Blue light has been widely used for the treatment of neonatal hyperbilirubinemia since the 1950s. Neonatal phototherapy can decrease plasma unconjugated bilirubin level, thus preventing bilirubin encephalopathy, and greatly reduces the exchange transfusion rate. Generally, it is accepted that the side effects of neonatal phototherapy are not serious and seem to be well controlled, however recent research has provided new evidence. The short-term side effects of phototherapy include interference with maternal-infant interaction, imbalance of thermal environment and water loss, electrolyte disturbance, bronze baby syndrome and circadian rhythm disorder. In addition, phototherapy may be associated with some long-term side effects such as melanocytic nevi and skin cancer, allergic diseases, patent ductus arteriosus and retinal damage. Therefore, it is necessary to develop evidence-based guidelines, new light devices and alternative agents, as well as individualized treatments, to minimize the side effects of phototherapy.
Evidence-Based Practice ; Humans ; Hyperbilirubinemia, Neonatal ; therapy ; Phototherapy ; adverse effects

OBJECTIVE: To study the effectiveness of Saccharomyces boulardii combined with phototherapy in the treatment of hyperbilirubinemia in neonates. METHODS: The neonates with hyperbilirubinemia who were hospitalized from January to December 2018 were enrolled and randomly divided into an observation group (n=61) and a control group (n=63). The neonates in the observation group were treated with phototherapy combined with Saccharomyces boulardii, and those in the control group were treated with phototherapy combined with placebo. Treatment outcomes were compared between the two groups. Fecal samples were collected 72 hours after treatment and 16s rRNA high-throughput sequencing was used to compare the features of gut microbiota between the two groups. RESULTS: There was no significant difference in the total serum bilirubin level between the two groups before treatment (P>0.05). At 24, 48, and 72 hours after treatment, the observation group had a significantly lower level of total serum bilirubin than the control group (P<0.05). Compared with the control group, the observation group had a significantly lower proportion of neonates requiring phototherapy again [20% (12/61) vs 75% (47/63), P<0.05]. Compared with the control group, the observation group had a significantly higher abundance of Bacteroides (P<0.05) and a significantly lower abundance of Escherichia coli and Staphylococcus in the intestine at 72 hours after treatment (P<0.05). CONCLUSIONS In neonates with hyperbilirubinemia, phototherapy combined with Saccharomyces boulardii can effectively reduce bilirubin level and prevent the recurrence of jaundice. Saccharomyces boulardii can favour the treatment outcome by regulating the gut microbiota of neonates.
Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal/therapy* ; Infant, Newborn ; Phototherapy ; Prospective Studies ; RNA, Ribosomal, 16S ; Saccharomyces boulardii

The American Academy of Pediatrics updated the guidelines for the management of hyperbilirubinemia in the newborn infants with a gestational age of ≥35 weeks in September 2022. Based on the evidence over the past 18 years, the guidelines are updated from the aspects of the prevention, risk assessment, intervention, and follow-up of hyperbilirubinemia in the newborn infants with a gestational age of ≥35 weeks. This article gives an interpretation of the key points in the guidelines, so as to safely reduce the risk of bilirubin encephalopathy and unnecessary intervention.
Infant, Newborn ; Humans ; Infant ; United States ; Child ; Hyperbilirubinemia, Neonatal/therapy* ; Bilirubin ; Hyperbilirubinemia/therapy* ; Kernicterus/prevention & control* ; Risk Assessment ; Gestational Age

OBJECTIVETo study the effect and safety of intensive phototherapy in the treatment of neonatal hyperbilirubinemia.

METHODSA total of 144 neonates with neonatal hyperbilirubinemia were randomly and prospectively divided into intensive phototherapy group and conventional phototherapy group, with 72 neonates in each group. The therapeutic effect and incidence of complications were compared between the two groups.

RESULTSWithin 12 hours after phototherapy, the total serum bilirubin level in the intensive phototherapy group was significantly lower than in the conventional phototherapy group (P<0.05), and the intensive phototherapy group had a significantly greater reduction in serum bilirubin level than the conventional phototherapy group (P<0.05). The intensives phototherapy group had a significantly shorter time of phototherapy than the conventional phototherapy group (P<0.05). The incidence rates of fever, diarrhea, rash, and hypocalcemia and reductions in blood calcium and hemoglobin levels after phototherapy showed no significant differences between the two groups.

CONCLUSIONSDuring the initial stage of phototherapy, intensive phototherapy can quickly and effectively reduce the serum level of bilirubin in neonates with neonatal hyperbilirubinemia. It can also shorten the total phototherapy time, and does not increase the incidence of adverse events. Therefore, it is superior to conventional phototherapy.

Female ; Humans ; Hyperbilirubinemia, Neonatal ; therapy ; Infant, Newborn ; Male ; Phototherapy ; adverse effects

OBJECTIVETo study the effect of automated peripheral arteriovenous exchange transfusion for treatment of severe hyperbilirubinemia in neonates.

METHODSFifty-three neonates with severe hyperbilirubinemia underwent automated peripheral arteriovenous exchange transfusion, and the changes in the blood gas, electrolytes and some biochemical indices after the exchange transfusion were evaluated.

RESULTSTreatment with the exchange transfusion resulted in a significant reduction in the total serum bilirubin with an exchange rate of 53.12% (P<0.01). The levels of serum kalium, calcium, magnesium, white blood cell count, platelets, and pH showed reductions while blood glucose exhibited a significant elevation changes after the transfusion (P<0.01), which all recovered the normal levels within 48 h. No obvious alterations occurred in the respiration, heart rate, blood pressure, or saturation of blood oxygen during the transfusion.

CONCLUSIONAutomated peripheral arteriovenous exchange transfusion can rapidly reduce serum bilirubin levels in neonates with severe hyperbilirubinemia without obviously affecting the blood gas balance or blood electrolyte or glucose levels.

Exchange Transfusion, Whole Blood ; methods ; Female ; Humans ; Hyperbilirubinemia, Neonatal ; therapy ; Infant, Newborn ; Male

OBJECTIVETo study the therapeutic effect and feasibility of rectoclysis with Tuihuang decoction (RTD) in treating hyperbilirubinemia of newborns.

METHODSOne hundred and seventy-five newborns with hyperbilirubinemia were randomly divided into the treated group and the control group. They were treated with western medicine plus double faced blue treatment while the treated group were given RTD additionally. Blood bilirubin was detected by micro-bilirubin detector daily during the treatment course. The time of jaundice regression, the speed of blood bilirubin reducing, liver function, and condition of rebounding were observed.

RESULTSThe 7-day curative rate of jaundice in the treated group was superior to that in the control group, showing significant difference (P < 0.05). The average speed of blood bilirubin reducing daily in the treated group was quicker than that in the control group (P < 0.01). The improvement of liver function, such as AST, ALT and gamma-GT in the treated group was superior to that in the control group (P < 0.01). Rebound rate of blood bilirubin in the control group was significantly higher than that in the treated group (P < 0.05).

CONCLUSIONRTD is an ideal therapy for treatment of hyperbilirubinemia of newborn, it shows obvious clinical efficacy and can effectively prevent the rebound of blood bilirubin.

Administration, Rectal ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Hyperbilirubinemia ; drug therapy ; Infant, Newborn ; Jaundice, Neonatal ; drug therapy ; Male ; Phytotherapy

Exchange Transfusion, Whole Blood ; methods ; Female ; Follow-Up Studies ; Humans ; Hyperbilirubinemia, Neonatal ; blood ; therapy ; Infant, Newborn ; Male

Blood Cell Count ; Exchange Transfusion, Whole Blood ; adverse effects ; methods ; Female ; Humans ; Hyperbilirubinemia, Neonatal ; blood ; therapy ; Infant, Newborn ; Male

OBJECTIVETo explore the clinical effects of colonic dripping with Taihuang liquid (THL) in treating neonatal hyperbilirubinemia (HBE).

METHODSOne hundred and thirty-eight neonates with HBE were randomly assigned to two groups. Conventional treatment and nursing were given to both groups, and THL was given additionally to the observation group by colonic dripping.

RESULTSSignificant differences between the observation group and the control group were shown in frequency of defecation (4.6 +/- 1.3 times/d vs 2.0 +/- 1.1 times/d), daily serum bilirubin reduction (31.5 +/- 10.1 micromol/L vs 23.3 +/- 8.3 micromol/L), and days for normalizing serum bilirubin level (5.6 +/- 3.5 d vs 7.8 +/- 4.1 d, all P < 0.01).

CONCLUSIONColonic dripping of THL could promote the excretion of bilirubin, so as to decrease the level of serum bilirubin in neonates with HBE.

Bilirubin ; blood ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Hyperbilirubinemia, Neonatal ; blood ; drug therapy ; Infant ; Infant, Newborn ; Male

OBJECTIVES: To investigate the preadmission follow-up condition of neonates hospitalized due to severe hyperbilirubinemia after discharge from the department of obstetrics and the influencing factors for follow-up compliance. METHODS: A multicenter retrospective case-control study was performed for the cases from the multicenter clinical database of 12 units in the Quality Improvement Clinical Research Cooperative Group of Neonatal Severe Hyperbilirubinemia in Jiangsu Province of China from January 2019 to April 2021. According to whether the follow-up of neonatal jaundice was conducted on time after discharge from the department of obstetrics, the neonates were divided into two groups: good follow-up compliance and poor follow-up compliance. The multivariate logistic regression model was used to identify the influencing factors for follow-up compliance of the neonates before admission. RESULTS: A total of 545 neonates with severe hyperbilirubinemia were included in the study, with 156 neonates (28.6%) in the good follow-up compliance group and 389 (71.4%) in the poor follow-up compliance group. The multivariate logistic regression analysis showed that low gestational age at birth, ≥10% reduction in body weight on admission compared with birth weight, history of phototherapy of siblings, history of exchange transfusion of siblings, Rh(-) blood type of the mother, a higher educational level of the mother, the use of WeChat official account by medical staff to remind of follow-up before discharge from the department of obstetrics, and the method of telephone notification to remind of follow-up after discharge were associated with the increase in follow-up compliance (P<0.05). CONCLUSIONS Poor follow-up compliance is observed for the neonates with severe hyperbilirubinemia after discharge from the department of obstetrics, which suggests that it is necessary to further strengthen the education of jaundice to parents before discharge and improve the awareness of jaundice follow-up. It is recommended to remind parents to follow up on time by phone or WeChat official account.
Case-Control Studies ; Female ; Follow-Up Studies ; Humans ; Hyperbilirubinemia, Neonatal/therapy* ; Infant, Newborn ; Obstetrics ; Patient Discharge ; Pregnancy ; Retrospective Studies