Unbound bilirubin levels in phototherapy‐treated preterm infants receiving soy‐based lipid emulsion
- 14 June 2020
- journal article
- research article
- Published by Wiley in Pediatrics International
- Vol. 62 (12), 1357-1363
- https://doi.org/10.1111/ped.14346
Abstract
Background Phototherapy is an effective treatment neonatal jaundice. Treatment indication uses total serum bilirubin (TSB), although unbound bilirubin (Bf) more accurately predicts handicap risk. The goals of this investigation were to examine the response of Bf and TSB to phototherapy in preterm infants, and we hypothesized that 1) TSB and Bf respond differently 2) the relationship between TSB and Bf is altered and 3) unexpected Bf elevations are found. Methods Preterm infants below 2 kg at birth and receiving Intralipid (IL) were enrolled measurements of TSB and Bf were obtained. TSB was measured by the diazo method and Bf with a fluorescent Bf sensor BL22P1B11‐Rh. Results Initial TSB and Bf levels (41.4±6.9 hours) were 8.0±9.0 mg/dl and 16.9±12.4 nM (p11 nM in 64, >17 nM in 18, and >22 nM in 7 infants. Conclusions Bf land TSB responded differently. While TSB and Bf correlated well before phototherapy, they did not during phototherapy. TSB showed a trend toward a reduction with treatment, Bf did not. While TSB ROR information is not helpful, ROR Bf data can be utilized to anticipate treatment. Potentially high Bf levels existed before and after phototherapy and the mean Bf level at phototherapy termination remained elevated in a significant proportion of infants.Keywords
Funding Information
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (1RO3HD077422‐01A1, R44HD080412‐05)
This publication has 46 references indexed in Scilit:
- Unbound Free Fatty Acids from Preterm Infants Treated with Intralipid Decouples Unbound from Total Bilirubin Potentially Making Phototherapy IneffectiveNeonatology, 2013
- An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestationJournal of Perinatology, 2012
- Bilirubin Binding Contributes to the Increase in Total Bilirubin Concentration in Newborns With JaundicePEDIATRICS, 2010
- Effect of Free Fatty Acids on Bilirubin–Albumin Binding Affinity and Unbound Bilirubin in Premature InfantsJournal of Parenteral and Enteral Nutrition, 2010
- Influence of clinical status on the association between plasma total and unbound bilirubin and death or adverse neurodevelopmental outcomes in extremely low birth weight infantsActa Paediatrica, 2010
- Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth WeightThe New England Journal of Medicine, 2008
- Inhibition of Glutamate Uptake by Unconjugated Bilirubin in Cultured Cortical Rat Astrocytes: Role of Concentration and pHBiochemical and Biophysical Research Communications, 1999
- Serum levels of unbound free fatty acids. II: The effect of intralipid administration in premature infants.Journal of the American College of Nutrition, 1997
- Neonatal Jaundice — What Now?Clinical Pediatrics, 1995
- Determination of Serum Unbound Bilirubin for Prediction of Kernicterus in Low Birthweight infantsPediatrics International, 1992