of IVIG to newborns with significant hyperbilirubinaemia due to ABO haemolytic disease should be cautiously administered and followed for complications. Key Words: Necrotizing enterocolitis. Hyperbilirubinaemia. Newborn. Intravenous immunoglobulins. Iso-immunization. INTRODUCTION important adverse reactions,6 one of which is described Blood group incompatibilities are most frequent and hereby. severe conditions causing hyperbilirubinaemia in the neonatal period.1 Phototherapy and in severe cases CASE REPORT exchange transfusion are used to prevent kernicterus A female newborn was admitted to our neonatal unit and reduce perinatal mortality. Exchange transfusion because of jaundice on the tenth hours after being born. is not free of severe complications such as thrombo- The baby was born by uncomplicated vaginal delivery to cytopenia, apnoea, pulmonary haemorrhage, haemodyna- a healthy 31-year-old mother who was fourth gravida mic instability, septicaemia and necrotizing enterocolitis and second para.
    [Show full text]
  • Delayed Cord Clamping in Red Blood Cell Alloimmunization: Safe, Effective, and Free?
    Editorial Delayed cord clamping in red blood cell alloimmunization: safe, effective, and free? Ryan M. McAdams Department of Pediatrics, University of Washington, Seattle, WA, USA Correspondence to: Ryan M. McAdams, MD, Associate Professor. Division of Neonatology, Department of Pediatrics, University of Washington, Box 356320, Seattle, WA 98195-6320, USA. Email: [email protected]. Abstract: Hemolytic disease of the newborn (HDN), an alloimmune disorder due to maternal and fetal blood type incompatibility, is associated with fetal and neonatal complications related to red blood cell (RBC) hemolysis. After delivery, without placental clearance, neonatal hyperbilirubinemia may develop from ongoing maternal antibody-mediated RBC hemolysis. In cases refractory to intensive phototherapy treatment, exchange transfusions (ET) may be performed to prevent central nervous system damage by reducing circulating bilirubin levels and to replace antibody-coated red blood cells with antigen-negative RBCs. The risks and costs of treating HDN are significant, but appear to be decreased by delayed umbilical cord clamping at birth, a strategy that promotes placental transfusion to the newborn. Compared to immediate cord clamping (ICC), safe and beneficial short-term outcomes have been demonstrated in preterm and term neonates receiving delayed cord clamping (DCC), a practice that may potentially be effective in cases RBC alloimmunization. Keywords: Red blood cell (RBC); delayed cord clamping (DCC); exchange transfusions (ET) Submitted Mar 29, 2016. Accepted for publication Apr 11, 2016. doi: 10.21037/tp.2016.04.02 View this article at: http://dx.doi.org/10.21037/tp.2016.04.02 Hemolytic disease of the newborn (HDN) is an alloimmune exchange transfusions (ET) may be performed to prevent disorder caused by transplacentally transmitted maternal kernicterus by reducing circulating bilirubin levels and immunoglobulin (Ig) G antibodies that bind to paternally to replace antibody-coated RBCs with antigen-negative inherited antigens present on fetal red blood cells RBCs.
    [Show full text]
  • JMSCR Vol||05||Issue||03||Page 19659-19665||March 2017
    JMSCR Vol||05||Issue||03||Page 19659-19665||March 2017 www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i3.210 Maternal and Neonatal Determinants of Neonatal Jaundice – A Case Control Study Authors Sudha Menon1, Nadia Amanullah2 1Additional Professor, Department of Obstetrics and Gynecology, Government Medical College Trivandrum, Kerala, South India 2Msc Nursing Student, Government Nursing College, Trivandrum Corresponding Author Dr Sudha Menon Email: [email protected] ABSTRACT Neonatal jaundice a common condition which affects about 60-80% of newborn and if severe can lead serious neurological sequelae. Determinants include neonatal and maternal factors. A prospective case control descriptive study in a tertiary care centre was done in 62 consecutive cases with neonatal jaundice and 124 consecutive newborns without jaundice served as controls. The major determinants for neonatal jaundice were low birth weight <2.5 kg (OR 24.54 95% CI 10.98 – 54.84 : P<0.0001), birth asphyxia (OR 16.5; 95% CI 4.63- 58.76, P<0.0001), Low APGAR score <7( OR 26.1; 95% CI 3.28- 207.47, P =0.0002), prematurity <37weeks ( OR 28.92 95% CI 12.15-68.82 P=0.0001) Preterm premature rupture of membranes (OR 58.57 95% CI 7.67 -449.87 P<0.0001) and malpresentation (OR 14.64 95% CI 3.16 - 67.792 tailed p =0.00004).The factors which evolved significant on logistic regression were Preterm premature rupture of membranes , gestational age <37 weeks , APGAR score below 7, Birth weight below 2500grams, Birth asphyxia and multiple pregnancy.
    [Show full text]
  • Newborn Metabolic Profile Associated with Hyperbilirubinemia with and Without Kernicterus
    Citation: Clin Transl Sci (2019) 12, 28–38; doi:10.1111/cts.12590 ARTICLE Newborn Metabolic Profile Associated with Hyperbilirubinemia With and Without Kernicterus Molly E. McCarthy1,2,*, Scott P. Oltman3, Rebecca J. Baer4,5, Kelli K. Ryckman6, Elizabeth E. Rogers7, Martina A. Steurer-Muller8, John S. Witte9 and Laura L. Jelliffe-Pawlowski10 Our objective was to assess the relationship between hyperbilirubinemia with and without kernicterus and metabolic profile at newborn screening. Included were 1,693,658 infants divided into a training or testing subset in a ratio of 3:1. Forty- two metabolites were analyzed using logistic regression (odds ratios (ORs), area under the receiver operating characteristic curve (AUC), 95% confidence intervals (CIs)). Several metabolite patterns remained consistent across gestational age groups for hyperbilirubinemia without kernicterus. Thyroid stimulating hormone (TSH) and C- 18:2 were decreased, whereas tyrosine and C- 3 were increased in infants across groupings. Increased C- 3 was also observed for kernicterus (OR: 3.17; 95% CI: 1.18–8.53). Thirty- one metabolites were associated with hyperbilirubinemia without kernicterus in the training set. Phenylalanine (OR: 1.91; 95% CI: 1.85–1.97), ornithine (OR: 0.76; 95% 0.74–0.77), and isoleucine + leucine (OR: 0.63; 95% CI: 0.61–0.65) were the most strongly associated. This study showed that newborn metabolic function is associated with hyper- bilirubinemia with and without kernicterus. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? ✔ A variety of neonatal and maternal characteristics are ✔ Forty-one infant metabolites collected at newborn known to be associated with increased risk of hyperbili- screening were shown to be associated with neonatal hy- rubinemia.
    [Show full text]
  • Hyperbilirubinemia and Kernicterus Jesus Peinado PGY2 Merle Ipson MD March 2009 Hyperbilirubinemia
    Hyperbilirubinemia and Kernicterus Jesus Peinado PGY2 Merle Ipson MD March 2009 Hyperbilirubinemia Most common clinical condition requiring evaluation and treatment in the NB Most common cause of readmission in the 1 st week Generally a benign transitional phenomenon May pose a direct threat of brain damage May evolve into kernicterus Kernicterus 1. Choreoathetoid cerebral palsy 2. High-frequency central neural hearing loss 3. Palsy of vertical gaze 4. Dental enamel hypoplasia (result of bilirubin-induced cell toxicity) Kernicterus Originally described in NB with Rh hemolytic disease Recently reported in healthy term and late preterm Reported in breast-fed infants w/out hemolysis Most prevalent risk factor is late preterm Late Preterm Infant Relatively immature in their capacity to handle unconjugated bilirubin Hyperbilirubinemia is more prevalent, pronounced and protracted Eightfold increased risk of developing TSB > 20 mg/dl (5.2%) compared to term (0.7%) Pathobiology Increased bilirubin load in the hepatocyte Decreased erythrocyte survival Increased erythrocyte volume Increased enterohepatic circulation Decreased hepatic uptake from plasma Defective bilirubin conjugation Bilirubin Metabolism Bilirubin Metabolism Bilirubin Metabolism How bilirubin Damages the Brain Determinants of neuronal injury by bilirubin 1. Concentration of unconjugated bilirubin 2. Free bilirubin 3. Concentration of serum albumin 4. Ability to bind UCB 5. Concentration of hydrogen ion 6. Neuronal susceptibility Intracellular Calcium Homeostasis
    [Show full text]
  • Histological Findings in the Kernicterus-Associated Vulnerable
    Palmela et al. Int J Pathol Clin Res 2015, 1:1 ISSN: 2469-5807 International Journal of Pathology and Clinical Research Research Article: Open Access Histological Findings in the Kernicterus-Associated Vulnerable Brain Regions are Linked to Neurodegeneration, Alterations in Astrocyte and Pericyte Distribution, and Vascular Modifications Inês Palmela1, Pedro Pereira2,3, Masaharu Hayashi4, Dora Brites1,5 and Maria A. Brito1,5* 1Research Institute for Medicines, Faculdade de Farmácia, Universidade de Lisboa, Portugal 2Laboratory of Neuropathology, Centro Hospitalar Lisboa Norte, Portugal 3Neuromuscular Unit, Institute of Molecular Medicine, Faculdade de Medicina, Universidade de Lisboa, Portugal 4Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Japan 5Department of Biochemistry and Human Biology, Faculdade de Farmácia, Universidade de Lisboa, Portugal *Corresponding author: Maria A. Brito, Medicines Research Institute (iMed. ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003 Lisbon, Portugal, Tel: 351217946449, Fax: 351217946491, E-mail: [email protected] Abstract Keywords Kernicterus is a severe manifestation of neonatal unconjugated Astrogliosis, Basement membrane, Blood-brain barrier, Caveolae, hyperbilirubinemia. We investigated the neuro-glia-vascular Hyperpermeability, Kernicterus, Pericyte vascular coverage, alterations in autopsy material from three infants with kernicterus. Transcytosis, Unconjugated bilirubin, Vascularization Histological and immunohistochemical studies were performed in the cerebellum, hippocampus and basal ganglia, the most vulnerable brain regions to bilirubin-induced neurotoxicity. The data obtained Introduction were compared with the relatively spared temporal cortex, as well as with three aged-matched controls with no hyperbilirubinaemia. Neonatal jaundice is extremely common in the first week of Our data showed a reduction of the external germinal layer life, affecting 60 to 85% of neonates [1].
    [Show full text]
  • Mortality Perinatal Subset, 2013
    ICD-10 Mortality Perinatal Subset (2013) Subset of alphabetical index to diseases and nature of injury for use with perinatal conditions (P00-P96) Conditions arising in the perinatal period Note - Conditions arising in the perinatal period, even though death or morbidity occurs later, should, as far as possible, be coded to chapter XVI, which takes precedence over chapters containing codes for diseases by their anatomical site. These exclude: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) Endocrine, nutritional and metabolic diseases (E00-E99) Injury, poisoning and certain other consequences of external causes (S00-T99) Neoplasms (C00-D48) Tetanus neonatorum (A33 2a) A -ablatio, ablation - - placentae (see alsoAbruptio placentae) - - - affecting fetus or newborn P02.1 2a -abnormal, abnormality, abnormalities - see also Anomaly - - alphafetoprotein - - - maternal, affecting fetus or newborn P00.8 - - amnion, amniotic fluid - - - affecting fetus or newborn P02.9 - - anticoagulation - - - newborn (transient) P61.6 - - cervix NEC, maternal (acquired) (congenital), in pregnancy or childbirth - - - causing obstructed labor - - - - affecting fetus or newborn P03.1 - - chorion - - - affecting fetus or newborn P02.9 - - coagulation - - - newborn, transient P61.6 - - fetus, fetal 1 ICD-10 Mortality Perinatal Subset (2013) - - - causing disproportion - - - - affecting fetus or newborn P03.1 - - forces of labor - - - affecting fetus or newborn P03.6 - - labor NEC - - - affecting fetus or newborn P03.6 - - membranes
    [Show full text]
  • Guideline for the Evaluation of Cholestatic Jaundice
    CLINICAL GUIDELINES Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition ÃRima Fawaz, yUlrich Baumann, zUdeme Ekong, §Bjo¨rn Fischler, jjNedim Hadzic, ôCara L. Mack, #Vale´rie A. McLin, ÃÃJean P. Molleston, yyEzequiel Neimark, zzVicky L. Ng, and §§Saul J. Karpen ABSTRACT Cholestatic jaundice in infancy affects approximately 1 in every 2500 term PREAMBLE infants and is infrequently recognized by primary providers in the setting of holestatic jaundice in infancy is an uncommon but poten- physiologic jaundice. Cholestatic jaundice is always pathologic and indicates tially serious problem that indicates hepatobiliary dysfunc- hepatobiliary dysfunction. Early detection by the primary care physician and tion.C Early detection of cholestatic jaundice by the primary care timely referrals to the pediatric gastroenterologist/hepatologist are important physician and timely, accurate diagnosis by the pediatric gastro- contributors to optimal treatment and prognosis. The most common causes of enterologist are important for successful treatment and an optimal cholestatic jaundice in the first months of life are biliary atresia (25%–40%) prognosis. The Cholestasis Guideline Committee consisted of 11 followed by an expanding list of monogenic disorders (25%), along with many members of 2 professional societies: the North American Society unknown or multifactorial (eg, parenteral nutrition-related) causes, each of for Gastroenterology, Hepatology and Nutrition, and the European which may have time-sensitive and distinct treatment plans. Thus, these Society for Gastroenterology, Hepatology and Nutrition. This guidelines can have an essential role for the evaluation of neonatal cholestasis committee has responded to a need in pediatrics and developed to optimize care.
    [Show full text]
  • C1 PAGE.Indd
    Neurology.org/N Child Neurology: A Case-Based Approach Cases from the Neurology® Resident & Fellow Section Child Neurology: A Case-Based Approach Cases from the Neurology® Resident & Fellow Section Editors John J. Millichap, MD Att ending Epileptologist Ann & Robert H. Lurie Children’s Hospital of Chicago Associate Professor of Pediatrics and Neurology Northwestern University Feinberg School of Medicine Chicago, IL Jonathan W. Mink, MD, PhD Frederick A. Horner, MD Endowed Professor in Pediatric Neurology Professor of Neurology, Neuroscience, and Pediatrics Chief, Division of Child Neurology Vice Chair, Department of Neurology University of Rochester Medical Center Rochester, NY Phillip L. Pearl, MD Director of Epilepsy and Clinical Neurophysiology William G. Lennox Chair, Boston Children’s Hospital Professor of Neurology Harvard Medical School Boston, MA Roy E. Strowd III, MEd, MD Assistant Professor Neurology and Oncology Wake Forest School of Medicine Winston Salem, NC © 2019 American Academy of Neurology. All rights reserved. All articles have been published in Neurology®. Opinions expressed by the authors are not necessarily those of the American Academy of Neurology, its affi liates, or of the Publisher. Th e American Academy of Neurology, its affi liates, and the Publisher disclaim any liability to any party for the accuracy, completeness, effi cacy, or availability of the material contained in this publication (including drug dosages) or for any damages arising out of the use or non-use of any of the material contained in this publication. TABLE OF CONTENTS Neurology.org/N Section 2. Pediatric stroke and cerebrovascular disorders 25 Introduction Robert Hurford, Laura L. Lehman, Behnam Sabayan, and Mitchell S.V.
    [Show full text]
  • AMERICAN ACADEMY of PEDIATRICS Management of Hyperbilirubinemia in the Newborn Infant 35 Or More Weeks of Gestation
    AMERICAN ACADEMY OF PEDIATRICS CLINICAL PRACTICE GUIDELINE Subcommittee on Hyperbilirubinemia Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation ABSTRACT. Jaundice occurs in most newborn infants. Hyperbilirubinemia”3 for a description of the meth- Most jaundice is benign, but because of the potential odology, questions addressed, and conclusions of toxicity of bilirubin, newborn infants must be monitored this report.) This guideline is intended for use by to identify those who might develop severe hyperbili- hospitals and pediatricians, neonatologists, family rubinemia and, in rare cases, acute bilirubin encephalop- physicians, physician assistants, and advanced prac- athy or kernicterus. The focus of this guideline is to tice nurses who treat newborn infants in the hospital reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy while minimizing the risks of and as outpatients. A list of frequently asked ques- unintended harm such as maternal anxiety, decreased tions and answers for parents is available in English breastfeeding, and unnecessary costs or treatment. Al- and Spanish at www.aap.org/family/jaundicefaq. though kernicterus should almost always be prevent- htm. able, cases continue to occur. These guidelines provide a framework for the prevention and management of DEFINITION OF RECOMMENDATIONS hyperbilirubinemia in newborn infants of 35 or more The evidence-based approach to guideline devel- weeks of gestation. In every infant, we recommend that clinicians 1) promote and support successful breastfeed- opment requires that the evidence in support of a ing; 2) perform a systematic assessment before discharge policy be identified, appraised, and summarized and for the risk of severe hyperbilirubinemia; 3) provide that an explicit link between evidence and recom- early and focused follow-up based on the risk assess- mendations be defined.
    [Show full text]
  • When Should We Start Phototherapy in Preterm Newborn Infants?
    256 Jornal de Pediatria - Vol. 80, Nº4, 2004 Redes multicêntricas e a qualidade da atenção neonatal Barros FC e Diaz-Rossello JL Referências 1. Joseph KS, Kramer MS, Marcoux S, Ohlsson A, Wen SW, 6. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. How Alexander A, et al. Determinants of preterm birth rates in many child deaths con we prevent this year? Lancet. 2003;362: Canada from 1981 through 1983 and from 1992 through 1994. 65-71. N Eng J Med. 1998;339:1434-9. 7. Matijasevich A, Barros FC, Forteza C, Diaz-Rossello JL. Atenção 2. Demissie K, Rhoads GG, Ananth CV, Alexander GR, Kramer MS, à saúde de crianças de muito baixo peso ao nascer de Montevidéu, Kogan MD, et al. Trends in preterm birth and neonatal mortality Uruguai: comparação entre os setores públicos e privado. J among blacks and whites in the United States from 1989 to Pediatr (Rio J). 2001;77:313-20. 1997. Am J Epidemiol. 2001;154:307-15. 8. Krauss Silva L, Pinheiro da Costa T, Reis AF, Iamada NO, 3. Bettiol H, Rona RJ, Chinn S, Goldani M, Barbieri MA. Factors Azevedo AP, Albuquerque CP. Avaliação da qualidade da associated with preterm births in Southeast Brazil: a comparison assistência hospitalar obstétrica: uso de corticóides no trabalho of two birth cohorts born 15 years apart. Paediat Perinat de parto prematuro. Cad Saúde Publica. 1999;15:817-29. Epidemiol. 2000;14:30-8. 9. Leone CR, Sadeck LSR, Vaz FC, Almeida MFB, Draque CM, 4. Horta BL, Barros FC, Halpern R, Victora CG.
    [Show full text]