Fernando Perazzini Facchini

Comparison of transcutaneous and plasma bilirubin measurement

OBJECTIVES To compare transcutaneous bilirubin measurements made using Bilicheck equipment with assays of capillary plasma using the Unistat bilirubinometer (Leica). METHODS Two hundred concomitant assays were performed (transcutaneous and in plasma), and the correlation and level of agreement between them was calculated. An assessment was also made of the influence of birth weight, skin color, gestational age, postnatal age and phototherapy. RESULTS The linear correlation coefficient was 0.92, and the mean difference between assays was 0.72 (+/-1.57) mg/dL, with a 95% confidence interval from -2.42 to +3.86. The best of a series of ROC curves demonstrated that transcutaneous assays at 14 mg/dL offer the best sensitivity (88.2%) and specificity (97.8%), with a positive predictive value of 78.9%, negative predictive value of 98.9 and are below the curve of 0.98. CONCLUSIONS Assays performed using Bilicheck can be substituted for capillary plasma assays up to 14 mg/dL. Above this level the device should only be used for screening for patients whose bilirubin should be assayed in blood.

Follow-up of neonatal jaundice in term and late premature newborns

OBJECTIVES To report on the results of a project following term and near term newborn infants who were jaundiced during the neonatal period. METHODS Neonates were referred to the follow-up clinic with weight >/= 2,000 g and/or gestational age >/= 35 weeks, and jaundice at discharge was initially assessed with an Ingram icterometer or Bilicheck and, if indicated, with a Unistat bilirubinometer (Leica). These newborn infants had bilirubinemia at or above the 40th percentile on the nomogram developed by Bhutani. All infants treated with phototherapy while in hospital were reassessed by laboratory methods 24 hours after withdrawal of treatment. Patients were rehospitalized for intensive phototherapy if their level was greater than or equal to 20 mg/dL. RESULTS From a total sample of 11,259 neonates, 2,452 (21.8%) were referred to the follow-up clinic, 87.2% (2,140) of whom did return. Eighty returned neonates were readmitted. Return appointments were set for 2,452 patients, 180 (7.3%) of whom had bilirubinemia >/= 15 mg/dL at discharge. Of these 180, 151 returned for follow-up. Twenty (13.2%) were readmitted for treatment. Of the total number of readmitted patients, two newborn infants had levels >/= 25 mg/dL and none >/= 30 mg/dL. All responded rapidly to intensive phototherapy, and there was no need for exchange transfusions. CONCLUSIONS Our results suggest that the regime adopted is effective for detecting and preventing hyperbilirubinemia at risk of causing bilirubin-induced encephalopathy in term and near term newborn infants.

Standardizing the calibration of phototherapy devices - a proposal

OBJETIVO: propor metodo de avaliacao e manutencao da eficiencia dos equipamentos mais comumente usados em nosso meio, de maneira a uniformizar os resultados obtidos em tratamentos fototerapicos por diferentes servicos. MATERIAL E METODOS: o radiometro/fotometro utilizado na medida da irradiância espectral e de fabricacao nacional e atende aos requisitos basicos indispensaveis. As padronizacoes de medida procuram ser facilmente aplicaveis e reprodutiveis aos aparelhos de fototerapia em uso no pais. O material necessario as afericoes, excetuando-se o radiometro, pode ser facilmente confeccionado em qualquer servico de neonatologia. Procuramos nos trabalhos publicados nos ultimos 10 anos no Medline os pertinentes a esta revisao. RESULTADO: propoe-se que a irradiância relatada nos trabalhos de fototerapia seja fornecida como Irradiância Espectral Media e descreve-se como obte-la, tanto em fototerapias com fontes fluorescentes como halogenas. COMENTARIOS: sao descritos os componentes dos radiometros/fotometros, cuja compreensao e importante para que possamos perceber variacoes na sensibilidade e diferencas significativas na irradância quando as faixas de leitura dos radiometros sao um pouco diferentes. A adocao de um tipo de equipamento padrao facilitaria muito a comparacao de resultados obtidos por diferentes servicos. Sao ainda comentadas as caracteristicas de diferentes equipamentos de fototerapia que podem interferir na mensuracao da irradiância dos mesmos.

Comparação entre a dosagem transcutânea e plasmática de bilirrubina

OBJECTIVES: To compare transcutaneous bilirubin measurements made using Bilicheck equipment with assays of capillary plasma using the Unistat bilirubinometer (Leica). METHODS: Two hundred concomitant assays were performed (transcutaneous and in plasma), and the correlation and level of agreement between them was calculated. An assessment was also made of the influence of birth weight, skin color, gestational age, postnatal age and phototherapy. RESULTS: The linear correlation coefficient was 0.92, and the mean difference between assays was 0.72 (±1.57) mg/dL, with a 95% confidence interval from -2.42 to +3.86. The best of a series of ROC curves demonstrated that transcutaneous assays at 14 mg/dL offer the best sensitivity (88.2%) and specificity (97.8%), with a positive predictive value of 78.9%, negative predictive value of 98.9 and are below the curve of 0.98. CONCLUSIONS: Assays performed using Bilicheck can be substituted for capillary plasma assays up to 14 mg/dL. Above this level the device should only be used for screening for patients whose bilirubin should be assayed in blood.

Acompanhamento da icterícia neonatal em recém-nascidos de termo e prematuros tardios

OBJECTIVE: To report on the results of a project following term and near term newborn infants who were jaundiced during the neonatal period. METHODS: Neonates were referred to the follow-up clinic with weight > 2,000 g and/or gestational age > 35 weeks, and jaundice at discharge was initially assessed with an Ingram icterometer or Bilicheck and, if indicated, with a Unistat bilirubinometer (Leica). These newborn infants had bilirubinemia at or above the 40th percentile on the nomogram developed by Bhutani. All infants treated with phototherapy while in hospital were reassessed by laboratory methods 24 hours after withdrawal of treatment. Patients were rehospitalized for intensive phototherapy if their level was greater than or equal to 20 mg/dL. RESULTS: From a total sample of 11,259 neonates, 2,452 (21.8%) were referred to the follow-up clinic, 87.2% (2,140) of whom did return. Eighty returned neonates were readmitted. Return appointments were set for 2,452 patients, 180 (7.3%) of whom had bilirubinemia > 15 mg/dL at discharge. Of these 180, 151 returned for follow-up. Twenty (13.2%) were readmitted for treatment. Of the total number of readmitted patients, two newborn infants had levels > 25 mg/dL and none > 30 mg/dL. All responded rapidly to intensive phototherapy, and there was no need for exchange transfusions. CONCLUSIONS: Our results suggest that the regime adopted is effective for detecting and preventing hyperbilirubinemia at risk of causing bilirubin-induced encephalopathy in term and near term newborn infants.

Systematic follow-up of hyperbilirubinemia in neonates with a gestational age of 35 to 37 weeks

OBJECTIVES To determine the outcomes of an intervention for follow-up of bilirubinemia in the first week of life in a cohort of newborn infants with gestational ages between 35 0/7 and 37 6/7 weeks and to determine risk factors for readmission for phototherapy (total bilirubin > 18 mg/dL). METHODS Retrospective cohort study carried out at a public teaching hospital. Neonates underwent periodic monitoring of total bilirubin levels (measured in plasma or by transcutaneous device) before and after discharge to assess the need for phototherapy. A systematic approach, based on risk percentiles of a bilirubin reference curve, was employed. RESULTS The study sample comprised 392 neonates. Only one outpatient visit was required in 61.7% of newborns. Peak total bilirubin was ≥ 20 mg/dL in 34 neonates (8.7%), and reached 25-30 mg/dL in three (0.8%). Phototherapy was indicated after discharge in 74 neonates (18.9%). Weight loss between birth and first follow-up visit and total bilirubin above the 40th percentile at discharge were risk factors for requiring phototherapy. Total bilirubin above the 95th percentile at discharge was associated with greater risk of readmission (RR = 49.5 [6.6-370.3]). Weight loss between discharge and first follow-up visit was the sole independent clinical predictor (RR = 1.16 [1.04-1.17]). CONCLUSION Systematic follow-up during the first week of life was effective in preventing dangerous hyperbilirubinemia. Encouraging breastfeeding and discharging neonates only after weight loss has been stabilized may prevent readmission due to hyperbilirubinemia.

Hiperbilirrubinemia neonatal prolongada devido à associação entre síndrome de Gilbert e doença hemolítica por incompatibilidade RhD

OBJECTIVE: To report on an infrequent association of pathologies causing considerable increase in bilirubin production and a signifiant decrease in its excretion. DESCRIPTION: The third pregnancy of an RhD negative woman. Her first child was normal and delivered to term and did not receive Rhogam. The second pregnancy was problematic due to Rh isoimmunization. She delivered a child to term, who required three exchange transfusions, but died on the 8th day of life. The third child was delivered at term, ORh positive, direct Coombs positive and had stump bilirubin of 6.5 mg/dl and hematocrit at 44%. Five hours after birth the child was jaundiced. Phenobarbital and intensive phototherapy were introduced. Hyperbilirubinemia was soon controlled, but relapsed whenever phototherapy was discontinued. On the 10th day of life the child received a transfusion for significant anemia. As jaundice persisted to the 13th day, associated Gilbert syndrome was considered and DNA sequence analysis was requested. The test demonstrated a mutant homozygote genotype UDPT1A1[TA]7TAA. Phototherapy remained necessary until the 17th day of life and she was discharged from hospital the following day, after bilirubinemia had been controlled. She returned for follow-up and exhibited normal growth and neurological development. COMMENTS: This case demonstrates the significance of increased bilirubin production/decreased bilirubin excretion causing intense hyperbilirubinemias and, in the abnsence of vigorous treatment, kernicterus. The effectiveness of intense phototherapy has also been demonstrated, reducing the risks of more aggressive treatments such as exchange transfusion. It also provides evidence of the importance of bilirubinemia follow-up until complete resolution.

Carcinoma dei dotti collettori del Bellini: case report con metastasi cutanea come inizialemanifestazione clinica

il carcinoma dei dotti collettori (cdc) rappresenta una neoplasia rara con decorso aggressivo, spesso metastatica al momento della diagnosi e, con una prognosi estremamente infausta. Si presenta con un’incidenza dell’1-3% tra le neoplasie renali e, a differenza dalla maggior parte di esse, origina dall’epitelio di rivestimento dei tubuli distali e dei dotti collettori di Bellini (1). Questa neoplasia ha la tendenza ad interessare pazienti in media più giovani, rispetto al più comune carcinoma renale a cellule chiare (rcc) (1, 2). riportiamo il primo caso documentato di carcinoma del Bellini con iniziale manifestazione clinica rappresentata da una metastasi cutanea del cuoio capelluto. carcinoma dei dotti collettori del Bellini: case report con metastasi cutanea come iniziale manifestazione clinica

Calcifilassi e necrosi peniena: case report e revisione della letteratura

IntroductionCalciphylaxis is a rare clinic condition characterised by skin necrosis due to medial and intimal calcification of small and medium arteries. Its observed in patients affected by end s...

Avaliação laboratorial da estabilidade do padrão calibrador de bilirrubina

Introducao: O preparo do padrao calibrador de bilirrubina e essencial para um controle adequado das dosagens laboratoriais da bilirrubinemia, visto que estas estao sujeitas a grande variabilidade nos resultados, dependendo do metodo de dosagem escolhido e da falta de padronizacao rigorosa na sua execucao. Uma vez preparado, este padrao calibrador deve ser dividido em aliquotas e estocado para ser utilizado de rotina. Objetivo: Avaliar os efeitos de diferentes condicoes de armazenamento de um padrao calibrador de bilirrubina sobre sua estabilidade, com finalidade de calibracao de equipamentos utilizados na determinacao da bilirrubinemia em neonatos. Material e metodos: Apos o preparo de um padrao calibrador com 25mg/dl de bilirrubina, este foi armazenado a 4°C, congelado a - 20°C e a - 70°C. Durante nove meses foram feitas dosagens consecutivas da bilirrubina da solucao padrao, as quais foram analisadas atraves da analise de variância de duas vias com blocagem. Resultados: As amostras congeladas a - 70°C nao sofreram degradacao significativa nos nove meses estudados, enquanto que, no periodo de tres meses, as congeladas a - 20°C e a 4°C sofreram uma degradacao de 5% e 24,18%, respectivamente, dos niveis iniciais de bilirrubina. Conclusao: A estocagem do padrao calibrador de bilirrubina a - 70°C e a recomendada para a preservacao dos niveis de bilirrubina.