早期光疗对早产儿黄疸的影响

目的：探讨在经皮胆红素监测下早期蓝光干预对早产儿高胆红素血症的防治作用。方法：选择2009年10月-2011年10月我院新生儿科收治的86例出生体重≤2000g,无出生窒息史的早产儿,按住院号单双号分为观察组46例和对照组40例。对照组按照我国2000年制定的新生儿黄疸干预推荐方案的干预标准进行光疗。观察组于出现黄疸和／或经皮胆红素〉85．50μmol／L,但尚未达方案的干预标准就进行光疗,监测经皮胆红素至黄痘消失。经皮胆红素值达187．5μmol／L以上时同时查静脉血监测血清总胆红素。比较2组早产儿经皮胆红素峰值及恢复正常时间。结果：观察组与对照组比较经皮胆红素峰值较低,黄疸持续时间较短,两组比较P均〈0．05,有统计学差异。结论：早产儿在经皮胆红素监测下进行早期蓝光干预有利于降低早产儿胆红素峰值,缩短黄疸持续时间。有效预防早产儿胆红素脑病。     

Heliotherapy for Neonatal Hyperbilirubinemia in Southwest,Nigeria: A Baseline Pre-Intervention Study

Background

A novel filtered-sunlight phototherapy (FSPT) device has been demonstrated to be safe and efficacious for treating infants with neonatal jaundice in resource-constrained tropical settings. We set out to provide baseline data for evaluating the clinical impact of this device in a referral pediatric hospital.

Methods

We reviewed the medical records of infants admitted for neonatal hyperbilirubinemia in an inner-city Children’s Hospital in Lagos, between January 2012 and December 2014 to determine the pattern, treatment and outcomes during the pre-intervention period. Factors associated with adverse outcomes were identified through multivariable logistic regression.

Results

Of the 5,229 neonatal admissions over the period, a total of 1,153 (22.1%) were admitted for neonatal hyperbilirubinemia. Complete records for 1,118 infants were available for analysis. The incidence of acute bilirubin encephalopathy (ABE) and exchange transfusion (ET) were 17.0% (95% CI: 14.9%–19.3%) and 31.5% (95% CI: 28.8%–34.3%) respectively. A total of 61 (5.5%, 95% CI: 4.3%–6.9%) of the jaundiced infants died. Weight on admission, peak total serum bilirubin (TSB), sepsis and exposure to hemolytic products were predictive of ABE, while age on admission, peak TSB, ABO incompatibility and ABE were predictive of ET. Rhesus incompatibility, asphyxia, exposure to hemolytic substances and ABE were associated with elevated mortality risk, while ET was a protective factor. Lack of routine irradiance monitoring and steady energy supply were frequent challenges for conventional blue-light phototherapy.

Conclusions

Severe hyperbilirubinemia is associated with high rates of ABE and ET in this setting, and remains a significant contributor to neonatal admissions and mortality. To be impactful, FSPT, complemented with improved diagnostic facilities, should effectively curtail jaundice-related adverse outcomes in this and comparable settings.     

Bilirubin and oxidative stress in term and preterm infants

Hyperbilirubinemia is the most frequent clinical problem neonatologists must deal with during the newborn period. It has been suggested that bilirubin is involved in the balance between antioxidant and pro-oxidant agents due to its antioxidant properties. However, the relevance of these effects in vivo in term and preterm infants is still debated. We performed a literature review of studies that investigated the association between total serum bilirubin (TSB) and oxidative stress in newborn infants. We found that studies in term infants give contradictory results, while studies in preterm infants suggest that the TSB increase is associated with an oxidative stress increase due to concurrent factors other than bilirubin level, such as heme oxygenase (HO) activity. Moreover, it could be speculated that low physiologic TSB values are associated with antioxidant effects, while high pathologic TSB values are associated with pro-oxidant effects. Literature data do not allow the establishment of whether if the antioxidant properties of bilirubin are important from a clinical point of view and can affect the outcome in ill infants.     

Early predictive value of cord blood bilirubin and dynamic monitoring of transcutaneous bilirubin for hyperbilirubinemia of newborns

ObjectiveTo study the early predictive value of cord blood bilirubin and dynamic monitoring of transcutaneous bilirubin for hyperbilirubinemia of newborns.Methods389 newborns delivered from June 2014 to December 2015 were enrolled as the research subjects; detailed records were made about the general data of newborns and mothers, and after cord blood bilirubin being graded, the incidence of hyperbilirubinemia was counted, and the prediction efficiency of cord blood bilirubin was analyzed by receiver operator characteristic (ROC) curve. At the same time, the transcutaneous bilirubin was detected continuously when the neonate was born and 24 h, 48 h and 72 h after birth, and the relativity between transcutaneous bilirubin at 72 h and serum bilirubin was analyzed.ResultsNo significant difference was found in the hyperbilirubinemia group and the non-hyperbilirubinemia group concerning general data of the newborns and their mothers. With the concentration of cord blood bilirubin increased, the incidence of hyperbilirubinemia also increased; separate prediction of hyperbilirubinemia by cord blood bilirubin showed a sensitivity and specificity of 71.4% and 65.6% respectively, and they need further dynamic monitoring. The daily mean of transcutaneous bilirubin in hyperbilirubinemia group was significantly higher than that in non-hyperbilirubinemia group at 24 h, 48 h and 72 h, and the measurement value of transcutaneous bilirubin at 72 h had a high correlation with serum bilirubin. When transcutaneous bilirubin value is higher than 18, the incidence of hyperbilirubinemia should be considered.ConclusionsThe increase of cord blood bilirubin effectively predict the occurrence of neonatal hyperbilirubinemia. There is a good correlation between levels of transcutaneous bilirubin and serum bilirubin. Moreover, combined detection of transcutaneous bilirubin and cord blood bilirubin can significantly improve the prediction accuracy of hyperbilirubinemia.     

血清NSE在金双歧、茵栀黄及蓝光照射治疗高胆红素血症新生儿脑损伤前后的临床意义

目的 分析血清神经元特异性烯醇化酶（NSE）含量在金双歧、茵栀黄及蓝光照射治疗前后高胆红素血症新生儿脑损伤的关系。方法 对130例高胆红素血症新生儿在治疗前及治疗后分别采用酶联免疫法测定血清NSE,同时行新生儿神经行为测定（NBNA）评分及急性胆红素脑病（ABE）的胆红素致神经功能障碍（BIND）评分,按血清总胆红素（TBIL）严重程度分为试验组和对照组,试验组包括：轻度升高组（A组）：205.2 μmol/L＜TBIL≤256.5 μmol/L;中度升高组（B组）：256.5 μmol/L＜TBIL≤342.0 μmol/L;重度升高组（C组）：TBIL＞342.0 μmol/L。对照组：金双歧、茵栀黄及蓝光照射治疗后的患儿TBIL＜91.9~171.0 μmol/L。比较各组高胆红素血症新生儿治疗前后血清NSE、NBNA评分及BIND评分,并对血清NSE与NBNA评分及BIND评分进行相关性分析。结果 各组高胆红素血症新生儿血清NSE、NBNA评分及BIND评分治疗前后差异均具有统计学意义（Ps<0.05）。血清NSE与NBNA评分呈负相关（r=-0.869,P<0.01）;血清NSE与BIND评分呈正相关（r=0.577,P<0.01）。结论 血清NSE水平变化可作为高胆红素血症新生儿脑损伤的检测指标。     

Body build structure of neonates

The paper presents anthropometric data on 292 healthy neonates delivered of normal births at the Women's Hospital of Tartu University (150 boys and 142 girls). The parameters of the neonates' physical development measured included height, weight, sitting height, length of sternum and abdomen, shoulder width, upper and lower width and depth of thorax, width and depth of abdomen, D. cristarum, D. trochanterica, pelvic depth, 12 circumferences, foot length and two skinfolds (on abdomen and back). The mean weight of a neonate was 3620.5 g±448.7 g (minimum 2400 g and maximum 4854 g). Boys were somewhat heavier than girls (3684.7 g and 3551.3 g respectively). The average height of the infants was 49.9 cm±1.9 cm (minimum 44 cm and maximum 54.5 cm). Correlation analysis of the characteristics showed that body structure is a system of wellcorrelated anthropometric measurements where the leading role belongs to height and weight. The changes in the relation between height and weight (height-weight classification in 3×3SD classes) cause systemic changes in other measurements. Therefore, in further micropaediatric and clinical research, the height-weight classification could be used as the primary model of the body as a whole.     

Carbon monoxide excretion as an index of bilirubin production in rhesus monkeys

The role of increased heme catabolism in neonatal hyperbilirubinemia was investigated in rhesus (Macaca mulatta) neonates through the measurement of carbon monoxide excretion rates (VECO), blood carboxyhemoglobin content (HbCO), and plasma bilirubin concentrations. Neonatal values were compared to those of adult rhesus monkeys. These indices of bilirubin production responded appropriately to administration of NEM-damaged erythrocytes and tin protoporphyrin. Our results indicate that VECO measurements are a valid index of changes in bilirubin production in the newborn rhesus monkey.     

新生儿高胆红素血症与先天性巨细胞病毒感染的相关性研究

目的:探讨新生儿高胆红素血症与巨细胞病毒(HCMV)感染的相关性及临床意义。方法:对170例疑为高胆红素血症新生儿血清标本分别检测HCMV的IgG和IgM及血清总胆红素(TBIL)。排除高胆红素血症新生儿血清标本100例为正常对照。结果:高胆红素血症患者血清HCMV-IgG、IgM阳性率高于正常对照组,两者比较有统计学意义。结论:巨细胞病毒感染与新生儿高胆红素血症相关性大,是引起高胆红素血症的主要病原之一。     

Photodegradation of riboflavin in neonates

The biologically most important flavins are riboflavin and its related nucleotides, all highly sensitive to light. It is because of its photoreactivity and its presence in almost all body fluids and tissues that riboflavin assumes importance in phototherapy of neonatal jaundice. The absorption maxima of both bilirubin and riboflavin in the body are nearly identical: 445-450 (447) nm. In consequence, blue visible light will cause photoisomerization of bilirubin accompanied by photodegradation of riboflavin. This results in diminished erythrocyte glutathione reductase, which indicates generalized tissue riboflavin deficiency and red cell lysis. Single- and double-strand breaks in intracellular DNA have occurred with phototherapy. This light exposure of neonates may result also in alterations of bilirubin-albumin binding in the presence of both riboflavin and theophylline (the latter frequently given to prevent neonatal apnea). Many newborns, especially if premature, have low stores of riboflavin at birth. The absorptive capacity of premature infants for enteral riboflavin is likewise reduced. Consequently, inherently low stores and low intake of riboflavin plus phototherapy for neonatal jaundice will cause a deficiency of riboflavin at a critical period for the newborn. Supplementation to those infants most likely to develop riboflavin deficiency is useful, but dosage, time, and mode of administration to infants undergoing phototherapy must be carefully adjusted to avoid unwanted side effects.     

Effect of phototherapy on oxidant/antioxidant status: a randomized controlled trial

In order to evaluate the effect of different types of phototherapy on oxidant/antioxidant status in hyperbilirubinemic neonates, an interventional randomized control trial was conducted on 120 neonates ≥35 weeks’ gestational age with indirect hyperbilirubinemia reaching phototherapy level. This study is registered with ClinicalTrials.gov as NCT03074292. Neonates were assigned to three groups; 40 neonates received conventional phototherapy, 40 received intensive phototherapy and 40 received blue light-emitting diodes (LED) phototherapy. Complete blood count (CBC), total serum bilirubin (TSB), total antioxidant capacity (TAC), malondialdehyde (MDA), nitric oxide (NO), copper (Cu), zinc (Zn), and iron (Fe) levels were measured before and 24?hours after phototherapy. TSB decreased postphototherapy in all three groups (p < .05 for all), with significantly lower levels following intensive and LED phototherapy compared to conventional phototherapy (p < .05 for both). TAC decreased postphototherapy in the three groups (p < .05 for all). MDA and NO increased postphototherapy (p < .05 for all), with the intensive phototherapy group having the highest levels followed by the conventional while LED phototherapy group showed the lowest levels in comparison to the other groups (p < .05). Cu, Zn and Fe increased postphototherapy in all three groups (p < .05 for all). Positive correlations were found between postphototherapy TSB with TAC, Cu and Zn (p < .05) and negative correlations with MDA, NO and Fe (p < .05) among neonates of the 3 studied groups. In conclusion, different photo therapies have an impact on oxidant/antioxidant balance and are associated with increased oxidative stress markers with the LED phototherapy being the safest.     

Sexual steroid levels and their clinical significance in the early neonatal age

Serum concentrations of progesterone (P) and estradiol (E2) in the umbilical cord blood were measured in healthy full term newborn infants and were related to the serum levels of indirect bilirubin at 72 hr postpartum in the same group of neonates. In those having higher concentration of bilirubin than 204 mumol/l at 72 hr after birth, cord P and E2 levels were significantly higher than in the rest of the group. Furthermore, strong correlation was found between serum levels of progesterone at 24 hr after birth and that of bilirubin at 72 hr postpartum in the same subjects. According to the authors' conclusion serum progesterone levels 24 hours after birth prognosticate the occurrence of neonatal hyperbilirubinaemia.     

Clinical aspects of continuous neonatal oxygen monitoring.

Twenty newborn infants (gestational age 30--40 weeks, weight 980--3400 g) were studied in two groups to compare two commercially available systems for continuous in vivo oxygen monitoring: the So2 catheter and the transcutaneous Po2 (TcPo2) electrode, and their respective electronic systems. Measurements from these systems were correlated with determinations made from samples intermittently drawn and measured by conventional So2 and Pao2 in vitro methods , respectively. Information about these two in vivo oxygen monitoring systems was then related to our previous experience with the bare-wire earlobe O2a electrode. Measurements from the two in vivo monitoring techniques studied showed good correlations with their respective in vitro oxygen measurements: So2 catheter, y = x - 3.08, r = 0.98 (range studied 74% to 100%) and transcutaneous electrode, y = 0.98x + 0.57, r = 0.89 (range studied 34 to 92 mm Hg). It was concluded that all three systems give a good reflection of central arterial oxygen (either Sao2 or Pao2)). The system to be used in specific clinical situations should depend on condition of the baby and stage of treatment, need for an umbilical line to measure other variables, equipment available, and training of personnel.     

金双歧治疗新生儿高胆红素血症的临床疗效研究

目的 探讨微生态制剂金双歧(双歧杆菌乳酸杆菌三联活菌片)对新生儿高胆红素血症的临床疗效,以找出能及早有效地纠正新生儿高胆红素血症,预防新生儿胆红素脑病发生的新方法.方法 通过随机抽样、收集青白江区人民医院2007年3月至2011年3月72例新生儿高胆红素血症患儿的临床资料并进行回顾性分析,将72例新生儿高胆红素血症患儿随机分为治疗组40例和对照组32例.对照组给予常规治疗,治疗组在常规治疗基础上,加用金双歧1片(0.5亿)/次,每天3次,温开水溶碎后喂服或经胃管注入,共7～10d.检测治疗前后两组血清胆红素水平、计算日平均经皮测胆红素下降值、平均住院时间和黄疸消退时间.结果 金双歧辅助治疗新生儿高胆红素血症,治疗后治疗组与对照组血清总胆红素水平分别为(58.21 +4.36) μmol/L和(64.16±5.29) μmol/L(P ＜0.01);治疗组和对照组日平均经皮测胆红素下降值、平均住院时间和黄疸退尽平均时间分别为( 10.35±2.46)、(7.68±1.35)μmol/L;( 6/54±2/59)、(9/05 +3/12)d; (6/38±1/38)、( 8/75±2/68)d;差异均有统计学意义(P＜0.01).结论 应用金双歧治疗新生儿高胆红素血症可迅速降低血胆红素水平,缩短治疗时间,预防胆红素脑病的发生疗效确切、安全,可作为治疗新生儿高胆红素血症的方法之一,值得临床应用推广.     

Paradoxical inward rib cage motion during rapid eye movement sleep in infants and young children

In neonates, rib cage motion on inspiration during rapid eye movement sleep is almost exclusively paradoxical. We wondered whether or not duration of paradoxical inward rib cage motion on inspiration during rapid eye movement sleep decreases in infancy and early childhood. Thirteen healthy infants from 7 to 31 months of age were tested during natural afternoon naps. Electroencephalogram, electrooculogram and electromyogram were all recorded. Airflow was measured by nasal and buccal thermistors, abdominal and rib cage anteroposterior diameters by magnetometers. Transcutaneous partial pressure of O2 was monitored. Diaphragmatic electromyographic activity was recorded using surface electrodes. The average total sleep time was 138 min ranging from 107 to 186 and rapid eye movement sleep time amounted to 15% of total sleep time ranging from 6 to 25. During rapid eye movement sleep, the total duration of paradoxical inward rib cage motion was measured and expressed as a percentage of rapid eye movement sleep time. We found that duration of paradoxical inward rib cage motion during rapid eye movement sleep decreased significantly with age (r = -0.66, P less than 0.02) which may be explained by the changes in chest wall compliance and geometry of the rib cage occurring with growth. We observed no decrease in transcutaneous partial pressure in O2 during paradoxical inward rib cage motion during rapid eye movement sleep in infants in contrast to that reported in neonates.     

Effect of a single breath of 100% oxygen on respiration in neonates during sleep

To determine the effect of a single breath of 100% O2 on ventilation, 10 full-term [body wt 3,360 +/- 110 (SE) g, gestational age 39 +/- 0.4 wk, postnatal age 3 +/- 0.6 days] and 10 preterm neonates (body wt 2,020 +/- 60 g, gestational age 34 +/- 2 wk, postnatal age 9 +/- 2 days) were studied during active and quiet sleep states. The single-breath method was used to measure peripheral chemoreceptor response. To enhance response and standardize the control period for all infants, fractional inspired O2 concentration was adjusted to 16 +/- 0.6% for a control O2 saturation of 83 +/- 1%. After 1 min of control in each sleep state, each infant was given a single breath of O2 followed by 21% O2. Minute ventilation (VE), tidal volume (VT), breathing frequency (f), alveolar O2 and CO2 tension, O2 saturation (ear oximeter), and transcutaneous O2 tension were measured. VE always decreased with inhalation of O2 (P less than 0.01). In quiet sleep, the decrease in VE was less in full-term (14%) than in preterm (40%) infants (P less than 0.001). Decrease in VE was due primarily to a drop in VT in full-term infants as opposed to a fall in f and VT in preterm infants (P less than 0.05). Apnea, as part of the response, was more prevalent in preterm than in full-term infants. In active sleep the decrease in VE was similar both among full-term (19%) and preterm (21%) infants (P greater than 0.5). These results suggest greater peripheral chemoreceptor response in preterm than in full-term infants, reflected by a more pronounced decrease in VE with O2. The results are compatible with a more powerful peripheral chemoreceptor contribution to breathing in preterm than in full-term infants.     

Serological evidence of Ureaplasma urealyticum infection in neonatal respiratory disease

Since up to 80 percent of pregnant women and 30 percent of neonates may be colonized with genital mycoplasmas, it is difficult to determine whether true infection occurs. The antibody responses to eight serotypes of U. urealyticum were assessed in mothers and infants in 21 cases of neonatal respiratory disease (RD) and 24 normal cases. Among the normal population of mothers and infants, a titer of greater than or equal to 1:32 occurred in 0.25 percent (1/394). In mother-infant paired titers, a fourfold difference occurred in 2.6 percent (5/192). Among 54 RD neonates, 55.6 percent had a titer of greater than or equal to 1:32 compared to only 4.2 percent of normal neonates (p less than .001). Fourfold elevations in antibody titers of greater than 1:32 were observed in the neonate in 52.4 percent of RD cases compared to 0 percent of 24 normal pairs (p less than .001) and in 28.6 percent of mothers of RD neonates compared to 0 percent in normal cases (p = .013). We observed that 43.3 percent of RD neonates with titers greater than or equal to 1:32 died compared to 16.6 percent of RD neonates exhibiting no elevation of antibody response over the maternal level. Among the six who died, 66.7 percent of neonates and 16.7 percent of their mothers had elevated titers, compared to 33.3 percent of 15 surviving infants and 40.0 percent of their mothers. These elevated antibody responses strongly support the concept that U. urealyticum causes infection in the perinatal period in association with neonatal respiratory disease. Since the elevation in titers was detected close to delivery in many cases, the infection may occur in utero.     

Cardiac autonomic balance in small-for-gestational-age neonates

The cardiac sympathetic nervous system is one putative key factor involved in the intrauterine programming of adult cardiovascular disease. We therefore analyzed cardiac autonomic system activity in small for gestational age (SGA) neonates. Heart rate variability (HRV) from 24-h ECG recordings were analyzed for time-domain and frequency-domain parameters in 27 SGA neonates [median 261 (240-283) days of gestation] compared with 27 appropriate for gestational age (AGA) neonates [median 270 (239-293) days of gestation]. In addition, salivary alpha-amylase levels were analyzed during resting conditions and in response to a pain-induced stress event in 18 SGA [median 266 (240-292) days of gestation] and 34 AGA [median 271 (240-294) days of gestation] neonates. Overall HRV was not significantly different in SGA neonates compared with AGA neonates (SD of all valid NN intervals: P = 0.14; triangular index: P = 0.29), and the sympathovagal balance [low frequency (LF)/high frequency (HF)] was similar (P = 0.62). Parameters mostly influenced by sympathetic activity did not reveal significant differences: (SD of the average of valid NN intervals: P = 0.27; average of the hourly means of SDs of all NN intervals: P = 0.66, LF: P = 0.83) as well as vagal tone-influenced parameters were unaltered (average of the hourly square root of the mean of the sum of the squares of differences between adjacent NN intervals: P = 0.59; proportion of pairs of adjacent NN intervals differing by >50 ms: P = 0.93; HF: P = 0.82). Median resting levels for alpha-amylase were not significantly different in SGA neonates (P = 0.13), and a neonatal stress stimulus revealed similar stress response patterns (P = 0.29). HRV and salivary alpha-amylase levels as indicators of cardiac autonomic activity were not altered in SGA neonates compared with AGA neonates. Thus, it appears that the intrauterine activation of the sympathetic system in SGA fetuses does not directly persist into postnatal life, and neonatal sympathovagal balance appears to be preserved.     

微生态制剂（培菲康）治疗新生儿高胆红素血症临床疗效评价

目的评价微生态制剂（培菲康）治疗新生儿高胆红素血症的临床疗效。方法110例在福建医科大学附属第一医院儿科住院治疗的新生儿高胆红素血症患儿分为治疗组和对照组;对照组65例给予肝酶诱导剂、光疗等综合治疗;治疗组45例在综合治疗基础上加用培菲康治疗。治疗前后检测患儿血清总胆红素和间接胆红素含量。采用SPSS11.0软件包进行统计学分析,α=0.05为显著性检验标准。结果时间-效应分析显示培菲康治疗组和对照组血清总胆红素下降值及95%CI（μmol/L）分别为142.6（126.7～158.4）、74.1（66.9～81.3）,血清间接胆红素下降值及95%CI（μmol/L）为115.7（103.3～128.1）、62.6（53.7～71.7）,差异有显著性（P〈0.05）;多元Cox回归分析显示患儿年龄、体重、孕周、入院前病程、入院血清总胆红素值/间接胆红素值及应用培菲康治疗为影响高胆红素血症患儿血清总胆红素/间接胆红素下降的主要因素;治疗组和对照组治愈例数（治愈率）分别为37例（82.2%）、8例（17.8%）,好转例数（好转率）分别为47例（72.3%）、10例（27.7%）,χ^2=1.448,P=0.229。2组均未见明显不良反应发生。结论应用培菲康治疗新生儿高胆红素,可促进胆红素分解和排泄,减少肠肝循环,减少肠道重吸收未结合胆红素,是治疗新生儿高胆红素血症一种可靠、安全的药物。     

Acute Histologic Chorioamnionitis Is a Risk Factor for Adverse Neonatal Outcome in Late Preterm Birth after Preterm Premature Rupture of Membranes

Background

The objective of this study was to determine whether acute histologic chorioamnionitis is associated with adverse neonatal outcomes in late preterm infants who were born after preterm PROM.

Methodology/Principal Findings

The relationship between the presence of acute histologic chorioamnionitis and adverse neonatal outcome was examined in patients with preterm PROM who delivered singleton preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Nonparametric statistics were used for data analysis. The frequency of acute histologic chorioamnionitis was 24% in patients with preterm PROM who delivered preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Newborns born to mothers with histologic chorioamnionitis had significantly higher rates of adverse neonatal outcome (74% vs 51%; p<0.005) than those without histologic chorioamnionitis. This relationship remained significant after adjustment for gestational age at preterm PROM, gestational age at delivery, and exposure to antenatal corticosteroids.

Conclusions/Significance

The presence of acute histologic chorioamnionitis is associated with adverse neonatal outcome in late preterm infants born to mothers with preterm PROM.     

Hyperbilirubinemia in Inuit neonates.

A prospective study was undertaken to determine if Inuit and Caucasian neonates have different patterns of physiologic jaundice. Daily blood samples obtained by heel pricks of Inuit and Caucasian neonates born at the Churchill (Man.) Health Centre were assayed for the total serum bilirubin concentration. The mean peak bilirubin level in the Inuit group was significantly higher than that in the Caucasian group (8.76 v. 6.04 mg/dl [150 v. 103 mumol/l]) and occurred later (on day 3 rather than day 2). Of the Caucasian neonates, those who were breast-fed in hospital had a significantly higher (P less than 0.05) mean peak bilirubin level than those who were not, and among all the neonates who were not breast-fed in hospital the Inuit had a significantly higher mean peak bilirubin level than the Caucasians (7.98 v. 3.64 mg/dl [136 v. 62 mumol/l]). These findings indicate that factors other than breastfeeding, some of which may be genetic, are responsible for the higher and later peak in the serum bilirubin concentration in Inuit neonates.