OBJECTIVES: To evaluate the clinical utility and translational potential of a remote jaundice monitoring system for home-based screening of neonatal hyperbilirubinemia. METHODS: A prospective self-controlled study was conducted, enrolling 538 newborns with gestational age ≥35 weeks, birth weight ≥2 000 g, and postnatal age ≤14 days at the Women's Hospital of Nanjing Medical University from March to October 2023. Four screening protocols with different predictive indicators were developed based on the Chinese Neonatal Transcutaneous Hourly Bilirubin Nomogram. The effectiveness of the system was evaluated, and the feasibility of using the remote jaundice monitoring system in actual home settings was analyzed. RESULTS: A total of 538 paired transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) measurements showed a strong correlation (r=0.85, P<0.001), with 95.0% (511/538) of samples within the 95% limits of agreement. Using TcB ≥ the 95th percentile as the predictive indicator, the system achieved 100% sensitivity, 46.2% specificity, and an area under the receiver operating characteristic curve of 0.731 (95%CI: 0.682-0.780). This approach could reduce unnecessary hospital visits by 41.4% (221/538). CONCLUSIONS The system integrates the QBH-801 transcutaneous bilirubinometer, intelligent early warning, and remote guidance services, establishing a closed-loop "hospital-to-home" management model. It demonstrates high safety and feasibility, with significant clinical translational value.
Humans ; Infant, Newborn ; Female ; Male ; Bilirubin/blood* ; Feasibility Studies ; Prospective Studies ; Hyperbilirubinemia, Neonatal/diagnosis* ; Neonatal Screening/methods* ; Jaundice, Neonatal/diagnosis*

OBJECTIVES: To examine the global, regional, and national disease burden of neonatal jaundice. METHODS: The 2019 Global Burden of Disease database was searched to collect incident cases/incidence and deaths/mortality of neonatal jaundice, as well as global socio-demographic index (SDI) and universal health coverage index (UHCI). The epidemiological trend of neonatal jaundice from 1990 to 2019 was analyzed. The correlations between incidence/mortality of neonatal jaundice and SDI and UHCI were evaluated. RESULTS: From 601 681 in 1990 to 626 005 in 2019, with a 4.04% increase in global incident cases of neonatal jaundice. The overall age-standardized incidence rate exhibited an increase [estimated annual percent change=0.13 (95%CI: 0.03 to 0.23)] during this period. Additionally, deaths due to neonatal jaundice decreased by 58.83%, from 128 119 in 1990 to 52 742 in 2019. The overall age-standardized mortality rate showed a decrease [estimated annual percent change=-2.78 (95%CI: -3.00 to -2.57)] over the same period. Countries with lower SDI, such as India, Pakistan, and Nigeria, reported a higher proportion of neonatal morbidity and mortality. In 2019, a negative correlation was observed between estimated annual percent change in age-standardized mortality rate and SDI (ρ=-0.320, P<0.05) or UHCI (ρ=-0.252, P<0.05). CONCLUSIONS The global incidence of neonatal jaundice is on the rise, while the mortality rate is declining. The burden of neonatal jaundice is influenced by social development, economic factors, and the level of medical care.
Infant, Newborn ; Humans ; Global Burden of Disease ; Jaundice, Neonatal/epidemiology* ; Incidence

OBJECTIVE: To explore the genetic etiology and differential diagnosis for a patient with jaundice. METHODS: Clinical data of the patient and his parents were collected. Genes associated with metabolic liver diseases were subjected to high-throughput sequencing. The pathogenicity of the candidate variants was predicted by using bioinformatics software. RESULTS: High-throughput sequencing revealed that the proband has harbored two variants of the ABCC2 gene (NM_000392) including c.3011C>T (p.T1004I) and c.3541C>T (p.R1181X), which were respectively inherited from his father and mother. Both variants have been previously unreported and predicted to be pathogenic by bioinformatics analysis. CONCLUSION The proband was diagnosed with Dubin-Johnson syndrome due to the compound heterozygous variants of the ABCC2 gene. Genetic testing has enabled accurate differential diagnosis of Dubin-Johnson syndrome in this patient.
Genetic Testing ; High-Throughput Nucleotide Sequencing ; Humans ; Jaundice, Chronic Idiopathic/pathology* ; Multidrug Resistance-Associated Protein 2 ; Multidrug Resistance-Associated Proteins/genetics* ; Mutation

OBJECTIVE: To explore the genetic etiology in four patients with hyperbilirubinemia, and discuss the correlation between clinical characteristics and molecular basis. METHODS: The data of clinical manifestation and auxiliary examinations were collected. Genomic DNA of the four patients was extracted and analyzed by next-generation sequencing using the panel including genes involved in hereditary metabolic liver diseases. Suspected variants were verified by Sanger sequencing. RESULTS: All of the four patients were males with normal liver enzymes. It was revealed that all the patients had heterozygous variants, among which c.3011C>T, c.2443C>T and c.2556del were the variants which have not been reported previously. CONCLUSION All of the patients were diagnosed as Dubin-Johnson syndrome (DJS) caused by ABCC2 gene variants. The novel variants add to the spectrum of genetic variants of the disease. Because of the favorite prognosis, precise diagnosis can greatly reduce the psychological pressure of patients and avoid excessive treatments. At the same time, it could provide pertinent genetic counseling for the families.
DNA ; Female ; Heterozygote ; Humans ; Jaundice, Chronic Idiopathic/genetics* ; Male ; Multidrug Resistance-Associated Protein 2 ; Multidrug Resistance-Associated Proteins/genetics* ; Phenotype

OBJECTIVE: To study the association of fatty acid composition in human milk with breast milk jaundice (BMJ) in neonates. METHODS: A total of 30 full-term neonates who were admitted to the neonatal intensive care unit from October 2016 to October 2017 and were diagnosed with late-onset BMJ were enrolled as the BMJ group. Thirty healthy neonates without jaundice or pathological jaundice who were admitted to the confinement center during the same period of time were enrolled as the control group. Related clinical data were collected, including sex, mode of birth, feeding pattern, gestational age, birth weight, gravida, parity, and peak level of total serum bilirubin. Breast milk was collected from the mothers, and the MIRIS human milk analyzer was used to measure macronutrients (fat, protein, and carbohydrate) and calorie. Gas chromatography was used to analyze the content of different fatty acids in breast milk. RESULTS: The control group had higher levels of macronutrients in human milk than the BMJ group, with significant differences in fat, dry matter, and calorie ( CONCLUSIONS Some macronutrients and fatty acid composition in human milk may be associated with the pathogenesis of BMJ in neonates.
Case-Control Studies ; Fatty Acids/analysis* ; Female ; Humans ; Infant, Newborn ; Jaundice, Neonatal/etiology* ; Milk, Human/chemistry* ; Nutrients/analysis* ; Pregnancy

OBJECTIVE: To explore the feasibility of remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease. METHODS: Forty six neonates of gestational age >35 weeks with ABO hemolytic disease admitted to Women's Hospital, Zhejiang University School of Medicine from January 20th, 2020 to February 29th, 2020 were enrolled in the study (study group). The newborns were followed up at home after discharge, the transcutaneous bilirubin (TCB) levels were measured by parents using the provided device and the results were sent to the doctor by smart phone using the installed APP. Fifty six newborns with ABO hemolytic disease admitted in 2018 who received conventional outpatient follow-up after discharge served as the control group. The demographic characteristics, total serum bilirubin (TSB) level during hospitalization, number of outpatient visit and rate of re-admission due to rebound hyperbilirubinemia were compared between the two groups. RESULTS: There were no significant differences between the two groups in gestational age, birth weight, delivery mode, gender, length of the first hospitalization, TSB level before phototherapy and before discharge, and the managements during the first hospitalization (all CONCLUSIONS The remote follow-up for neonatal jaundice at home can effectively reduce the number of outpatient visits without increasing the risk of readmission and severe neonatal hyperbilirubinemia for newborns with ABO hemolytic disease.
Bilirubin ; Erythroblastosis, Fetal/diagnosis* ; Female ; Humans ; Hyperbilirubinemia, Neonatal/diagnosis* ; Infant, Newborn ; Jaundice, Neonatal/diagnosis* ; Monitoring, Physiologic/methods* ; Phototherapy

To systematically review effectiveness and safety of Yinzhihuang Oral Liquid in the treatment of neonatal jaundice. A systematic retrieval was performed throughout China National Knowledge Infrastructure( CNKI),Wan Fang,VIP,Sino Med and PubMed,Medline,Cochrane Library databases from the establishment to April 2019. Randomized controlled trials of Yinzhihuang Oral Liquid in treatment of neonatal hyperbilirubinemia were retrieved. Clinical studies in line with the inclusion criteria were involved for data extraction,and the quality of the included literatures was evaluated by the risk bias assessment tool in the Cochrane review manual. Finally,Meta-analysis was performed by Rev Man 5.3 software. A total of 30 studies were involved,involving 3 923 child patients,including1 940 in observation group and 1 983 in control group. According to the results of Meta-analysis,the total effective rate( RR = 1. 22,95%CI[1. 18,1. 26],P<0. 000 01),level of TBi L after treatment( MD =-38. 78,95%CI[-48. 38,-29. 18],P<0. 000 01),time to jaundice resolution( MD =-1. 76,95% CI[-2. 10,-1. 41],P < 0. 000 01) and daily average decrease value of bilirubin( MD =11. 67,95%CI[8. 89,14. 45],P<0. 000 01) of observation group were significantly better than those of control group,with statistically significant differences. Adverse reactions were reported in nine studies,mainly including diarrhea,vomiting,fever,rash and other symptoms,which did not affect the treatment effect. The effectiveness of Yinzhihuang Oral Liquid combined with conventional therapy in treating neonatal jaundice was better than conventional therapy alone,with little adverse reactions. However,most of literatures included had a low research quality,which impacted the reliability of the conclusion. Therefore,it is suggested to conduct more largesample-size,multicenter,scientifically designed,strictly implemented high-quality randomized controlled trials in the future,in order to study the efficacy and safety of Yinzhihuang Oral Liquid in the treatment of neonatal jaundice.
China ; Drugs, Chinese Herbal/therapeutic use* ; Humans ; Infant, Newborn ; Jaundice, Neonatal/drug therapy* ; Reproducibility of Results

OBJECTIVES: Herbal remedies such as purgative manna are used to treat neonatal jaundice. In this study Bilineaster drop (purgative manna) and phototherapy, and phototherapy treatment alone were compared by assessing phototherapy duration and number of days in hospital. METHODS: There were 150 consecutive term neonates with jaundice, weighting from 2,500 g to 4,000 g enrolled in this randomized double blind clinical trial. The neonates were randomly assigned to intervention and control groups. The control patients received only phototherapy and the intervention group underwent phototherapy treatment and purgative manna drop (5 drops per kg of body weight, 3 times a day). Direct and total measurements of bilirubin concentration in the serum were measured and the reduction in concentration of bilirubin was calculated. RESULTS: There were 28% of patients whose hospital duration following phototherapy was 2 days, for Bilineaster and phototherapy treatment this was 49.3% of patients. At 48 hours and 72 hours the reduction in the concentration of total bilirubin in the serum was statistically significantly different across groups (p < 0.05) but at 24 hours and 96 hours there were no significant differences between groups (p > 0.05). The reduction in direct bilirubin concentration in the serum was significantly different between groups at 72 hours and 96 hours (p > 0.001). CONCLUSION: Purgative manna and phototherapy, can statistically significantly reduce total bilirubin concentration at 48 hours and 72 hours compared with phototherapy alone, and reduce the length of hospital stay for jaundiced neonates at 2 days compared with phototherapy treatment.
Bilirubin ; Body Weight ; Herbal Medicine ; Humans ; Infant, Newborn ; Jaundice ; Jaundice, Neonatal ; Length of Stay ; Phototherapy

Benign biliary strictures are uncommon in children. Classically, these cases are managed surgically, however less invasive approaches with interventional radiology and or endoscopy may have similar results and improved safety profiles While benign biliary strictures have been described in literature on several occasions in young children, (most older than 1 year and once in an infant 3 months of age), all reported cases were managed surgically. We present two cases of benign biliary strictures in infants less than 6 months of age that were managed successfully with novel non-invasive procedures and a review of all current pediatric cases reported in the literature. Furthermore, we describe the use of a Rendezvous procedure, which has not been reported as a treatment approach for benign biliary strictures.
Child ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Endoscopy ; Humans ; Infant ; Infant, Newborn ; Jaundice, Neonatal ; Radiology, Interventional

PURPOSE: The purpose was to explore the breastfeeding experiences of mothers of infants with breast-feeding or breast milk jaundice. METHODS: In-depth qualitative interviews and content analysis were conducted with nine mothers of newborns with breastfeeding and/or breast milk jaundice who breastfed their babies during the first year postpartum. RESULTS: Mothers' experiences can be described in four phases and six themes. (1) Prenatal stage: build breastfeeding belief, i.e., breastfeeding is best and a natural behavior, without awareness of neonatal jaundice; (2) stage after neonatal jaundice started to appear: include two themes, questioning beliefs in breastfeeding and happiness in being a mother. Mothers lacked knowledge and ignored the threat of neonatal jaundice, mainly focused on their physical discomforts and worried about insufficient breast milk; they also felt an intimate mothereinfant bond through breastfeeding; (3) stage when newborns had confirmed diagnosis of breastfeeding or breast milk jaundice that required medical attention: include two themes, diagnosis of breastfeeding or breast milk jaundice and phototherapy caused negative emotions and regaining original beliefs about breastfeeding. They struggled through emotional swings and inconsistent advices about whether phototherapy and formula supplementation are needed. Then, they decided breastfeeding or breast milk jaundice is only temporary and retrieved initial beliefs of breastfeeding. (4) Stage after neonatal jaundice faded and mothers continued breastfeeding: insisting and adapting. CONCLUSION: Breastfeeding mothers were unaware of neonatal jaundice until medical attention was required; they experienced physical and mental distress and gradually learned to manage jaundice while insisting on breastfeeding through their breastfeeding beliefs and happiness in being mothers.
Anxiety ; Breast Feeding ; Breast ; Diagnosis ; Happiness ; Humans ; Infant ; Infant, Newborn ; Jaundice ; Jaundice, Neonatal ; Milk, Human ; Mothers ; Phototherapy ; Postpartum Period ; Qualitative Research