The use of early phototherapy treatment for babies weighing less than 2,000 g is safer when compared to the late group, considering satisfactory the maintenance of transcutaneous bilirubin levels below 10 mg/dl.

Objective: To identify clinical and genetic risk factors for moderate hyperbilirubinemia during the first week of life.Study Design: Using univariate and multivariate multiple regression analyses, the RR for clinical factors, the African variant of glucose-6-phosphate dehydrogenase (G6PD) deficiency (G202A/A376G), and (TA) n UGT1A1 polymorphisms were established in a cohort of 608 Brazilian newborn infants. Hyperbilirubinemia was monitored until 134.5±49.8 h of life (IQR, 111.0 to 156.7). The dependent variable was total bilirubinemia (TB)X12.9 mg per 100 ml estimated by transcutaneous or plasma bilirubin measurements.Result: The African variant of G6PD deficiency and (TA) 7 /(TA) 7 and (TA) 7 /(TA) 8 polymorphisms present in 6.1 and 12.0% of newborns, respectively, were not risk factors for moderate hyperbilirubinemia. Coexpression of G6DP deficiency and UGT1A1 polymorphisms occurred in 0.49% of the subjects. Independent clinical predictors for TBX12.9 mg per 100 ml were gestational age <38 weeks and reference curve percentiles >P40th. Conclusion:In this study, G6PD deficiency and UGT1A1 gene promoter polymorphisms were not risk factors for moderate hyperbilirubinemia. Genetic factors may vary considerably in importance among different populations.

Our results suggest that the regime adopted is effective for detecting and preventing hyperbilirubinemia at risk of causing bilirubin-induced encephalopathy in term and near term newborn infants.

ResumoObjetivos: Comparar dosagens transcutâneas de bilirrubina pelo Bilicheck com a dosagem plasmática capilar pelo bilirrubinômetro Unistat (Leica). Métodos: Foram realizadas 200 dosagens concomitantes(transcutânea e plasmática), calculadas a correlação e concordância entre elas e feita avaliação da influência do peso de nascimento, raça, idade gestacional, idade pós-natal e uso de fototerapia. Resultados AbstractObjectives: To compare transcutaneous bilirubin measurements made using Bilicheck equipment with assays of capillary plasma using the Unistat bilirubinometer (Leica). Methods:Two hundred concomitant assays were performed (transcutaneous and in plasma), and the correlation and level of agreement between them was calculated. An assessment was also made of the influence of birth weight, skin color, gestational age, postnatal age and phototherapy. Results:The linear correlation coefficient was 0.92, and the mean difference between assays was 0.72 (±1.57) mg/dL, with a 95% confidence interval from -2.42 to +3.86. The best of a series of ROC curves demonstrated that transcutaneous assays at 14 mg/dL offer the best sensitivity (88.2%) and specificity (97.8%), with a positive predictive value of 78.9%, negative predictive value of 98.9 and are below the curve of 0.98. Conclusions:Assays performed using Bilicheck can be substituted for capillary plasma assays up to 14 mg/dL. Above this level the device should only be used for screening for patients whose bilirubin should be assayed in blood.J Pediatr (Rio J). 2007;83(3):283-286: Bilirubin, hyperbilirubinemia, jaundice, newborn, transcutaneous bilirubin measurement.

Objective: to propose a method to evaluate and maintain the efficiency of equipment commonly used in Brazil in order to obtain uniform results in phototherapy treatments in different services.Material and methods: the radiometer/photometer used to measure spectral irradiance is locally manufactured and fulfills basic requirements. Measure standardization seeks to be applicable and reproducible to phototherapy devices employed in Brazil. The material necessary for measurements can be easily assembled by the neonatology staff, except for the radiometer. We searched Medline for papers relevant to this review published throughout the last 10 years.Results: irradiance in phototherapy issues should be referred to as "medium spectral irradiance". We describe how to obtain medium spectral irradiance using fluorescent and halogen phototherapies.Comments: the components of a radiometer/photometer are described. This knowledge is fundamental to understanding sensibility variations and to justifying differences in irradiance when ranges of radiometer recording are a little different. The standardization of this device will certainly simplify the comparison between results in different services.We also analyzed characteristics of different equipment used in phototherapy that might interfere with their irradiance.J Pediatr (Rio J) 2001; 77 (2): 67-74: phototherapy, radiometry, equipment. ResumoObjetivo: propor método de avaliação e manutenção da eficiên-cia dos equipamentos mais comumente usados em nosso meio, de maneira a uniformizar os resultados obtidos em tratamentos fototerápicos por diferentes serviços.Material e métodos: o radiômetro/fotômetro utilizado na medida da irradiância espectral é de fabricação nacional e atende aos requisitos básicos indispensáveis. As padronizações de medida procuram ser facilmente aplicáveis e reprodutíveis aos aparelhos de fototerapia em uso no país. O material necessário às aferições, excetuando-se o radiômetro, pode ser facilmente confeccionado em qualquer serviço de neonatologia. Procuramos nos trabalhos publicados nos últimos 10 anos no Medline os pertinentes a esta revisão.Resultado: propõe-se que a irradiância relatada nos trabalhos de fototerapia seja fornecida como Irradiância Espectral Média e descreve-se como obtê-la, tanto em fototerapias com fontes fluorescentes como halógenas.Comentários: são descritos os componentes dos radiômetros/ fotômetros, cuja compreensão é importante para que possamos perceber variações na sensibilidade e diferenças significativas na irradância quando as faixas de leitura dos radiômetros são um pouco diferentes. A adoção de um tipo de equipamento padrão facilitaria muito a comparação de resultados obtidos por diferentes serviços. São ainda comentadas as características de diferentes equipamentos de fototerapia que podem interferir na mensuração da irradiância dos mesmos.J Pediatr (Rio J) 2001; 77 (2): 67-74: fototerapia, radiometria, equipamento. Proposta de padronização para aferição de equipamentos de fototerapia Standardizing the calibration...

ResumoObjetivo: O tétano neonatal é uma infecção com alta mortalidade, constituindo-se um problema em países subdesenvolvidos, onde há deficiente assistência pré-natal. A despeito desse fato e da decrescente incidência da doença no estado do Rio Grande do Sul, relata-se um caso de tétano neonatal ocorrido em 1997.Métodos: Entrevista da mãe e verificação de seu estado vacinal, exame clínico do recém-nascido, exame cultural de coto umbilical e revisão do prontuário médico. Revisão da literatura e verificação do perfil epidemiológico do tétano neonatal no Rio Grande do Sul.Resultados: Mãe saudável, com esquema completo de vacina antitetânica há 4 anos, pré-natal sem intercorrências e parto hospitalar. Família de bom nível socioeconômico, diferenciando-se dos demais casos notificados no Estado, em que a maioria não teve acompanhamento pré-natal nem parto hospitalar. O paciente é um menino que no 24º dia de vida iniciou com febre, crises de cianose, hipertonia dos membros superiores e inferiores e opistótono. Crescimento de Clostridium tetani ao exame cultural de secreção do coto umbilical. Tratado com penicilina G, gentamicina, sedação e antitoxina tetânica. Alta em boas condições.Conclusões: A deficiente assistência pré-natal em países subdesenvolvidos é o maior fator de risco para a elevada incidência da doença nestas regiões. Contudo, em gestantes com bom nível socioconômico e acompanhamento pré-natal, como ocorre no caso descrito, o diagnóstico não deve ser excluído diante da constatação de sinais sugestivos. AbstractObjective: Neonatal tetanus is an infection with high mortality, constituting a problem in underdeveloped countries, where there is faulty prenatal attendance. In spite of this and of the decreasing incidence of the disease in the state of Rio Grande do Sul, we report a case of neonatal tetanus identified in 1997.Method: We interviewed the infant's mother and verified her vaccination history. We conducted a clinical examination of the newborn, anaerobic culture of umbilical stump and review of medical records. We also reviewed the literature and verified the epidemic profile of neonatal tetanus in Rio Grande do Sul.Results: Healthy mother, with complete outline of tetanus vaccination 4 years ago, prenatal uncomplicated and hospital delivery. Family of good socioeconomic level, differing from the other cases notified in the State, in that most did not have prenatal care nor hospital delivery. The patient is a boy. In the 24 th day of life he presented fever, cyanosis, lower and upper limbs muscle hypertonia and opisthotonos episodes. An anaerobic culture of the umbilical stump grew Clostridium tetani. He was treated with penicillin G, gentamicin, sedation and tetanus immunoglobulin. He left hospital in good conditions.Conclusions: Faulty prenatal care in underdeveloped countries is the largest risk factor for high incidence of this disease in these areas. However, in pregnant women with good socioeconomic level and prenatal care, as in the case described here, this diagnosis should not be excluded i...

Objectives: To determine the outcomes of an intervention for follow-up of bilirubinemia in the first week of life in a cohort of newborn infants with gestational ages between 35 0/7 and 37 6/7 weeks and to determine risk factors for readmission for phototherapy (total bilirubin > 18 mg/dL). Methods:Retrospective cohort study carried out at a public teaching hospital. Neonates underwent periodic monitoring of total bilirubin levels (measured in plasma or by transcutaneous device) before and after discharge to assess the need for phototherapy. A systematic approach, based on risk percentiles of a bilirubin reference curve, was employed. Results:The study sample comprised 392 neonates. Only one outpatient visit was required in 61.7% of newborns. Peak total bilirubin was ≥ 20 mg/dL in 34 neonates (8.7%), and reached 25-30 mg/dL in three (0.8%). Phototherapy was indicated after discharge in 74 neonates (18.9%). Weight loss between birth and first follow-up visit and total bilirubin above the 40th percentile at discharge were risk factors for requiring phototherapy. Total bilirubin above the 95th percentile at discharge was associated with greater risk of readmission ). Weight loss between discharge and first follow-up visit was the sole independent clinical predictor (RR = 1.16 [1.04-1.17]). Conclusion:Systematic follow-up during the first week of life was effective in preventing dangerous hyperbilirubinemia. Encouraging breastfeeding and discharging neonates only after weight loss has been stabilized may prevent readmission due to hyperbilirubinemia.J Pediatr (Rio J). 2011;87(4):301-306: Hyperbilirubinemia, jaundice, premature infant, newborn infant. ResumoObjetivos: Identificar os resultados do acompanhamento da bilirrubinemia na primeira semana de vida em uma coorte de recém-nascidos (RNs) de 35 0/7 a 37 6/7 semanas de idade gestacional e estabelecer fatores de risco para reinternação para fototerapia pós-alta hospitalar (bilirrubinemia total > 18 mg/dL). Métodos:Estudo de coorte retrospectivo em hospital público universitário. Os recém-nascidos tiveram acompanhamento da bilirrubina total plasmática ou transcutânea pré-e pós-alta da enfermaria de alojamento conjunto para avaliação da necessidade de fototerapia. Foi empregada uma abordagem sistematizada, utilizando-se os percentis de risco de uma curva de referência. Conclusão:A abordagem sistematizada da bilirrubinemia na 1ª semana foi efetiva na prevenção de hiperbilirrubinemias perigosas. O suporte à amamentação e a alta hospitalar após a estabilização da perda de peso podem ser medidas preventivas da reinternação por hiperbilirrubinemia.J Pediatr (Rio J). 2011;87(4) IntroduçãoOs recém-nascidos (RNs) prematuros apresentam maior risco de reinternação por hiperbilirrubinemia durante a 1ª semana de vida, em comparação aos RNs a termo 1,2 . A hiperbilirrubinemia nessas crianças é mais prevalente e intensa, podendo acarretar consequências graves devido à neurotoxicidade que ocorre em menor tempo de vida em

Objective: To evaluate the use of two phototherapy guidelines for the treatment of hyperbilirubinemia in newborn babies weighing less than 2,000 g. Methods:Eighty-one newborn infants with birth weight less than 2,000 g were studied. They were divided in two groups: the early group, which started phototherapy 12 hours after birth, undergoing treatment for at least 96 hours; and the late group, which received phototherapy whenever the transcutaneous bilirubin reached 8 mg/dl and phototherapy suspended when bilirrubin levels fell to 5 mg/dl. The following factors were analyzed: maintenance of transcutaneous bilirubin levels below 10 mg/dl, mean value of daily transcutaneous bilirubin, the highest transcutaneous bilirubin value and the period it first occurred, and duration of treatment.Results: In the early group, 20% of all patients showed transcutaneous bilirubin level higher than 10 mg/dl compared to 60% of patients in the late group. The highest daily mean rate of transcutaneous bilirubin in the early group was 6.6 mg/dl, which happened on the 7th day. In the late group, it was 8.6 mg/dl on the 2nd day after birth. The median duration of phototherapy treatment used in the early group was 96 hours (minimum of 96 and maximum of 156 hours) and in the late group, 51 hours (minimum of zero and maximum of 120 hours). None of the babies needed changes in the treatment (double phototherapy or exchange transfusion). Conclusion:The use of early phototherapy treatment for babies weighing less than 2,000 g is safer when compared to the late group, considering satisfactory the maintenance of transcutaneous bilirubin levels below 10 mg/dl.