Report about term infants with severe hyperbilirubinemia undergoing exchange transfusion in Southwestern China during an 11-year period, from 2001 to 2011

Yu, Canfeng; Hui-fan, LI; Zhang, Qiannan; He, Huayun; Chen, Xinhong; Zeng, Hua

doi:10.1371/journal.pone.0179550

Cited by 30 publications

(29 citation statements)

References 18 publications

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“…In our report, blood group incompatibility HDN is still the major cause of ETT (63/123) and ABO-HDN is the leading etiology (33.3%), followed by Rh-HDN. Results from an 11-year study with total 614 infants conducted in China [21] as well as an 8-year single-center experience in Turkey [23] showed the major identifiable cause of severe hyperbilirubinemia was ABO-HDN with the frequencies of 59.5% and 27.8%, respectively. In contrast, the retrospective research with 398 newborn infants from 1997 to 2013 in Serbia [24] found ABO and Rh-HDN were the most common causes of severe neonatal hyperbilirubinemia with the same frequency of 38.0%.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the East Asian race is one of the important risk factors for severe hyperbilirubinemia [19] and ETT is still an important clinical treatment of severe neonatal hyperbilirubinemia in mainland China [20,21], but there are relatively few studies on ETT in China. Therefore, in this study, our aim was to investigate the incidence of ETT in the treatment of severe neonatal hyperbilirubinemia in Wuhan.…”

Section: Introductionmentioning

confidence: 99%

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A single-center experience on exchange transfusion therapy in 123 full-term cases of severe neonatal hyperbilirubinemia in Wuhan

Duan

Gan

2020

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective: To describe the clinical experience in application of exchange transfusion therapy (ETT) in the treatment of severe neonatal hyperbilirubinemia. Methods: The clinical data and examination results of severe neonatal hyperbilirubinemia fullterm cases treated by ETT were analyzed retrospectively, the etiology and risk factors of severe neonatal hyperbilirubinemia were statistically analyzed, and the statistical characteristics of the children in each etiological group and the incidence of adverse events of ETT were analyzed. Results: The age of jaundice, peak total bilirubin after phototherapy and ETT in 123 full-term infants were 2.0 (1.0, 3.0) days, 4.0 (2.0, 7.0) days and 4.0 (2.0, 7.0) days, respectively, of which 68 were male and 55 were female. The main pathogeny of severe neonatal hyperbilirubinemia was blood group incompatibility hemolytic disease of newborn (HDN). Age of ETT, total bilirubin after ETT, gender and BAEP results were different between ABE and non-ABE infants. Weight loss can be used as a predictor of hospitalization length. The major adverse events related to ETT were hypocalcemia, hypomagnesemia, hyponatremia and thrombocytopenia. Conclusions: ETT can rapidly reduce the level of total bilirubin to prevent ABE and play an important role in the treatment of neonatal hyperbilirubinemia, but the whole process of ETT needs to be closely monitored.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A single-center experience on exchange transfusion therapy in 123 full-term cases of severe neonatal hyperbilirubinemia in Wuhan

Duan

Gan

2020

The Journal of Maternal-Fetal & Neonatal Medicine

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“…Although generally harmless, some extremely hyperbilirubinemic neonates may develop bilirubin-induced neurological dysfunction (BIND), including acute bilirubin encephalopathy and permanent neurological sequelae, kernicterus, characterized by cerebral palsy, impaired mental development, and neurological deafness [ 1 ]. Despite the dramatically reduced incidence of BIND worldwide, owing to phototherapy and exchange transfusion, this condition remains a severe problem in low-income and middle-income countries, where neonates do not receive timely and prompt intervention [ 2 – 4 ]. Apparently, understanding the mechanisms governing the neurotoxicity of unconjugated bilirubin (UCB) is essential for the development of new strategies of therapeutic intervention.…”

Section: Introductionmentioning

confidence: 99%

Unconjugated bilirubin induces pyroptosis in cultured rat cortical astrocytes

Feng

Qian

et al. 2018

J Neuroinflammation

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BackgroundBilirubin-induced neurological dysfunction (BIND), a severe complication of extreme neonatal hyperbilirubinemia, could develop into permanent neurodevelopmental impairments. Several studies have demonstrated that inflammation and nerve cell death play important roles in bilirubin-induced neurotoxicity; however, the underlying mechanism remains unidentified.MethodsThe present study was intended to investigate whether pyroptosis, a highly inflammatory form of programmed cell death, participated in the bilirubin-mediated toxicity on cultured rat cortical astrocytes. Further, VX-765, a potent and selective competitive drug, was used to inhibit the activation of caspase-1. The effects of VX-765 on astrocytes treated with bilirubin, including the cell viability, morphological changes of the cell membrane and nucleus, and the production of pro-inflammation cytokines, were observed.ResultsStimulation of the astrocytes with unconjugated bilirubin (UCB) at the conditions mimicking those of jaundiced newborns significantly increased the activation of caspase-1. Further, caspase-1 activation was inhibited by treatment with VX-765. Compared with UCB-treated astrocytes, the relative cell viability of VX-765-pretreated astrocytes was improved; meanwhile, the formation of plasma membrane pores was prevented, as measured by lactate dehydrogenase release, trypan blue staining, and ethidium bromide (EtBr) uptake. Moreover, DNA fragmentation was partly attenuated and the release of IL-1β and IL-18 was apparently decreased.ConclusionPyroptosis is involved in the process of UCB-induced rat cortical astrocytes’ injury in vitro and may be the missing link of cell death and inflammatory response exacerbating UCB-related neurotoxicity. More importantly, the depression of caspase-1 activation, the core link of pyroptosis, attenuated UCB-induced cellular dysfunction and cytokine release, which might shed light on a new therapeutic approach to BIND.

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“…Worldwide, an estimated 481,000 term infants suffer from severe hyperbilirubinemia annually [ 5 ]. At least 75% of these infants live in South East Asia, China, and sub-Saharan Africa [ 5 , 6 ]. A recent survey in Indonesia indicated that the incidence of severe hyperbilirubinemia, defined as a total serum bilirubin of more than 340 μmol/L (20 mg/dL), is 7%.…”

Section: Introductionmentioning

confidence: 99%

Adherence to hyperbilirubinemia guidelines by midwives, general practitioners, and pediatricians in Indonesia

et al. 2018

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Severe hyperbilirubinemia, which may result in kernicterus, is seen more frequently in low and middle-income countries, such as Indonesia, than in high-income countries. In Indonesia midwives, general practitioners (GPs), and pediatricians are involved in the care of jaundiced newborn infants. It is unknown whether the high incidence of severe hyperbilirubinemia in this country is related to a lack of awareness of existing hyperbilirubinemia guidelines issued by, for example, the World Health Organization, the American Academy of Pediatrics, or the Indonesian Health Ministry, or to a lack of adherence to such guidelines. The aim of this questionnaire study was to assess health professionals’ awareness of existing guidelines and their adherence to these guidelines in daily practice. We handed out a ten-question questionnaire to midwives, GPs, and pediatricians that included questions about the professionals themselves as well as clinical questions. The midwives completed 291 questionnaires, the GPs 206, and the pediatricians 154, all of which we used for our analysis. Almost 30% of the midwives and 23% of the GPs were either unaware of any existing guidelines or they did not adhere to them. Only 54% of the midwives recognized the warning signs of severe hyperbilirubinemia correctly, compared to 68% of the GPs and 89% of the pediatricians. Twenty-eight percent of the midwives and 31% of the GPs indicated that their first follow-up visit was after 72 hours, while 90% of them discharged infants after less than 48 hours after birth. The awareness of and adherence to guidelines for preventing and treating hyperbilirubinemia is low amongst the midwives and GPs in Indonesia. This may be an important contributing factor in the high incidence of severe hyperbilirubinemia in Indonesia.

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Report about term infants with severe hyperbilirubinemia undergoing exchange transfusion in Southwestern China during an 11-year period, from 2001 to 2011

Cited by 30 publications

References 18 publications

A single-center experience on exchange transfusion therapy in 123 full-term cases of severe neonatal hyperbilirubinemia in Wuhan

A single-center experience on exchange transfusion therapy in 123 full-term cases of severe neonatal hyperbilirubinemia in Wuhan

Unconjugated bilirubin induces pyroptosis in cultured rat cortical astrocytes

Adherence to hyperbilirubinemia guidelines by midwives, general practitioners, and pediatricians in Indonesia

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