Neonatal Physiological Jaundice and Repertoire of Movements on the Second or Third Days of Life

Physiological jaundice appears after the first day of life and has a mild form in most cases. High bilirubin levels can lead to jaundice of the basal ganglia and cause severe movement disorders in the form of 35 extrapyramidal forms of cerebral palsy. The aim of the study was to assess the effect of bilirubin levels on the 36 motor activity of infants and the relationship between bilirubin levels and selected sociometric and biometric 37 characteristics. 38 The study included a group of 77 newborns of both sexes. Medical records were analyzed to determine 39 their socio- and biometric characteristics. Bilirubin levels were evaluated using transcutaneous bilirubin (TcB) 40 measurement with a Minolta JM- 103 jaundice meter according to Kramer’s method consisting in bilirubi n 41 measurements in different parts of the body. The head measurement was considered the most important for 42 infants on the second or third day of life, and it was considered a reference for other variables. Analysis of 43 neonatal activity was performed using video recording with a Sony camera with Full HD 1080p resolution 44 (1920x1080, 60 fps). Each infant was assessed independently by three experts qualified in Prechtel's General 45 Movements Assessment diagnosis. 46 No statistically significant differences in quantitative movement characteristics were observed between 47 infants with normal and elevated bilirubin levels. The relationships were found between sociometric and 48 biometric characteristics and bilirubin levels measured on the head. The analyses indicated that in the course of 49 physiological jaundice, the bilirubin levels had no effect on their qualitative and quantitative movement 50 parameters in the group of infants studied. of infants with elevated bilirubin normal The showed no significant the of the for observing possible in of physiological


33
Physiological jaundice appears after the first day of life and has a mild form in most cases. High 34 bilirubin levels can lead to jaundice of the basal ganglia and cause severe movement disorders in the form of 35 extrapyramidal forms of cerebral palsy. The aim of the study was to assess the effect of bilirubin levels on the 36 motor activity of infants and the relationship between bilirubin levels and selected sociometric and biometric 37 characteristics.

38
The study included a group of 77 newborns of both sexes. Medical records were analyzed to determine 39 their socio-and biometric characteristics. Bilirubin levels were evaluated using transcutaneous bilirubin (TcB)

46
No statistically significant differences in quantitative movement characteristics were observed between 47 infants with normal and elevated bilirubin levels. The relationships were found between sociometric and 48 biometric characteristics and bilirubin levels measured on the head. The analyses indicated that in the course of 49 physiological jaundice, the bilirubin levels had no effect on their qualitative and quantitative movement 50 parameters in the group of infants studied.

57
Physiological jaundice appears after 24 hours of life, with its highest bilirubin levels reported between 58 the 3rd and 5th days of life. In most cases, it has a mild course. High bilirubin levels can lead to jaundice of the 59 basal ganglia. Therefore, bilirubin levels should be measured in every infant with jaundice to decide on treatment 60 options. Visual assessment of jaundice is insufficient to evaluate its clinically significant severity. Therefore, 61 transcutaneous bilirubin measurement is used, which does not require biochemical blood tests [1].

62
Neurological disorders due to bilirubin toxicity can appear with varying severity, from mild encephalopathy to 63 kernicterus. At first, the symptoms are not very characteristic and include reluctance to suck, apathy, irritability, 64 and decreased muscle tone. In the later stages, an increase in extensor muscle tone, extended head, hyperthermia,

68
Based on the analysis of many reports published over the last two decades, non-invasive transcutaneous bilirubin 69 (TcB) meters are very useful as screening tools and provide a reliable estimate of total serum bilirubin

73
The aim of the study was to analyze the effect of bilirubin levels on motor activity of infants in terms of 74 quality of motor patterns and selected kinematic parameters and to determine which independent variables, i.e.

75
infant sex, place of residence, mother's and father's education, parents' professional activity, pregnancy sequence, 76 birth weight, feeding method, type of delivery, rh incompatibility, and Apgar score determine bilirubin levels   were adopted as normal: 4-8 mg% on the head, 5-12 mg% on the chest, 8-16 mg% on the abdomen, 11-18 mg% 94 on the limbs, and more than 18 mg% on the hands and feet [5]. It was decided that motor activity and selected 95 biometric characteristics would be assessed in relation to TcB results in the head area. This procedure was 96 justified by the fact that the infants were examined on the 2nd or 3rd day of life and jaundice appeared first on 97 the head and then on the chest, abdomen, and hands and feet.

98
The analysis of movement patterns was based on video recordings obtained with a Sony camera with a Full HD

147
In the study group of infants, bilirubin levels were measured transcutaneously according to the Kramer 148 scheme. The results on individual body parts were as follows: 7.04 mg% on the head in the frontal region, 7.09 149 mg% on the upper body, 6.09 mg% on the abdomen, 5.54 mg% on the limbs, and 2.75 mg% on the hands and the head in the frontal region, and data were obtained on the mean bilirubin level, which was 7.04 mg%. The 153 lowest recorded level was 5.7 mg%, whereas the highest was 13.9 mg% (normal range: 4-8 mg%).

154
The experts assessing writhing movements classified 35 infants in the normal movement (N) group and 155 39 infants in the poor repertoire (PR) group. In the group of infants studied, no pathological movements 156 suggesting the development of cerebral palsy described as cramped-synchronized and chaotic movements were

169
The examinations revealed a relationship between some of the sociometric and biometric characteristics 170 studied and bilirubin levels measured on the head. Median bilirubin was significantly higher in infants whose 171 mothers were economically active than in those whose mothers did not work. Infants with normal bilirubin 172 levels were significantly more likely to be born in subsequent deliveries than those with bilirubin above normal.

173
Furthermore, infants whose bilirubin levels were above normal were heavier than those whose bilirubin was 174 normal. The later after birth the bilirubin level was measured (age in hours), the more often these infants had 175 bilirubin levels above normal compared to those whose bilirubin was normal. The analysis of further 176 characteristics such as infant's sex, rh incompatibility, place of residence, father's professional activity, parents' 177 education, infant's health status according to Apgar score, feeding method, and type of delivery had no 178 significant influence on transcutaneously measured bilirubin levels on the head in the course of physiological

198
In our study, the highest bilirubin level was 13.9 mg% (normal values: 4-8 mg%). It can be assumed that 199 slightly elevated bilirubin does not differentiate infants in terms of motor activity (global movements). A peak

210
Experts selected infants with normal movements and poor repertoire. However, the different motor 211 levels did not show any associations with bilirubin levels.

212
The proposed methodology for the evaluation of kinematic parameters of limb movements allowed for 213 the analysis of differences in velocity and acceleration between the group of infants with elevated bilirubin and 214 its normal levels. The analysis showed no significant differences between these parameters. Slightly exceeding 215 bilirubin levels does not significantly affect the kinematic parameters of the infant's spontaneous motor activity.

216
The accuracy of the measurement method used in our study and the impact of the acquisition conditions limit the 217 opportunities for observing possible small changes in the velocity in the case of neonatal physiological jaundice.

220
The analysis of the research material collected in the present study leads to the following conclusions: