Identification of risk for neonatal haemolysis

Bhutani, Vinod K.; Maisels, M. Jeffrey; Schutzman, David L.; Cuadrado, Martin E. Castillo; Aby, Janelle; Bogen, Debra L.; Christensen, Robert D.; Watchko, Jon F.; Wong, Ronald J.; Stevenson, David K.

doi:10.1111/apa.14316

Cited by 28 publications

(12 citation statements)

References 20 publications

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“…Because of this stoichiometry, the rate of CO production (or excretion) as measured as COHb (680,681), total body CO excretion (VeCO) (626), or end-tidal breath CO (ETCO) (617) can serve as an index of the rate of bilirubin production. Several studies have shown that COHb and ETCO, when corrected for inhaled CO, and VeCO levels correlate well in preterm and term neonates and have been used to identify those infants with increased rates of bilirubin production, particularly those undergoing hemolysis (77,627). In the first week of life or 'transitional period', bilirubin production rates in newborns are increased due to a high turnover of RBCs (629,682).…”

Section: A Heme Catabolism and Its Regulationmentioning

confidence: 99%

“…Bilirubin production decreases; whereas bilirubin elimination increases as a function of postnatal age in days. Thus, a deviation in this normal pattern of transitional hyperbilirubinemia reflects the likelihood of developing significant hyperbilirubinemia as defined by the Bhutani hour-specific bilirubin nomogram (TSB > 95 th percentile prior to age days) (76,77). By using this nomogram, an infant's hour-specific TSB level can be categorized into defined risk zones (low, lowintermediate, high-intermediate, or high) based on percentiles in order to guide interventions and follow-up.…”

Section: B the Effect Of Hemolysismentioning

confidence: 99%

“…Most therapeutic guidelines recommend more aggressive management of severe hemolytic NNJ, as hemolysis is believed to increase the risk for bilirubin neurotoxicity (20,77,79,358,360). (77,79) G6PD deficiency has been a risk factor in cases of kernicterus reported in recent years (359).…”

Section: Hemolysismentioning

confidence: 99%

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Molecular Physiology and Pathophysiology of Bilirubin Handling by the Blood, Liver, Intestine, and Brain in the Newborn

Hansen

Wong

Stevenson

2020

Physiological Reviews

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Bilirubin is the end product of heme catabolism formed during a process that involves oxidation-reduction reactions and conserves iron body stores. Unconjugated hyperbilirubinemia is common in newborn infants, but rare later in life. The basic physiology of bilirubin metabolism, such as production, transport, and excretion, has been well described. However, in the neonate, numerous variables related to nutrition, ethnicity, and genetic variants at several metabolic steps may be superimposed on the normal physiological hyperbilirubinemia that occurs in the first week of life and results in bilirubin levels that may be toxic to the brain. Bilirubin exists in several isomeric forms that differ in their polarities and is considered a physiologically important antioxidant. Here we review the chemistry of the bilirubin molecule and its metabolism in the body with a particular focus on the processes that impact the newborn infant, and how differences relative to older children and adults contribute to the risk of developing both acute and long-term neurological sequelae in the newborn infant. The final section deals with the interplay between the brain and bilirubin and its entry, clearance, and accumulation. We conclude with a discussion of the current state of knowledge regarding the mechanism(s) of bilirubin neurotoxicity.

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Section: A Heme Catabolism and Its Regulationmentioning

confidence: 99%

Section: B the Effect Of Hemolysismentioning

confidence: 99%

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Molecular Physiology and Pathophysiology of Bilirubin Handling by the Blood, Liver, Intestine, and Brain in the Newborn

Hansen

Wong

Stevenson

2020

Physiological Reviews

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“…FDA-approved point-of-care noninvasive monitors can quantify the end-tidal CO of neonates. Our recent work, and that of others, has shown that measuring ET-COc during newborn hospitalization can identify hemolysis [19][20][21]. In our new management program, we will obtain an ETCOc on all neonates who meet the phototherapy initiation criteria.…”

Section: Etcoc Measurement For Those Receiving Phototherapy To Determmentioning

confidence: 99%

Improving the Bilirubin Management Program in the Newborn Nursery: Background, Aims, and Protocol

et al. 2020

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Background: Practices to detect and manage hyperbilirubinemia in newborn nurseries are highly variable. American Academy of Pediatrics guidelines in 1999, 2004, and 2009 have generated, perhaps unintentionally, divergent practices that might not all be of equivalent value. Evidence-based progress is needed to define less invasive, less expensive, uniform, and safe methods to reduce ER visits and hospital readmissions for jaundice treatment and bilirubin encephalopathy. Objectives: This research briefing is intended to inform readers of a new prospective quality improvement program aimed at testing the value of specific changes in newborn nursery hyperbilirubinemia detection and management. This new program includes predetermined means of assessing those specific changes, which relate to diagnosis, safety, outcomes, and cost. Methods: In this briefing, we present the perceived problems in our present bilirubin management system, as voiced by stakeholders. We report our proposed means to test minimization of those problems utilizing already acquired data on approximately 400,000 well babies in the Intermountain Healthcare system of hospitals in the western USA. We then describe our methods of assessing specific outcomes in a pre-versus postpractice change analysis. Results and Conclusions: The University of Utah Newborn Nursery will implement a quality improvement project in bilirubin management during 2020 to test the feasibility and effectiveness of several changes to our current bilirubin management program. We maintain that the improved understanding generated by this project will be a step toward new evidence-based strategies for reducing ER visits and hospital readmissions for jaundice treatment and preventing bilirubin encephalopathy.

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“…La medición de la BTc se ha utilizado asociada con la Bs junto con la medición del monóxido de carbono al final de la respiración (ETCO, por sus siglas en inglés), permitió identificar a los pacientes con (12) hemolisis en forma precoz .…”

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Bilirrubinometro transcutáneo: una herramienta necesaria como screening de la hiperbilirrubinemia severa en neonatos antes del alta hospitalaria

Mesquita¹

2019

Pediatr (Asunción).

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Identification of risk for neonatal haemolysis

Abstract: The combined use of TB/TcB percentile risk assessments and ETCOc measurements can identify infants with haemolytic hyperbilirubinaemia. The addition of TB ROR can identify those infants with elimination disorders.

Cited by 28 publications

References 20 publications

Molecular Physiology and Pathophysiology of Bilirubin Handling by the Blood, Liver, Intestine, and Brain in the Newborn

Molecular Physiology and Pathophysiology of Bilirubin Handling by the Blood, Liver, Intestine, and Brain in the Newborn

Improving the Bilirubin Management Program in the Newborn Nursery: Background, Aims, and Protocol

Bilirrubinometro transcutáneo: una herramienta necesaria como screening de la hiperbilirrubinemia severa en neonatos antes del alta hospitalaria

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