MyMedR

Clinical features differentiating biliary atresia from other causes of neonatal cholestasis

Lee WS, Chai PF

Ann Acad Med Singap, 2010 Aug;39(8):648-54.

PMID: 20838708

INTRODUCTION: This study determined any clinical features which may help to differentiate biliary atresia (BA) from other causes of neonatal cholestasis (NC).

MATERIALS AND METHODS: A prospective and observational study was conducted on consecutive infants with NC referred to the University of Malaya Medical Centre, Malaysia, between November 1996 and May 2004.

RESULTS: The 3 most common causes of cholestasis among the 146 infants with NC studied were idiopathic neonatal hepatitis (n = 63, 43%), BA (n = 35, 24%) and congenital cytomegalovirus hepatitis (n = 13, 9%). Common clinical features at presentation were jaundice (100%), hepatomegaly (95%), splenomegaly (52%) and pale stools (47%). Three clinical features noted to be sensitive for BA were the presence of acholic or variably acholic stools on admission, a liver which was firm/hard in consistency and a palpable liver of ≥4 cm (sensitivity of 77%, 80% and 94%, respectively), but the corresponding specificity was poor (51%, 65% and 39%, respectively). The stools of 2 children with BA were pigmented initially but became acholic subsequently.

CONCLUSIONS: We did not find any single clinical feature with sufficient sensitivity and specificity to differentiate BA from other causes of NC. Repeated inspection of stools colour is necessary as occasionally, patients with BA may have initial pigmented stools. Biochemical assessment and imaging studies are important in the assessment of any infant with NC.

Matched MeSH terms: Jaundice, Neonatal/diagnosis

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

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/diagnosis

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/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/diagnosis*

Late onset group b beta-hemolytic streptococcus infection in a neonate manifesting as a urinary tract infection: a rare clinical presentation

Zurina Z, Rohani A, Neela V, Norlijah O

Southeast Asian J. Trop. Med. Public Health, 2012 Nov;43(6):1470-3.

PMID: 23413711

Group B beta-hemolytic streptococcus (GBS) sepsis is a serious bacterial infection in neonates, with significant morbidity and mortality. We report here a neonate with late onset GBS infection manifesting as a urinary tract infection (UTI) in an infant presenting with prolonged neonatal jaundice. The pathogenesis of this late onset is postulated.

Matched MeSH terms: Jaundice, Neonatal/diagnosis

Pre-admission consultation and late referral in infants with neonatal cholestasis

Lee WS

J Paediatr Child Health, 2008 Jan;44(1-2):57-61.

PMID: 17640283

To study factors leading to delayed referral in neonatal cholestasis at a tertiary centre in Malaysia.

Matched MeSH terms: Jaundice, Neonatal/diagnosis

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