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Achmad Surjono Achmad Surjono
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Prealbumin level at biochemical marker of nutritional assessment in premature infants Achmad Surjono, Achmad Surjono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 21, No 04 (1989)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (230.568 KB)

Abstract

Controversies in adequate nutrition for premature infants still exist. No single anthropometric or biochemical measures currently available are reliable for premature nutritional assessment.The aim of this study is to determine the usefulness of serial prealbumin serum levels in identifying adequacy of nutritional intake in premature infants during their neonatal period. A group of 18 infants ranging in birthweight between 1030-2050 g, nursed in the Dr. Sardjito Hospital until one month of age were included for study. Breast and formula milk were given in increasing amount and depending upon acceptance 120 Cal/kg of body weight/day should be achieved. Peripheral capillary blood samples were obtained for prealbumin examinations (by radial-immunodiffusion method) on the first day and at weekly interval afterwards. The infants were weighed daily and serum albumin was examined on 14 and 28 days of age.It turns out that the mean serum prealbumin in the first day of life was 7.9 ± L8 mg% and a significant increment levels on weekly measurements were obtained. It is shown that no correlation was found.between the prealbumin and albumin levels. Body weights correlated poorly with serial prealbumin values.It seems that prealbumin, with a short half-life of 1.9 days can be used as a sensitive nutritional assessment in premature infants. Modifying of adequate protein and caloric provision could be applied early to prevent malnutrition in the neonatal period of premature infants.Key Words: prealbumin - serum albumin - premature infants - nutritional assessment - caloric requirement
Hyperbilirubinemia in the newborn infants; unbound bilirubin approach Achmad Surjono, Achmad Surjono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 27, No 01 (1995)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (243.194 KB)

Abstract

A guideline for management of hyperbilirubinemia in the newborns based solely on total/indirect serum bilirubin levels is considered outmoded. An approach to the identification of newborns at risk of bilirubin toxicity due to the increase of unbound bilirubin is proposed. Unbound bilirubin can easily enter the brain and bind to the nerve cells.A peroxidase oxidation method using unbound bilirubin - analyzer (UB-analyzer) offers a rapid, accurate and reproducible measurement of unbound bilirubin. Phototherapy, either continuous or intermittent can be applied to term and preterm infants on the monitoring of unbound bilirubin levels.Temporary cessation of breast-feeding is not advised in healthy term newborns with hyperbilirubinemia. On the contrary, more frequent feeding is advocated. Caution and substitution should be taken in giving any drugs having a potent displacer on bilirubin-albumin binding, especially In premature infants.Key words : newborn infants --hyperbilirubinemia -- unbound bilirubin -- phototherapy -- displacing drugs
Displacement of bilirubin from human albumin by drugs Achmad Surjono, Achmad Surjono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 18, No 02 (1986)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (247.389 KB)

Abstract

The displacing effect of 18 commonly used drugs on bilirubin-albumin binding were studied quantitatively. The competitive results of certain concentrations of drugs were measured by peroxidase oxidation method on standard bilirubin-albumin solution (bilirubin 0.255 mmol, albumin 0.45 mmol. bil /alb 0.56). Sulfisoxazole, the known clinically potent bilirubin-displacer was used as control. The apparent binding constant to the high-affinity site of albumin (Kd) of mephenamate (1.4 X 105), indomethacin (1.23 X 105), diflunisal (8.4 X 104), diazepam (6.7 X 104) and furosemide (3 X 104) were stronger than sulfisoxazole (1.72 x 104). Latamoxef, aminophylline and cefalotin were slightly lower than sulfisoxazole. The maximal displacing factors (MDF) were also determined, whereas sulfisoxasole was 2.29. Taking the MDF 1.2 as the upper limit for significant danger of displacement, mephenamate (4.02), latamoxed (1.63) and diflunisal (1.24) showed a higher risks Moderate to slight risks of displacement were recorded on indomethacin, cevalotine, cefotaxime, acetyl salicylic acid, aminophylline, phenobarbital, furosemide and ampicillin. No possible bilirubin-displacer were shown by sulir. idac, diazepam, doxapzam, digoxin, amikacin, gentamicin and kanamycin. Caution and substitution should be considered in giving non-steroid and-inflammatory drugs for closure of patent ductus arteriosus and latamoxef for sepsis in premature infants because of their potential risk of bilirubin encephalopathy. Key Words: albumin-bilirubin-binding drugs - displacing effect - kernicterusanti-inflam matory drugs - bilirubin encephalopathy
Breast milk, weight loss and hyperbilirubinemia in fitllterm newborn infants in the first week of life Achmad Surjono, Achmad Surjono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 25, No 01 (1993)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (154.053 KB)

Abstract

The objectives were to find out the proportion of hiperhilinthinemia in term of breast-fed newborn infants, the figure of their weight loss and any significant difference in weight loss between hyperbilirubinemic group as compared with control.The subjects consist of a total of 210 singleton full-term newborn babies delivered in Dr. Sardjito Hospital from January 1 to June 30, 1992, with 5 minute Apgar score more than six and on permission of the mothers.The serum total bilirubin (TB) and unbound bilirubin (UB) were measured on day 3 and 5. TB concentration was measured spectrophotometrically and UB level was determined by peroxidase oxidation method using UB-analyzer, an automated micromethod. Body weight and first week conditions of the infants were recorded daily. Mean (± SD) TB and UB values in the third day were 10.30 ± 3.42 mg% and 0.24 ± 0.16 p.g%, respectively. The proportion of hyperbilirubinemia was 11.9%, in whom 44% received phototherapy (UB level 0.5 pg%). The mean weight loss (%) was 3.95 ± 1.84: No statistically significant difference on weight loss was found between hyperbilinthinemic and control group (p > 0.05).Hyperbilirubinemia in breast-fed term newborn infants can be considered a minor problem. Considering the benefit of mother milk, in particular for exclusive breast feeding, temporary cessation of breast feeding is not needed. On the contrary, more frequent suckling is advised with a close observation of UB levels.Key Words : breast feeding fulltenn infants hyperbilirubinemia unbound bilirubin weight loss
Hyperbilirubinemia in the newborn infants; unbound bilirubin approach Achmad Surjono Achmad Surjono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 27, No 01 (1995)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (243.194 KB)

Abstract

A guideline for management of hyperbilirubinemia in the newborns based solely on total/indirect serum bilirubin levels is considered outmoded. An approach to the identification of newborns at risk of bilirubin toxicity due to the increase of unbound bilirubin is proposed. Unbound bilirubin can easily enter the brain and bind to the nerve cells.A peroxidase oxidation method using unbound bilirubin - analyzer (UB-analyzer) offers a rapid, accurate and reproducible measurement of unbound bilirubin. Phototherapy, either continuous or intermittent can be applied to term and preterm infants on the monitoring of unbound bilirubin levels.Temporary cessation of breast-feeding is not advised in healthy term newborns with hyperbilirubinemia. On the contrary, more frequent feeding is advocated. Caution and substitution should be taken in giving any drugs having a potent displacer on bilirubin-albumin binding, especially In premature infants.Key words : newborn infants --hyperbilirubinemia -- unbound bilirubin -- phototherapy -- displacing drugs
Breast milk, weight loss and hyperbilirubinemia in fitllterm newborn infants in the first week of life Achmad Surjono Achmad Surjono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 25, No 01 (1993)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (154.053 KB)

Abstract

The objectives were to find out the proportion of hiperhilinthinemia in term of breast-fed newborn infants, the figure of their weight loss and any significant difference in weight loss between hyperbilirubinemic group as compared with control.The subjects consist of a total of 210 singleton full-term newborn babies delivered in Dr. Sardjito Hospital from January 1 to June 30, 1992, with 5 minute Apgar score more than six and on permission of the mothers.The serum total bilirubin (TB) and unbound bilirubin (UB) were measured on day 3 and 5. TB concentration was measured spectrophotometrically and UB level was determined by peroxidase oxidation method using UB-analyzer, an automated micromethod. Body weight and first week conditions of the infants were recorded daily. Mean (± SD) TB and UB values in the third day were 10.30 ± 3.42 mg% and 0.24 ± 0.16 p.g%, respectively. The proportion of hyperbilirubinemia was 11.9%, in whom 44% received phototherapy (UB level 0.5 pg%). The mean weight loss (%) was 3.95 ± 1.84: No statistically significant difference on weight loss was found between hyperbilinthinemic and control group (p > 0.05).Hyperbilirubinemia in breast-fed term newborn infants can be considered a minor problem. Considering the benefit of mother milk, in particular for exclusive breast feeding, temporary cessation of breast feeding is not needed. On the contrary, more frequent suckling is advised with a close observation of UB levels.Key Words : breast feeding fulltenn infants hyperbilirubinemia unbound bilirubin weight loss
Displacement of bilirubin from human albumin by drugs Achmad Surjono Achmad Surjono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 18, No 02 (1986)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (247.389 KB)

Abstract

The displacing effect of 18 commonly used drugs on bilirubin-albumin binding were studied quantitatively. The competitive results of certain concentrations of drugs were measured by peroxidase oxidation method on standard bilirubin-albumin solution (bilirubin 0.255 mmol, albumin 0.45 mmol. bil /alb 0.56). Sulfisoxazole, the known clinically potent bilirubin-displacer was used as control. The apparent binding constant to the high-affinity site of albumin (Kd) of mephenamate (1.4 X 105), 'indomethacin (1.23 X 105), diflunisal (8.4 X 104), diazepam (6.7 X 104) and furosemide (3 X 104) were stronger than sulfisoxazole (1.72 x 104). Latamoxef, aminophylline and cefalotin were slightly lower than sulfisoxazole. The maximal displacing factors (MDF) were also determined, whereas sulfisoxasole was 2.29. Taking the MDF 1.2 as the upper limit for significant danger of displacement, mephenamate (4.02), latamoxed (1.63) and diflunisal (1.24) showed a higher risks Moderate to slight risks of displacement were recorded on indomethacin, cevalotine, cefotaxime, acetyl salicylic acid, aminophylline, phenobarbital, furosemide and ampicillin. No possible bilirubin-displacer were shown by sulir. idac, diazepam, doxapzam, digoxin, amikacin, gentamicin and kanamycin. Caution and substitution should be considered in giving non-steroid and-inflammatory drugs for closure of patent ductus arteriosus and latamoxef for sepsis in premature infants because of their potential risk of bilirubin encephalopathy. Key Words: albumin-bilirubin-binding drugs - displacing effect - kernicterusanti-inflam matory drugs - bilirubin encephalopathy
Prealbumin level at biochemical marker of nutritional assessment in premature infants Achmad Surjono Achmad Surjono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 21, No 04 (1989)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (230.568 KB)

Abstract

Controversies in adequate nutrition for premature infants still exist. No single anthropometric or biochemical measures currently available are reliable for premature nutritional assessment.The aim of this study is to determine the usefulness of serial prealbumin serum levels in identifying adequacy of nutritional intake in premature infants during their neonatal period. A group of 18 infants ranging in birthweight between 1030-2050 g, nursed in the Dr. Sardjito Hospital until one month of age were included for study. Breast and formula milk were given in increasing amount and depending upon acceptance 120 Cal/kg of body weight/day should be achieved. Peripheral capillary blood samples were obtained for prealbumin examinations (by radial-immunodiffusion method) on the first day and at weekly interval afterwards. The infants were weighed daily and serum albumin was examined on 14 and 28 days of age.It turns out that the mean serum prealbumin in the first day of life was 7.9 ± L8 mg% and a significant increment levels on weekly measurements were obtained. It is shown that no correlation was found.between the prealbumin and albumin levels. Body weights correlated poorly with serial prealbumin values.It seems that prealbumin, with a short half-life of 1.9 days can be used as a sensitive nutritional assessment in premature infants. Modifying of adequate protein and caloric provision could be applied early to prevent malnutrition in the neonatal period of premature infants.Key Words: prealbumin - serum albumin - premature infants - nutritional assessment - caloric requirement
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