MyMedR

Fulltext Alpha-1-antitrypsin deficiency in babies with prolonged jaundice

Zakiah I, Zaini AR, Jamilah B, Zawiah A

Malays J Pathol, 1992 Dec;14(2):91-4.

Over a three-year-period, 310 babies with prolonged jaundice admitted to GHKL were studied, to determine the incidence of alpha-1-antitrypsin deficiency as a cause of the problem. Ninety-two babies (29.7%) were found to be alpha-1-antitrypsin deficient. The percentage incidence was found to be highest in Indians (33.3%), followed by Malays (31.9%) and Chinese (26.7%). There was a male preponderance with a M:F ratio of 1.6:1. Most of these babies presented at the hospital at the age of more than two weeks but less than one month. Apart from the problem of prolonged jaundice and alpha-1-antitrypsin deficiency, 2 had associated bleeding problems, 11 associated infections and 3 respiratory problems. Two babies had clinical features of Down's syndrome, 2 had G6PD deficiency and 1 had congenital hypothyroidism. AST, ALT and ALPO4 were high in 20, 26 and 3 babies respectively.

Matched MeSH terms: Jaundice, Neonatal/etiology; Jaundice, Neonatal/epidemiology*

Transcutaneous bilirubinometry in fullterm Chinese and Malay infants

Tan KL

Acta Paediatr Scand, 1982 Jul;71(4):593-6.

PMID: 7136674

Matched MeSH terms: Jaundice, Neonatal/blood*; Jaundice, Neonatal/therapy

Phototherapy in neonatal jaundice

Sinniah D, Lee EL

Med J Malaysia, 1977 Jun;31(4):328-30.

PMID: 562970

Matched MeSH terms: Jaundice, Neonatal/therapy*

Fulltext Factors affecting severity of neonatal jaundice in patients presenting from home

Pang MF, Ling SG

JUMMEC, 2000;5(1):24-27.

A descriptive study of full-term neonates with jaundice was carried out to determine factors affecting severity of neonatal jaundice for those infants presenting to the hospital from their homes. Severe jaundice (serum bilirubin >=250 µmol/l) was significantly more likely in infants whose mothers consumed traditional herbs during the postpartum period (p<0.001) and if the jaundice was first detected by the parents or relatives rather than by medical personnel (p<0.05). In addition, the interval between detection of jaundice and presentation to hospital was significantly longer in jaundice that was first detected by parents compared to those detected by medical personnel. In conclusion, factors affecting severity of neonatal jaundice for infants who present from home could be influenced by the socio-cultural practices of maternal postpartum use of herbs, the ability of parents to detect jaundice and the urgency of tlie parents in seeking medical treatment once the jaundice was detected. Further studies need to be done to explore the association of these factors with neonatal jaundice more specifically. KEYWORDS: Hyperbilirubinaemia, socio-cultural practices, herbs.
Study site: Paediatric Institute, Kuala Lumpur Hospital, Malaysia

Matched MeSH terms: Jaundice, Neonatal*

The first isolate of Tatumella ptyseos in Malaysia

Tan SC, Wong YH, Jegathesan M, Chang SM

Malays J Pathol, 1989 Aug;11:25-7.

PMID: 2632996

Tatumella ptyseos, the type species for the genus Tatumella, is a newly established member of the Family Enterobacteriaceae. It is a Gram-negative, oxidase negative, fermentative rod that grows on Mac Conkey agar. This first isolate was obtained from the blood culture of a neonate having neonatal jaundice with presumed sepsis. The organism was in vitro sensitive to Gentamicin, Chloramphenicol, Cotrimoxazole and Ampicillin. The patient was treated with Ampicillin and Gentamicin and recovered uneventfully.

Matched MeSH terms: Jaundice, Neonatal/complications; Jaundice, Neonatal/diagnosis; Jaundice, Neonatal/drug therapy; Jaundice, Neonatal/microbiology*

Effect of turning vs. supine position under phototherapy on neonates with hyperbilirubinemia: a systematic review

Lee Wan Fei S, Abdullah KL

J Clin Nurs, 2015 Mar;24(5-6):672-82.

PMID: 25319831 DOI: 10.1111/jocn.12712

To determine the most effective position jaundiced neonates should assume during phototherapy from appraised randomised controlled trials.

Matched MeSH terms: Jaundice, Neonatal/therapy*

Fulltext What Do Mothers know about Neonatal Jaundice? Knowledge, Attitude and Practice of Mothers in Malaysia

Ng SY, Chong SY

Med J Malaysia, 2014 Dec;69(6):252-6.

PMID: 25934954 MyJurnal

Study site: Hospital Teluk Intan, Perak, Malaysia

Matched MeSH terms: Jaundice, Neonatal*

Phototherapy for neonatal jaundice in Chinese, Malay and Indian infants

Tan KL

Aust Paediatr J, 1976 Mar;12(1):43-6.

PMID: 962730

Matched MeSH terms: Jaundice, Neonatal/therapy*

Hemoglobin Tak in a newborn Malay

Lie-Injo LE, Randhawa ZI, Ganesan J, Kane J, Peterson D

Hemoglobin, 1977;1(8):747-57.

PMID: 604313

The trait condition for hemoglobin Tak, was found in a 4-day old newborn Malay who suffered from severe neonatal jaundice. The beta chain of the abnormal hemoglobin was elongated by 11 residues at the C-terminus and had the same structure as reported for Hb Tak. The mother was heterozygous for this abnormal hemoglobin, the father was normal. The mother and child, 4 years later, did not show clinical or hematological symptoms except definitely increased resistance of their erythrocytes to hypotonic saline solutions and slight anisopoikilocytosis. The abnormal gene in the two reported Thai families and in our Malay family may have the same origin.

Matched MeSH terms: Jaundice, Neonatal/blood

Screening for G71R mutation of the UGT1A1 gene in the Javanese-Indonesian and Malay-Malaysian populations

Sutomo R, Talib NA, Yusoff NM, Van Rostenberghe H, Sadewa AH, Sunarti, et al.

Pediatr Int, 2004 Oct;46(5):565-9.

PMID: 15491385

There are significant differences in the prevalence and severity of neonatal jaundice among various populations. Recently, it has been reported that a mutation of the UGT1A1 gene, glycine to arginine at codon 71 (G71R), is related to the development of neonatal jaundice in East Asian populations. However, whether the G71R mutation contributes to the high incidence of neonatal jaundice in different Asian populations remains unknown. The authors screened for this mutation in the Javanese-Indonesian and Malay-Malaysian populations.

Matched MeSH terms: Jaundice, Neonatal/diagnosis; Jaundice, Neonatal/ethnology; Jaundice, Neonatal/genetics*

Red cell metabolism and severe neonatal jaundice in West Malaysia

Lie-Injo LE, Virik HK, Lim PW, Lie AK, Ganesan J

Acta Haematol., 1977;58(3):152-60.

PMID: 409030 DOI: 10.1159/000207822

A study was carried out of 332 babies suffering from severe neonatal jaundice who were admitted to the General Hospital, Kuala Lumpar, Malaysia. Of the 332 neonates, 51 were premature and 281 were full-term babies, 178 (110 Chinese, 58 Malay, 9 Indian and 1 European-Pakistani) had bilirubin levels of 20 mg% or higher, requiring exchange blood transfusion. Of the Chinese neonates, 23 (20.9%) had G6PD deficiency, 9 (8.2%) had Hb Bart's and 2 (1.8%) had an abnormal haemoglobin, one Hb Q and one fetal variant. Among the Malay infants, 10 (17.2%) had G6PD deficiency, 7 (12.1%) had Hb Bart's and 10 (17.2%) had abnormal haemoglobins (four had Hb E trait, one had Hb K and Bart's in addition to Hb E, three had Hb CoSp with Hb Bart's, one had Hb Q and one Hb Tak). One of the nine Indian neonates had G6PD deficiency and one had Hb S trait. The one European-Pakistani baby was a carrier of Hb D Punjab. In addition to G6PD deficiency, abnormal haemoglobins seem to have contributed to the high incidence of severe neonatal jaundice in Malaysia. The mean activities of GP, GR and GR after stimulation with FAD were higher, while the mean activity of PK and mean level of reduced glutathione were lower than in normal cord bloods. The percent increase of GR after FAD stimulation was significantly lower; fewer in this group had increases above 20% than in normal cord blood. The possible significance of the findings is discussed.

Matched MeSH terms: Jaundice, Neonatal/blood*; Jaundice, Neonatal/enzymology*; Jaundice, Neonatal/etiology

Fulltext Clinical Practice Guideline: Management of neonatal jaundice, Second Edition

Citation: Clinical Practice Guideline: Management of neonatal jaundice, Second Edition. Putrajaya: Ministry of Health, Malaysia; 2014

Quick reference: http://www.acadmed.org.my/view_file.cfm?fileid=706
Training manual: http://www.acadmed.org.my/view_file.cfm?fileid=765

Older version: Management of Jaundice in Healthy Term Newborns., Kuala Lumpur: Ministry of Health, Malaysia; 2003
http://www.acadmed.org.my/view_file.cfm?fileid=192

Matched MeSH terms: Jaundice, Neonatal

Efficacy of phototherapy for neonatal jaundice is increased by the use of low-cost white reflecting curtains

Djokomuljanto S, Quah BS, Surini Y, Noraida R, Ismail NZ, Hansen TW, et al.

Arch. Dis. Child. Fetal Neonatal Ed., 2006 Nov;91(6):F439-42.

PMID: 16877479

To determine whether the addition of low-cost reflecting curtains to a standard phototherapy unit could increase effectiveness of phototherapy for neonatal jaundice.

Matched MeSH terms: Jaundice, Neonatal/economics; Jaundice, Neonatal/therapy*

Randomized controlled trial of oral versus intravenous fluid supplementation on serum bilirubin level during phototherapy of term infants with severe hyperbilirubinaemia

Boo NY, Lee HT

J Paediatr Child Health, 2002 Apr;38(2):151-5.

PMID: 12030996

OBJECTIVE: To compare the rates of decrease in serum bilirubin levels in severely jaundiced healthy term infants given oral or intravenous fluid supplementation during phototherapy.

METHODS: A randomized controlled study was carried out in the neonatal intensive care unit (NICU) of Hospital Universiti Kebangsaan Malaysia over a 12-month period. Fifty-four healthy term infants with severe hyperbilirubinemia were randomized to receive either solely enteral feeds (n = 27) or both enteral and intravenous (n = 27) fluid during phototherapy.

RESULTS: There were no significant differences in the mean birthweight, mean gestational age, ethnic distribution, gender distribution, modes of delivery and types of feeding between the two groups. Similarly, there was no significant difference in the mean indirect serum bilirubin (iSB) level at the time of admission to the NICU between the enteral (359 +/- 69 micromol/L [mean +/- SD]) and intravenous group (372 +/- 59 micromol/L; P = 0.4). The mean rates of decrease in iSB during the first 4 h of phototherapy were also not significantly different between the enteral group (10.4 +/- 4.9 micromol/L per h) and intravenous group (11.2 +/- 7.4 micromol/L per h; P = 0.6). There was no significant difference in the proportion of infants requiring exchange transfusion (P = 0.3) nor in the median duration of hospitalization (P = 0.7) between the two groups. No infant developed vomiting or abdominal distension during the study period.

CONCLUSION: Severely jaundiced healthy term infants had similar rates of decrease in iSB levels during the first 4 h of intensive phototherapy, irrespective of whether they received oral or intravenous fluid supplementation. However, using the oral route avoided the need for intravenous cannulae and their attendant complications.

Matched MeSH terms: Jaundice, Neonatal/blood; Jaundice, Neonatal/therapy*

Breastfeeding during breast milk jaundice - a pathophysiological perspective

Prameela KK

Med J Malaysia, 2019 12;74(6):527-533.

PMID: 31929480

INTRODUCTION: Exclusive breastfeeding for the initial six months of life is crucial and it is recommended . Breast milk jaundice is an innocuous condition that occurs in some healthy, breastfed infants. However, the potential dangers of jaundice in the neonate such as bilirubin induced neuronal pathology, mandates a better understanding of the pathophysiology of breast milk jaundice and the impact of breastfeeding during jaundice. In this context , advice on continued breastfeeding must consider both the benefits of breastfeeding and the possible disadvantages of the jaundice.

METHODS: Reviewing literature and integrating relevant information facilitated the appraisal of this important topic. This article reviewed neonatal jaundice, the entry of bilirubin into the immature brain and how breastfeeding may impact jaundice in the neonate.

RESULTS: While some substances in breast milk may be responsible for jaundice on the one hand, there is an irrefutable spectrum of advantages conferred by continued breastfeeding, on the other. As the breastfed infant benefits from fewer infections, enhanced organ and physiological barrier maturity, as well as the prospect of genetic modification of certain diseases, these useful actions could also reduce risks of early jaundice and its complications.

DISCUSSION: An exciting field for further research, holistic integration of knowledge clarifies both the overall advantages of breastfeeding and wisdom of its continued counsel. In fact, breast milk jaundice may reflect a holistic expression of tissue protection and enhanced neonatal survival.

Matched MeSH terms: Jaundice, Neonatal/etiology*; Jaundice, Neonatal/metabolism

Glucose-6-phosphate dehydrogenase (G6PD) variants in Malaysian Chinese

Ainoon O, Joyce J, Boo NY, Cheong SK, Zainal ZA, Hamidah NH

Hum Mutat, 1999 Oct;14(4):352.

PMID: 10502785 DOI: 10.1002/(SICI)1098-1004(199910)14:4<352::AID-HUMU1

We screened 38 G6PD-deficient male Chinese neonates for known G6PD mutations using established PCR-based techniques. We found 50.0% (19 of 38) were mutation 1376G>T, 34.2% (13 of 38) were mutation 1388G>A, 5.2% (2 of 38 ) were mutation 95A>G and 2.2% (1 of 38) was mutation 1024C>T. In 7% (3 of 38) of the cases the mutations remained uncharacterised. Sixty three percent (24 of 38) of the G6PD deficient neonates had neonatal jaundice with 28.9 % (11 of 38) developing moderate to severe hyperbilirubinemia. The group of neonates with 1388 mutation showed the highest incidence of moderate to severe hyperbilirubinemia requiring phototherapy and/or exchange transfusion respectively. Majority (70%) of the G6PD deficient neonates showed severe enzyme deficiency. However, there was no meaningful association between the level of enzyme activity and the severity of neonatal jaundice. In summary, four mutations account for more than 90% of the G6PD deficiency cases among the Chinese in Malaysia and the pattern of distribution of the molecular variants is similar to those found among the Chinese in Taiwan and southern mainland China. Our findings also suggest the possible association of nt 1388 mutation with severe neonatal jaundice.

Matched MeSH terms: Jaundice, Neonatal/enzymology; Jaundice, Neonatal/genetics

Drive-through transcutaneous bilirubin screening for neonatal jaundice: A safe and efficient system during the COVID-19 pandemic

Chua BS, Song LH, Chang CT, Lim XJ, Nachiappan J

J Paediatr Child Health, 2021 01;57(1):12-14.

PMID: 33078471 DOI: 10.1111/jpc.15226

The coronavirus disease 2019 (COVID-19) cases was on an increasing trend, including in Malaysia. The Malaysian Ministry of Health had implemented a range of measures, such as the use of masks and social distancing, to reduce the risk of transmission. Traditionally, newborns are evaluated for neonatal jaundice using visual assessment, a capillary heel prick and serum bilirubin (SB) sampling in primary health-care clinics. This approach requires the physical presence of both parents and their newborns in the primary health-care clinics, causing crowding and increasing the risk of COVID-19 infections. To alleviate crowding, we implemented the transcutaneous bilirubin drive-through (DT) service, which is an established, non-invasive, painless and rapid method to determine the bilirubin levels. Throughout the screening, both parents and baby will be confined to their car. A total of 1842 babies were screened in our DT setting from April to July 2020. Of the total babies, 298 (16.1%) required venesection for SB measurement and 85 required admission for phototherapy. None with severe jaundice were missed since the implementation of this service. The average test duration per neonate was less than 5 min, while conventional venous bilirubin laboratory testing required an average of 1.5 h per neonate. The cost of the SB laboratory test and consumables was approximately USD 5 per test, with an estimated cost savings of USD 7720. DT screening may be introduced in health-care settings to reduce crowding and eliminate the need of painful blood sampling in newborns.

Matched MeSH terms: Jaundice, Neonatal/blood; Jaundice, Neonatal/diagnosis*

The point-of-care Bilistick method has very short turn-around-time and high accuracy at lower cutoff levels to predict laboratory-measured TSB

Boo NY, Chang YF, Leong YX, Tok ZY, Hooi LC, Chee SC, et al.

Pediatr Res, 2019 08;86(2):216-220.

PMID: 30696987 DOI: 10.1038/s41390-019-0304-0

BACKGROUND: This study aimed to determine the accuracy of a point-of-care Bilistick method for measuring total serum bilirubin (TSB) and its turn-around-time (TAT) against hospital laboratory methods.

METHODS: This prospective study was carried out on 561 term-gestation jaundiced neonates in two Malaysian hospitals. Venous blood sample was collected from each neonate for contemporary measurement of TSB by hospital laboratories and Bilistick. TAT was the time interval between specimen collection and TSB result reported by each method.

RESULTS: The mean laboratory-measured TSB was 194.85 (±2.844) µmol/L and Bilistick TSB was 169.37 (±2.706) µmol/L. Pearson's correlation coefficient was: r = 0.901 (p

Matched MeSH terms: Jaundice, Neonatal/blood*; Jaundice, Neonatal/diagnosis*

Fulltext A review of Orang Asli newborns admitted to a neonatal unit in a Malaysian general hospital

Kandasamy Y, Somasundram P

Singapore Med J, 2007 Oct;48(10):926-8.

PMID: 17909678

The Orang Asli are the indigenous population in peninsular Malaysia and are in fact a diverse sub-ethnic group with different languages. Our aim was to collect data on Orang Asli newborns, from western and central Pahang, that were admitted to a general hospital with paediatric specialist services.

Matched MeSH terms: Jaundice, Neonatal/ethnology*; Jaundice, Neonatal/epidemiology

Fulltext Prevalence of uridine glucuronosyl transferase 1A1 (UGT1A1) mutations in Malay neonates with severe jaundice

Azlin I, Wong FL, Ezham M, Hafiza A, Ainoon O

Malays J Pathol, 2011 Dec;33(2):95-100.

PMID: 22299209 MyJurnal

A number of genetic risk factors have been implicated in the development of neonatal severe hyperbilirubinaemia. This includes mutations in the uridine glucoronosyl transferase 1A1 (UGT1A1) gene which is responsible for unconjugated hyperbilirubinemia in Gilbert's Syndrome. We studied the prevalence of UGT1A1 gene mutations in a group of Malay neonates to determine whether they are risk factors to severe neonatal jaundice. One hundred and twenty-five Malay neonates with severe hyperbilirubinemia were studied. Ninety-eight infants without severe hyperbilirubinaemia were randomly selected from healthy Malay term infants (controls). DNA from EDTA cord blood samples were examined for UGT1A1 mutations nt211G > A and nt247T > C using established Taqman SNP genotyping assays and the UGT1A1*28 variant was detected by the Agilent 2100 bioanalyzer. All samples were also screened for common Malay G6PD variants using established techniques. The frequency of UGT1A1 211G > A mutation is significantly higher in the severely hyperbilirubinemic group (13%) than the control group (4%; p = 0.015) and all the positive cases were heterozygous for the mutation. There was no significant difference in the frequency of UGT1A1*28 mutation between the severely hyperbilirubinemic (3.5%) and the control group (0.01%; p = 0.09). None of the neonates in both groups carried the nt247 T > C mutation. The prevalence of G6PD mutation was significantly higher in the severely jaundiced group than control (9% vs 4%; p = 0.04). In conclusion, nt 211 G > A alleles constitute at least 12% of UGT1A1 mutations underlying unconjugated hyperbilirubinemia and appears to be a significant independent risk factor associated with severe neonatal hyperbilirubinemia in the Malay newborns.

Matched MeSH terms: Jaundice, Neonatal/genetics*

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