Maria do Céu Pereira Gonçalves¹*, Giovanna Marcella Cavalcante Carvalho² and Márcia Gonçalves Ribeiro³

¹Department of Physiotherapy at Estácio de Sá University, Rio de Janeiro; Division of Physiotherapy in Infant Health at the Petrópolis Municipal Health Foundation; Neonatal Intensive Care Unit at Alcides Carneiro Teaching Hospital, Petrópolis, Rio de Janeiro, Brazil
²Pedro Ernesto University, State University of Rio de Janeiro, Brazil
³Pediatrics Division, Faculty of Medicine, Federal University of Rio de Janeiro, Brazil

*Corresponding Author: Maria do Céu Pereira Gonçalves, Department of Physiotherapy at Estácio de Sá University, Rio de Janeiro; Division of Physiotherapy in Infant Health at the Petrópolis Municipal Health Foundation; Neonatal Intensive Care Unit at Alcides Carneiro Teaching hospital, Petrópolis, Rio de Janeiro, Brazil.

Received: January 20, 2023; Published: February 28, 2023

Abstract

Objective: to identify the mean total serum bilirubin (TSB) level in preterm newborns with abnormal primitive reflex responses at corrected age (CA) of one month; to determine whether there is an association between TSB levels and abnormal primitive reflex responses and righting reactions; and to investigate the influence of phototherapy on primitive reflexes.

Design: we conducted a prospective cohort study with 10-week follow-up.

Settings: intermediate care and rooming-in units at a teaching hospital, and maternity clinic in Petrópolis, Rio de Janeiro, Brazil.

Patients: sample of 343 infants with gestational age below 36 weeks, five-minute Apgar score of ≥ 7, and no history of intraventricular hemorrhage detected using transfontanelle ultrasound performed up to corrected gestational age (CGA) of 40 weeks.

Main outcome measures: assessment of primitive reflexes and righting reactions at CGA of 35 weeks; physical examination using the Dubowitz examination ("The Neurological Assessment of the Preterm and Full-term Newborn Infant"); retest of primitive reflexes and righting reactions at CA of one month on infants weighing ≥ 2500g on the day of the test.

Results: mean birth weight and TSB were 1814g ± 465g and 8.3 ± 2.7mg/dL (5.6 - 23.8mg/dL), respectively, in the abnormal response group, compared to 2152g ± 525g and 6.2 ± 3.8mg/dL (1.8 - 18mg/dL), respectively, in the normal response group. Phototherapy was used on 67.9% of the infants in the abnormal response group, compared to 24.1% in the normal response group. The findings reveal that infants who underwent phototherapy with TSB > 8.3mg/dL showed the following abnormal primitive reflex responses and righting reactions: palmar grasp, plantar support, sucking, Babkin, Moro, neck righting, and labyrinthine righting, as well as asymmetrical tonic neck reflex and tonic labyrinthine reflex, both of which are pathological reflexes.

Conclusion: infants with TSB > 8.3 ± 2.7mg/dL showed abnormal primitive reflexes and righting reactions, despite undergoing phototherapy.

Keywords: Primitive Reflex; Hyperbilirubinemia; Kernicterus; Bilirubin Encephalopathy

References

1. Bhutani VK and Johnson LH. “Kernicterus: A Preventable Neonatal Brain Injury”. Journal of the Arab Neonatal Forum 2 (2005): 12-24.
2. Lucey JF. “Bilirubin and brain damage”. Pediatrics 69 (1982): 381.
3. Springer SC. “Kernicterus”. New York: Medscape (2014).
4. Porth CM and Matfin G. “Pathophysiology: Concepts of Altered Health States”. 8^th Philadelphia: Lippincott Williams and Wilkins (2008).
5. Buthani VK. “Prevention of the cerebral injury by Kernicterus”. 5⁰ International Symposium of the Neonatology. Rio de Janeiro (2006).
6. Gonçalves Céu MP., et al. “Manifestation of primitive reflexes in premature infants who showed bilirubin rate above 5.5 mg/Dl. XX Brazilian Congress of the Perinatology”. Journal of Pediatrics of the State of Rio de Janeiro. RJ. XI.1 (2010): 92.
7. Hamza A. “Kernicterus”. Autopsy and Case Reports 1 (2019): e2018057.
8. Almeida MFB. “When should we start phototherapy in preterm newborn infants?” Journal de Pediatria4 (2004): 256-258.
9. Hazinski MF. “Nursing care of the critically ill child”. Lotus: Mosby-year Book (1992): 739.
10. Hansen TWR. “Therapeutic approaches to neonatal jaundice: an international survey”. Clinical Pediatrics 35 (1996): 309-316.
11. Watchko JF and Maisels MJ. “Jaundice in low-birth-weight infants: Pathobiology and outcome”. Archives of Disease in Childhood”. Fetal and Neonatal 88 (2003): 455-458.
12. Wong RJ and Bhutani VK. “Unconjugated hyperbilirubinemia in term and late preterm infants: Management”. UpToDate1 (2020): 1-15.
13. Maisels MJ., et al. “An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation”. Journal of Perinatology. 32 (2012): 660-664.
14. Bhutani VK and Wong RJ. “Hyperbilirubinemia in the premature infant (less than 35 weeks gestation). Site: www.UpToDate. Last literature review version 18.3: September (2010)
15. Bastos F., et al. “Preliminary report on management of neonatal jaundice in maternity clinics of São Paulo city, Brazil”. Einstein (São Paulo 1 (2007): 56-62.
16. Dubowitz L and Dubowitz V. “The Neurological Assessment of the Preterm and Full-term Newborn Infant”. Philadelphia: Lippincott (1991).
17. , et al. “Kernicterus in Preterm Infants”. Pediatrics 123.6 (2009): 1052-1058.
18. Govaert P., et al. “Changes in globuspallidus with preterm kernicterus”. Pediatrics 112 (2003): 1256-1263.
19. American Academy of Pediatrics. Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation”. Pediatrics 114 (2004): 297-316.
20. Maisels MJ and Watchko JF. “Treatment of jaundice in low-birth-weight infants”. Archives of Disease in Childhood Fetal and Neonatal 88 (2003): 459-463.
21. Bhutani and Wong. “Bilirubin neurotoxicity in premies”. Journal of Clinical Neonatology 2 (2013): 61-69.
22. , et al. “Risk Factors for Neurotoxicity in Newborns with Severe Neonatal Hyperbilirubinemia”. Pediatrics 128.4 (2011): 925-931.
23. Wong RJ and Bhutani VK. “Unconjugated hyperbilirubinemia in term and late preterm infants: Management”. UpToDate1 (2020): 1-15.
24. Turkel SB., et al. “Lack of identifiable risk factors for Kernicterus”. Pediatrics 66 (1980): 502-506.
25. Kim MH., et al. “Lack of predictive indices in Kernicterus: a comparison of clinical and pathologic factors in infants with and without Kernicterus”. Pediatrics 66 (1980): 852-858.
26. Chou SC., et al. “Management of hyperbilirubinemia in newborns: measuring performance by using a benchmarking model”. Pediatrics6 Pt 1 (2003): 1264-1273.
27. Brown AK and Johnson LH. “Loss of concern about jaundice and the reemergence of kernicterus in full-term infants in the era of managed care”. In: Fanaroff A, Klaus MH, editors. The yearbook of neonatal and perinatal medicine. Saint Louis: Mosby-Year Book (1996): 16-28.
28. Bhutani Vk and Johnson “Newborn jaundice and kernicterus-health and societal perspectives”. Indian Journal of Pediatrics 5 (2003): 407-416.
29. Gkoltsiou K., et al. “Serial brain MRI and ultrasound findings: Relation to gestation age, bilirrubin level, neonatal neurologic status and neurodevelopmental outcome in infants at risk of kernicterus”. Early Human Development 12 (2008): 829-838.
30. Odutolu Yetunde and Anthony J Emmerson. “Low bilirubin kernicterus with sepsis and hypoalbuminaemia”. Case Report (2013): 1-3.
31. NICE neonatal Jaundice Clinical Guidelines (2010).
32. Cashore WJ. “Bilirubin and jaundice in the micropremie”. Clinics in Perinatology 27 (2000): 171-179.

Citation

Citation: Maria do Céu Pereira Gonçalves.,et al. “Effects of TSB Levels above 5mg/dl on Primitive Reflex Responses and Righting Reactions in Preterm Newborns". Acta Scientific Paediatrics 6.3 (2023): 21-27.

Copyright

Copyright: © 2023 Maria do Céu Pereira Gonçalves., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.