Invasive bilirubin measurements remain the gold standard for the diagnosis and treatment of infants with severe neonatal hyperbilirubinemia. The present paper describes different methods currently available to assess hyperbilirubinemia in newborn infants. Novel point-of-care bilirubin measurement methods, such as the BiliSpec and the Bilistick, would benefit many newborn infants, especially in low-income and middle-income countries where the access to costly multi-analyzer in vitro diagnostic instruments is limited. Total serum bilirubin test results should be accurate within permissible limits of measurement uncertainty to be fit for clinical purposes. This implies correct implementation of internationally endorsed reference measurement systems as well as participation in external quality assessment programs. Novel analytic methods may, apart from bilirubin, include the determination of bilirubin photoisomers and bilirubin oxidation products in blood and even in other biological matrices. IMPACT: Key message: Bilirubin measurements in blood remain the gold standard for diagnosis and treatment of severe neonatal hyperbilirubinemia (SNH). External quality assessment (EQA) plays an important role in revealing inaccuracies in diagnostic bilirubin measurements. What does this article add to the existing literature? We provide analytic performance data on total serum bilirubin (TSB) as measured during recent EQA surveys. We review novel diagnostic point-of-care (POC) bilirubin measurement methods and analytic methods for determining bilirubin levels in biological matrices other than blood. Impact: Manufacturers should make TSB test results traceable to the internationally endorsed total bilirubin reference measurement system and should ensure permissible limits of measurement uncertainty.
- MeSH
- bilirubin krev MeSH
- biologické markery krev MeSH
- lidé MeSH
- novorozenec MeSH
- novorozenecká hyperbilirubinemie krev diagnóza terapie MeSH
- novorozenecká žloutenka krev diagnóza terapie MeSH
- novorozenecký screening * MeSH
- point of care testing * MeSH
- prediktivní hodnota testů MeSH
- prognóza MeSH
- reprodukovatelnost výsledků MeSH
- stupeň závažnosti nemoci MeSH
- upregulace MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
Severe neonatal hyperbilirubinemia (SNH) is a serious condition that occurs worldwide. Timely recognition with bilirubin determination is key in the management of SNH. Visual assessment of jaundice is unreliable. Fortunately, transcutaneous bilirubin measurement for screening newborn infants is routinely available in many hospitals and outpatient settings. Despite a few limitations, the use of transcutaneous devices facilitates early recognition and appropriate management of neonatal jaundice. Unfortunately, however, advanced and often costly screening modalities are not accessible to everyone, while there is an urgent need for inexpensive yet accurate instruments to assess total serum bilirubin (TSB). In the near future, novel icterometers, and in particular optical bilirubin estimates obtained with a smartphone camera and processed with a smartphone application (app), seem promising methods for screening for SNH. If proven reliable, these methods may empower outpatient health workers as well as parents at home to detect jaundice using a simple portable device. Successful implementation of ubiquitous bilirubin screening may contribute substantially to the reduction of the worldwide burden of SNH. The benefits of non-invasive bilirubin screening notwithstanding, any bilirubin determination obtained through non-invasive screening must be confirmed by a diagnostic method before treatment. IMPACT: Key message: Screening methods for neonatal hyperbilirubinemia facilitate early recognition and timely treatment of severe neonatal hyperbilirubinemia (SNH). Any bilirubin screening result obtained must be confirmed by a diagnostic method. What does this article add to the existing literature? Data on optical bilirubin estimation are summarized. Niche research strategies for prevention of SNH are presented. Impact: Transcutaneous screening for neonatal hyperbilirubinemia contributes to the prevention of SNH. A smartphone application with optical bilirubin estimation seems a promising low-cost screening method, especially in low-resource settings or at home.
- MeSH
- bilirubin krev MeSH
- biologické markery krev MeSH
- časná diagnóza MeSH
- chytrý telefon MeSH
- lidé MeSH
- mobilní aplikace MeSH
- novorozenec MeSH
- novorozenecká hyperbilirubinemie krev diagnóza terapie MeSH
- novorozenecká žloutenka krev diagnóza terapie MeSH
- novorozenecký screening * přístrojové vybavení MeSH
- prediktivní hodnota testů MeSH
- prognóza MeSH
- reprodukovatelnost výsledků MeSH
- stupeň závažnosti nemoci MeSH
- upregulace MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
Although phototherapy (PT) is a standard treatment for neonatal jaundice, no validated clinical methods for determination of bilirubin phototherapy products are available. Thus, the aim of our study was to establish a such method for clinical use. To achieve this aim, a LC-MS/MS assay for simultaneous determination of Z-lumirubin (LR) and unconjugated bilirubin (UCB) was conducted. LR was purified after irradiation of UCB at 460 nm. The assay was tested on human sera from PT-treated neonates. Samples were separated on a HPLC system with a triple quadrupole mass spectrometer detector. The instrument response was linear up to 5.8 and 23.4 mg/dL for LR and UCB, respectively, with submicromolar limits of detection and validity parameters relevant for use in clinical medicine. Exposure of newborns to PT raised serum LR concentrations three-fold (p < 0.01), but the absolute concentrations were low (0.37 ± 0.16 mg/dL), despite a dramatic decrease of serum UCB concentrations (13.6 ± 2.2 vs. 10.3 ± 3.3 mg/dL, p < 0.01). A LC-MS/MS method for the simultaneous determination of LR and UCB in human serum was established and validated for clinical use. This method should help to monitor neonates on PT, as well as to improve our understanding of both the kinetics and biology of bilirubin phototherapy products.
- MeSH
- bilirubin analogy a deriváty krev chemie MeSH
- chromatografie kapalinová MeSH
- fototerapie metody MeSH
- lidé MeSH
- molekulární struktura MeSH
- novorozenec MeSH
- novorozenecká žloutenka krev terapie MeSH
- sérum chemie MeSH
- tandemová hmotnostní spektrometrie MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Therapies to prevent severe neonatal unconjugated hyperbilirubinemia and kernicterus are phototherapy and, in unresponsive cases, exchange transfusion, which has significant morbidity and mortality risks. Neurotoxicity is caused by the fraction of unconjugated bilirubin not bound to albumin (free bilirubin, Bf). Human serum albumin (HSA) administration was suggested to increase plasma bilirubin-binding capacity. However, its clinical use is infrequent due to difficulties to address its potential preventive and curative benefits, and to the absence of reliable markers to monitor bilirubin neurotoxicity risk. We used a genetic mouse model of unconjugated hyperbilirubinemia showing severe neurological impairment and neonatal lethality. We treated mutant pups with repeated HSA administration since birth, without phototherapy application. Daily intraperitoneal HSA administration completely rescued neurological damage and lethality, depending on dosage and administration frequency. Albumin infusion increased plasma bilirubin-binding capacity, mobilizing bilirubin from tissues to plasma. This resulted in reduced plasma Bf, forebrain and cerebellum bilirubin levels. We showed that, in our experimental model, Bf is the best marker to determine the risk of developing neurological damage. These results support the potential use of albumin administration in severe acute hyperbilirubinemia conditions to prevent or treat bilirubin neurotoxicity in situations in which exchange transfusion may be required.
- MeSH
- bilirubin krev MeSH
- fototerapie metody MeSH
- lidé MeSH
- modely nemocí na zvířatech MeSH
- mozeček účinky léků MeSH
- myši MeSH
- nemoci nervového systému etiologie prevence a kontrola MeSH
- novorozenecká hyperbilirubinemie krev komplikace MeSH
- novorozenecká žloutenka krev komplikace MeSH
- sérový albumin aplikace a dávkování MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- myši MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Článek se zabývá současným pohledem na problematiku novorozenecké žloutenky v praxi PLDD, možnostmi jejího sledování a posuzování a úskalími jejího hodnocení v každodenní praxi.
The article discusses the topic of neonatal jaundice, the possibilities for monitoring and evaluation as well as the relevant resulting problems in the setting of general paediatrics practise.
- MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- fototerapie metody MeSH
- kojení MeSH
- lidé MeSH
- monitorování fyziologických funkcí metody MeSH
- novorozenec MeSH
- novorozenecká hyperbilirubinemie klasifikace MeSH
- novorozenecká žloutenka * etiologie krev prevence a kontrola terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- přehledy MeSH
Icterus is a yellow discoloration of skin, sclera and mucosa. It is a symptom that can be physiological as well as pathological. The intensity of the discoloration ranges from slight yellowish tint to rich orange or greenish brown color.
- MeSH
- bilirubin analýza diagnostické užití metabolismus MeSH
- farmakoterapie metody MeSH
- fototerapie metody MeSH
- hyperbilirubinemie diagnóza klasifikace terapie MeSH
- lidé MeSH
- nemoci novorozenců etiologie imunologie terapie MeSH
- novorozenec MeSH
- novorozenecká žloutenka diagnóza krev MeSH
- žloutenka diagnóza etiologie klasifikace MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- MeSH
- bilirubin analýza MeSH
- glutathionperoxidasa analýza MeSH
- katalasa analýza MeSH
- lidé MeSH
- novorozenec MeSH
- novorozenecká žloutenka krev MeSH
- odběr fetální krve využití MeSH
- superoxiddismutasa analýza MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- kongresy MeSH
Autorky se zabývají problematikou neinvazivního měření bilirubinu u novorozence. Upozorňuji na problematiku interoretace těchto výsledků.
The authors discuss the non-invasive measuring of bilirubine in neonates. They point to the issues of results interpretation.
- MeSH
- bilirubin analýza škodlivé účinky MeSH
- dítě MeSH
- fotometrie metody přístrojové vybavení statistika a číselné údaje MeSH
- fototerapie statistika a číselné údaje MeSH
- hyperbilirubinemie diagnóza etiologie krev MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- novorozenecká žloutenka diagnóza etiologie krev MeSH
- referenční hodnoty MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- MeSH
- biliární cirhóza diagnóza chirurgie MeSH
- bilirubin krev MeSH
- cholestáza etiologie patologie MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- hyperbilirubinemie etiologie patologie MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- novorozenecká žloutenka diagnóza etiologie krev MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
