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Neonatal Jaundice

Jaundice is one of the most common conditions requiring medical attention in newborn babies. Approximately 60% of term and 80% of preterm babies develop jaundice in the first week of life, and about 10% of breastfed babies are still jaundiced at 1 month of age. In most babies with jaundice thevre is no underlying disease, and this early jaundice (termed ‘physiological jaundice’) is generally harmless. However, there are pathological causes of jaundice in the newborn, which, although rare, need to be detected. Such pathological jaundice may co-exist with physiological jaundice.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: May 2010
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Screening for Bilirubin Encephalopathy [Internet]

Kernicterus or chronic bilirubin encephalopathy is a devastating disease. Thus, it is important to examine strategies to prevent the development of kernicterus.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: October 2009
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Management of neonatal hyperbilirubinemia

This review investigated the efficacy of treatments for neonatal hyperbilirubinaemia, namely phototherapy. The authors concluded that phototherapy combined with cessation of breast-feeding was the most effective treatment for healthy infants with jaundice. These conclusions should be interpreted with caution as they are based on a few studies in which the definition of hyperbilirubinaemia and the time of bilirubin measurement varied.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Screening for bilirubin encephalopathy

This review concluded that a combination of risk factors and early total serum bilirubin measurement had better ability to predict hyperbilirubinaemia than risk factors alone. These conclusions were based on a single study, which combined with limitations in the search, quality assessment and synthesis mean that the authors' conclusions are unlikely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Metalloporphyrins for treatment of unconjugated hyperbilirubinemia in neonates

Metalloporphyrins may reduce very high levels of jaundice in newborn babies, but more research is required on safety and to compare it with other treatments. Jaundice is very common in newborn babies, and is caused by the liver producing too much bilirubin, a yellow‐coloured bile substance. A very high level of bilirubin can damage the developing brain, and is treated with phototherapy (light therapy) or exchange transfusions. Metalloporphyrins are drugs that can prevent the formation of bilirubin, but they might also cause photosensitivity (sensitivity to light) and anaemia (decreased hemoglobin levels in the blood). The review of trials found some evidence that metalloporphyrins might be able to reduce bilirubin, but more research is needed on short and long‐term effects and to compare it with other treatments.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Single versus double volume exchange transfusion in jaundiced newborn infants

Extremely high levels of bilirubin (severe jaundice) can lead to brain damage. Severe jaundice in newborns can occur as a result of a variety of causes including rhesus hemolytic disease, ABO incompatibility, atypical antibodies etc. Removal of blood from the affected infant and replacing with fresh blood from the blood bank (exchange transfusion) is used as a treatment for severe jaundice in newborn infants. The affected infant's blood is removed in small portions and equal volume of blood is replaced during exchange transfusion. Traditionally twice the blood volume of baby is removed and the replaced with fresh blood. Exchange transfusion has been shown to reduce brain damage in severely jaundiced babies; however, exchange transfusion is associated with serious adverse events including death. It is likely that the complications of exchange transfusion would increase with amount of blood exchanged. This review was undertaken to examine if single volume (removal of blood equivalent to the blood volume of the baby) is as effective as double volume (removal of twice blood volume of the baby) in reducing the brain damage and bilirubin levels in newborn infants with severe jaundice. Only one randomised trial fulfilled the criteria for inclusion in the analysis. This study compared single and double volume exchange transfusion in jaundice due to ABO hemolytic jaundice. The study found no significant difference in bilirubin levels following exchange. This study did not look at any long term neurodevelopmental outcome (brain damage). Based on the available data, there is insufficient evidence to support or refute the use of single volume exchange transfusion as opposed to double volume exchange transfusion in jaundiced newborns.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Diagnosis and Management of Infantile Hemangioma [Internet]

To systematically review evidence addressing the diagnosis and management of infantile hemangiomas (IH).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: January 2016
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Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage

The guideline covers diagnosis of early pregnancy loss, including the use of ultrasound scanning and biochemical testing. Investigations incur costs and the use of serial measurements may delay decision making. The guideline includes guidance on when senior and/or specialist advice should be sought in order to avoid errors and unnecessary delay.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: December 2012
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Antenatal Care: Routine Care for the Healthy Pregnant Woman

The original antenatal care guideline was published by NICE in 2003. Since then a number of important pieces of evidence have become available, particularly concerning gestational diabetes, haemoglobinopathy and ultrasound, so that the update was initiated. This update has also provided an opportunity to look at a number of aspects of antenatal care: the development of a method to assess women for whom additional care is necessary (the ‘antenatal assessment tool’), information giving to women, lifestyle (vitamin D supplementation, alcohol consumption), screening for the baby (use of ultrasound for gestational age assessment and screening for fetal abnormalities, methods for determining normal fetal growth, placenta praevia), and screening for the mother (haemoglobinopathy screening, gestational diabetes, pre-eclampsia and preterm labour, chlamydia).

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: March 2008
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Drug Class Review: Skeletal Muscle Relaxants: Final Report [Internet]

Skeletal muscle relaxants are a heterogeneous group of medications commonly used to treat two different types of underlying conditions: spasticity from upper motor neuron syndromes and muscular pain or spasms from peripheral musculoskeletal conditions. The purpose of this report is to determine whether there is evidence that one or more skeletal muscle relaxant is superior to others in terms of efficacy or safety.

Drug Class Reviews - Oregon Health & Science University.

Version: May 2005
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Systematic review of the safety of trimethoprim-sulfamethoxazole for prophylaxis in HIV-infected pregnant women: implications for resource-limited settings

Daily prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMZ) significantly decreases morbidity and mortality among people living with HIV. Some clinicians are reluctant to use TMP-SMZ in pregnant and breastfeeding HIV-infected women because of concerns about the possible teratogenicity when used in the first trimester and about its potential to induce hyperbilirubinemia near term and during early breastfeeding. We systematically reviewed evidence regarding the toxicity of TMP-SMZ prophylaxis in pregnant and breastfeeding women to help guide practice in resource-limited settings. We identified relevant literature by searching PubMed and MEDLINE via OVID, Embase, and Science Citation Index for data on hyperbilirubinemia, kernicterus, and teratogenicity associated with administration of sulfonamides and TMP-SMZ through July 2005. We also reviewed the reference lists of identified articles. Most studies demonstrated that TMP-SMZ was not associated with hyperbilirubinemia when administered to mothers during pregnancy and breastfeeding. No cases of kernicterus were reported in neonates after maternal ingestion of sulfonamides. There is mixed evidence linking ingestion of TMP-SMZ and other sulfonamides in early pregnancy to elevated risks of oral clefts, neural tube defects, and cardiovascular and urinary tract abnormalities, although some sources found that supplementation with folic acid might ameliorate this potential risk. Existing guidelines recommend that HIV-infected pregnant women receive prophylaxis, but they differ with regards to stage of disease at which to initiate treatment, need for CD4+ T-lymphocyte testing, and prophylaxis during the first trimester. Existing data indicate that the risk of serious injury to neonates from maternal use of daily TMP-SMZ prophylaxis during pregnancy and breastfeeding is small. Given the substantial benefits of TMP-SMZ prophylaxis for HIV-infected women living in resource-limited settings, this review indicates that it is safe to abide by the WHO guidelines recommending daily TMP-SMZ prophylaxis for HIV-infected pregnant women.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Clofibrate for unconjugated hyperbilirubinemia in neonates: a systematic review

OBJECTIVE: To evaluate the effect of clofibrate for unconjugated hyperbilirubinemia in neonates.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

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